
Ketamine lifts depression via a byproduct of its metabolism - MollyR
https://www.sciencedaily.com/releases/2016/05/160504141131.htm
======
willholloway
S-Ketamine injected through the ear drum, into the middle ear, is currently
undergoing phase III trials as a treatment for noise or infection induced
tinnitus.

Chronic tinnitus is currently a condition which if one were to go to the
doctor and ask for a cure one would be told to get used to it as there is not
much that can be done.

The pace of medical and biotech advancement is increasing as the FDA has
relaxed a bit and better understanding of human biology is creating cures for
what once were incurable diseases. Exciting times, but not fast enough for me.

The most interesting question for me these days: How can we 10x the number of
dollars and scientists engaged in medical research, and then 10x that?

~~~
obiefernandez
Dammit, I got my hopes up... :(

"The treatment, delivered directly into the inner ear via three injections
over three days, must catch the disorder while the problem is still within the
ear, before the brain has begun overcompensating for the loss of hearing. Once
that happens, no amount of adjustment to the receptors on the auditory nerves
will do any good.

Because it is not known when that transition from ear to brain occurs, one of
the current trials, of 300 European patients, is specifically testing tinnitus
sufferers who have developed the condition no more than three months prior to
treatment. The other, a study of 330 North American patients, is investigating
a therapy within one year post-trauma. Preliminary results suggest that
S-ketamine is effective beyond three months, but declines in effectiveness
within a year of the initial trauma, so later stages of the trial are being
refocused on the four- to six-month time frame. The trials will be completed
at the end of this year, and Auris hopes to submit to the US Food and Drug
Administration (FDA) for approval in the summer of 2016."

------
univalent
I wish there was a good program advocating the effectiveness of
Electroconvulsive therapy (and maybe some studies around harmful effects on
long term usage). I've taken basically every drug on the spectrum (benzos,
SSRIs, et.al.) for most of my life since I was a teenager and nothing helped
as much as ECT.

~~~
martin1975
Bit tangential but I think this can be informative for some sufferers - I've
been taking zoloft for a few years now as I have (or had I should say)
panic/anxiety attacks and co-morbid depression which went untreated for
decades ... I inquired from my doctor about ECT, and although ECT is the
cadillac of treatments, in some patients that it has not worked, to my great
surprise, nicotine has had a really great effect on reducing or eliminating
depression.

I'm not advocating taking up smoking, although it is something worthwhile to
consider if things like ECT don't help. There's probably ways nicotine can be
therapeutically administered without the negative side-effects of burning
tobacco.

~~~
intopieces
There is, unfortunately, a social stigma associated with the non-tobacco-
smoking form of nicotine ingestion and the components to those devices
(e-cigarettes) are not regulated enough for us to be fully sure of their
effects.

~~~
aminorex
You mean batteries and heating elements? No, to be less obtuse, I must infer:
Clearly you mean the fluids.

Let me get this straight...you are actually claiming that regulation increases
knowledge? The mind boggles.

That is a shocking and novel epistemological formula - although obviously it
has been the implicit subtext of public education in the u.s. for over a
century.

~~~
intopieces
No, I'm talking about the heating elements.

'Our results demonstrate that overall electronic cigarettes seem to be less
harmful than regular cigarettes, but their elevated content of toxic metals
such as nickel and chromium do raise concerns," said Constantinos Sioutas,
professor at the USC Viterbi School of Engineering, and corresponding author
of the study, which was published online on August 22 by the Journal of
Environmental Science, Processes and Impacts.

The metal particles likely come from the cartridge of the e-cigarette devices
themselves - which opens up the possibility that better manufacturing
standards for the devices could reduce the quantity of metals in the smoke,"
said Arian Saffari, a PhD student at USC Viterbi and lead author of the paper.
"Studies of this kind are necessary for implementing effective regulatory
measures. E-cigarettes are so new, there just isn't much research available on
them yet.'

[http://www.eurekalert.org/pub_releases/2014-08/uosc-
ses08281...](http://www.eurekalert.org/pub_releases/2014-08/uosc-
ses082814.php)

But now that you mention it, the vapor does emit alarming levels of
formaldehyde when the devices are used at high voltage:

[http://www.nejm.org/doi/full/10.1056/NEJMc1413069](http://www.nejm.org/doi/full/10.1056/NEJMc1413069)

~~~
jungletek
The methodology of that NEJM study was flawed and naive, at best. Look into
it.

