Ketamine: the new Prozac?

Though my pharmaceuticals of choice are certainly not in the same class as the SSRIs, I was nonetheless intrigued by this article  about NMDA-receptor antagonists producing virtually instantaneous relief from depressive symptoms. Ketamine, an anesthetic and sometimes horse tranquilizer, may provide new insights into the way we treat depression.

But let’s start with our current standard: fluoxetine. Also known as Prozac, it is perhaps one of the most well known pharmaceuticals on the market, and is currently the most prescribed medication in the US. It’s prescribed for a variety of conditions, including Generalized Anxiety Disorder and Major Depressive Disorder (or, Clinical Depression). What is less widely known, however, is that neither doctor nor pharmacological engineer truly understands how or why it works – and doesn’t work – and, in fact, a large body of evidence indicates that it is no more effective than placebo. This isn’t a vendetta against Prozac, mind you — most of the newer antidepressants, particularly those in the class of drugs to which Prozac belongs — Selective Seretonin Reuptake Inhibitors, or SSRIs — have been proven no more effective than placebo time and again in various clinical trials. Clinical trials that produce unfavorable results or that are inconclusive often go unpublished, while one or two trials with positive results ensure Big Pharma turns a profit on their (multi-billion dollar) investment. It all sounds a bit suspect, but considering the astronomical risks they’re taking… I can almost look past it.

In any case, Prozac and other antidepressants are used primarily to treat Major Depressive Disorder (MDD), a psychiatric illness afflicting millions of Americans. MDD is characterized by: a loss of interest or pleasure in activities that used to be enjoyable, insomnia and/or sleeping excessive amounts, fatigue, lethargy, feelings of worthlessness or inappropriate guilt, poor concentration or difficulty making decisions, and thoughts of suicide or death. These symptoms must persist for at least 2 weeks in order to be diagnosed as MDD.

Now, although Prozac is often helpful, it carries quite a side effect profile with it. Compare the symptoms of depression to the adverse effects associated with Prozac:

aggressiveness, impulsiveness, irritability, restlessness, or inability to sit still; severe or persistent anxiety, trouble sleeping, or weakness; suicidal thoughts or attempts; tremor; unusual or severe mental or mood changes; unusual weakness; and worsening of depression (among others

Interestingly, the side effects of Prozac seem to coincide for the most part with the symptoms of MDD itself. Though it is unlikely that a patient would experience even a small proportion of the potential side effects, it is nonetheless a peculiar similarity. Although Prozac may often prove effective, most studies indicate it’s no more effective than placebo — and its side effect profile suggests we have no idea how it’s producing the positive outcomes that we do see.

All right – it’s starting to sound like I’m on a soapbox, so I’ll step down from my unintentional tirade. I won’t deny that SSRIs DO help a lot of people, even if we don’t know why, even if we have to deal with a number (WITH A SHITTON) of unpleasant side effects. The plot really started to thicken for me when (flashback to the beginning of the post — remember the link to that article about ketamine? Here I come, making a point at last) I read a new study which examined the antidepressant effects of a SINGLE dose of ketamine — administered intravenously – effects which caused total remission of symptoms in a majority of cases and which lasted a full seven days post administration. Additionally, these antidepressant effects were determined to be independent of any euphoria or intoxication related to the ketamine state. Again, ketamine is an NMDA-receptor antagonist, and it produces dissociative effects much like PCP or dangerously high doses of cough syrup (Robo-trippin!). It’s used as an anesthetic and a horse tranquillizer, and apparently it cures even the bluest of blues (at least until the clock strikes twelve and Depressed Dave turns back into a pumpkin, er, I mean a psychiatric patient).

WHAT. THE. HELL. I don’t know about you, but that blows my mind.

There are numerous advantages to a basically instantaneous reversal of depressive symptoms. Most importantly, this eliminates the risk of suicidal ideation and self-harm that many patients experience when their depression does not improve or worsens; furthermore, SSRIs carry a risk of actually inducing suicidal thoughts or actions — a side effect clinicians must watch out for. Ketamine, on the other hand, produces instant results with no risk of treatment-induced suicidal tendencies. What’s more, the patient won’t have to wait the typical 6-8 weeks for treatment to begin improving their quality of life. They’ll feel better before the doctor sends them home, even. Granted, the relief is short-lived, and ketamine is known to have addiction potential. But the mechanisms at work here, as well as the warp-speed recovery, are the keys to newer, more effective drugs and better treatment outcomes (happier patients! happier golden retrievers from those Cymbalta commercials! … who does depression hurt? …EVERYONE).

But unfortunately, we’re stuck with Prozac for the time being. All in all, it’s clear that we know very little about how these compounds produce the results they do, and even less about what causes the imbalances causing depression in the first place. Though I am certainly not one to discourage the use of pharmaceuticals, I do think it’s time we exercise more caution in clinical practice, as these drugs – which are prescribed more and more every day – may permanently alter your brain in ways we don’t yet understand. While it may still be a worthwhile option in the more severe cases (though not the mild to moderate cases of depression — read more here), a Lexapro a day won’t keep the weepies away for long for Joe Six-Pack and his Hockey Mom wife suffering from a touch of Seasonal Affective Disorder (or worse – suburban psychosis).

Parting words: depression is very real, and it’s not something you wear on your sleeve. If you think you’re depressed, talk to someone; and, if need be, talk to your doctor about medication. It’s still the best shot we have — just don’t make the decision to commit to pharmacotherapy lightly.

And for the FINAL parting words, a little dark humor (or at least, it’s humorous for me): I never could take those Zoloft commercials from like 2004 seriously. I’m pretty sure the Zoloft lump is a character out of a Shel Silverstein book… The Missing Piece Meets the Big O, I think? Come on, Pfizer. Don’t exploit my childhood like that.

