“Harebrained Approach” to Treating Depression With Horse Tranquilizer Turns 10 Years Old
Pioneers in The Ketamine Journey: Ed Domino, MD, (right) wrote the first paper describing ketamine’s anesthetic properties in humans (1965). Denise Charney, MD (left) was a senior author on the first paper reporting ketamine’s effectiveness for depression (2000). David Feifel, MD, PhD, (center) launched the first program using IV ketamine infusions to treat patients for depression (2008).
When psychiatrist David Feifel established the first program using the anesthetic drug ketamine to treat patients with depression, many considered it a harebrained idea. Today ketamine is considered the biggest psychiatric breakthrough in 50 years.
LA JOLLA, Calif., Jan. 2019 /PRNewswire/- In the waning months of 2008, a little over ten years ago, Dr. David Feifel launched the world’s first clinical program administering intravenous ketamine to patients with depression. Ketamine, approved as a human anesthetic in 1969, is perhaps best known as a horse tranquilizer and a recreational club drug. By no means an obvious choice as a breakthrough treatment for depression, Dr. Feifel, a tenured professor of psychiatry at the University of California, San Diego, at the time, nevertheless saw ketamine’s potential after reading a 2006 paper by a team of NIH researchers who observed rapid antidepressant effects in a small group of patients suffering from chronic depression after they received a low dose of ketamine intravenously.
“I was skeptical about those results,” admits Dr. Feifel, “but I figured if ketamine worked half as good as described in that paper, then it would be a game changer since millions of people live with debilitating depression that is not alleviated by conventional treatments and many of them end their life.”
It took Dr. Feifel many months to get the UCSD Health System to approve his request to give ketamine to severely depressed patients; but, once they did, his skepticism gave way to awe and excitement. Patients were emailing saying things like, “Today was the first beautiful day of my life,” and, “I finally know what it’s like to be glad to be alive.”
While patients heaped gratitude on him, the reaction among many of Dr. Feifel’s colleagues in the psychiatry establishment was far less supportive. “Many thought it was too risky to be giving it to patients until much more research was conducted, but with over 40,000 suicides a year in the US, I felt the risk of not offering this potentially life-saving drug to severely depressed patients outweighed the risks of offering it.”
In 2017, Dr Feifel and several colleagues published an analysis of antidepressant resistant patients that he had treated with intravenous ketamine. 1 They found that, on average, there was a 50% reduction in the severity of depression symptoms 24 hours after the first ketamine treatment and 40% of the patients no longer met the threshold for clinical depression. It was the first confirmation that ketamine worked in patients who were receiving it in an authentic treatment context as well as it did in well-controlled clinical trials where patients are carefully selected.
Considered audacious for treating depressed patients with ketamine in 2008, Dr. Feifel, now a UCSD professor emeritus and the director of Kadima Neuropsychiatry Institute, has since been joined by dozens of progressive physicians across the US and abroad who routinely use ketamine to treat depressed patients who have failed other approaches. The drug has also become increasingly recognized as a major breakthrough treatment by mainstream psychiatry. The American Psychiatric Association recently issued guidelines for using the treatment, and Cleveland Clinic recently listed ketamine for depression in its top ten list of medical breakthroughs. In September, Johnson and Johnson submitted a new drug application to the FDA to market a modified ketamine drug that will be taken intranasally and several other pharmaceutical companies are developing drugs for depression based on ketamine.
As for Dr. Feifel, having administered thousands of ketamine treatments, he and his team continue to push the envelope developing new ways to optimize its therapeutic effects 2, which are now recognized to include benefits for PTSD, OCD, and even drug and alcohol addiction. To mark the start of his second decade of using ketamine to treat psychiatric conditions, Dr. Feifel and his team plan to roll out two new innovations that they believe will synergize with the effects of ketamine and are investigating several others. Dr. Feifel concludes, “I have not seen any treatment in my career as dramatically effective as ketamine, but it’s far from perfect and there is much work yet to be done.”
Feifel D, Malcolm B, Boggie D, Lee K, Low-Dose Ketamine for Treatment Refractory Depression in an Academic Clinical Practice Setting, Journal of Affective Disorders, 2017, 221:283–288
Feifel, D. Breaking Sad: Unlocking the Breakthrough Potential of Ketamine’s Rapid Antidepressant Effects. Drug Development Research. 2016, 77(8):489-494.
About Kadima Neuropsychiatry:
Kadima Neuropsychiatry Institute is an independent treatment and research center devoted to providing advanced treatments to patients with neuropsychiatric conditions who have failed conventional treatments. Kadima also conducts research to enhance and optimize advanced treatments and discover new ones. More information about Kadima Neuropsychiatry Institute and Dr. Feifel can be obtained at www.kadimanp.com.
