Ketamine: nasal spray for depression

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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It almost sounds like a miracle: Severe depression that magically disappears into nothing in a few days or even hours. And that even with people who do not respond to the usual therapies.

Ketamine is the name of the substance that has been traded as a beacon of hope for such patients for some time. The drug is an old friend: it is used as an anesthetic.

For some time now, doctors in Germany have been prescribing ketamine "off label" - i.e. outside the actual approval area - as an infusion therapy against depression. In the USA, a ketamine derivative has now received approval for depression therapy for the first time. It is given in the form of a nasal spray. An application for approval in Europe is already pending.

New approach, new hope

"The great thing about it is that with ketamine you have a completely different effect than the currently usual antidepressants," says Prof. Ulrich Hergerl, CEO of Deutsche Depressionshilfe, in an interview with The most common antidepressants include so-called serotonin reuptake inhibitors (SSRIs). They increase the level of the neurotransmitter known as the "happiness hormone" in the brain.

In most cases, it can be used to treat depression very well. But the effect is absent in every third to tenth patient. "With ketamine you now have a chance that these patients will also respond," said the psychiatrist. The substance has a blocking effect on the glutamate receptors in the brain. This dampens the overexcited state that many depression patients find themselves in. “They live in a permanent permanent alarm,” says Hegerl.

Lower euphoria

However, he dampens overly high-flying expectations: It may be that ketamine will prove to be a great method for a subgroup of depression patients. “Nevertheless, you have to reduce the initial euphoria a bit. Because the originally very good results were not confirmed in the later studies. "

Ketamine only works in every second to third patient who traditional therapies cannot help. The effect then sets in faster than with common antidepressants, which often only have an effect after weeks of patient use. “But you don't yet know whether ketamine, used for months, won't lose its effectiveness,” says Hegerl. The relapse rate for the drug is also high.In addition, nobody knows whether it can cause long-term damage in the long term. “There is little experience there,” says Hegerl.

Addictive party drug

Perhaps the biggest catch with ketamine: unlike SSRIs, the drug can be addictive. In fact, it has made a career for itself as a party drug under the name “Special-K”. In the USA, therefore, the nasal spray is not given to patients. You must come to specially approved centers for treatment. And that two to three times a week.

They must remain there under observation for at least two hours after the spray. Because under the action of the ketamine, the patients often stand next to themselves, perceive themselves as strange and disconnected from their own body. "If you have a choice, you would prefer a non-addictive drug," says Hegerl.

But despite all the shortcomings: Ketamine is another arrow in the quiver of psychiatry with which depression can be brought under control. If nothing else helps, it is a great gift.

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