Between Depression Super Cure and 'Club Drug' Stigma... What is the future of ketamine?

23-05-12

[The Hankyoreh S] Shin Chan-young's poison to the mind, medicine to the mind - Ketamine

From anesthetic to medicine for incurable diseases

Specially effective for patients who have not taken conventional medicine

In the misunderstanding of ‘club drugs’ due to hallucinogenic effects

Concerns about side effects such as near-death experience controversy

There is an area in which Korea ranks first with a figure that is twice the average of the Organization for Economic Cooperation and Development (OECD). is the suicide rate. Many celebrities and entrepreneurs suffered from depression and left us too soon. It would be better not to say that I chose it myself. Depression forced it. Depression is known to occur in more than 5% of the total population and is twice as common in women as in men.

It is more important than anything else to help those around you who are suffering alone due to a break in communication. The late Ewha Womans University Emeritus Chair Professor Lee O-ryeong once said that the silence that appears in everyday life, such as looking at an empty classroom in a crowded playground on a sports day, is “experiencing death.” She shouldn't be left alone too long in an empty classroom. We have to hold hands and come out.

A cure for depression that has emerged like a comet

There are more than 36 types of treatments available worldwide, and there are many people around who are taking medicine, so many people know that depression is a “cold of the mind” that can be cured or controlled by just taking medicine. Unfortunately, however, about 30% of all depressed patients often do not see a clear effect even if they take two or more drugs for a long time. Such cases are called intractable (treatment-refractory) depression. Electroconvulsive therapy is sometimes recommended for patients who do not respond to drugs and are concerned about suicidal thoughts, which is to induce convulsions by anesthetizing the patient and giving strong electrical stimulation to the brain. It is a proven method of treatment, but it is also true that I would like to avoid it if there is a medicine.

Like other psychiatric medicines, antidepressants come out first and study them to understand the treatment mechanism of depression backwards. Since the use of tuberculosis drugs in the 1950s and the discovery that these substances were effective in treating depression, various antidepressants have resulted in drugs that increase the amount of several neurotransmitters, such as norepinephrine, serotonin, and dopamine, inside the brain. Therefore, intractable depression can be considered as a type of depression with relatively little relation to these three neurotransmitters, but exactly what mechanism causes intractable depression has remained a mystery until recently.

In this situation, a substance that appeared like a comet is an old anesthetic called ketamine. Developed in the early 1960s, this drug was widely used during the Vietnam War, where a relatively safe anesthetic was needed due to its low respiratory failure. The mediocre old drug ketamine is receiving attention in the field of psychiatry and neurology through the confirmation of its therapeutic effect on intractable depression. In 2000, researchers such as Robert Berman and John Crystal of Yale University in the United States confirmed that ketamine administered to depressed patients at a concentration much lower than the concentration that exhibits an anesthetic effect produced a rapid and powerful antidepressant effect. Through research over the past 20 years, ketamine has been evaluated as the drug that has revolutionized the treatment of depression most dramatically in the last half century. Compared to previously used drugs that improve depression only when administered for at least 2 weeks, there is a report that ketamine can take effect after 2 hours in a rapid case, and it is known that a single administration shows an effect for at least several weeks.

Ketamine has been reported to be more effective, especially in patients who have had poor response to conventional treatment. Dr. Thomas Insel, former director of the Institute of Mental Health at the National Institutes of Health (NIH), praised ketamine for its therapeutic properties, and the U.S. Food and Drug Administration (FDA) approved the ketamine enantiomer in 2019 and Korea in 2020. Among substances with similar structures but different properties as if reflected in a mirror), esketamine has been approved as a treatment for depression and is being used to treat intractable depression. Studies of the antidepressant effects of ketamine have deepened our understanding of the effects of modulation of excitatory and inhibitory neurotransmission on the expression of depressive symptoms. The hypothesis that the neurobiological origin of depression is caused by abnormal synaptic plasticity and deterioration of neural connectivity between brain regions due to genetic and environmental causes has recently gained more power, and based on this, the development of drugs for intractable depression is accelerating.

All drugs are poison. And all poison is medicine. Depending on the dose, the genetic background of the individual and the condition at that time, poison becomes medicine and medicine becomes poison. All the more so with drugs that act on the most beautiful and sophisticated product of evolution, the human brain.

Ketamine as an anesthetic is classified as a dissociative anesthetic and induces hallucinations. By exploiting this property, ketamine is also misused and abused as a so-called 'club drug'. Recently, it has become a big social problem in the United States and Korea, and it is often reported in the media. Due to concerns about addiction, hallucinations, and mental dissociation, there is also an opinion that ketamine for the treatment of depression is not as effective as originally thought, as it must be used while hospitalized on the same day and must be used repeatedly.

Will it be medicine? Will it be poison?

A characteristic side effect of ketamine is nightmares. According to a study by British researchers, ketamine administration triples the risk of having unpleasant dreams. Ketamine is also claimed to cause “near-death experiences.” Near-death experiences are symptoms that people claim to have felt after returning from a near-death situation, such as floating in the air and looking at their bodies, feeling peaceful and happy, reminiscing about life in snapshots, traveling through a long tunnel of light, For example, the feeling of seeing a bright and colorful light. A joint research team from Belgium, the United States, Argentina and France analyzed more than 15,000 descriptions of near-death experiences and mental symptoms caused by drugs acting on the nervous system, narcotics, anesthetics, and drugs of dependence. It has been reported that it is the substance that causes the phenomenon. There is also a hypothesis that a substance similar to ketamine is released from the brain just before death. Will ketamine cause us nightmares or will it bring new hope to those who are suffering near death? It all depends on how ketamine is used and utilized and ongoing research into drugs with fewer side effects. The choice is in our hands.