Originally published at: https://boingboing.net/2019/03/06/us-fda-approved-chemical-cousi.html
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I’ve been receiving ketamine injections for my treatment-resistant depression for almost six months, and it’s been life-changing. This is great news if the FDA approval - and the non-needle delivery method - means that more people can get access to it, covered by insurance.
That said, the whole saga of ketamine treatment for depression is an amazing, absurd, tragic indictment of our medical system and of drug prohibition.
Ketamine is an amazingly safe drug, far more so than other anaesthesia agents. It’s not used much in hospital settings because of “emergence effects”, a polite way of saying that sometimes when you come out of it you’re tripping. It’s been used by non-anaestheologists (field medics, EMTs, etc) safely for half a century.
It’s been known for decades that ketamine is an effective treatment for depression, often showing profound effects within hours of the first dose. There’s really no controversy over it. And pharma has been completely stumped on depression, not coming up with any new types of medication in decades, despite the existence of millions of people who aren’t helped (or are incompletely helped) by existing medication.
So why the hell does almost no one offer it in the US, and generally costing thousands of dollars for the first month of treatment, not covered by insurance?
Because it’s TOO CHEAP. There is no profit motive for anyone to spend 9-10 figures getting FDA approval for a new use of a drug that wholesales for $0.50/dose.
Also, it FEELS GOOD. If ketamine’s major side effects were headaches, you’d be able to get a prescription to take home, get the office visit covered by insurance, maybe pay $20 if the insurance doesn’t cover the drug itself. Instead the major side effects are dizziness for an hour and floating through the astral plane feeling profoundly relaxed for 20 minutes. This means it has “abuse potential”, so patients cannot be trusted with it unsupervised, so every treatment means paying hundreds of dollars, taking hours out of the middle of the weekday, and getting someone to give you a ride back and forth to the doctor.
How fucked up is it that the only reasons we haven’t adopted a wildly effective new treatment for a painful and crippling condition, when millions desperately need such a treatment, are that it’s too cheap and it feels too good?
I’m unaware of any studies suggesting that esketamine (the S-isomer of ketamine) is more effective than racemic ketamine for depression. Some studies suggest it’s less effective. But it can be patented, which means they can charge $600/dose for it, and it only needs to work almost as well as ketamine for it to be hugely effective.
Personally, I’ve switched to sourcing my own ketamine from the dark web and dosing myself twice a week at a cost of about $60/month, rather than going to a psychiatrist twice a month and paying $600/month for the privilege. I am a very cautious person, and “let’s get drugs off the street and inject myself with them unsupervised” is about the last thing I’d expect to find myself doing, but… I just couldn’t come up with any reasons not to get better treatment and pay less for it.
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The roadblocks to actually using ketamine or anything like it remind me of the ones that people who use Ritalin face – only worse. At least you can have a 30-day supply of Ritalin at home instead of having to go to a clinic to take your pills.
Neither Ketamine nor Ritalin are addictive and both are vastly safer than opiates but guess which is the least restricted?
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3/6 test subjects killing themselves after taking this drug has me skeptical it can do anything to relieve severe depression. They said in the TIME article, they suspect it has nothing to do with it but, this doesn’t seem reassuring.
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Tough to interpret that statistic when severe depression carries a huge risk of suicide in and of itself. I have not read the study, but this was the knock on fluoxetine (Prozac) as well. If you select a population that has a very high suicide risk, and find that a significant number commit suicide, it might not mean it is due to the medicine. The question is what is the relative risk of the treated vs untreated groups. We don’t, and likely never will, have a perfect treatment, but if this is an improvement (and that is the big if) we need to figure out how to use it safely.
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It also can be due to the medication but not for the reasons people think. One theory about why anti-depressants can lead to suicide is basically that the riskiest time for suicide isn’t when people are at the deepest bottom of their depression. Many of those people simply couldn’t get the energy or mental coordination to carry out a suicide attempt. Instead it’s when people are getting better from a major depression that they are at the highest risk. So if a drug works it may increase the risk of suicide in the very short term. But it’s more like it moves the increased risk to an earlier date.
That said, one anti-depressant made the aliens beam thoughts of suicide into my head*. It turns out drugs do weird things to our brains.
* A description of my experience at the time.
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Is it a microdose, or is the patient suppose to go into a full-blown k-hole?
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Agreed. There is a “highest risk” period starting roughly 2 weeks after initiation to roughly 6 weeks after initiation. Energy comes up first, so you still feel like hell, but now have the energy to do something about it. It is well recognized and why we monitor our patients weekly after starting SSRI’s out to ~8 weeks. The overall suicide rate drops if measured over a timeframe of years, but that initial period can be quite scary.
ETA: Any medication that messes with you mind is kinda terrifying, if you think about it. I always suggest counseling fisrt, but sometimes that is just not sufficient.
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Chemical cousin?
If I can’t visit the Office of Coincidence Control, forget it.
Having known some people with severe depression, and knowing how they fight to claw their way out of that hole, a new weapon in that war is good news. It may not be the best thing for every sufferer, but if it helps some of them, great.
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Erm…Ritalin is definitely addictive and totally abusable.
Ketamine thus far seems cool.
Paul ER nurse.
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a relative of the dissociative psychedelic/anaesthetic ketamine
I don’t think this language makes the connection strongly enough. Codeine and morphine are relatives. Esketamine is a straight-up ketamine isomer.
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Indeed, it’s an enantiomer. I revised my text to say “twin.” Thanks.
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Just wait until the FDA discovers mushrooms and Ecstasy 
It is remarkable that Too Cheap and Feels Good are things that trip up the FDA. I’m generally in favor of drug regulation (but generally not in favor of criminalization) but . . . it should be done in a environment with less conflict of interest than exists in the current FDA. That Too Cheap and Feels Good are problems is a pretty clear sign how skewed our FDA is toward money and (to some extent) control.
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Erm…Ritalin is definitely addictive and totally abusable.
Ketamine thus far seems cool.
All the more so then, yes?
And this is the essence of the problem. Our country is full of bitter, evil, spiteful little shits who are incapable of experiencing joy and hate the idea that anyone else might be happy.
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Ketamine definitely has addiction/abuse potential. I’ve had friends ruin their lives with it. It’s been known as ‘techno smack’ on the rave scene for years.
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Or they are worried that depressed people are going to sell their drugs for money instead of taking them. It super sucks but prescription drug abuse is a huge problem in the US.
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And if there weren’t so many busybodies running around sticking their noses into other people’s business, people would be able to get whatever drugs they wanted, and the the possibility that people would sell their prescription drugs wouldn’t be an issue.
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I don’t know anything, but as someone with a loved one who has experienced profound relief from depression by using ketamine, this feels like Johnson and Johnson acting as a cartel. The stuff is impossible to find due to prohibition (in my aging circles, anyway), let alone in a high-quality variety, but now J&J can act as the lone “dealer,” and artificially raise the price to $800/session? As I said, I don’t know how drug cartels work, I don’t understand economics… but this is fucked up. It’s beyond fucked up.
And yeah, it has abuse potential, but so does alcohol. And moderate drinkers have been shown to out-live both heavy drinkers and those who abstain completely, probably due to its therapeutic effects on anxiety. I shouldn’t be surprised that drug legalization is finally starting to arrive, but only for the wealthy.
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