New research

The case for ketamine as a depression treatment was underscored earlier this summer with the publication of a study from Northwestern University highlighting its efficacy as a fast-acting antidepressant and some of the brain chemistry behind why it works. Research has shown that ketamine is a particularly fast-acting depression treatment, taking effect in a matters of hours as opposed to traditional medication which takes weeks.

The Northwestern study in mice showed that ketamine’s rapid impact is due to the fact it increases the activity of a small number of newborn neurons in the brain. Not sure what all that means? Basically, it honed in on the way that ketamine works and could hopefully lead to more targeted pharmaceutical approaches in future.

“We narrowed down the population of cells to a small window that is involved,” said lead study author Dr. John Kessler, a professor of neurology at Northwestern University Feinberg School of Medicine, and the Ken and Ruth Davee Professor of Stem Cell Biology. “We now know exactly which cells we want to target, we can design drugs to focus only on those cells.”

Overstated findings

Cool, right? While getting closer to identifying these cells really is a breakthrough, the knowledge that ketamine is a rapid-acting depressant (the detail which has been focussed on in media coverage of the study) isn’t exactly a fresh finding. This, at least, is the case according to Dr Ben Sessa MBBS BSc MRCPsych and the Co-Founder and Head of Psychedelic Medicine at Awakn Life Sciences, a revolutionary UK-based provider of psychedelic-assisted psychotherapy.

“Ketamine's role as a rapid acting antidepressant (RAAD) is not new. This has been known for more than 20 years and it is used widely throughout the world in RAAD ketamine infusion clinics, mostly in the USA. Nor is it a new discovery, with this study, that ketamine acts by stimulating rapid neurogenesis (new dendrite growth), which translates into immediate positive psychological changes,” Dr Sessa explains. “This has been long known in the ketamine clinical community. I’m not sure how revolutionary this study's findings are in the bigger picture — but the localisation of a small number of specific cells with this study is new.”

However, even if the study isn’t as groundbreaking as it may have been painted in the press, it does come with an obvious positive: adding even further weight to the premise that ketamine can help us fight depression and provide near-immediate relief for those currently suffering. “The role of ketamine as a RAAD when given as infusions and - even more so - the value of ketamine when combined with psychotherapy as we do at Awakn with KAP, is hugely important and significant,” highlights Dr Sessa.

“Typical antidepressants like SSRIs can take up to 4-6 weeks to start working, and during that crucial stage many patients will take their lives whilst waiting for the traditional antidepressant drugs to start working. So ketamine's immediate psychological effects - related directly to these biological findings of rapid dendrite growth – represents a huge clinically beneficial approach for patients."

Will the NHS fund ketamine treatments in future?

In the US, some doctors have been recommending ketamine off-label since the early 2010s for severely depressed or suicidal patients and private ketamine infusion clinics have cropped up across the country over the past decade, providing supervised intravenous ketamine treatment for mental health problems.

In 2019, things changed after the Food and Drug Administration (FDA) approved “esketamine” (Spravato), a nasal-spray derived from ketamine, to be prescribed for treatment-resistant depression. However, there were vocal critics in the science community who suggested that the new drug may not be as effective as generic ketamine and that not enough research had been done around its effects. Another concern was the fact that this nasal spray was being promoted as a medication on its own, rather than in conjunction with therapy.

But what’s the situation in the UK? For us, ketamine is a controlled substance so is illegal to use recreationally – but like in the US it is licensed for medical use as an anaesthetic, hence its reputation as a horse tranquilliser. That means that clinics such as Dr Sessa’s Awakn Life Sciences are able to administer ketamine off-license (often intravenously) for depression and addiction. Typically, it’s administered within psychedelic therapy, which uses consciousness-altering drugs to treat mental health conditions in combination with talking therapy.

Over here, the esketamine nasal spray has been approved for use and has been licensed by the Medicines and Healthcare Products Regulatory Agency (MHRA) and is currently being used in some private practices. However, the medication has been rejected three times by the National Institute for Health and Care Excellence (NICE) which decides what drugs can be licensed for use on the NHS.

While there’s still a long journey to go, research and media coverage of ketamine-assisted therapies are continuing to mount. Hopefully, one day, the work of clinics like Awakn will eventually get the public funding they need to help all the people out there whose lives could be transformed by psychedelic therapies.

You can learn more about Awakn Clinics work via their website.