HAPPY THRILLS
Taking ketamine pills twice a week ‘stops depression in its tracks’, study finds
Experts explained why the drug is not on the NHS yet
KETAMINE pills benefit those with depression and can be taken at home, a study suggests.
The party drug that goes by ‘K’ can be used to treat psychiatric disorders, research is showing, with Twitter boss Elon Musk reportedly microdosing it to treat the condition.
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But is not yet available on the NHS for these purposes. Some specialised sites offer the drug off-liscence in specific circumastances.
Ketamine is an illegal class B drug with a possession penalty of up to five years in prison.
Though ketamine was described as an 'impressive antidepressant' after these findings, participants were still in an controlled setting with support from researchers.
Scientists led by Professor Paul Glue of University of Otago, Dunedin, New Zealand, tested a newly formulated tablet, called R-107, which contains ketamine.
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They split 168 participants with treatment resistant depression - which is not responding to standard treatment - and randomly assigned them to receive either R-107 or placebo tablets.
They had all shown to respond to ketamine as a treatment beforehand.
The researchers found that 71 per cent of patients in the placebo group experienced a relapse into depression after 13 weeks.
This compared with 43 per cent of patients who received 180mg R-107 twice weekly.
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The researchers also gave each person a score on a depression scale between 0 and 60 before and after the trial, and say the ketamine helped reduce this score by 6.1 points at least.
Someone with severe depression would have a score of 35 to 60 on the MADRS scale.
Ketamine - a horse tranquiliser - is usually administered intravenously or, in a few recent cases, via a nasal spray.
It can cause side effects such as feeling dissociated, anxiety, nausea and feeling lightheaded shortly after doses.
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But R-107 can deliver the drug more slowly into the blood and there were no changes in blood pressure and ‘minimal’ reports of dissociation or sedation, according to findings published in Nature Medicine.
The most common side effects were dizziness, headache and anxiety.
Dr Paul Keedwell, consultant psychiatrist and fellow of the Royal College of Psychiatrists, said: “This novel study further underlines the impressive antidepressant effect of ketamine, but in the much more convenient and acceptable form of a slow-release tablet.
"The researchers demonstrated a major upside of oral ketamine - that side effects did not separate significantly from placebo. In other words a ketamine tablet, as opposed to an infusion, is well tolerated. This is consistent with previous research.
“The study addressed the thorny issue of maintaining improvement after the initial response.
"Their results suggest that many will continue to do well with longer term treatment, provided higher doses are used, but more research is needed with higher numbers of patients.
“A potential downside of taking oral ketamine is that there are likely to be large individual differences in absorption and metabolism, so further research is needed to determine the ideal dosing regime.”
There are gaps in scientific knowledge about dosage levels and long-term side effects of using ketamine for depression.
Dr Rupert McShane, Consultant Psychiatrist at Oxford Health NHS Trust and Associate Professor at Department of Psychiatry, University of Oxford, said: "Whilst the cost of intravenous ketamine is about £10 per dose, administering it in clinic is itself costly and inconvenient.
"Esketamine nasal spray is licensed for people who have not responded to at least two antidepressants but is not available on the NHS because of the cost of the drug (up to £489 per dose). "
Health watchdogs rejected esketamine for NHS use in 2022.
Dr McShane said two studies have shown that it is as effective for severe depression as electroconvulsive therapy, which is normally considered the gold standard treatment.
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He adds: "This study confirms that oral ketamine, like intravenous ketamine, is an antidepressant but that the effect depends on the dose.
"The results are good enough to justify the larger phase 3 trials that will be necessary for a licence for the 180mg twice weekly dose."
What is ketamine and can it treat depression?
Ketamine is a general anaesthetic and illegal class B drug.
When a person takes ketamine recreationally, it reduces sensations in their body which can make them feel dream-like and detached, chilled, relaxed and happy, according to the UK national anti-drug advisory service Frank.
It can also cause a person to feel confused, nauseated, alter perception of space and cause hallucinations. If too much is taken it can cause a person to lose the ability to move their body, called a 'K-hole'.
Ketamine is also a medication that doctors use as an anaesthetic to induce loss of consciousness, such as to help with physical pain.
Does it work for depression?
The Oxford Health NHS Foundation Trust says that ketamine's brief rapid antidepressant effect has been confirmed in several clinical trials over the last 20 years.
It has been the subject of numerous studies exploring its efficacy against severe depression which is not responding to treatment.
Some of the first findings were that of study in 2000, published in Biological Psychiatry. It showed that one singular intravenous dose of ketamine could produce rapid effects within one hour that would last up to a week.
Further studies made the same conclusions, but research was needed to look at whether it can be used more long-term.
A study in 2010, published in Neuropsychopharmacology, found repeated doses could sustain the antidepressant effect over a long period, but the benefits stopped after treatment did.
There are still significant gaps in knowledge about dosage levels, treatment protocols and safety of long term use.
Is it available on the NHS?
Ketamine has not been licensed for use as an antidepressant in the UK.
The Oxford Health NHS Foundation Trust website says it can be used as an “off-label” treatment for depression, which is when a doctor prescribes a drug for other purposes than intended.
It adds that ketamine therapy can be given to people who have depression which has not responded to other treatments.
The health trust provides a self-pay ketamine treatment service after suitability is agreed following a referral letter from a GP or psychiatrist.
Patients are then given a series of intravenous ketamine infusions, with the average duration of initial benefit 10 days, according to the trust’s website.
Oral ketamine, supplied as a liquid which can be taken at home, can help maintain the benefit of infusions.
A closely related version, nasal esketamine, is licensed but has not been approved for routine NHS use, mainly because of cost - £480 per dose.