Wk of 3.11.19

After reading the articles I would have to agree with Erik Messamore when he states that instead of doing more clinical trials and waiting for the results of the effectiveness of esketamine measures should have been taken to get ketamine approved by the FDA. It had already been proven to work in patients with resistant severe depression and reduced suicidal ideations in these people. If this would have been done perhaps many suicides that have happened throughout this time could have been prevented. We live in a society where everything revolves around money and since this drug was approved in 1970 it was not going to make the desired profit, hence there wasn't much revolt to get it approved. The new treatment will be very profitable but at the same time not everyone will be able to afford it and many people who suffer from these conditions are of low socioeconomic status and will not be able to benefit from its effects. How cost effective is it for a patient to have to visit the psychiatrist two times a week in order to get the treatment? To the cost of the treatment you must add the cost of the visit, gas, and the time spent by them in the office. I believe the well being of patients should come before the profit physicians and researchers could get from the treatments. I also believe that now that the direct effects are seen more studies should be done in time about the long term effects of the medication.

I actually didn't know much about how Ketamine was being used in psychiatry before reading the articles. As the article said, Ketamine has a bad reputation as an illicit drug. We have this stigma that it is something bad. I was a little hesitant about the use of Ketamine for treatment but the reading the article has definitely changed my mind. Joe Wright was able to completely turn his life around after dealing with depression for his whole life. Dana Manning had tried everything including ECT and nothing worked, except Ketamine. She mentions that it was only time she ever felt normal. That is a strong statement. Then, I read that there were ketamine clinics that started to open all the way back in 2012. If clinics opened more than ten years ago, why hasn't ketamine made a bigger impact in the field of psychiatry until now? Why aren't we using ketamine more? I think there were a couple of points that the article mentions, which includes research. We didn't have lot of research about Ketamine and the clinical trials were small. Now, we do have more research that allows us to administer Ketamine in a safer way. I think it also helps that a big company such as Johnson and Johnson is involved. This aspect also helps us get over this stigma that Ketamine is only an illicit drug. Furthermore, it is now FDA approved. I hope that we can continue to learn more about Ketamine so that we can use it to help people with depression.

The psychological damages of depression such as isolation, ruined relationships, loss of jobs or even go to the extremes like attempting and committing suicide are things that are on the mind of the provides on how they can help them. As the FDA approved the Esketamine for the use of severe MDD it at first was a seen and finally the answer for this, but as it’s mentioned in both article questions regarding various things started to appear.
There is the need of guidance on the use, and its distribution. The accessibility to the patient even though is created to prevent the abuse of it make is almost some sort of impossible for the patient to be beneficiate from it. One of the most important questions is until when the patient will be need to be in the treatment, does it really decrease the suicide ideation or attempts, what will be the long term impact of Esketamine in the severe MDD patient? Still more research should be done to be able to answer this question so us as providers we can advise, guide and try to give to the patients a life as normal as possible and most importantly suicide prevention.

Ketamine, the article describes as once known as a dirty drug, is making some major strides that I was not aware of. I think its great that there is an increasing amount of research being done and promising results for our suicidal patients. This whole ketamine movement is sort of similar to the marijuana movement, once a dirty drug but now a form of therapy. The only difference is it seems as though ketamine is taken more seriously and therefore gathers more research. Its interesting to see what other untraditional drugs will be discovered as a source of therapy for stubborn diseases.
Esketamine/sprovato being FDA approved and available for administration in certified clinics is great. Once again very similar to the boundaries of the medical marijuana industry. I agree with the arising question of how much ketamine will actually get into a patient’s system if sprayed nasal form and if it would be wasting money if not all of the medicine is absorbed verses the IV form. Also, the article makes a good point about the business aspect, no one took ketamine treatments seriously until it became lucrative. Unfortunately, this truly reinforces how medicine has changed over the years from patient centered care to just business.

“It’s like you have 50 pounds on your shoulders, and the ketamine takes 40 pounds off.”
I was shadowing while one of the patient in the clinic was being given Ketamine treatment and words above in the quotation marks, from the article, are very similar to what this patient said right after the treatment. He said that I feel like this weight is lifted off my shoulders and I feel relieved. This was the same pt that, 30 minutes ago, was very withdrawn from his surroundings, showed no interest in the conversation and visibly had flat affect. Thirty minutes into the treatment and he is a different person, he is very engaged with everybody in the room, making jokes, smiling a lot and had a very comfortable, less anxious body language. It almost felt like a miracle! Being able to see the immediate effects of this drug, first hand, was amazing. However, after reading the article, I see this other side of medicine, which is not just to watch these ‘miracles happen’ but is about the financial and political aspect of bringing a treatment into actual practice. A life saving drug is ignored because it doesn’t carry much financial potential. Article, however, does leave on a positive note with esketamine and with other researches being able to replicate the results. It is very hopeful to think that we may be able to treat not just the treatment resistant depression but also suicidal ideation with the same drug.
Another focus of the article was suicidal ideation and I find it very interesting how they separated depression from suicide. Article mentions that suicide can have chemical physiology that is different from suicide, which is really fascinating because I have always thought of suicide as an aftermath of other mental illnesses. To see suicide as a separate entity in it self is definitely a new perspective for me.

I never thought that Ketamine would be used as a form of treatment in MDD patients seeing as how it made people behave recreationally. However, we've definitely come a long way in medicine and I think it's exciting to see just how far Ketamine will help patients with their psychiatric disorders. Just a couple of weeks ago we were discussing marijuana and its positive uses for people dealing with pain and anxiety. The fact that it can reduce suicide ideations as well is another bonus for doctors helping these kinds of patients. This weeks article was definitely eyeopening and I can't wait to see where this takes on normalizing the chemical imbalance in patients with these various forms of drugs that were once looked upon negatively.