It's slightly worrying the language from pharma is very similar to the early opiod days.
"The voice of the pain patient is underrepresented! We should approve opioids"
Now is
"The voice of the depressed patient is underrepresented! We should approve nasal ketamine".
I'm all for new therapies but ketamine can be highly addictive and causes really nasty side effects in high quantities (bladder problems being horrific from what I've heard). I hope we don't see a huge spike in ketamine abuse in 10 years time like what happened after overprescription of opioids.
I also think this will be extremely popular. Current antidepressants are not very effective and take a long time to work. This seems to work very quickly. Who would want to wait 8 weeks Vs hours to get better? It would not surprise me if J&J have massively downplayed the potential addiction risk of this.
Ketamine is plentiful on the street and you can legally buy ketamine analogs online. I don’t see this new route of getting it from a psychiatrist as a huge abuse risk.
Subjectively, it’s not as good a “take the pill and forget your problems” drug as opioids, benzos, and alcohol are. It can be used in that way if you take a huge “k-hole” dose and dissociate completely, and some people do get addicted. But at common doses, certainly whatever they are going to prescribe, it’s more of a “think about your problems and figure out how to solve or accept them” drug like mushrooms and LSD.
> Ketamine is plentiful on the street and you can legally buy ketamine analogs online. I don’t see this new route of getting it from a psychiatrist as a huge abuse risk.
Exactly the same thing could be said about opiates.
I'm all for new and novel methods for treating depression, but everyone seems to be jumping on this like it's a magical depression cure with no negative externalities.
You could use the same argument for Oxycontin surely. Heroin was always out there on the street, but it's only when opioids were prescribed to the masses via doctors that it reached ecedemic proportions.
I'm not saying it is addictive as heroin etc but it's definitely addictive. And will people start increasing their doses as they become tolerant to the antidepressant effects, etc?
I think responding to this requires giving a summary of the effects of different drugs, to build a simple mental model of how they could cause addiction.
Group A: Drugs like benzos, alcohol, and opioids provide pleasant sensations upfront, killing your pains and anxieties, but those problems return in even worse form when the drug wears off. It’s as though your brain’s baseline for what counts as suffering had been lowered by the experience of being coddled. It’s very clear how this leads to compulsive redosing and addiction.
Group B: Psychedelic drugs like mushrooms and LSD induce unpleasant feelings as they take effect, followed by a more positive (perhaps euphoric) experience once the brain adjusts to the presence of the drug, and then less potent pleasant after-effects when the drug wears off. It seems like the brain has raised the bar for suffering - suddenly the fact that you can see things in the correct color, gravity is pointing in the right direction, and you have clarity of thought makes life feel easy. You might redose to extend the peak effects, but you aren’t going to take any more for a while once it wears off. It would be tough to get addicted to these. However, a depressed person might have trouble with the come-up, and could experience a panic attack. You’d want a very skilled therapist if you’re trying to treat depression this way.
IMO ketamine kind of straddles the line here. The onset of the dissociation can be stressful, but it’s not that hard. You don’t forget your problems, but they feel like the problems of somebody that you know closely and care a lot about, so you can try to solve them from a different perspective. You can feel that you are doing something great, which can lead to compulsive redosing, but you keep the lessons you learn when it wears off. It’s not as though your problems come back in even worse form like you get with group A. Although if you really blast yourself, the dissociation can get so strong that you don’t care about your problems at all, which gives you more of a group A experience while you are peaking. I’m not a scientist and I may be wrong about this, but I think the antidepressant effects are not caused directly by the drug or metabolites that one could become tolerant of. I think that they are a result of the brain’s recent experience of looking at life from a non-depressed perspective.
Simply letting people die is not a sane solution to black market drug use. Drug distribution can be restricted without completely denying drug approval. Look at Xyrem for example.
I think you're misunderstanding my point. It's not that people will go to doctors and use it recreationally instead of getting off the black market. I'm sure that will happen to a certain degree but as you say it's not a huge driver to restricting treatments.
It's that millions of people will be taking it when they never would have before from a doctor, and it is definitely addictive. Drug companies have an insane incentive to down play/hide studies that show it is addictive.
I don't think it's true that using this as directed would cause addiction. But even if it were true, addiction treatment is a better outcome than a funeral any day of the week.
"Letting innocent people die from treatment-resistant depression is a perverse priority" is exactly how we ended up with OxyContin. The priority ought to be getting the good result (stopping deaths from treatment-resistant depression) without an expected or unexpected bad result (a horrible problem like OxyContin.)
Emotional language like "letting innocent people die" is a huge red flag when it comes to having a good discussion about the issue.
