‘Party drug’ Ketamine is poised to become the latest in a growing line of drugs previously associated with recreational use to be offered on the NHS after reports that it could be licensed to treat depression within 18-months. Astonishingly successful clinical trials involving ketamine have shown it to be up to 10-times as successful as existing treatments for patients whose depression is defined as ‘treatment resistant’.
If, as expected, licensing is approved in coming months, ketamine will become the first ‘new’ drug used in the treatment of depression in 35 years. The development comes shortly after moves to make medical cannabis and cannabis-based drugs available by prescription from the NHS. Cannabis, or marijuana as the same drug is also known, has in the recent past been considered only a recreational drug with no medicinal qualities and classified alongside cocaine and heroin. However, belated clinical trials designed to test whether empirical evidence of medicinal qualities for the treatment of conditions as varied as some forms of cancer, MS, chronic pain, epilepsy and anxiety and depression have shown huge promise.
Depression is a condition that the Royal College of Psychiatrists estimates affects one in five individuals at some stage of their life. It’s also notoriously difficult to treat, provoking excitement at the rich promise shown by clinical trials of ketamine.
While the pure, medical form of ketamine could be licensed within as little as a year there are concerns that its public persona as a party drug with an additional association with ‘date rape’ cases could be controversial and provoke concern. The National Institute for Health Research is planning to counter this with a ‘three-point strategy’ around the launch that will educate and provide context for ketamine’ medicinal use.
The medical form of ketamine that will treat depression, which is slightly different to that approved for use as an anaesthetic, is produced by Janssen, a Belgian-based part of the Johnson&Johnson group. It’s delivered to patients as a nasal spray. The company this month submitted an application to the European Medicines Agency to license the spray providing supporting evidence from ‘phase three’ clinical trials. The results of that final round of trials demonstrated remission of depression symptoms in 47% of the patients involved. That stands against a success rate of just 4% for current treatments.
The potential of ketamine and other drugs also classed as ‘rapid-acting’ in the treatment of depression are considered by Rupert McShane who led to UK trials for the Janssen spray as “the most exciting developments in psychopharmacology for 50 years”. There is also some initial evidence that the application of medical ketamine could extend to a range of other psychological conditions such as general anxiety disorder, PTSD, anorexia, borderline personality disorder, extreme OCD and thoughts of suicide.
However, with a lack of historical data on the long term effects of using ketamine and other drugs medically, experts will approach prescription with caution and patients will be closely monitored.
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