Most antidepressants take weeks or months to take effect. A ketamine-based drug takes only hours
over 30 years since a genuinely new type of drug for treating depression, or indeed any psychiatric illness, has come to market. Most antidepressants to date have been based on the “monoamine hypothesis”, which holds that depression is caused by low levels of a class of chemical messengers in the brain. Unfortunately, over a third of patients fail to respond to these drugs, and even when the drugs do work, it can take weeks or months for their effects to kick in.
Widely used as an anaesthetic, ketamine blocks specific chemical receptors, especially one for glutamate, the most abundant chemical messenger in the brain. Animal research in the 1990s implicated glutamate in depression. A small clinical trial in 2000 showed that not only did ketamine have antidepressant effects in humans, but it took hold within hours. Subsequent studies showed it worked on treatment-resistant depression.
The main side-effect of ketamine is that it has hallucinogenic effects, such as out-of-body or “dissociative” experiences. There is some evidence suggesting the side-effects of esketamine, although similar, are slightly less severe. Nevertheless, the potential for abuse, together with elevated blood pressure and the dangers of wandering around in such a state, are why thehas recommended a strict treatment strategy.
In research and in clinics that give ketamine to patients able to pay around $3,000, the drug is administered intravenously. The new treatment is taken in the form of a nasal spray. Janssen says the cost of a one-month course will be between $4,720 and $6,785. Previous studies of generic ketamine suggest the effects of multiple doses last a few weeks, on average, but as long as a few months in some people.
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