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Post by Admin on Apr 25, 2018 15:52:09 GMT -4
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Post by Nicholas Romagnoli on Apr 25, 2018 18:59:05 GMT -4
These are interesting reads. Starting out with Ketamine, it appears from the proof of concept study there is significant improvement in suicidal ideation during the "medication gap." (although the positive effect of ketamine waned significantly as days passed) As it is known traditional antidepressant medications take several weeks to take effect, there is a window of minimal support. Ketamine's near instant effect allows for its adjunctive use to traditional therapies. However, nothing in life can be so sweet without its consequences. Ketamine has its history as a drug of a abuse. Making it more readily available to the public via medicinal prescription raises ethical concerns of nonmaleficence on a population level, i.e. maxim primum non nocere. It will be interesting to see what becomes of Ketamine in the near future.
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Post by Tylee Rickett on Apr 25, 2018 22:16:36 GMT -4
My initial response to the Ketamine study is very positive simply because depression is such a common problem and any advances in treatment could help so many people. My main concern is the obvious question about addiction and illegal distribution.
What interests me the most is when Canuso talks about "looking at the biochemical pathways that might be important in depression." I would be very interested to see what kind of research they can follow up with, and how far and how detailed they can go with this information. Are these pathways something that we will eventually be able to hone in on and formulate a medication that is still rapid acting and helpful in resistant depression, but is less addictive and/or has a better side effect profile? This would be ideal, but I'll be interested to see what information they can gain even just from a larger trial in the future.
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Post by Adam Bryan on Apr 25, 2018 22:39:00 GMT -4
It is an amazing breakthrough to have a possible medication that can help bridge the "efficacy gap" of current pharmacotherapy. Especially with respect the MDD and the ever growing suicide crises. Of course more studies need to be done to assess the effectiveness of esketamine as well as the long term ramifications of such treatment (abuse potential, dependence, resistance, etc.), but it is definitely a step in the right direction. With such high numbers of suicides related to depression there is a dire need for ways in which to effectively treat patients in real time. This is a pretty radical step to help those patients that cant afford to wait a month for their medications to kick in. Its really interesting to see studies and research going into using drugs like ketamine and MDMA to treat some of the toughest psychiatric disorders. These new studies could hold the key to many more efficacious medications to help combat mental illness. Awesome reads!!!
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Jonathan Rivera-Diaz
Guest
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Post by Jonathan Rivera-Diaz on Apr 25, 2018 23:18:58 GMT -4
It’s great news that researchers are looking for new treatments to quickly reduce depression and ease suicidal ideation. Treatments of this nature are greatly needed in our society in cases in which we see people who are unable to handle their problems, and the actual medication takes a few weeks to have a positive effect in controlling depression. It seem that Ketamine Spay may be a good alternative for these problems. Even though the study group was in a short group, it shows good results, which seems promising. Although it seems as a good alternative, it also can be a drug that could cause more problems than benefits due to its abuse potential. Because of possible abuse, I think we need to develop a good system to avoid a problem like the opioid problem that we have today. Probably it’s not going to be used as a treatment and is going to be used to develop new treatments. If it’s going to be used as treatment it also has to be used in an extremely controlled environment, and used with patients who actually need it. On the other hand, how do we separate the patients who have real depression and suicidal thoughts from those who just want to get high?
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Post by Jessel Ramdass on Apr 26, 2018 9:27:38 GMT -4
These are some pretty interesting articles and I’m very surprised that ketamine is going to be a possible treatment for suicidal depression. Growing up in the Caribbean, drugs like MDMA and ketamine were painted as a drug of “the homeless and needy” and rightfully so as Trinidad was a central hub for drug exportation to the rest of the Caribbean and Europe when Pablo Escobar had his reign. I do agree with some of the points raised by some of the other people on the forum and within the different articles where there is a need to filter out those who genuinely need it vs those who are “just looking to get high” as another crisis similar to the current opioid epidemic would be another burden on physicians and the general public. I agree with Dr Arps’ take on regulation in doing the same method as Methadone clinics and using urine tests to detect ketamine levels. In conclusion, I think this is a fascinating breakthrough and I am interested in how it will be implemented not only in these settings but in other illnesses not related to psychiatry. I will be following the progress in the near future. Thanks for the amazing read!
-JR
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Post by crystalrathore on Apr 26, 2018 10:38:53 GMT -4
Thanks for these articles. I have seen several patients in the office who receive ketamine infusions and was curious about its stance in the scientific community. Just yesterday, there was a patient who was so forlorn about his treatment-resistant depression and desperately seeking an understanding and a solution. It is hopeful to see that ketamine is being considered and already being implemented in places, with the added benefits of rapid onset and curtailment of suicidal thoughts. While the success of the small clinical trial is comforting, the side effects are certainly concerning, in particular the potential for addiction, especially given the current opioid epidemic and crisis. The ABC article highlighted a frightening similarity to the market entry of oxycodone, and how through aggressive marketing, its therapeutic benefit has been eclipsed by abuse. This point, along with ketamine's other possible side effects - cardiovascular stimulation, hallucinations, and dissociation - should be given extra attention given the trial's evidence of short-term effect (completely wearing off by day 25). However, on the other hand, I am still comforted by the fact that the ketamine is accompanied by standard measures - anti-depressants and counseling. It would be nice to see this combination safely administered and a stable solution found for such a widespread problem. My thoughts are about the same on medical MDMA. I worry that this drug will be easily tampered with and/or misused and am interested to see how far this research goes.
