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Drugs as medicine? ‘Ketamine is not more evangelism than is necessary’

Can ketamine, narcosemiddel and party drugs offer a solution for people with intractable depression? That is the question that Robert Schoevers, professor of psychiatry at the UMCG, tries to answer.

Almost one in five Dutch people will get in his life with depression, according to figures from the MENTAL health service. In about 20 percent of them is that depression is so persistent that regular treatments such as cognitive behavioral therapy or antidepressants will not start properly. For people who would ketamine be a godsend.

Psychiatrists and therapists are still hesitant

Since 2000, appeared optimistic publications on the antidepressant effect of the drug. Nevertheless, psychiatrists and therapists are still hesitant. “That hopeful messages are often based on small, short-term studies, which is still no conclusive evidence of efficacy and applicability, certainly in the somewhat longer term,” says secretarial college.

“To provide evidence, his major research is required”
Robert Schoevers, professor of psychiatry at the UMCG

To scientifically demonstrate whether ketamine really works so well, started secretarial college a research, that is currently in Nijmegen, Den Haag and Groningen. “To be tough as nails to prove, are large, carefully conducted research is required in a large number of patients with a new drug compared with a control treatment.”

The participants in the study are people with intractable depression, for whom other forms of treatment do not catch on. A part of them is given a placebo, another part for six weeks on a low dose of ketamine in pill form. Therein is the research of Schoevers worldwide, the largest study in this way is carried out.

Ketamine is seen as a possible medication for people with intractable depression, for whom other forms of treatment do not catch on (Photo: 123RF).

Research is done in 2020

“The research actually consists of two parts, because after their participation, all subjects also have the opportunity to a trial of therapy with ketamine. Of course, we will continue them also carefully monitor. That way we learn more and more about the long-term effects and side effects of the drug.”

Schoevers hopes the research of mid-2020 to complete. About the preliminary results of the second part of the study, he is cautiously optimistic. “We see very good effects, but restraint is also needed. It will not be the first time that a promising drug eventually does not as well proven to work, or even can be dangerous in the long term.”

Figures

  • 1 in 5 Dutch people get to do with depression
  • At 20 percent of people skip regular treatments are not good to
  • 1.1 million people in the Netherlands to swallow anitdepressiva

How does it work exactly?

In depressed people, there is often an imbalance between the brain areas where emotions such as fear and stress, and cognitive control, in which all the emotions and signals are filtered and can be controlled. “Now it seems that ketamine the neuroplasticity (the ability of brain cells to make new connections, and themselves to constantly update, red.) promotes, so that imbalance will be restored.”

One of the most striking effects of ketamine is the speed in which it works. “It is often much faster than a regular antidepressant result. We are currently investigating whether that positive result then it means that people over long periods of time ketamine should continue to use, and how active that is. There is still little known about it.”

“There are reasonably effective treatments for depression, where health care, however, all the ins and outs of kent”
Robert Schoevers, professor of psychiatry at the UMCG

Long-term use of ketamine can damage the urinary tract, liver or cognitive functions cause. In addition, ketamine is also an addictive drug. Or there are also positive effects and the means therefore can be used as medicine, is now investigated.

Schoevers: “There are already quite effective to other treatments for depression, where health care, however, all the ins and outs of kent. A ketaminebehandeling is only meant for people with intractable depression who do benefit from previous treatments.”

“We are looking for is a method where she is the ketamine for a number of weeks or months use in a low frequency, and next to regular treatments. For example, to avoid relapse, or people from the deepest valley to attract.”

Antidepressants are also prescribed for anxiety and pain

According to the Foundation for Pharmaceutical statistics use approximately 1.1 million people in the Netherlands of antidepressants. Incidentally, not all people are on antidepressants swallow depressed. It is every now and then also prescribed with fears and pains.

In the nineties of the previous century there appeared many new forms of antidepressants on the market. But in the past few years, there is not a lot more happened in this area. “It is good that there is active search for new treatments for people in whom conventional treatments do not start properly,” says secretarial college.

“If you look at the extent to which people with a chronic depression suffer you can compare that with a disease like cancer. For these people, life is very heavy, and it affects both their mental and physical health. There is practically nothing that brings relief.”

Ketamine is not part of the opium act

The world health organization (WHO) the existence of ketamine among the safest and most effective methods for analgesia and pain relief in the science are known. The means is since 1985 used as a drug, and falls under the Geneesmiddelenwet in place of the opium act.

“I want ketamine not more praise than is strictly possible”
Robert Schoevers, professor of psychiatry at the UMCG

The idea that ketamine can help against depression, it is nevertheless fairly new. Around 2000 came the first sounds on this. “In hindsight you can think: why has it taken so long?” says secretarial college. “But it takes a lot of time to be a drug researched and approved to get a large group of people. That can be frustrating, but good research is necessary.”

What also may play a role in the reluctance is that ketamine use in recreational settings is used as tripmiddel. According to the National Drugs Monitor Trimbos Institute is the means of becoming more and more popular.

“I don’t want more praise than is strictly possible,” says secretarial college. “I want to avoid people at home to go to work, with all the negative consequences.”

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