

Ketamine Improved Bipolar Depression Within Minutes, Study Suggests - mrsebastian
http://www.sciencedaily.com/releases/2012/05/120530100247.htm

======
phren0logy
Studies about ketamine have been rolling in over the past few years. Some
important notes:

1\. Almost all of these are looking at IV ketamine at very low doses (lower
than anestheic or "recreational" dosing).

2\. Like most of these trials, this is also a small trial (18 patients).

3\. This was an adjunctive therapy, for patients who were on stable dosing of
lithium or valproic acid which are first line for bipolar disorder.

Cool stuff, but preliminary at this point. Hopefully it will lead to options
that are safer, more convenient, and with less abuse potential but maintain
the rapid response that appears to be related to glutamatergic activity.

~~~
rdl
Recreational ketamine use is almost all insufflated (snorted) or intramuscular
(IM) injection, right? I'm not sure how different the effects would be for IM
vs. IV, except maybe a slightly faster onset and higher peak.

The "rule of halves" for different forms of drugs (pill vs. mucous
membrane/sublingual vs. insufflated vs. smoked vs. injected) is interesting,
but I'm not sure where IM vs. IV falls.

~~~
ArmstrongRSBC
Insufflated it takes about ten minutes to come on. It is extremely
overwhelming - not necessarily in a bad way. Disassociates are by far the
weirded class of drugs.

~~~
mikescar
I've witnessed enough weird ketamine trips to hope nobody close bothers with
it again.

It's too sketchy and has a wide variety of effects on people, depending on
your brain chemistry. It can produce sedation, or very fast anti-depressant
effects, and/or other unusual body responses [1].

[1] <http://en.wikipedia.org/wiki/Ketamine#Adverse_effects>

~~~
rdl
Whereas I think it is dramatically underused -- it's a great battlefield or
improvised conditions anaesthetic, since it doesn't depress respiration very
much. All of the psychiatric features are minor compared to being able to do
surgery quickly and not kill the patient.

------
someone_welsh
YMMV; Annecdotes != data; correlation != causation etc.

but I've known a lot of modest, moderate and heavy recreational ket users -
It's been quite a popular recreational drug in the UK for about 15 years. I
would perceive (being not a doctor or anything useful) that the proportion of
them which are depressed in some way is a noticeably higher than the rest of
the people I've ever met.

It's an addictive drug (perhaps not physically, but definitely
behaviourally/psychologically). In my opinion it grossly interferes with
peoples' ability to interact with those who don't partake. I find it difficult
to recall a single example of its use improving someone's well-being - the
converse in fact.

Anyway, just adding my observations/bit of life experience.

------
fractalcat
Heroin also improves depression within minutes. Ketamine is even more
dangerous, and may cause severe cognitive difficulties with long-term use like
other NMDA antagonists like ethanol and the benzodiazapenes (which, it should
be noted, actually worsen depression in the long run).

~~~
spot
ketamine is being studied as single (for depression) or occasional (two week
interval in the case of this study) dose, at which frequency there are no
known deleterious effects. if you have evidence to the contrary, let's see it.

saying it is more dangerous than heroin is pretty dubious don't you think? Do
you have any evidence better than this:
[http://en.wikipedia.org/wiki/File:Rational_scale_to_assess_t...](http://en.wikipedia.org/wiki/File:Rational_scale_to_assess_the_harm_of_drugs_\(mean_physical_harm_and_mean_dependence\).svg)
?

~~~
Alex3917
That scale is propaganda, I wouldn't cite it as a source for anything.

~~~
spot
please rebut:
[http://www.thelancet.com/journals/lancet/article/PIIS0140-67...](http://www.thelancet.com/journals/lancet/article/PIIS0140-6736\(07\)60464-4/fulltext)

~~~
Alex3917
\- The full methodology isn't actually published anywhere.

\- The rankings are creating by combining a lot of different factors that
don't have anything to do with each other, e.g. by combining harm to the user
with harm to society. This means that drugs like coffee end up being more
dangerous than drugs like heroin, simply because more people use coffee than
heroin so the total social costs are greater.

\- The harms for drugs are measured as they are typically used, rather than
correcting for things like differences in demographic and route of
administration. This leads to drugs like heroin looking more dangerous than
they are, because people who have drug abuse problems tend to gravitate toward
drugs like heroin. (Whereas people who use, say, Khat tend not to be the worst
of the worst as drug abusers go.)

\- The harms of the drugs caused by prohibition are not accounted for. (E.g.
they are counting people using dirty needles and impure/unknown/fake drugs as
being a harm that stems from heroin, but they aren't counting using dirty
needles and fake Starbucks as being a harm that stems from drinking coffee.)

\- They're not accounting for the benefits of drug use, only the harms.

I could keep going, but I think I've sufficiently proven my point and then
some.

------
tokenadult
Wow! This press release, on an important issue of treatment of a dangerous
illness, triggers more than the usual number of warning signs

<http://norvig.com/experiment-design.html>

of an overinterpreted study. I wish the researchers well. Other thoughtful
comments here have already pointed out issues such as the very small sample
size and limited follow-up given to the patients.

------
zbuc
> When the patients received ketamine, their depression symptoms significantly
> improved within 40 minutes, and remained improved over 3 days. Overall, 79%
> of the patients improved with ketamine, but 0% reported improvement when
> they received placebo.

So they only checked up on them for three days. Bipolar depression is
generally chronically recurring. Sufferers will feel "better" for a short
period of time, and then slip back into depressive mind-states.

This would be much more interesting if it was a longer-reaching study.

~~~
tambourine_man
0% placebo effectiveness sounds strange.

~~~
phren0logy
It is in a typical treatment group, but not all that strange in a treatment-
resistant population who have specifically been selected because they haven't
responded to other things.

------
bashour
Wow - that is exciting and readily applicable research which can save many
lives in a short amount of time.

------
TheRevoltingX
Hard to be depressed when Jesus got you....

------
shortlived

        Study Suggests
    

Let's talk when it reads "study proves . . ."

~~~
roguecoder
That typically means "scientist is willing to lie to journalist".

