Physician’s Weekly continued its #PWChat series on Thursday, Nov. 16, with Steven P. Levine, MD, on the use of ketamine to treat depression.

The discussion focused on why there is a need for alternatives to antidepressants, like ketamine, for treating depression, how ketamine, a psychedelic club drug, ever became even a possibility for the treatment of depression, what makes ketamine a promising alternative to antidepressants and other standard depression care, and much more.

You can view our upcoming schedule, or read our other #PWChat recaps here.

Below are the highlights from the chat. You can read the full transcript here.

 

 

Question 1

OK, let’s get this thing started:

Q1: Why is there a need for alternatives to antidepressants, such as #ketamine, for treating #depression?#PWChat

— Physician’s Weekly (@physicianswkly) November 17, 2017

A1: Millions of people suffer from #depression each year, and the current options just don’t work very well. Many don’t benefit, they take too long to work, and side effects are difficult. #ketamine can be a quick, effective, and safe option. #PWchat

— KetamineTreatment SF (@ActifyNeuro) November 17, 2017

For 8 years I did traditional mood stabilizers and antidepressants. I was just trading one set of symptoms for another #PWChat

— Bell HopeFlower (@BHopeflower) November 17, 2017

Because a third of mentally ill patients don’t respond to the current offerings in psychiatry. Furthermore, when someone is suicidal, they can’t wait 4-6 weeks to see if a medication will work which it might not. It saves lives! #PWChat

— Ketamine Saved Me (@KetamineSavedMe) November 17, 2017


Question 2

Q2: How did #ketamine, a psychedelic club drug, ever become even a possibility for the treatment of #depression?#PWChat

— Physician’s Weekly (@physicianswkly) November 17, 2017

A2: #ketamine was developed in 1962 for general anesthesia and many have been aware of its #antidepressant properties since the 70’s. Research at Yale in the 90’s really brought it into focus, and every study since has been just as remarkable #PWchat

— KetamineTreatment SF (@ActifyNeuro) November 17, 2017

Is it not the same concepts of mushrooms, and ayahuasca?

— Bell HopeFlower (@BHopeflower) November 17, 2017

There are other medicines with psychedelic properties that hold tremendous therapeutic promise. They share some aspects of the experience, though the mechanisms are different. #PWchat

— KetamineTreatment SF (@ActifyNeuro) November 17, 2017

Could #ketamine have additional uses for improving wellbeing among healthy ppl? Many ppl find the k-hole enlightening #pwchat

— Dr Stephen Bright (@stephenjbright) November 17, 2017

I personally believe so! #Ketamine has made me such a spiritual person and has enlightened me in so many ways. This alone has made a huge impact on my life. I get mad at pharmaceutical companies for trying to strip the #psychedelic properties of it. #PWChat

— Ketamine Saved Me (@KetamineSavedMe) November 17, 2017


Question 3

Q3: What makes #ketamine a promising alternative to #antidepressants and other standard #depression care?#PWChat

— Physician’s Weekly (@physicianswkly) November 17, 2017

A3: #antidepressants don’t help moderate #depression, work somewhat better than placebo for severe depression, and make about 30% of people worse. #ketamine has been highly effective in every study, improving depression, #anxiety, and #suicidal symptoms within hours #PWchat

— KetamineTreatment SF (@ActifyNeuro) November 17, 2017

I participated in a #ketamine clinical trial at UAB for suicide ideation. 24hrs after infusion all suicidal thoughts were gone. #PWchat

— Beverly (@b4evrwld) November 17, 2017


Question 4

Q4: What quality research is there to support the use of #ketamine for #depression? #PWChat

— Physician’s Weekly (@physicianswkly) November 17, 2017

A4: There have actually been multiple randomized controlled clinical trials, the gold standard of research, and multiple meta-analyses (combining data from multiple studies), of #ketamine for #depression, all positive. #PWchat

— KetamineTreatment SF (@ActifyNeuro) November 17, 2017

There isn’t a single high-quality study suggesting the #ketamine may not be safe or may be ineffective in treating #depression?#PWChat

— Physician’s Weekly (@physicianswkly) November 17, 2017

None that I’m aware of! #PWchat

— KetamineTreatment SF (@ActifyNeuro) November 17, 2017


Question 5

Q5: Without FDA approval for #ketamine to treat #depression, shouldn’t patients & providers be wary of using it for depression?#PWChat

