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It’s early days yet but a recent report in The Lancet Psychiatry journal calls for a new approach for using low doses of the “party drug” ketamine as a treatment for depression.

Since 2011, scientists from Oxford University have been treating 101 people with moderate to severe symptoms of depression with intravenous doses of ketamine. Of those, 42 have reported sustained improvements in their symptoms and 70 reported some improvement after just one dose. This has been hailed as a significant result when compared to other anti-depressant medication, only surpassed by electroconvulsive therapy (ECT) in effectiveness.

Ketamine is licensed in the UK for medical use as an anaesthetic as well as being an effective pain killer. Its illegal recreational use however (known as “Special K”), carries a five year prison term. Current estimates indicate that 3% of the UK population – or 2 million people – suffer from depression, with 158,000 of those describing their symptoms as “severe” and resistant to treatment.

The trial used a carefully administered approach that allowed the scientists to calculate the overall response rate to the drug over a period of time. Patients received one, 40 minute intravenous infusion of ketamine. They then had the option of receiving two more infusions, followed by an oral dose given twice a week, with the possibility of further ‘top-up’ infusions in the following weeks and months.

Some trial patients saw significant improvements, if not immediately then certainly over the course of the treatment. One, Louise, described how the ketamine treatment slowed down the “constant, overwhelming bombardment of negative intrusive thoughts surging through [my] brain” allowing her to fight back. “I’m the most stable I've been in years and have hardly spent any time in hospital compared to before ketamine,” she says. Another, David, said that the ketamine allowed him to “live for a few days a week rather than just exist”.

For the treatment to be rolled out on a national scale, Dr Rupert McShane, the consultant psychiatrist who led the programme, has recommended creating a new medical registry to track where and how ketamine is prescribed and provide a “layer of scrutiny that currently we don’t have for any antidepressants”. He is supported by Paul Keedwell, Consultant Psychiatrist at Cardiff University. “More research is needed and having a registry allows researchers to share new findings, positive or negative,” he said. “For example, one challenge is to determine how to prolong any positive effects, perhaps through multiple dosing, or by adding other drugs.”

However, Allan Young, of the Royal College of Psychiatrists, reacted more cautiously. “Despite clinical trials showing rapid improvement in mood after ketamine infusion, there are still significant gaps in our knowledge about dosage levels, treatment protocols and the effectiveness and safety of long term use,” he said. “Before ketamine can be recommended for use in clinical practice, extensive research is required to understand how to optimally use ketamine for treating depression.” For psychiatry help contact Psychiatry Concierge.