------
rm_-rf_slash
The recent emergence of studies suggesting psychedelics as a novel means of
treating depression and other mental illnesses is a double-edged blade: the
sheer capability of drugs like LSD and psilocybin and ketamine to hard-reset
the brain's pathways is a huge leap from the accepted style of treatment that
often boils down to "Take these pills, check in each week, maybe you'll feel
better in a month or two."

However, it also gives people the false impression that all they need to do is
chew on some shrooms and listen to the Grateful Dead for a couple of hours and
suddenly they will be free of all addiction and depression forever.

Every time a study like this comes out there is a predictable pattern in
patients' depression scores: immediately after psychedelic treatment,
depression signs plunge, wade around the low end for a while, then steadily
creep back up.

With the exception of people whose brains simply do not work as they should (I
have a friend who is chronically depressed because his body can't produce
enough serotonin even with antidepressants), depression is often as influenced
by external factors as internal ones. A spectacular drug trip won't change the
reality of having a death in the family, not being able to find a job after
being laid off at 45, or simply the stress of the modern, always-on world.

Discoveries like these are always helpful towards understanding the brain and
how to formulate effective treatment, but in the end, mental health will
always be vastly more complex and harder to cure than any physical ailment.
There will never be anything close to an ibuprofen for the brain.

~~~
llamataboot
#1) The serotonin theory of depression has seen way better days. There's
simply no way you (or anyone) can say with such reductive certainty that your
friend is "not producing enough serotonin"

[http://bigthink.com/devil-in-the-data/the-chemical-
imbalance...](http://bigthink.com/devil-in-the-data/the-chemical-imbalance-
myth)

#2) The novel method of ketamine doesn't really appear to be related to the
psychedelic trip itself -- indeed many people are using regular sub-threshold
doses of ketamine in their self-designed regimens and seem to be getting good
results. LSD and psilocybin treatment seems to be mostly about insights gained
during the experience -- much like a supercharged therapy session. Ketamine on
the other hand, appears to have some sort of mode of action that isn't about
insight and is more about a "brain reset" of sorts.

#3) I do agree with you that mental health issues defy reductivity simply
because they encompass biological, psychological, and sociological systems
that all interact.

~~~
rm_-rf_slash
All good points, although I would supplement that "microdosing" tiny amounts
of powerful hallucinogens (with doses so low that psychoactive effects can
barely be registered) has also gained traction in recent years. Proponents of
microdosing argue that taking 1/20th of a tab of acid every few days allows
them to remain productive while under the influence, and that the effects are
more positive and profound than they have experienced with traditional
antidepressants. It's no silver bullet but it is an option that merits further
study.

[http://motherboard.vice.com/read/a-brief-history-of-
microdos...](http://motherboard.vice.com/read/a-brief-history-of-microdosing)

------
CPLX
> How can we 10x the number of dollars and scientists engaged in medical
> research, and then 10x that?

Have you considered multiplying by 100? Note that the preceding sentence also
has the advantage of having a real actual verb in it.

Though I suppose it's pointless to rail against insufferable tech buzzword-
speak, or typical valley-style nonsensical 10x statements at this point. Oh
well.

~~~
willholloway
Exponential growth doesn't happen in one discrete operation, friend.

Here's some more interesting info about the trials for s-ketamine as a
tinnitus treatment.

The vision for the company that is trying to bring intratympanic s-ketamine to
market as a tinnitus treatment was very interesting to me.

The founder was looking for new uses for drugs that are currently approved and
with long safety records, that could be tested on animals.

I thought it was interesting criteria for a low-hanging fruit search of the
problem space in medicine, considering regulatory realities as well as
financial ones.

~~~
CPLX
> Exponential growth doesn't happen in one discrete operation, friend.

Correct. In fact, it simply doesn't happen at all in a category like medical
research spending.

Even if it did it's not likely the returns to that spending would grow
exponentially.

But to humor you, by what mechanism do you think medical spending in the U.S.
will grow from its current $95bn per year amount to $9.5 trillion?