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Post by Justin Bricchi on Apr 28, 2018 15:20:30 GMT -4
Hi Class, I found these articles to be very interesting, from a standpoint of treatment-resistant depression options and pharmacology benefits. Additionally, the articles that provided more information on some of the ketamine treatments that currently take place in our office. There are two interesting points that I was hoping to discuss further; one dealing with the benefits of the treatment and the other being the study design. Mundell (2018) and Nutt (2018) both mention that these ketamine treatments are effective at reducing/eliminating depressive and suicidal symptoms in just hours after administration, but that the relief short; lasting only a few days. This pharmacology provides benefits to current depression treatments (i.e. antidepressants), which can take 4 to 6 weeks to produce a desired effect (Mundell, 2018). Therefore, ketamine treatments may eventually lend itself to a ‘bridging therapy’ for individuals who suffer from severe depression/suicide, who can be started on an antidepressant, but may be to high-risk to wait for it to take effect. The other point I wanted to bring up was the study that was mentioned in the articles. Mundell (2018) stated that “All of the participants were deemed to have such severe depression that they were at imminent suicide risk”. Despite this, the study was double-blinded and participants were given the ketamine spray or placebo (Mundell, 2018). I can appreciate the importance of study rigor, but wouldn’t this population (i.e. High-risk suicide) not be ideal for placebo studies? I mention this because, after showing that ketamine does reduce suicidal ideation, wouldn’t the study need to abruptly end to allow for all participates to be treated via beneficence? Another issue/confounding factor may be that the participants were also currently taking antidepressants; therefore, additional studies may need to see if ketamine has an additive/synergistic effect or if it can work alone (Mundell, 2018; Nutt, 2018). What do you think? Thanks for reading and all the best, Justin Reference Mundell, E. J. (2018). Ketamine Spray May Help Stop Depression, Suicide. Retrieved from www.webmd.com/depression/news/20180417/ketamine-spray-may-help-stop-depression-suicide#1 on April 27, 2018. Nutt, A. E. (2018). Nasal spray of party drug shows promise as fast-acting antidepressant, researchers say. Retrieved from www.washingtonpost.com/news/to-your-health/wp/2018/04/20/nasal-spray-of-party-drug-shows-promise-as-fast-acting-antidepressant-researchers-say/?noredirect=on&utm_term=.98862d9936d6 on April 27, 2018. |
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Post by Bolutife Fawole on May 2, 2018 11:33:37 GMT -4
I find these articles to be quite enlightening. The discovery of medication that helps treat suicidal ideations in patients with MDD would be of immense benefit to the psychiatric field.This discussion does bring two schools of thought to mind. Do we offer ketamine as treatment in the notion that we are obligated offer the best possible remedy to patients , ignoring the worst case scenario Or our we compelled by our obligations to humanity to avoid the possibility of yet another opioid crisis and instead shun this so far short term possibly adjunctive therapy ?
Another issue is are we comfortable with using an already recreationally used drug in patients suffering from psychiatric illnesses especially one with the dissociative effects?
Overall i find this article quite invigorating , a huge step in treatment of patients with MDD but one which must be closely monitored !!!
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Post by Precious Ezeamama on May 11, 2018 14:01:33 GMT -4
It is amazing that an episode of depression can be immediately resolved much like nasal congestion. The more common method for antidepressant treatment takes up to four to six weeks which lives the patient down and out before the drug takes effect. That makes me wonder how many patients have harmed them physically or experienced a negative outcome in life while waiting for their treatment to take effect. Using Katamine in the form of nasal spray is truly a break though treatment option and the result from the clinical trial is promising for further studies, In light of the good result we also have to consider the negative findings this treatment option may not be affective for everyone causing further harm in a small sample size. Side effects included agitation, aggression, dizziness and abnormal heart rhythm. Ketamine family medication cause a rise in blood pressure and this would automatically disqualify participants with high blood pressure.
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kjas
New Member
Posts: 1
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Post by kjas on May 25, 2018 19:11:54 GMT -4
My first time hearing about esketamine nasal spray treatment was in the office as the physician was educating the patient who has a history of MDD and in on numerous antidepressants and not satisfied with the results. I was intrigued and really looking forward to reading articles further discussing the nasal spray and MDMA. Thank you for sharing such informative articles.
It seems that esketamine is helping with depressive symptoms for at least the first 24 hours as shown by the 30-40% reduction in depression scores according to the Web MD article. It also appears that there is reduction in suicidality which makes it even more effective for a fast response in treatment of suicidal patients which is GREAT!
Some of my questions/ concerns are how would we approach the patients' relapse or how would we approach patients who have invested money and time and are angry about not seeing long term results. Moreover, the nasal spray may help decrease suicide rates in MDD pts but does it also help with depressive symptoms? Also advertising such things on the internet makes it accessible for the eyes of adolescent, making it a concern since they might think it's okay to illegally use ketamine to self treat a self diagnosed depression.
I do understand the concerns about ketamine being addictive and abused like opiods. However, throughout my experiences with patients it appears, as health care providers, it's more important to inform MDD patients about all available treatment options like ECT and Esketamine and their potential side effects including addictive and abusive qualities versus not letting them know at all based on our personal opinions.
We are definitely in need of new treatment for patients with MDD since so many people have it & it is serious disorder. I really hope longer and larger studies with least amount of confounding factors are pursued in various age categories to better understand if esketamine nasal spray could be the right (or even best) treatment for MDD.
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