Monday, December 3, 2018

Reading the Research: Ketamine

Welcome back to Reading the Research, where I trawl the Internet to find noteworthy research on autism and related subjects, then discuss it in brief with bits from my own life, research, and observations.

Today's article both introduces a potential new treatment for depression and it managed to prick a personal pet peeve of mine.  Normally these kinds of articles just go into my Twitter feed, where I link to them and then snark for sentence or two before rolling my eyes and continuing on with my life.   However, today the article came with sufficiently good information regarding depression (which is comorbid with autism, and often plagues caregivers and parents of autistic people as well), that it didn't feel right to simply grump at it and then ignore it.  

All that said, meet ketamine.  Discovered in 1962, it's mainly used in anesthesia due to its tendency to provide pain relief while sedating the user into a trance-like state.  In more recent years, it's been found to be an effective and quick-acting treatment for major depression, bipolar disorder, and, as this article terms it, "treatment-resistant depression."  

If the quotation marks and phrasing didn't make it really obvious, this is my pet peeve.  The US healthcare system is so enamored of its SSRIs (selective seratonin reuptake inhibitors) and its other drugs that it terms any depression that doesn't respond to them "treatment-resistant."  As if there are literally no other treatments except for SSRIs.

You know what else treats depression?  Regular exercise, nutritious food (free of any allergens), supplements to make sure you're getting all the nutrition you need, and neurofeedback therapy.  Otherwise known as all the things I manage my own depression with.  But oh nooooo, those don't exist, if SSRIs don't help the person manage their depression it must be treatment-resistant!  Ugh.  Uuuuuuggggghhhhhh.

The quick-acting anti-depressant effects of ketamine were discovered in the year 2000.  It is now 2018 and we are only just now deciding to focus on this new lead, and pare down what kind of dosages work best?  If we'd looked into this 15 years ago, how many lives could we have saved from suicide?  How many people could we have aided in fighting off the haze and pain of depression, so they could start to improve their lives?

But no, try all these SSRIs, one at a time over months and years of your life, and hope you find one that works.  Sorry about the nasty side-effects they usually come with.  And if you can't find one that works, your depression is "treatment-resistant" and everyone just shrugs and tells you that it sucks to be you.

Like I said, pet peeve.  Hopefully understandable pet peeve.

My intense frustration aside, this is a very basic intro study into dosages for ketamine.  While some studies have shown positive effects lasting as long as a month, this particular study only showed it for up to 5 days.  And it seems the dosage is very tricky still, with some people responding to very small dosages, and some requiring larger ones.  The article notes, "each patient needs a tailored treatment plan," which is basically consistent with good therapy for any condition.

There is no single magic bullet cure for mental illnesses.  My own therapy plan has a lot of moving parts and requires a lot of work to keep up, but it's very worth it.  I don't anticipate ever needing ketamine, but I've had a bout of major depression before, and I suppose it could happen again if my spouse died or something like that.  So I'm glad to see some work is finally being done on this.

Even if ketamine never becomes a mainstream medication for treating depression, having it available for use in emergency rooms for severely depressed and suicidal patients would be a significant improvement over what we currently have.  I'll be keeping a hopeful eye out for further developments.

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