Elon Musk causes stir with ketamine endorsement. Science here.

Elon Musk, owner of X, recently described using small amounts of ketamine “once every two weeks” to manage the “chemical surges” that cause his depression. He says it’s helpful to get out of a “negative frame of mind.”

This has led to a range of reactions in the media, including on X (formerly Twitter), from strong support for Musk’s choice of treatment, to allegations that he has a drug problem.

But what exactly is ketamine? And what is its role in the treatment of depression?

It was first used as an anesthetic

Ketamine is a dissociative anesthetic used in surgery and for pain relief.

At certain doses, people are awake but disconnected from their bodies. This makes it useful for paramedics, for example, who can continue to talk to injured patients while the drug blocks the pain, but without affecting the person’s breathing or blood flow.

Ketamine is also used to sedate animals in veterinary practice.

Ketamine is a mixture of two molecules, usually referred to as S-Ketamine and R-Ketamine.

S-Ketamine, or esketamine, is stronger than R-Ketamine and was approved in 2019 in the United States under the drug name Spravato for severe, long-term depression that has not responded to at least two other types of treatment .

Ketamine is thought to change chemicals in the brain that affect mood.
Although it is not known exactly how ketamine works in the brain, scientists think that it changes the amount of the neurotransmitter glutamate and therefore changes the symptoms of depression.

How did it develop?

Ketamine was first synthesized by chemists at the Parke Davis pharmaceutical company in Michigan in the United States as an anesthetic. It was tested on a group of prisoners at Jackson Prison in Michigan in 1964 and was found to act quickly with few side effects.

The US Food and Drug Administration approved ketamine as a general anesthetic in 1970. It is now on the World Health Organization’s Core List of Essential Medicines for health systems worldwide as to anesthetic drug.

In 1994, following patients’ reports of improvement in depression symptoms after surgery where ketamine was used as an anesthetic, researchers began studying the effects of low doses of ketamine on depression.

The results of the first clinical trials were published in 2000. In the trial, seven people received intravenous ketamine or a saline solution for two days. Like previous case studies, ketamine was found to reduce symptoms of depression quickly, often within hours, and the effects lasted up to seven days.

Over the past 20 years, researchers have studied the effects of ketamine on treatment-resistant depression, bipolar disorder, post-traumatic stress disorder, obsessive-compulsive disorder, eating disorders, and substance use reduction , with generally positive results.

A study in a community clinic providing intravenous ketamine therapy for depression and anxiety found that most patients reported improvement in depression symptoms eight weeks after starting regular treatment.

While this may sound like a lot of research, it’s not. A recent review of ketamine research conducted over the past 30 years found only 22 studies of ketamine involving a total of 2,336 patients worldwide. In comparison, in 2021 alone, 1,489 studies were conducted on cancer drugs.

Is ketamine prescribed in Australia?

Although research results on ketamine’s effectiveness are encouraging, scientists still don’t really know how it works. This is why it is not available to GPs in Australia as a standard treatment for depression. Instead, ketamine is mainly used in specialized clinics and research centers.

However, the clinical use of ketamine is increasing. Spravato Nasal Spray was approved by Australia’s Therapeutic Goods Administration (TGA) in 2021. It should be administered under the direct supervision of a healthcare professional, usually a psychiatrist.

The dose and frequency of Spravato varies for each person. People usually start with three to six doses over several weeks to see how it works, moving to biweekly treatment as a maintenance dose. The nasal spray costs between A$600 and A$900 per dose, which will significantly limit many people’s access to the drug.

GPs in Australia can prescribe ketamine “off label” they can prescribe 8 drugs. This means that it is up to the GP to assess the person and their medication needs. But drug experts recommend caution due to a lack of research on negative side effects and long-term effects.

What about its illicit use?

Concern about the use and misuse of ketamine increases with highly publicized deaths related to the drug.

Ketamine has been used as a recreational drug since the 1970s. People say it makes them feel euphoric, trance-like, floating and dreamy. However, the amounts used recreationally are usually higher than those used to treat depression.

Information on deaths from ketamine is limited. Those reported are due to accidents or the combination of ketamine with other drugs. No deaths have been reported in the treatment settings.

Reducing stigma

Depression is the third leading cause of disability worldwide and effective treatments are needed.

Seeking medical advice on treating depression is wiser than following Musk’s advice on which drugs to use.

However, Musk’s public discussion of his mental health challenges and treatment experiences has the potential to reduce the stigma surrounding depression and seeking help for mental health conditions.

Julaine Allan, Associate Professor, Mental Health and Addictions, Rural Health Research Institute, Charles Sturt University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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