Is your assumption that basic medical research will grow to consume 57% of the
country's GDP, or do you anticipate growing the size of our nation's economy
by approximately 50% to accomplish this feat?

Assuming you've got that sorted, who do you think should get the $9.4 trillion
dollars in additional medical research spending you propose?

~~~
willholloway
Sounds fanciful, right? Only if you impose the constraint of this being an
effort by ~4% of the human population, the population of the United States.

The U.S once spent 75% of global research dollars, it's share has now dropped
to below 50% as Asia has come online in this sphere.

If current spending is just 95 billion in the US, that has been quite a drop
from previous years, but for a thought experiment, if US level research
spending was the same per capita for the rest of the 96% of the human
population, we would be somewhere around 2.3 Trillion globally.

There are billions of people outside the U.S, some with minds as sharp as
WSU's Joe Harding, who as of right now are left out. But where do we find the
money to lift them out of poverty?

One answer, we discover cures for some really expensive ailments, like
diabetes, heart and respiratory disease.

What is the cost of disease? It is terrible. With an aging population, it has
the capacity to ruin developed nations.

While we tinker around the edges, and manage chronic disease like diabetes
with insulin, or Parkinson's with carbidopa, we spend large fortunes and get
poor outcomes.

SENS is moving in the right direction. We need the ability to repair ourselves
at the cellular level, and we are making progress in this regard.

What is the prize of discovering how to repair the inner workings of the
molecular machinery that make us up?

> First, Non communicable diseases already pose a substantial economic burden
> and this burden will evolve into a staggering one over the next two decades.
> For example, with respect to cardiovascular disease, chronic respiratory
> disease, cancer, diabetes and mental health, the macroeconomic simulations
> suggest a cumulative output loss of US$ 47 trillion over the next two
> decades. This loss represents 75% of global GDP in 2010 (US$ 63 trillion).
> It also represents enough money to eradicate two dollar-a-day poverty among
> the 2.5 billion people in that state for more than half a century. [1]

So yes, $9.4 trillion is a good global goal, but I believe there is
opportunity for tremendous cost savings.

Open source drug discovery, open source cancer treatment, that is what I am
interested in these day. I would like to see an army of pro-amateurs
collaborating online and performing experiments on mice in their garage, a
hacker movement for biotech.

We are on the cusp of fantastic gains in health and longevity. We have only
just begun to understand the molecular processes that age us and make us sick.
Lets pick up the pace.

[1]
[http://www3.weforum.org/docs/WEF_Harvard_HE_GlobalEconomicBu...](http://www3.weforum.org/docs/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf)

And PS:

I checked out your page, you did some work for my favorite band, The Hold
Steady. Awesome :)

~~~
groovy2shoes
Thank you so much for taking the time to give a level-headed response to GP.
While many seem to disapprove of their tone, I actually found GP's questions
to be rather good ones, and was wondering the same things myself. And as I
keep reading, rather than the usual name-calling I've come to expect from Web
fora, I see nothing but very good, detailed answers in reply. Thank you for
that.

------
openasocket
OK, I've been skeptical in the past about studies suggesting drugs like
ketamine and MDMA could be used to treat depression. Ketamine especially would
not be a good anti-depressant pill, because it is highly addictive, not to
mention you're giving a _depressant_ to a depressed person.

However, this result is promising. This study has claimed to have isolated the
anti-depressant effect to a particular product of ketamine metabolism, and
that this compound contains none of the anesthetic and addictive properties.
Obviously, this is just a single study, performed on mice, but it is a
promising first step towards the potential development of a new anti-
depressant.

~~~
pierrec
" _not to mention you 're giving a _depressant_ to a depressed person_"

Heh, these concepts are unrelated to the point that this statement could make
a decent joke. As a rough example, it's on the level of "not to mention that
you're installing a clock application on a computer that's _already
overclocked_ ".

~~~
tgb
Love the example. In reminded of snopes' take on the "the car called Nova
failed to sell in Mexico because 'no va' means 'it doesn't go' in Spanish"
myth. Their example was of Americans not wanting to buy a car called "Notable"
because it had no table.

~~~
50CNT
Or was "not able".

