Up until recently, most people, upon hearing the word ketamine, probably thought “horse tranquilizer.” Typically, on one of the many legal or police procedural television shows out there, a suspect would use it to immobilize their victim, and the heroes would talk about ketamine like it was a substance capable of bringing down the Hulk. It is a powerful anesthetic that can cause a dissociative state, but it’s also used to start anesthesia, relieve pain, and more recently, treat depression.
Ketamine went from being a drug that was stolen from animal clinics and used recreationally, to a date rape drug, to a fast acting (if still off-label) treatment for depression and suicidal ideation. Unlike more traditional antidepressants, such as Prozac, which can take weeks to start working, ketamine can take effect in hours. It’s administered either nasally or by infusion.
Until now, no one was really sure why it worked so rapidly, but a new study from Stanford University suggests that ketamine’s effectiveness relies on the same brain receptors that opioid painkillers activate. In fact, opioids had been used for depression treatment in the past, until we began to understand how addictive they can be. For the study, 12 volunteers with treatment-resistant depression were given either ketamine, naltrexone – an opioid that can block and reverse the effects of opioids – or a saline solution. Many of the volunteers who received saline reported a quick improvement in their depression symptoms, while those who had gotten naltrexone showed no improvement. People who took ketamine at the same time as the naltrexone experienced depressive symptoms at the same level as the ones who had the saline placebo, which researchers say is evidence that it’s not the high that recreational users get from ketamine that’s causing the improvement in mood.
The effect of ketamine on opioid receptors isn’t as strong as with fentanyl or oxycodone, but it’s still enough that experts are worried about the possibility for dependence and addiction. Still, the study was preliminary, and much more research would need to be done to determine the exact effects. It was also quite small, with only the 12 volunteers involved. Those who are skeptical of the study say that it doesn’t necessarily prove that ketamine is working through the opioid system, but it could just be that the drug requires those brain receptors to be operational.
If ketamine is ever to be approved by the FDA for use by people with depression, it would have to be prescribed carefully. Much the same as how doctors look patient’s risk factors before prescribing opioids, they’d want to make sure there’s no personal or family history of addiction or a presence of any other factors that would make it too dangerous.
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