— Physician’s Weekly (@physicianswkly) November 17, 2017

A5: Nope. FDA approval has nothing to do with safety – they do not proactively evaluate medicines. They review an application from an interested body, typically Pharma, that spends hundreds of millions to billions on a new patented product. #PWchat

— KetamineTreatment SF (@ActifyNeuro) November 17, 2017

Shouldn’t physicians and providers be wary of not offering a VERY promising treatment that can and WILL save lives? If we stick with the current offerings that don’t work, how will we evolve in #psychiatry. It would be heartless not to offer it to certain patients. #PWChat

— Ketamine Saved Me (@KetamineSavedMe) November 17, 2017

A5 (2): #ketamine is an old, cheap generic, and no one has the financial interest to spend the kind of money necessary for FDA approval-size trials. Ketamine has been FDA approved for anesthesia since 1970. #PWchat

— KetamineTreatment SF (@ActifyNeuro) November 17, 2017


Question 6

Q6: Shouldn’t patients and providers also be wary that the side effects of taking repeated small doses of #ketamine are unknown?#PWChat

— Physician’s Weekly (@physicianswkly) November 17, 2017

A6: We should always consider that any treatment can do harm. @ActifyNeuro has now treated close to 2,000 patients with almost 20,000 #ketamine infusions across 10 locations since 2011. We have not seen any evidence of long-term harm. #PWchat

— KetamineTreatment SF (@ActifyNeuro) November 17, 2017

If I had to choose between potential long term side effects of #Ketamine and actual suicide and living everyday in a literal hell…I’ll take my chances. This is my life I’m fighting for & I will try anything to get back what my illness stole from me! #bipolar #depression @PWChat

— Ketamine Saved Me (@KetamineSavedMe) November 17, 2017

A6 (2): Patients receive much higher doses for anesthesia, pain control, procedural sedation in emergency settings, and on burn units. We do need a national patient registry though so we can formally monitor outcomes and prove safety #PWchat

— KetamineTreatment SF (@ActifyNeuro) November 17, 2017


Question 7

Q7: #Ketamine runs from $400 to $800 per infusion & is rarely covered by insurance. How can patients w/ #depression afford it?#PWChat

— Physician’s Weekly (@physicianswkly) November 17, 2017

A7: @ActifyNeuro is working hard to increase insurance coverage and access to #depression care. Because our patients are seen by psychiatrists, they can often recoup a portion of the cost if they have “out of network benefits”. #PWchat

— KetamineTreatment SF (@ActifyNeuro) November 17, 2017

A7 (2): There are already some examples of insurers covering #ketamine for #depression and @ActifyNeuro is driving this forward. #PWchat

— KetamineTreatment SF (@ActifyNeuro) November 17, 2017


Question 8

Q8: How do you respond to @APAPsychiatric’s conclusion that #ketamine isn’t ready for wide use for treatment-resistant #depression?#PWChat

— Physician’s Weekly (@physicianswkly) November 17, 2017

A8: It is understandable that @APAPsychiatric would take a conservative stance on #ketamine for #depression. However, most of the members of the committee that published that conclusion now offer ketamine for depression at their academic centers. #PWchat

— KetamineTreatment SF (@ActifyNeuro) November 17, 2017

 


Question 9

Q9: Why are some scientists skeptical that #ketamine is a good long-term solution to #depression? How would you reply to them?#PWChat

— Physician’s Weekly (@physicianswkly) November 17, 2017

A9: Sadly, many have biased views based on competing interests. Others are ignorant of the life-changing and lasting benefits we are seeing in clinical practice. #PWchat

— KetamineTreatment SF (@ActifyNeuro) November 17, 2017

Agreed. They are too scared to do anything not FDA approved even if that means saving lives! Sorry, that’s a bit harsh. #PWChat

— Ketamine Saved Me (@KetamineSavedMe) November 17, 2017

A9 (2): But, my reply is simple, “Give me a better alternative to #ketamine for #depression, and I’ll gladly abandon ketamine and offer it.” #PWchat

— KetamineTreatment SF (@ActifyNeuro) November 17, 2017


Question 10

Q10: Speaking of alternatives to #ketamine for #depression, Do esketamine & rapastinel look to be promising developments in this field?#PWChat

— Physician’s Weekly (@physicianswkly) November 17, 2017

A10: They, and other new drugs in development for #depression that are based on #ketamine’s mechanism, do indeed. They have some potential limitations relative to already-available ketamine, but I can’t wait to offer my patients more options! #PWchat

— KetamineTreatment SF (@ActifyNeuro) November 17, 2017