yesf you ask a Wall Street investor what will be the next big thing in the pharmaceutical industry –a drug as lucrative as Viagra or aspirin, which is known as a blockbuster (‘best seller’)–, will he bet on some derivative of the ketamine, a hallucinogenic drug with suddenly surprising and hopeful anti-depression properties. Laboratories have understood this and have embarked on a frantic race to market their own molecule ‘inspired’ by ketamine. If they’re spending hundreds of millions on a new generation of antidepressants, it’s because it’s worth it.
Worldwide, 14,000 million euros are invoiced. Two companies have taken the lead – Johnson & Johnson and Allergan – blessed by the seal of ‘breakthrough therapy’ given to them by the FDA, the US government agency responsible for approving new drugs. In practice, this condition speeds up procedures that, as usual, can take more than a decade. Clinical trials are in the last phase.
Psychiatrists have known about its antidepressant effects since 2006, but also its addictive power and side effects
But many are not willing to wait that long. Dozens of private clinics in the United States already administer ketamine, especially in the Los Angeles and San Francisco metropolitan areas. The dropper lasts about 50 minutes and can cause hallucinations. It is not a cheap treatment, each dose costs about 750 dollars (625 euros), but it is fashionable, especially among the computer scientists of Santa Monica beach, known as Silicon Beach, where there are about 500 technology companies.
It is also being applied in Europe. A clinic in Bristol, England, claims in The Times that it has a waiting list of 400 people willing to pay 7,000 euros for treatment.
A wave of suicides due to depression with great media resonance has influenced, such as that of Edward Thomas Mackoviak, an Apple engineer; Joseph Thomas, Uber programmer; Austen Hewinz, founder of the start-up Cambrian Genomics; Autumn Radke, president of a bitcoin payment company; among others… Faced with the imminence of massive use of ketamine, psychiatrists in the United Kingdom have requested that a national registry be kept of those to whom it is prescribed to monitor the results and prevent abuse. But what advantages, and also what risks, would its large-scale commercialization entail?
An old acquaintance… very dangerous
For chemists, ketamine is an old acquaintance. It is a compound synthesized for the first time in 1962. It is a powerful pain reliever that has been used by military doctors in combat zones. And also by veterinarians to anesthetize horses. As if that were not enough, its illegal use as a recreational drug – called Powder K, CK or Kit Kat, due to a psychedelic effect of unfolding baptized as ‘hole K’, which makes the person who injects it feel that he is leaving his body – makes her a disreputable candidate. It produces hallucinations and intoxication, oneiric states and mystical experiences that resemble agony. And the consequences of an overdose can be very serious: coma, cardiorespiratory failure and even death. It is prohibited in many countries, including Spain (since 2010).
Ketamine engages the brain’s glial cells, a kind of glue for nerve tissue. That’s why you act so fast
However, psychiatrists have known about its antidepressant effects since 2006. But also its addictive power. And other side effects, such as bladder damage, palpitations, cognitive problems… And it is still necessary to study what the consequences of its long-term use may be. “We know that ketamine is safe as an anesthetic, but as a general rule a person is only anesthetized once, they don’t get an anesthetic (on a regular basis) for months or years. We have no idea what he can do », acknowledges Dr. Cristina Cusin, from Massachusetts General Hospital, to the magazine Time.
maximum expectation
The expectation is high, especially since April, when the prestigious American Psychiatric Association published a consensus statement stating that “there is conclusive evidence of the antidepressant effects of ketamine applied by drip and that these are fast and robust , albeit transitory. This effectiveness refers to major depression, suicidal ideation and post-traumatic stress disorder. And it’s based on two staggering statistics. The first is speed. The effect of ketamine begins to be noticed in a matter of hours, when traditional antidepressants take weeks or months. The second is the success rate. That reaches a brutal 60-70 percent with patients who no longer respond (or have never responded) to any other treatment. Transience, however, is a drawback. The effect of ketamine wears off in a few days or weeks, and this means that patients need new doses to keep the disease at bay.
Worldwide, 12,000 million euros are invoiced in antidepressants. Hence the frantic race of laboratories
And no one is safe from being overwhelmed by that paralyzing cocktail of infinite futility, sadness, and reluctance that is depression. You can be called Brad Pitt, Bruce Springsteen or JK Rowling. You can be an achiever and have it all. Being in the prime of life, on the crest of the wave… It doesn’t matter. «Suddenly, one begins to feel bad. He doesn’t know why, but one day it’s wrong. And the next too. And so, day after day, you don’t improve. The problem is that you don’t know what is really happening to you », the soccer player Andrés Iniesta told in his autobiography. It is also a recurrent condition, so that more than half of those who have had a depressive episode will relapse. And it is difficult to cure. One in three people do not respond to antidepressants.
the new prozac
Will ketamine become the new Prozac? The world’s most famous antidepressant was discovered in 1987, made Lilly gold, and went generic (fluoxetine) in 2001. Since then, there has been no major advance in the treatment of major depression. Thirty years without good news is too long… And suddenly there are encouraging studies on ketamine. Magazine Nature has published two that can be decisive. One from the University of Illinois, showing that ketamine engages glial cells in the brain, a kind of glue for nerve tissue. The glial cells act as ‘secretaries’ of the neurons, passing messages to them without delay and using glutamate, a neurotransmitter, as a ‘telephone’. This would explain why the effect of ketamine is so fast. In comparison, the usual antidepressants, which act on serotonin levels in the brain’s pleasure circuit, use a much more convoluted path, as if they had to present an official request to make an appointment.
The other study, in mice, from the University of Maryland (last year), notes that the mood enhancement appears to be produced by a smaller molecule extracted from ketamine itself, when it is broken down by the liver. When this molecule is isolated and administered purified, no side effects or addiction are seen. That’s where the shots of the pharmaceutical companies go, determined to find a molecule similar to ketamine, but that is free of its side effects. The laboratories want to find a variant, patent it and market it as soon as possible. But there are researchers who believe that some of ketamine’s psychotropic effects, such as splitting, could be related to its antidepressant properties. The synapses (neuronal connections) are modified, some circuits turn on, others turn off… And the patient ‘reconnects’ and reconciles with the world in a mysterious way that we do not understand.
Ketamine treatment for depression lasts 50 minutes and each dose costs 625 euros
Redo the ski slope
Dr. Ben Sessa, who runs the pioneering British center for this type of therapy, Awakn Clinic, believes that many mental health problems are the result of childhood trauma. Not necessarily what we usually call child abuse, but all the ways a child is taught to believe that they are worthless or unworthy of being loved. “The more you use a neural pathway (a type of thinking),” says Sessa, “the more connections it gets to make and the faster it gets. And the more you reinforce it, the more likely it is that problems will arise, from addiction to depression.”
Ketamine, according to Sessa, manages to block the use of certain neural pathways and promotes the growth of others. Sessa uses the analogy of skiing. “Imagine you have a ski slope; if you go down the mountain the same way every day, the skis always follow the same path automatically, following the previous track. Ketamine is like snow falling on that slope, so the next day there are no ski marks and you don’t have to go down that trail. You can take a new one.” And that’s where psychotherapy comes in. He plays the role of the ski guide suggesting new and better paths down the mountain. One, ketamine, closes the bad paths, the other, psychological therapy, opens the good ones. “And it’s not just a hypothesis,” says Sessa. “Studies of brain tissue have shown neuronal regeneration associated with ketamine. It favors neuroplasticity”.
www.hoy.es
Eddie is an Australian news reporter with over 9 years in the industry and has published on Forbes and tech crunch.