Ketamine is a drug that has been used for decades as an alternative to general anesthesia for some pediatric and other surgeries, and more recently has been used for some types of chronic neurologic pain. A relatively recent but increasing use is for severe depression that has been refractory to various antidepressants. There have been both anecdotes and small clinical trials that suggest that for some patients a slow, low dose IV infusion of Ketamine can lead to dramatic relief of severe depression symptoms, and that this relief may last for a week or more. See a discussion on the Scientific American Blog discussing a specific case and the growing numbers of physicians who are using Ketamine off-label for select patients.
Severe depression is a life-threatening condition, with high rates of suicide. We have for years hospitalized patients, and measures as extreme as electroconvulsive therapy continue to be used occasionally despite the real risks of memory loss that can be permanent. Ketamine is a legal U.S. drug for other indications, and off label use is not illegal, it’s simply not FDA approved. Side effects seem to be infrequent and minor when patients without psychotic episodes are not treated. This treatment is clearly in the early stage of study, but because of a lack of profitability no major push is being made to rigerously study Ketamine for depression.
An interesting side-story in the Ketamine-for-depression saga is the big pharma is racing to find a Ketamine-like drug that works like Ketamine so that they can seek FDA approval for a new drug covered by their patent so they can bring an expensive new treatment to market. They apparently anticipate a large enough market to make this expensive process worth the effort. I’d prefer to find a way to have publically or philanthropically funded research done to see if this inexpensive generic works well enough to get FDA approval and bring an affordable effective treatment to market.
Ketamine for depression just an example of the lack of good research into usefulness of inexpensive generic drugs for indications where they are not FDA approved, and of head-to-head comparisons of inexpensive drugs for common problems. It would be really useful to know if all angiotensin receptor blockers and ACE inhibitors are about the same for treatment of hypertension or if one or more are safer or more effective that the others. No studies are underway because many of the drugs are inexpensive generics, and pharma certainly does not want to know if their product is inferior to the alternatives while it is still under patent protection and highly profitable. Examples of studies I’d love to see would be head-to-head studies of various beta-blockers for hypertension, diuretics for hypertension and the different SSRI’s for specific types of depression and anxiety. Maybe sometime the government will figure out that the cost of these studies would have great yields in health care improvement and savings by avoiding use of more expensive branded non-superior alternatives and fund these studies. Maybe, but with the pharma lobby intact it is unlikely.