Who would have thought that the drugs Ecstasy and Ketamine, outlawed by the Controlled Substances Act, would be found to have properties that really helped people. These drugs became popular during the 1990s as "club drugs" prolific in all-night raves. MDMA, popularly known as Ecstacy, and Ketamine were drugs that could earn you the same sentence for selling them as it would if you were caught selling heroin or methamphetamine.
Now, however, scientific study of these drugs has discovered a substantial benefit for people who have certain problems. In the Aug. 2, 2010, edition of the Archives of General Psychiatry, Ketamine was reported to be of help for the treatment of depression in patients with bipolar disorder. Just prior to that, a study in the July edition of Journal of Psychopharmacology reported that ecstasy was a potentially beneficial treatment for posttraumatic stress disorder.
One of the things that makes these findings so remarkable has to do with the uproar these drugs caused back in the ’90s. As recreational drugs used mostly by youth, there was grave concern about the uncontrolled abuse and proliferation of these substances. Little, however, was actually known about the drugs. The authors of the study on Ketamine make the argument that severely depressed patients may need unusual treatments, particularly in a depressive crisis when standard treatment medications are ineffectual. Commonly used antidepressants can take weeks to have an effect. "This delayed onset of antidepressant effects can result in considerable morbidity, including increased suicide risk," stated the study authors.
Bipolar depression is commonly treated with lithium and antidepressants like Celexa and Prozac. These antidepressants relieve depression by altering levels of the neurotransmitter serotonin in the brain. But Ketamine causes a dissociation from negative thoughts and feelings by preventing another neurotransmitter, glutamate, from interacting with a receptor in the brain that usually processes it. Brain autopsies have suggested that glutamate activity is associated with bipolar disorder, and past studies have shown that severing the glutamate-receptor link can rapidly lift symptoms in people with major depression within two hours. So the thinking is that in bipolar patients, a fast-acting injection of Ketamine can break down emotional responses and counteract depression’s most immediate effects.
The Ketamine study was conducted under the supervision of Carlos Zarate Jr, M.D. of the National Institute of Mental Health and consisted of a sample of 18 patients. Although this is a very small sample, their results were remarkable. The promise of this research is that if someone with bipolar disorder is at a high suicide risk in a depressive crisis, Ketamine may be able to quickly block the short-term suicidal impulse, allowing time to settle them down and treat them for long-term problems. Although this effect was "robust and rapid," according to the authors, it did not last. Two weeks after receiving the Ketamine, patients were no better off than before.
Ketamine is the rare anesthetic that does not have a direct effect on the heart or lungs. It has actually been around for quite a while and was even used in World War I as a battlefield anesthetic. It is also widely used in veterinary medicine, which may have contributed to the drug being referred to in recreational drug circles as a "horse tranquilizer."
The research presented here is preliminary. Much more research is needed before either Ketamine or Ecstasy will be mainstream treatments, if that ever comes to pass. It is important to note, however, that both drugs would be inexpensive for any psychiatric facility. Neither drug was ever patented and their chemical formulations are available to anyone. It is very interesting, and atypical these days, that potential therapies for depression and bipolar disorder may lie not in pricey new pharmaceutical research, but in substances that we used to think of as party drugs.
C. Kirven Weekley, Ph.D. is a clinical psychologist with offices in Covington and Norcross. He specializes in the evaluation and treatment of adults for depression, anxiety, relationship problems and medical issues. He can be reached at (770) 441-9244.