Lucy in the sky with ketamine: Psychoactive drugs have potential for a major breakthrough in treating depression.

Abstract

EMBO Reports (2018) e47118 “It felt like being in a pod […], like a little boat, going along through rooms [that had] white breathing walls.” This is how American standup comedian Neal Brennan described his experience with ketamine, a psychoactive drug also known as Special K in the club scene, in an interview with fellow comedian Joe Rogan. “I just couldn't get over the fact that this was happening in a doctor's office,” he said about taking ketamine as a medication against depression. > One may argue that treating psychologically unstable patients with an addictive drug that has psychedelic side effects is not a good idea. Ketamine was introduced commercially in the United States in 1970 as an anesthetic. At lower doses, it causes dissociations, out‐of‐body experiences, and hallucinations, which explains its career as club drug. But during the past two decades, it has also gained attention as a fast‐acting antidepressant. Its antidepressant effect was first noted by researchers at Yale University in the 1990s, and the effect was reproduced in a larger double‐blind, placebo‐controlled trial at the US National Institute of Mental Health, published in 2006. A number of studies have since shown the effectiveness of ketamine in treating patients with depression, suicidal ideation, and post‐traumatic stress disorder [1]. Researchers have called it the biggest breakthrough in depression research in half a century. Ketamine is not yet approved by regulatory agencies, but is widely used off‐label by private so‐called ketamine clinics. New medications to treat depression are urgently needed. The last significant innovation—Prozac, the first selective serotonin reuptake inhibitor (SSRI)—is now 30 years old, and SSRIs and many me‐too drugs of similar structure and function still dominate the treatment of depression. They are, however, anything but satisfactory. It takes 6–8 weeks for their effect to kick in, and …