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Experts Back Ketamine for Medical Depression: Promise, Caution, and What’s Next
Depression is a major public health challenge. Many people don’t respond to standard treatments such as SSRIs (selective serotonin reuptake inhibitors) and therapy. In recent years, ketamine has emerged as a promising option, especially for treatment-resistant depression. Experts are now more willing to endorse its use — but with careful caveats.
What is Ketamine & Esketamine.
• Ketamine was originally developed as an anaesthetic. In sub-anaesthetic doses it has been found to produce rapid antidepressant effects.
• Esketamine, a derivative, has been developed into a nasal spray formulation (for example, Spravato) and is approved in some places for treatment-resistant depression.
What the Research Says
Rapid response in treatment-resistant cases
• Meta-analyses of clinics and trials consistently show that a significant proportion of people with treatment-resistant depression respond to ketamine. One systematic review incorporating real-world studies (n ≈ 2,600 across many studies) found ~45% response rate and ~30% remission.
• In a head-to-head trial comparing intravenous ketamine to electroconvulsive therapy (ECT) in non-psychotic treatment-resistant depression, ketamine produced substantial responses and had fewer cognitive or memory side effects compared with ECT.
New formulations being studied
• Slow-release (extended-release) ketamine tablets have shown promise in preventing relapses. A UK Phase 2 trial found that those on tablets had fewer relapses over 13 weeks compared to placebo, with some side-effects (dizziness, dissociation) more common at higher doses.
What Experts (in the UK and internationally) Are Saying Now
• The Royal College of Psychiatrists (RCPsych) in the UK has endorsed the use of ketamine-based medications in clinical settings for depression, saying that among treatments involving psychedelics, ketamine is the most studied for rapid relief of depressive symptoms.
• But they are clear: ketamine should be used only in specialist settings, with appropriate oversight and monitoring. It’s not yet recommended for routine use outside those settings.
• The RCPsych and other bodies warn against “hype” around psychedelics more generally. For other substances like MDMA or psilocybin, they say the evidence is still early, side-effects are less well understood, and long-term benefits are not yet established.
Benefits vs Risks
Advantages
• Speed: Ketamine can reduce depressive symptoms much faster than traditional antidepressants, which often require weeks to take full effect.
• Efficacy in hard cases: Those who have not responded to other treatments often show improvement.
• Alternatives where others fail: It provides another option for people for whom therapy and multiple meds haven’t worked.
Risks & Limitations
• Side effects: Possible short-term effects include dissociation, dizziness, changes in blood pressure, sometimes nausea. In trials some participants experienced relapses when ketamine was stopped.
• Duration and sustainability: The antidepressant effect may diminish; what happens long-term is less clear.
• Abuse potential: Ketamine is a controlled substance (in the UK, Class B) and has known potential for misuse. Using it outside controlled clinical settings raises concerns.
• Cost and access: In some jurisdictions, it’s expensive, or not yet licensed for general use. Regulatory and NHS coverage varies.
Implementation & What Experts Recommend
• Use ketamine in specialist clinical settings, under the care of trained professionals. Monitoring before, during, and after treatment is essential.
• Patient selection matters: people with treatment-resistant depression (those who failed other treatments) are the current main group. Also careful screening for risks (e.g. cardiovascular, substance misuse history).
• Explore the right doses, the schedule (how often, how many infusions or doses), and ways to maintain improvements (e.g. booster doses).
• Continue research: especially into long-term effects, optimal formulations (oral, slow-release tablets, nasal spray, IV), how ketamine works in the brain, and how to reduce side effects.
Policy and Regulatory Landscape
• Licensing: Esketamine is licensed in some countries for treatment-resistant depression. In the UK, there is availability in Scotland via NHS; in England, access is more limited.
• Guidelines: Bodies like RCPsych are issuing position statements to guide safe, evidence-based use. They emphasise that evidence is promising but still evolving.
What Remains to be Addressed
• Long-term safety and efficacy: How sustained are the benefits over many months or years? What cumulative side effects might occur?
• Comparisons with other treatments: E.g. how does ketamine compare to ECT or newer antidepressants, in terms of both effectiveness and quality of life?
• Optimal delivery: Which route (IV vs intranasal vs tablets) gives the best balance of efficacy, convenience, safety?
• Cost-effectiveness: Will health services (e.g. NHS in the UK) accept the cost and set up infrastructure for safe delivery?
• Ethical/regulatory oversight: How to prevent misuse, ensure informed consent, control unregulated clinics.
Conclusion
The scientific and clinical community is increasingly in favour of ketamine as part of the toolkit against depression — particularly for patients who haven’t improved with traditional therapies. The evidence of rapid antidepressant effects and potential utility of new formulations (like slow-release tablets) is strong enough that many experts now accept ketamine’s medical use in controlled contexts.
However, experts are clear: this is not a magic bullet. There are genuine uncertainties and risks. Proper oversight, patient selection, regulatory frameworks, and more research are needed to ensure that ketamine is used safely and effectively.
Attached is a news article regarding ketamine used for medical depression
https://www.bbc.co.uk/news/articles/cyvjy7m3vmdo.amp
Article written and configured by Christopher Stanley
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