The drug ketamine has gone from Vietnam battlefields to nightclub dance floors to a promising depression treatment.
The drug is a derivative of PCP, which explains why it causes hallucinations. It was created in the 60s and used quickly as a safe and effective anesthetic.
However, it didn't take long before it was abused. Besides its current use as in the operating room, it is a party drug known as Special K.
Jeffery Talbot of Henderson-based Roseman University has long studied ketamine. He’s currently director of the university’s Research Center on Substance Abuse and Depression.
“We are recognizing there are demonstrably anti-depressant effects of low dose Ketamine, certainly what would be lower than anesthetic use,” he said.
He told KNPR's State of Nevada that he first discovered ketamine's potential as an anti-depressant when looking for a countermeasure to stimulants like cocaine.
“We recognized very quickly that that molecule could have anti-depressant effects,” he said.
He said researchers knew about the potential for 20 years but it was shelved because the other drugs for depression were being prescribed so heavily.
The drug works to block certain receptors in the brain responsible for processing sensory information, which explains its hallucinogenic effects.
It also impacts receptors that control mood and feelings, which is why it is an effective treatment for depression.
Talbot said he has seen remarkable improvement in some depression patients treated with ketamine, including one of the first in Southern Nevada.
Talbot said the young man suffered from chronic depression starting in his teens and by his early 20s, he was disabled by the depression and unable to work.
Within days of taking ketamine, he was looking for work and interacting again with family and friends.
The young man's depression did not return while on ketamine but unfortunately, he died from an opioid overdose.
It is the opioid crisis that has people concerned about ketamine. The drug has a long history of abuse and many people are concerned that it would be an easy step from a clinical use to abuse, which is what happened with opioids.
“That is a concern that has to be at the forefront in this drug's development or medications that are like it that are in the pipeline now through a number of drug companies,” Talbot said.
But he did point out that ketamine has a much lower risk for addiction and abuse than opioids have.
In addition to potentially treating depression, ketamine may also help stop suicidal thoughts.
“We do know that one effect of Ketamine can be to decrease suicidal ideation, the impulse to harm oneself," he said, "That’s been shown in a number of studies.”
The other remarkable thing about the drug is the speed at which it can work. Current anti-depressants can take weeks or months to finally work, but ketamine can take hours.
“Perhaps the revolutionary aspect of this in anti-depressant drug development is the fact of having a medication that a patient can take and feel better within hours,” he said.
While the potential of the drug is huge, the downsides are just not known, Talbot said.
"We simply need to understand more about how the drug works," he said, "The best way to say it is we know what the drug can do. We know that it can produce really remarkable anti-depressant like effects in some patients. We know that it can produce anti-suicidal effects… we don’t understand how to predict in which patients those responses will occur or the magnitude of the response.”
Talbot compared it to a scale. There needs to be a balance between the positive effect of a drug and negative effect of the drug.
Currently, researchers can see the positive side of the drug but there is not enough research on the negative effects to balance the scale, especially when it comes to the drugs long-term effect.
“Until we know that, it really is a cautiously optimistic story that we hope plays out in a way that will benefit patients. We just don’t know yet,” he said.
Talbot admits that is an unsatisfying answer to the millions of people across the world who suffer from depression.
Pharmaceutical giant Johnson & Johnson is in the late stages of the regulatory approval process for a nasal spray version of the drug. And if it’s OK’d, it would be the first new class of drugs for the treatment of depression in more than 30 years.
Jeffery Talbot, Director, Roseman University Research Center on Substance Abuse and Depression