Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF July 13, 2018 | Archived Issues

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New Drug Treatments for Major Depression Emerging

A powerful anesthetic called ketamine is spawning a new generation of drug treatments for depression that has shown the ability to provide fast-acting relief, according to Waguih William IsHak, MD, FAPA, professor of Psychiatry and vice chair of Education and Research at Cedars-Sinai, who recently spoke to Heathline about the benefits and risks of these drugs.

After more than a decade without much innovation, IsHak explained, two major pharmaceutical companies are developing these new kinds of antidepressants. One medication is a nasal spray modeled after ketamine’s chemical structure; the other drug is chemically different, but mimics ketamine’s effect on the brain.

Approved by the FDA in 1970 as a pain treatment, ketamine was first used by U.S. soldiers during the Vietnam War. The drug has garnered recent interest because, unlike traditional antidepressants, ketamine sometimes can improve a patient’s mood within minutes.

But there are risks. Noting ketamine’s reputation as a tranquilizing club drug, IsHak pointed out both the drug’s need to be administered, usually intravenously, under supervision, and its side effect of dissociative symptoms.

Oral ketamine prescribed for pain has also caused concern, IsHak added.

"People take it to get high to get those dissociative feelings and hallucinations if they take higher doses," IsHak told Healthline. "So, I think that’s definitely a serious concern."

IsHak suggested finding a way to make oral administration safer so people can take the drug on their own rather than under supervision. He said that if changes like this could be made, ketamine-type medications could become an effective treatment.

"If this is oral with rapid onset of action," IsHak explained, "I can tell you this is something I’d prescribe as a first line and not wait until we exhaust two or three trials of other medicines."

This year, the Cedars-Sinai Inpatient Pain Management team led by Charles Louy, MD, presented their findings on the use of ketamine in pain and depression, jointly with the psychiatry team led by IsHak, at the American Psychiatric Association’s annual meeting, which was held in New York City in May 2018.