Can psychedelic drugs work magic on depression?
We think of psychedelic drugs, hallucinogens, as party drugs. Drugs that let us escape our minds, and even let us feel like we're escaping our bodies.
Magic mushrooms, Ayahuasca and Peyote have long been understood by non-western cultures to free the mind and help heal emotional trauma.
Today, researchers are discovering that the drug, ketamine, can do the same thing. Ketamine or "Special K" is known on the street as an illicit party drug. It can give users an out-of-body experience, a feeling of dissociation.
But ketamine is intended for use by doctors and veterinarians as an anaesthetic. It also has a darker side as the so called "date rape drug".
Dr. Pierre Blier is leading research at the Royal Ottawa Mental Health Centre using low doses of ketamine to treat patients with severe and treatment-resistant depression, and in particular, patients who have thoughts of suicide.
In fact, pharmaceutical companies are conducting multi-centre clinical trials on ketamine, and researchers are optimistic that an intra-nasal version may be on the market as soon as 2019.
Dr. David Nutt has looked at the brains of people while they've been on LSD, but also on other hallucinogens like psilocybin, the ingredient that makes magic mushrooms "magic."
And he thinks the findings -- as they relate to people with depression, in particular -- are too powerful to ignore.
The following interview with Dr. Pierre Blier has been condensed and edited for clarity.
Bob McDonald: Tell me a bit about ketamine. What is it exactly?
Pierre Blier: Ketamine is an anaesthetic agent that's been used for over forty five years, planet-wide. It's the most widely used anesthetic agent and it's not until the recent years that some people had the bad idea of trying to get this medicine illegally and abuse it on the street.
BM: Well if it was designed as an anesthetic what gave you the idea that it might work to alleviate depression?
PB: One of my colleagues at Yale University, Dr. John Kristal, was using very small doses like the ones that cause this "in-between sensation." You know, when people are going under for anesthesia…to try to mimic some of the symptoms that we've seen in some mental disorders. This is where it evolved from.
BM: What are people feeling when they take it?
PB: Well they feel a little bit spacey or dissociated. And like Maureen [a trial participant ed.] mentioned there can be a very rapid antidepressant action occurring.
BM: Maureen did say that she tried antidepressants for many years but nothing worked. Why do you think ketamine is different?
PB: Because the mechanism of action is different, it targets different neurons in the brain. One of the primary actions is that it blocks of certain receptor subtype in the brain for the transmitter which is called glutamate, and that triggers a cascade of events. And it doesn't mean that something is wrong with the glutamate system. Glutamate produces, through this action, a surge, an even greater amount of glutamate release.
BM: Where are you in your research right now? What effect have you seen?
PB: We've seen the rapid antidepressant effect in treatment-resistant patients like Maureen. But what is striking is that we also saw a very important effect in decreasing or completely making the suicidal ideation disappear. And what we unveiled in our research is that the anti-suicide ideation effect is independent of the antidepressant effect.
So in other words, the 40 percent who don't respond overall to ketamine still see their suicide ideation being abolished.
BM: Is this instant?
PB: It may be immediate in some patients. It actually often occur after 24 hours in some people, and people like Maureen she said three injections. So that was in the first five days.
BM: And how long does it last?
PB: Well you saw in the case of Maureen she was already on antidepressants when she started the trial. So she had basically ten infusions over a period of six weeks and it lasted eight months.
BM: Well if ketamine has such wonderful results is it possible that we'll see it available for prescriptions soon?
PB: The pharmaceutical industry has developed the preparation of ketamine called esketamine which, instead of having to inject intravenously, can be inhaled under medical surveillance, of course.
And there are at least three trials ongoing in different countries, in different centres. We are one of the centers and if everything goes well we're talking probably about commercialization in late 2019.
BM: I'm thinking about people who might hear this program and say "oh well you know maybe I can just use it for depression and not to get high." But just depression.
PB: Well, I would not recommend that because actually first of all when you take any drugs from the street you don't know what's in it. There could be contaminants, it could be cut with methamphetamine or anything else. So I really do not recommend that because you could be taking some harmful substances. Like I said ketamine is commonly used under medical surveillance care low doses in infusion if it's accepted.
BM: What impact could ketamine have, if it's accepted?
PB: It could have a major impact because, for example, it could be given to people who have had treatment resistance like Maureen. And then we would have the capacity to get them well very fast. And then more research will have to be carried out to see if it could be used earlier in the sequence of treatment. And like I mentioned before almost everybody experiences a decrease in suicidal ideation. And that's the major impact because there are 4,000 Canadians dying from suicide in Canada every year, 11 a day.
*Click listen to hear Maureen talk about her experience taking ketamine to treat depression.