The journey of Ketamine from anesthetic agent to treatment for depression is quite fascinating. It's a prime example of how a drug can find a new and highly significant medical use beyond its original purpose. This has come to be through ongoing research and clinical observation.
Ketamine was first synthesized in 1962. It was initially developed as a safer alternative to existing anesthetic agents like Phencyclidine, which had severe side effects. Ketamine was found to be fast-acting but with fewer side effects.
In the 1970s and 1980s, Ketamine became a party drug because of its hallucinogenic and dissociative effects. Like most drugs, it had a few street names, including Special K, Purple, Vitamin K, Cat Valium, Kit Kat, Green K, and Super C.
The abuse of Ketamine led to its classification as a Schedule III controlled substance in the United States, limiting its medical use.
The antidepressant effect of Ketamine was discovered by chance, really. People who abused this drug noticed it helped with their depression. Doctors also noticed that those who had Ketamine for surgeries had improvements in their depressive symptoms. This led to several researches which showed the benefits of Ketamine for depression. These studies showed that Ketamine relieved symptoms of depression quickly, even in cases where other antidepressants did not help. It was fast-acting, reducing symptoms within hours, unlike other antidepressants, which could take weeks.
From the 2000s, many doctors went off-label, using Ketamine to treat depression. Ketamine infusion therapy became available in clinics even though it was not approved by the US Food and Drug Administration - FDA.
In 2019, the FDA approved a nasal spray formulation of esketamine. Janssen Pharmaceuticals markets this medication under the brand name Spravato. Esketamine is the s-enantiomer of Ketamine - this means that they are both very similar in their chemical structures.
Spravato is the first approved nasal spray medication for treatment-resistant depression in adults. It also has approval for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior.
So, how does Spravato work? Well, it is interesting because this medication works differently from other antidepressants. It acts on the NMDA receptors in the brain and increases the amount of a chemical called glutamate. This process helps with mood regulation and synaptic plasticity - which means the ability of your brain cells to modify the strength of the connections and how messages are transmitted in your brain. What is exciting about this new way of treating depression is that it can work quite quickly.
Spravato is only used in adults. It is not for use in children. Also, spravato is not a first-line medication. It is only prescribed if you have tried and failed at least two other medications for depression. Even when prescribed Spravato, you have to take other antidepressants with it.
This nasal spray relieves depressive symptoms within hours to days - much faster than other medications used to treat depression. Antidepressants like Zoloft can take weeks to act.
Does Spravato have side effects? Well, all medications do! So does Spravato. It can cause drowsiness, nausea, vomiting, spinning sensation, high blood pressure, anxiety, and reduced sense of touch and sensation. Another common side effect is feeling disconnected from yourself, your thoughts, feelings, space, and time. This is known as dissociation; some describe it as an out-of-body experience. Others may have dizziness, suicidal thoughts, feeling drunk, and problems passing urine.
Note, though, that these side effects do not happen to everyone. Most people tolerate Spravato quite well. If side effects occur, they tend to go away quickly. Because Spravato can increase blood pressure, treatment centers check blood pressure before the first dose, at 40 minutes and 2 hours.
Due to the risk of side effects, abuse, and misuse, Spravato is only available through a special program from Certified Centers. This is the Spravato Risk Evaluation and Mitigation Strategy Program - REMS.
You should avoid taking Spravato if you have any of these medical conditions - 1. Aneursym - this is when there is a bulge and weak spot in your blood vessel. 2. Arteriovenous malformation - this is an abnormal connection between your veins and arteries 3. History of bleeding in your brain. 4. Allergy to Ketamine or Esketamine.
Spravato can interact with central nervous system depressants like benzodiazepines, opioids, and alcohol. Combining this nasal spray with psychostimulants like amphetamines, methylphenidate, and modafinil can increase your blood pressure.
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