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Can ketamine, a molecule with a sulphurous reputation, help certain depressives? Research is accumulating to confirm this, especially when no other treatment works. But caution remains in order, because its serious side effects remain a challenge to manage.
“New treatments for severe depression are urgently needed and ketamine shows promise for patients who respond.“, summarizes Australian researcher Julaine Allan, specializing in mental health, to AFP.
Much faster action than traditional antidepressants
Ketamine is not a classic antidepressant, like those developed since the 1960s. It is, basically, an anesthetic but, for around twenty years, psychiatrists have been using it as an avenue against depression.
In contrast to the usual antidepressants, ketamine acts in a dazzling manner, even if we do not know precisely by what physiological mechanisms it responds to depressive symptoms.
It therefore appears promising in two main cases. When timely and urgent treatment is required, primarily in the face of suicidal crises but not only. And when no conventional medication works, that is to say in the case of so-called resistant depression.
In recent months, several studies, published in prestigious journals, have confirmed the interest of ketamine in these two perspectives.
More and more studies confirm its interest
On the first level, a study published in April in the BMJ shows that young mothers had their risk of postpartum depression reduced after receiving a single dose of esketamine, a derivative of ketamine, when their babies were born.
On the second level, a study published this Monday in Nature Medicine shows that treatment with ketamine prevented more depressive relapses compared to patients taking a placebo.
Certainly, given the small nature of the sample – around a hundred people – and certain methodological choices, it is too early to draw a firm conclusion.
But these studies add to a body of evidence favorable to the use of ketamine in the face of depression, a benefit which causes little doubt among psychiatrists.
An alternative to electroshock
“It should be considered as an intermediary between classic antidepressants and electroshocks.“, explains to AFP psychiatrist Michel Hoffmann, based at Geneva hospitals, who evokes real “enthusiasm” in the medical community.
“For patients for whom traditional treatments do not work, ketamine opens up the possibility of not going as far as electroshock“, he explains.
But although esketamine has already been approved for several years in the United States and Europe against certain depressions, some psychiatrists remain reluctant.
A risk of addiction not to be neglected
Without denying the effectiveness of ketamine, they fear the risk of addiction, especially since the molecule is often misused as a drug, a use sadly publicized by the overdose deaths of personalities such as American actor Matthew Perry.
“Will ketamine soon be given to patients with suicidal thoughts? Difficult to say, because there is a real risk that widespread use of ketamine will cause a new opioid crisis“, warned in 2022, in an editorial in BMJpsychiatrist Riccardo De Giorgi, in reference to the health crisis which has caused hundreds of thousands of deaths in the United States due to the misuse or excessive use of certain medications.
The challenge is therefore to reduce the risk of abuse, as well as serious side effects, such as the appearance of dissociative personality disorders.
This is the whole point of the study published by Nature Medicine. It aims to test a new method of administering ketamine: a tablet that gradually releases the treatment into the body.
Potentially, it’s more convenient and less risky to use than intravenous treatment or a nasal spray, the two forms in which esketamine is currently approved.
In this area, the study gives promising results even if, again, they need to be confirmed. “Patients reported few side effects: euphoria, dissociation…“, underlines its main author, Paul Glue, to AFP. “So I don’t think these tablets would attract people who want to misuse ketamine.”.