The American Spectator

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Jay W. Molyneaux br> Wellington, Florida /p> p> KETAMINE CONCERNS br> Re: Michael Fumento's Ketamine and Depression : /p>

After reading Michael Fumento's article several points need to be made. In the first place, after clicking the link and reading the study itself, it bears emphasizing that the sample size (18 patients) is extremely small. This by definition makes it difficult to say much with certainty about the validity of the outcomes the authors are trying to measure. In addition, since all of these people failed 6 conventional antidepressants, making them an unusual subset of patients, one can say nothing at all about whether this treatment would be superior to, inferior to, or even work on the vast majority of patients who DO respond to conventional antidepressants.

Secondly, ketamine is far from a benign drug. There are several reasons why it is used primarily in veterinary practice, and only sparingly, if at all, by most anesthesiologists (including myself) in this country. It significantly raises blood pressure and cardiac oxygen demand, making it an increased risk for, if not outright inappropriate to use for those with heart disease. It also causes unpleasant, and often extremely unpleasant, visual, auditory, or proprioceptive hallucinations in the immediate post-dose period and subsequent nightmares in as many as 30% of patients. The resource Mr. Fumento cites somewhat glosses over this difficulty, claiming that the delirium and dreams go away in 24 hours; however, this need not be the case, and there is much anecdotal evidence which indicates that harrowing nightmares may persist for weeks or even months after a single dose.

Thirdly, one of the circumscribed areas of anesthetic practice where ketamine is popular is in severe burn cases, which often have to be seen to surgically multiple times over a period of weeks. Anyone who has done this notes that a marked tolerance develops, requiring continuously increased doses to achieve the same therapeutic effects. While there is nothing in the study to suggest this would be the case in treating depression, since the patients did not receive long-term treatment, there is nothing to rule it out. The test subjects received half of the dose required to induce the low end of general anesthesia, meaning there is not a lot of wiggle room to increase the dose if tolerance is indeed an issue.

p>Having said all of that, it IS an interesting avenue for further research. However, the tone of the piece suggests that a possible cure for depression is just around the corner. This somewhat akin to saying "Hey, some guys just figured out how to make a wheel out of wood, let's start building an interstate system." br> -- B.J.M.

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