Who will respond best to ketamine for major depression? New research takes a look

Who will respond best to ketamine for major depression?  New research takes a look

Famous as the K-club specialty drug, ketamine is today considered a miracle drug for some people with difficult-to-treat depression.

However, a new study finds that certain types of patients are more likely to gain rapid and significant benefit from ketamine than others.

Overall, while most patients benefit from the drug, about a third experience “rapid improvement” in their health. Depression symptoms, the researchers said. Several patient characteristics appear to predict the extent of that benefit.

Lead researcher Brittany O’Brien, assistant professor of psychiatry and behavioral sciences at Baylor College of Medicine in Houston, concluded: “People with major depression with a history of childhood trauma may have ability to react faster and stronger to ketamine”.

In 2019, the US Food and Drug Administration approved a ketamine derivative called esketamine (Spravato) for the treatment of depression that has not responded to at least two common antidepressants. Supposedly a nasal spraysesketamine is different from ketamine, which is an injectable anesthetic that can have mind-altering effects.

The new study included nearly 300 people with severe depression who were treated with three ketamine infusions in an outpatient clinic. The average participants were 40 years old and most were male. They have failed to respond to at least two antidepressants in the past. Mood changes were measured using the standard depression scale during six clinic visits.

Among the school groupsThree distinct response patterns to ketamine were identified by the investigators.

One group had severe depression prior to treatment but experienced rapid and significant improvement in symptoms. The second group with major depression received minimal benefit, and the third group—who had less depression than the other two groups before treatment—had a gradual improvement in mental health. depressive symptoms.

Research shows that people with major depression with a history of childhood abuse and trauma are the most likely to respond quickly and strongly to ketamine.

“This finding needs further testing and care to better understand the potential role of trauma in treatment response to ketamine,” said O’Brien.

How past trauma affects responses to ketamine is not fully understood, but sensitization may play a role. Sensitization occurs when a person is exposed to a stimulus and becomes more sensitive to it over time.

“We believe ketamine may work well for some people with depression because the drug blocks the effects of sensitization,” says O’Brien. “Ketamine can act as a barrier to block whatever stimulant is causing the depression.”

So who should ask their doctor about a ketamine infusion to treat depression?

“It’s worth considering ketamine if first-line treatment for depression [i.e., indicated and approved medications, evidence-based psychotherapies] been prescribed, tried, but not effective enough in relieving symptoms,” O’Brien said.

She added, “Many studies have shown that infusions of ketamine given in a controlled environment by medical professionals are safe and non-addictive.

New research appears in the January 2023 issue of the journal Journal of Emotional Disorders.

Researchers are getting closer to finding out who will respond best to ketamine therapy, said Dr. Joshua Berman, assistant professor of psychiatry at Columbia University Medical Center in New York City. and why.

“We can’t say whether you should or shouldn’t take ketamine or how quickly you’ll react based on this study, but it’s a step forward,” said Berman, who was not affiliated with the new study. know.

Among other things, these results provide new information on ketamine responses in individuals with childhood trauma and abuse. However, these people can’t bring it all together to make general recommendations, Berman said.

Exactly how ketamine helps with depression is still not fully understood. But it works faster than conventional antidepressants, which can take six to eight weeks to work, Berman notes. With ketamine, some people feel better within a few hours of the first infusion.

“The effects don’t last as long as conventional antidepressants, and people are more likely to need ongoing treatment, although some people get better and better after they reduce their dose and go through it,” says Berman. a short course of maintenance therapy”.

Groups of people who should not take ketamine to treat depression include people with a history of schizophrenia, those at higher risk of ketamine abuse, and people with certain heart conditions.

“For most people, ketamine is safe,” says Berman.

He noted that IV ketamine There is no official FDA approval to treat depression, but there are many clinical trials and a lot of experience behind it.

“It’s a new treatment, and there are certainly a lot of areas that we don’t know as much as we do with other treatments, but it’s past time to call it experimental,” says Berman. .

Ketamine use needs to take place in the context of overall psychiatric management of depression, he said.

“Work with your psychiatrist and ask him or her to help direct you to people who can safely provide that service,” Berman advises.

Ketamine and hallucinogens such as psilocybin and MDMA are generating a lot of buzz in the psychiatric community. As the use of psychedelic-guided therapy expands, over time, researchers can learn which therapy is most helpful for individuals, says Berman.

This could lead to the development of new drugs for depression.

“We can take advantage of the biological properties of these molecules so that they can be used more passively than with guided psychotherapy and without the risk of dissociation,” Berman said. .

“It is possible that over time we will gain the confidence to make these therapies available to people sooner even if they are not exhibiting treatment-resistant depression,” he added.

More information:
Brittany O’Brien et al, Reconstructing distinct trajectories of the antidepressant response to intravenous ketamine, Journal of Emotional Disorders (2022). DOI: 10.1016/j.jad.2022.10.031

Harvard University offers more about ketamine for depression.

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