A Molecular Masterclass conference delved into the benefits, research, and policy surrounding ketamine therapy.
The masterclass explored ketamine at the intersection of clinical care, research, and investment, and featured the world’s top researchers, clinicians, companies, advocates, and experts. Attendees at the conference were able to learn more about the potential of ketamine and NMDA receptor antagonists in the treatment of key mental and physical conditions.
The benefits of ketamine
Sitting on the pharmacology panel with Dr Jeff Becker, MD, Jason Wallach, PhD and David Lodge, PhD was psychiatrist and psychoanalyst Martha Koo of Neuro Wellness Spa, which offers transcranial magnetic stimulation (TMS), IV ketamine, IV nutrition, photobiomodulation, and general psychiatry for medication management.
Koo emphasised the importance of the mind-brain connection and of being able to offer patients excellent care that includes both biological and psychodynamic interventions.
Koo said: “Ketamine is an amazing therapy for depression, anxiety, and chronic pain. It functions as a NMDA receptor antagonist, preferentially blocking the NMDA receptors on GABAergic interneurons to cause a surge of glutamate and a cascade of events leading to improved neurogenesis, synaptic strength, and global brain connectivity.
“In essence, we believe that ketamine is very important in reversing neuronal atrophy caused by stress from chronic illnesses, such as pain, anxiety, PTSD, and depression. On a broader level, I believe IV ketamine therapy assists patients to become more psychologically flexible, for example engage in deeper self-awareness, gain insights from additional perspectives, acquire more acceptance, be less avoidant, and cope better with adversity.
“With the first infusion some patients are rid of all suicidal thoughts and most are simply less overwhelmed by their symptoms. After a series of infusions ketamine helps individuals be in complete remission from anxiety, depression, and pain.”
Koo said she has had a phenomenal experience treating patients with IV ketamine, many of whom feel demoralised and hopeless after trying many types of therapy without success.
She added: “I have never had an issue with dependence or addiction, which I think people in the community erroneously fear with ketamine. I believe stigma surrounding mental illness and treatment is lessening. The public is currently much more aware that mental illnesses are medical illnesses requiring professional treatment, are prevalent and can be disabling. If ketamine therapy became FDA approved and covered by insurance, we could offer hope and joy to so many. I also think that the community needs to understand that, yes, ketamine has been abused but ketamine, itself, is not addictive.
“It does not work via the dopamine reward pathway. People can abuse many substances, including glue, but that is very different from a substance having, on a chemical basis, a risk for developing tolerance and dependence.”
Ketamine research and policy
Ketamine was approved as an anaesthetic in 1960 by the FDA. Koo noted that more research needs to be performed and that access to ketamine is a huge issue for patients.
“We have a solid amount of research about ketamine’s pharmacokinetics and pharmacodynamics. What our field is lacking is quality controlled studies that define the ideal protocols for dose, route of administration, set and setting, and additional therapy modality for acute treatment.
“Likewise, we do not have adequate data on the use of maintenance, or booster, IV ketamine, or ongoing use of IM ketamine, nasal ketamine, or even other NMDA receptor antagonists such as memantine in between IV ketamine therapy to prevent illness recurrence,” said Koo. “Ketamine is not FDA approved or covered by insurance for uses outside of anaesthesia. Overcoming barriers of cost would allow access for many more people.”
Panellist Dr Rupert McShane, a consultant psychiatrist and associate professor at Oxford who has treated over 300 patients with ketamine, emphasised that more research is needed into its use.
Speaking to Health Europa editor, Stephanie Price, Dr McShane commented: “We do a lot of monitoring in our clinic, but if a patient doesn’t respond, or relapses, there is no evidence to support clinicians in what they should do next, so there is a strong chance the dose of the drug will be increased. This is very important as doctors need help in order to know what to do, and that help usually comes in the form of data from randomised controlled trials. However, we do not have that for the long-term use of ketamine.
“Inevitably, what has happened is that there are wide varieties of practice regarding the doses of ketamine that are used, the frequencies that people are given the drug, and the routes by which the drug is administered. This creates the possible advantage that, if one were to gather all the data, it might be possible to draw conclusions about which strategies were most successful. However, the reality is that collating data from different clinics in this way is unlikely to happen.
“When a drug has a licence like esketamine does, the data are high quality. In contrast, there is much less information on long-term use of ketamine and it is of lower quality. We badly need research into long-term use. People also need to start publishing their data, but it is not easy to do because patients are treated in a less standardised way in clinical practice than in research.
“There is another problem with the structure of regulation at the moment, in that it doesn’t allow the regulators the use of a single platform for collecting data across multiple drugs. It is crucial to be able to track how much people are switching between different drugs or other rapidly acting antidepressants.”