Severe Depression – the Holy Grail

When I first became involved in drug research, over 40 years ago, one of the main targets for new drug discovery was an antidepressant that had a rapid onset of action. At that time, all antidepressants took about 2-3 weeks to achieve an effect, and in the last 40 years no drug company has been able to shorten this period, as far as I know.  They also carried a number of unpleasant side effects, as do the present-day ones.

I was thrilled, therefore, to read about the intravenous use of ketamine, which seems to have an almost instant effect on severe depression – well, in 2 hours. Eighteen adult men and women, who had failed to benefit from at least two antidepressant regimes, were given a dose of saline or ketamine, intravenously. A week later they were given the alternative ‘treatment’.

Within 1½ hours those given ketamine had improvement of their depression, with the effect lasting a week. For a third of them, there was remission of their symptoms. Clearly the mechanism of effect is different from the current one – selective serotonin reuptake inhibition, or SSRI. Ketamine, an anesthetic agent, which is sometimes known as “special K”, can cause hallucinations and euphoria, and is abused occasionally as a recreational drug.

These results are truly remarkable. The investigators realize how dramatic their findings are, and emphasize that the drug should only be studied in a research setting and not used clinically, for the present. Other specialists are wary – they believe problems may emerge when it’s used more widely. Nevertheless, let’s enjoy the good news right now – the discovery represents a big step forward in dealing with severe depression, and if not ketamine, a product with a related approach may prove to be one answer to this distressing condition.