Please login to the form below

Could ketamine be the next big thing in depression?

Account Executive Will Frostick discusses the established treatment model for depression and its limitations, as well as a new entrant poised to revolutionise the field – ketamine.
Depression is a leading cause of disability worldwide and with more than 1 in 10 suffering from symptoms, it is likely to affect many of us in some way over our lifetimes.However, despite the large public health burden of depression, therapeutic discovery in this field has lagged significantly behind other areas of medicine and our ability to combat depression and relieve its symptoms is limited.

Antidepressant treatment: a history

For the last 50 years, antidepressant research and medicine has been dominated by the monoamine hypothesis. This theory links depression to the depletion or perturbation of signals from certain neurotransmitters, such as serotonin and norepinephrine, whose chemical structures belong to a class of molecules known as monoamines.The theory suggests we can reduce depression by stn ever since.Like many scientific breakthroughs, the monoamine hypothesis was found by chance. Doctors noticed that tuberculosis patients treated with isoniazid showed signs of improved mood.Isoniazid is antituberclular but it also interferes with monoamine metabolism, slowing neurotransmitter breakdown once it is released. As a result, more monoamines are left active in the brain for longer periods of time. It was also observed that reduced monoamine levels could predict suicidality.Based on this evidence, the monoamine hypothesis has risen to the forefront of depression science.

Stagnation, stagnation, stagnation

Since the isoniazid discovery, an abundance of antidepressants based on the monoamine hypothesis have entered the market.While there is some variance in the molecular mechanism, these drugs still work on the same general principle. For example, Prozac (fluoxetine) is a selective serotonin reuptake inhibitor, or SSRI.SSRIs inhibit brain cells’ natural process of ‘vacuuming-up’ (reuptake) a specific monoamine (serotonin). Much like isoniazid, this has the overall effect of increasing the amount of monoamine left hanging around (see figure above).This general model has been used to treat millions of patients and was the first major breakthrough in depression medicine. However, there has been little to revolutionise the field in the half century since.Nearly all the treatments entering the market have been ‘me too’ drugs, and while second generation therapies have demonstrated improved tolerability and more specific biological actions, the approach has failed to generate notably more effective therapies.Response rates have stagnated over the years and tricyclic clomipramine, one of the oldest antidepressant drugs, remains one of the most effective.

What are we missing?

There is more to be concerned about than inertia. Although antidepressants reliably increase neurotransmitter levels in the brains of patients, this does not always translate into symptom relief.Response rates are often only marginally greater than placebo, and much of the symptom relief can be linked to an active placebo effect. Even though neurotransmitter levels rise within hours, it can take 4-6 weeks to see any therapeutic benefit (although not to see the side effects). Further still, pharmacological depletion of monoamines in healthy volunteers does not cause depression either. These criticisms call into question the presumption that depression is caused by an impairment of monoaminergic neurotransmitter function. This clearly suggests the monoamine model is insufficient. Limited efficacy combined with painstakingly long onset times are letting down vulnerable patients. Fortunately, a new approach is emerging and excitement is building about “the most important breakthrough in antidepressant treatment in decades”. Ketamine as a depression treatment may seem unorthodox to some but the early results are remarkable.



Download the full article from Blue Latitude Health

3rd August 2017

Share

Tags

Company Details

Blue Latitude Health

+44 203 328 1840

Contact Website

Address:
Blue Latitude Health
Crusader House
145-157 St John Street
London
EC1V 4QJ
United Kingdom

Latest content on this profile

Behavioural insights to navigate complex healthcare markets
Blue Latitude Health Head of Insight Martine Leroy reveals how her team uses behavioural insights to help develop strong pharma brands and services, which successfully navigate complex situations.
Blue Latitude Health
Biotech: it's a people business
Nancy Hunter is the Marketing Director at a cutting-edge pharmaceutical company. Here she explains how a sharp focus on patients’ needs is driving a new operating model for marketing first-in-class drugs, and she describes how her mother’s experience as a cancer patient has shaped her own outlook on healthcare.
Blue Latitude Health
Is the pharma business model ready for precision medicine?
Precision medicine promises to revolutionise patient outcomes and reduce costs for industry but is pharma ready for it? Blue Latitude Health co-founder Head of Strategy Fred Bassett explores the challenges and opportunities while introducing the latest issue of 'Perspective' magazine on this weighty topic.
Blue Latitude Health
Personas: a top tool for personalising pharma marketing campaigns
Healthcare customers are calling for greater personalisation in care from providers. Here, we explain why personas are the top tool for ensuring your brand meets this need efficiently and effectively.
Blue Latitude Health
Does your medical information service work for your users?
Customer Experience Consultant Nilu Davies reveals how you can ensure your medical information service is fit for purpose.
Blue Latitude Health
Meet the CEO behind ReNeuron’s cutting-edge stem cell therapies
Blue Latitude Health speaks to Olav Hellebo, CEO of ReNeuron, to find out about the biotech’s latest innovation in stem cell therapy and to learn his perspective on navigating the challenges that come with developing products in this complex market.
Blue Latitude Health