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ADD Bloggers & Google Scholar, the black hole

Well, it’s certainly been a while since my last post. Should I feign surprise or guilt…? Promise to inundate the cybersphere with inconceivable amounts of… posts…? Once upon a time, I would have… but come on. Let’s face it: I’ll write like five things on here, probably all on one topic, because I’m all excited about something, and just as quickly I’ll vanish and leave my poor blog to decay as my neglect crushes its fading spirits…

Whoa. Things just got dark. Anyway, sorry to have vanished. I promise to inundate the cybersphere with inconceivable amounts of…posts. Cross my heart.

And for the first wave of my inundation, there are two things on my mind I’d like to flood your brains with. The first was the profile of an ADD blogger, which I’ve already discussed. The second is the task of researching literature, particularly on Google Scholar and the like. ‘Lit searching,’ as I call it, is not so much a small but important task before one writes a research paper… but rather a monstrous vortex that draws you into its fierce gravitational pull until nothing, not even your flimsy thesis statement and hopelessly convoluted outline, can ever hope to escape from its orbit. I mean, for god’s sake, there’s a button you can click that brings up two dozen “Related Articles” and another that brings up just as many articles that CITE the article I’m looking at. And odds are, I’m not looking at an article that’s even remotely relevant to my topic. Actually, it’s fairly likely I don’t even have a topic yet. I’m just jumping into a lit search, seeing where the treacherous waters of the research ocean will take me (hint: the answer is 8 hours into the future, with a headache, and a class to attend with no sleep).

Maybe it’s because my brain is just… nature’s little bottle of entropy (chaos in a can), but I suspect that I’m not the only one who never learned how to structure a research paper… how to RESEARCH for a research paper… and how to not care passionately about the topic I finally do decide upon. Of course my heart inevitably ends up ruthlessly murdered by the brutally pragmatic professor who says my ideas are too “broad” and “grandiose” for a 10-page paper. He tells me I need to “narrow my scope” and make it more “workable.”

I feel like my existence is too broad and grandiose for the rest of the world, for whom a 10-page paper is wholly adequate. I’m not sure I’ll ever be “workable.”

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ADD/ADHD is (loosely) the theme of this blog. Follow @RitalinSpin on twitter for attentionally dysfunctional ruminations and commentary.

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Freshly sown..

..are the seeds of my unbridled energy unfurled unto the unsuspecting (but perfectly plowed) cyberfield.

I don’t suppose I have a purpose for finally entering the 21st century and unloading each and every one of my unfiltered whims and reveries. I must admit, writing down even the nonsense I concoct in that ephemeral bridge between dream and reality… it helps. my overworked brain is actually quite relieved to see (hear?) the chatter manifested, external, the incessant, maddening chatter that lines the walls of my mind like the regrettable wallpapering choices of decades past. Having written two, perhaps three sentences of a blogpost (wisened, in my vast wisdom and extensive experience), I am pleased to inform you that blogging is the new Valium. Or Prozac. Or whatever else the British Journal of Medicine finds the most favorable clinical trials on (true story).

I suppose the real reason I’m writing a blog (a blog… it still sounds so frivolous and nerdy) is to dish out little slices of my jumbled psyche and perhaps show the world a little bit about ADHD, about psychotropic medications, about the fascinating phenomena colliding, exploding in your brain — about the phenomena exploding in MY brain. And so on. The misconceptions about mental disorders (surprisingly, considering our era’s progressive attitudes) run rampant, sticking much like that wallpaper we talked about (I know that everyone, somewhere has gazed one too many times on the decorative plunders of yesteryear — don’t tell me you can’t relate!) to the victims of poorly understood conditions; the stigma alone can discard any and all impressions one may have had. Once labeled with a mental disorder, you are — in society’s heart of hearts, anyway — you are quietly transferred to the category of “functionally insane.” To save face, you will not be handed an eviction notice, but rather, a pitiful look and a forced laugh. I’d rather eat tacks for snacks — and yes, I did just make an angsty teen band reference; I am entitled to my past! I’m rather fond of the term “functionally insane,” I must say; I think the trend as of late has been not, under any circumstances, to ostracize the mentally ill, though it seems a bitter pill to swallow. One hears tales of schizophrenics who lead normal lives as long as they comply with their medication. The madman hearing voices is miraculously cured, and society declares it’s ready to accept the reformed loon, but I can see terror in their eyes as they ponder the possibility of the single missed dose that sent the newly sane citizen back over the edge toward his disquieting blur of self and surrounding.

Alas, the rambling has already begun. I had hoped to keep it in check — such is the plight of an overcaffeinated squirrel cracked out on PCP, as an acquaintance once described me. I couldn’t tell if it was condescension or endearment that elicited such an unusual remark, but I have since come to accept myself for who I am: an overcaffeinated squirrel cracked out on PCP. Although I would never admit it to his stupid jerk face with his dumb jerk mouth, it is both accurate and amusing (but I hope the government has stopped those animal experiments with various hallucinogenics — if you’re ever bored/looking to be horrified, look up “cat on LSD” on youtube. I’ll see you in hell).

And this is where I conclude the errant wanderings of my cyberpen (or cyberhoe, I suppose? because of the cyberfarm I’m apparently running? metaphorical consistency is crucial!). In the future, I hope to arrive at a point, perhaps, or maybe even just convey some sort of information. Just one fact, at the very least. Like a snapple cap fact. Note to self: buy snapple… In any case, I am worthless at properly concluding anything in my life, and so it goes with this blog post. Suddenly — like Rick Perry’s swift apology for whatever racist thing he did. Or the invasion of ants in the corner of your bedroom (true story; I am not, however, equally swift to counterstrike… hopefully my lease will be up before any real confrontation arises).

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