X owner Elon Musk recently described using small amounts of ketamine “once every other week” to control the “chemical tide” that causes his depression. He says getting out of a “negative mindset” helps.

This prompted a range of reactions from the media, including X (formerly Twitter), ranging from strong support for Musk’s chosen treatment to accusations that he has a drug problem.

But what exactly is ketamine? What role does it play in treating depression?

It was originally used as an anesthetic

Ketamine is a dissociative anesthetic used for surgery and pain relief.

At certain doses, people are awake but lose contact with their bodies. This makes it useful for caregivers, for example, who can continue to talk to an injured patient while the drug relieves pain, but without affecting the patient’s breathing or blood flow.

Ketamine is also used in veterinary practices to sedate animals.

Ketamine is a mixture of two molecules, commonly known as S-ketamine and R-ketamine.

S-ketamine (or esketamine) is stronger than R-ketamine and was approved in the United States in 2019 under the drug name Spravato to treat severe and long-term depression that has not responded to at least two other types of treatment.

Ketamine is thought to alter chemicals in the brain that affect mood. While the exact way ketamine works on the brain is unknown, scientists believe it alters levels of the neurotransmitter glutamate, thereby altering the symptoms of depression.

How was it developed?

Ketamine was first synthesized as an anesthetic by chemists at Davis Pharmaceuticals in Park, Michigan, USA. In 1964, the drug was tested on a group of inmates at Jackson Prison in Michigan and found to be fast-acting and have few side effects.

The U.S. Food and Drug Administration approved ketamine as a general anesthetic in 1970. It is currently included in the World Health Organization’s Core List of Essential Medicines for Global Health Systems as an anesthetic drug.

In 1994, researchers began studying the effects of low-dose ketamine on depression after patients reported improvements in depressive symptoms after surgery using ketamine as an anesthetic.

The first clinical trial results were published in 2000. In the trial, seven people received intravenous ketamine or a saline solution over two days. As in the earlier case study, ketamine was found to rapidly reduce symptoms of depression, usually within hours, with effects lasting up to seven days.

Over the past 20 years, researchers have studied ketamine’s effects on treatment-resistant depression, bipolar disorder, post-traumatic stress disorder, obsessive-compulsive disorder, eating disorders, and reducing substance use, with generally positive results.

A study of community clinics offering intravenous ketamine treatment for depression and anxiety found that most patients experienced improvement in depressive symptoms eight weeks after starting regular treatment.

While this may sound like a lot of research, it’s not. A recent review of ketamine studies conducted over the past 30 years found only 22 ketamine studies involving a total of 2,336 patients worldwide. By comparison, there are 1,489 cancer drug studies underway in 2021 alone.

Is Ketamine prescribed in Australia?

Although research results on ketamine’s effectiveness are encouraging, scientists still don’t know how it works. That’s why it’s not readily available to GPs in Australia as a standard depression treatment. Instead, ketamine is used primarily in specialized clinics and research centers.

However, the clinical use of ketamine is increasing. Spravo nasal spray was approved by the Australian Therapeutic Goods Administration (TGA) in 2021. It must be used under the direct supervision of a health care professional, usually a psychiatrist.

The dosage and frequency of Spravo varies from person to person. People usually start with three to six doses over a few weeks to see how it works, then treat every two weeks as a maintenance dose. The nasal spray costs between A$600 and A$900 per dose, which will significantly limit access to the drug for many people.

Ketamine can be prescribed “off label” by GPs in Australia, who can prescribe Schedule 8 drugs. This means it is up to the GP to assess the patient and their medication needs. But due to a lack of research on the drug’s side effects and long-term effects, experts on the drug recommend using it with caution.

What about its illegal use?

Ketamine-related deaths have been widely reported, fueling concerns about ketamine use and abuse.

Ketamine has been used as a recreational drug since the 1970s. People report that it makes them feel euphoric, trance-like, floating, and dreamy. However, doses used for recreational use are generally higher than those used to treat depression.

There is limited information on deaths caused by ketamine. The reported cases are due to accidents or the combination of ketamine and other drugs. No deaths have been reported in the treatment setting.

reduce stigma

Depression is the third leading cause of disability worldwide and requires effective treatment.

It would be wiser to seek medical advice about treating depression than to listen to Musk’s advice on which medications to use.

However, Musk’s open discussion of his mental health challenges and treatment experiences has the potential to reduce the stigma around seeking help for depression and mental health issues.

(author:Julaine Allan, Associate Professor of Mental Health and Addictions, Institute of Rural Health, Charles Sturt University)

(Disclosure Statement:Julaine Allan receives funding from the Australian Government to conduct research on mental health and substance use interventions, treatments and outcomes)

This article is republished from The Conversation under a Creative Commons license. Read the original article.

(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)