Ketamine isn't an opioid and treats depression in a unique way

Medical XPress ^ | July 31, 2019 | Johns Hopkins University School of Medicine

[ConservativeMind]

Ketamine has gotten a bad rap as an opioid when there's plenty of evidence suggesting it isn't one, Johns Hopkins experts say. They believe this reputation may hamper patients from getting necessary treatment for the kinds of depression that don't respond to typical antidepressants. In a new paper, the researchers clarify the mechanism behind ketamine's mechanism of action in hopes of restoring the therapy's standing among health care professionals and the public.

In March of this year, the U.S. Food and Drug Administration approved ketamine as a nasal spray to treat depression.

"A study done late last year delivered a black eye to ketamine, and as a result of the coverage, there was a wholesale acceptance by both potential patients and physicians that ketamine is an opioid," says Adam Kaplin, M.D., Ph.D. "This is most worrisome if people continue to think this way, particularly in the wake of the opioid epidemic; clinicians won't refer patients for a treatment, despite that it has been shown to be incredibly effective for many patients with treatment-resistant depression.

Naltrexone—the drug used to reverse accidental opioid overdoses—binds to opioid receptors on the surface of brain cells and prevents opioids like morphine or heroin from sticking to them and acting on the brain, preventing the high.

In late 2018, researchers showed that naltrexone also blocks the antidepressant effects of ketamine, which led them to propose that ketamine must also bind to the same opioid receptors and thus concluded that ketamine must be an opioid. Kaplin says that there's plenty of contrary evidence demonstrating that ketamine sticks to an entirely different receptor on brain cells: the NMDA receptors—involved in learning and memory—instead of the opioid receptors.

The drug works much faster than other traditional antidepressants on the market, sometimes even after one or two uses.

[ConservativeMind]

I must admit I have been skeptical about this drug’s capacity for doing anything with depression, but if I knew someone with depression and on ineffective drugs, this is what I would encourage trying.

Sometimes, diet, exercise, sleep, and getting one’s life otherwise in order still leaves gaps that medicines can help address.

[BipolarBob]

I asked my street drug dealer about ketamine and he can't get the stuff. I guess it's back to meth and crack cocaine.

/s

[EEGator]

I know a guy...

[BBQToadRibs]

Medical Underwriter here. We consider it an opioid and for insurance won’t touch anyone with a 10’ pole using it. Seen too many people crash and burn on it. May as well play with fentanyl.

[tomkat]

In late 2018, researchers showed that naltrexone also blocks the antidepressant effects of ketamine, which led them to propose that ketamine must also bind to the same opioid receptors and thus concluded ..

Incorrectly, perhaps ?
Correlation and causation are two different critters.

just sayin'

[Rurudyne]

Better to do without. People have it in their minds that life shouldn’t suck and they’ve been sold a bill of goods. Not only does life frequently suck, even badly, it is okay if it does. It is okay if people are depressed and unhappy, if they do without or are poor.

[ConservativeMind]

Were those people using the ketamine in an office-only setting?

That’s what this is describing.

[BBQToadRibs]

No, recreationally. The ER’s are starting to see an upswing in these cases too.

[John S Mosby]

Ketamine— invented/formulated by Parke-Davis& Co. long ago— is , or was, a Veterinary product. In large enough doses will take down (knock out) an elephant.

So— “veterinarian office” use?... possibly. Lot of those workers can only relate to animals.. and, are depressed as relates to human interactions..... a theory anyway?

[sockmonkey]

11 ear old drag kid demos snorting ketamine on the couch

https://twitter.com/i/status/1084332546895368192

[unlearner]

“It is okay if people are depressed and unhappy, if they do without or are poor.”

I think you are confusing disappointment, sadness, and grief, with depression. Depression is different than being unhappy.

Depression (major depressive disorder) is a persistent, longterm emotional low. Often it is clinically diagnosed as repressed anger (i.e. anger turned inwardly).

There are degrees of depression in which a person may be unable to function or even live at all. Such emotional pain is not normative. Often people who seem to have everything going for them are severely depressed. They may be smart, well-liked, rich, physically fit and attractive, otherwise healthy, etc. but still depressed. The Kennedy girl who just died of an overdose is a good example.

Disappointment, sadness, and grief are things all people, including those who are totally healthy, experience. Depression is a mental illness which is not fully understood medically or scientifically. Or, at least the ultimate cure for depression has not been found by medical science.

[Rurudyne]

I understand depression.

“It is okay if people’s lives suck” encompasses it.

[unlearner]

They say ignorance is bliss. However, some people on this forum don’t claim to know everything and have a thirst for knowledge even when it upsets the status quo. But learning starts with knowing what you don’t know.

[unlearner]

They say ignorance is bliss. However, some people on this forum don’t claim to know everything and have a thirst for knowledge even when it upsets the status quo. But learning starts with knowing what you don’t know.

[Rurudyne]

I don’t claim to know everything.

But depression I know.

And it is simply okay if people’s lives just plain suck. In trying to medicate away the bad feels our society has only chased after the wind. Better to just cope and get on with life rather than have unrealistic expectations of it.

[unlearner]

“In trying to medicate away the bad feels our society has only chased after the wind. Better to just cope and get on with life rather than have unrealistic expectations of it.”

That might be the answer for you or those you know firsthand. But it is not a blanket answer to the issue.

I do generally agree about medication. Some people are helped when they find the medication that is right for them, but for most it is a shot in the dark. And there are other ways of treating or coping (which is what you are describing) with depression.

Also, people are capable of experiencing multiple emotions at once. So a person can have general depressive disorder and still have times of joy, laughter, and happiness, while still always carrying a lingering sadness. Sometimes it is a matter of choosing to focus on what is positive in life. Often those with chronic depression are trapped in cyclical thought patters that keep them focussed on the negative.