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Ketamine Relieves Symptoms Of Multidrug-Resistant Depression in 24 Hours

 MD-FM Thursday October 17, 2013 




Sarah :

MD-FM, Medical News from around the world with Peter Goodwin


PETER: Hello, and to begin with: a commonly prescribed anaesthetic rapidly relieved symptoms in patients with refractory depression.

SARAH: Yes, in a trial of 76 patients, reported in the American Journal of Psychiatry a sub-anaesthetic dose of ketamine improved symptoms in about two thirds of patients who’d previously failed at least three antidepressants, some even five or six. In contrast to this, fewer than a third of all patients responded to medazoline, another anaesthetic used as control. Symptoms were reduced in less than a day, and the effect lasted up to a week, senior study author Sanjay Mathew:

Mathew: “That’s definitely a very important issue because nothing in psychiatry works particularly fast. So if you have a patient that’s been suffering for many years, had tried many different medications, if you have an intervention that can break the cycle of depression within a few hours, that’s a big deal. Certainly if it’s working in that type of patient it should work in non-refractory patients as well, so it could change the paradigm of how we are treating inpatients.”

SARAH: Dr. Sanjay Mathew, from Baylor College of Medicine in Houston, Texas. Ketamine works differently from traditional antidepressants in that it influences glutamate signalling. So this study could open up new avenues for research. Some teams, for instance, are looking at using it to prevent suicide in emergency units:


Mathew: “There is other data that’s converging to suggest that it could have anti-suicidal properties as well. The idea would be, if a patients is admitted to an inpatient unit, they either came after a suicidal attempt or they have serious thoughts of wanting to hurt themselves, could ketamine help this individual stabilize on the inpatient unit while they are receiving other care?”  

SARAH:  Sanjay Mathew from Texas.


PETER: Mental disorders, especially dementia and personality disorders, are strong independent risk factors for accidental death. These are the findings of a national cohort study of the entire Swedish population published in The British Journal of Psychiatry. It shows that among people who died from accidents, 26% had a psychiatric diagnosis as compared with only 9% in the general population.



PETER: News now from the THS international congress on drug addictions, hepatitis and aids, which took place in Biarritz, France, last week: Experts there have been discussing the success of the first “drug consumption room”, in Vancouver, Canada, ten years after its launch. It’s saved lives and improved safety.


SARAH: Yes, the conference heard the rate of fatal overdoses dropped 35 per cent in the neighbourhood where the facility’s located, compared to only nine per cent in the rest of the city. It reduced HIV infection, improved health AND also security, answering one of the main concerns of opponents of this concept.  Brandon Marshall, from Rhode Island, published a scientific evaluation of the facility in The Lancet:


Marshall: “Some of the public and the business owners in the neighborhood, their concerns were that the facility would bring drug users into the neighborhood and that there would be a lot of disorder… In fact we’ve actually seen positive impacts on public disorder and in the ten years since it opened, with all of the evidence that we have backing the benefits of the facility, we’ve really seen a shift in public opinion, in favor of it, to the point where the majority of people in Vancouver now fully support the intervention and in fact would like to see it expanded.


SARAH: That was Dr Brandon Marshall of Brown University School of Public Health in Providence, Rhode Island, talking to us from the THS conference in Biarritz. Interestingly, this coincides exactly with the French council of state saying a clear “Non!” to the proposed opening of the first French drug consumption room.


Marshall: “I can understand the opposition first but, if you really take a look at the evidence, you will see that the benefits are really quite clear... Ours was open in 2003 with an exemption from federal drug laws. The federal government took the facility to court, the case went to the supreme court of Canada, where in 2012 they ruled that the facility, based on our evidence, should remain open really as a life-saving tool to improve the health of drug users”


SARAH: Brandon Marshall, from New York.




PETER:  And the New York State Health Department has mandated that all healthcare workers either get vaccinated against influenza OR wear a surgical mask to reduce rates of transmission during the upcoming flu season.


SARAH: Yes and it’s provoked controversy! Arthur Caplan, from New York University, wrote an editorial about it in JAMA:


Caplan: “For many years we’ve been trying to get people to get their flu shot but, still, flu shot rates are poor. I’ve done some surveys about why healthcare workers don’t want to get shots: some say “I don’t need it, I don’t get sick.” That may be true but that doesn’t mean they can’t infect other people. Other people say they don’t like shots, but that seems like a poor excuse for a healthcare worker! A few people are still afraid about the safety of the shot although, again, it’s a very safe vaccine. And then some people just say: I don’t like the idea of being told what to do.

SARAH: Obviously the question of intrusion on personal life by a  “nanny state” is a factor that many people think about. But Dr. Caplan had strong views about the argument of infringing people’s personal choices:


Caplan-2: “Look --when you’re a doctor or a nurse, you take an oath to put the patient’s interest before your own interest. That’s in all the codes of ethics of doctors and nurses around the world. Remember, there’s lots of things that healthcare workers are made to do --the flu shot isn’t the first thing. There’s controls over your hair, there’s mandatory TB testing… I just see this as one more additional protection.”


SARAH: But Arthur Caplan thought most workers will end up going for the vaccine eventually:


Caplan-3: “You know, wearing a mask is a pain in the neck! It’s just hard to do, you have to change it a lot, it’s uncomfortable… I think, after a few days of that, you’re going to see everybody saying: “you know what? I’ll take the shot.” Once New York State does it, other American states will follow and we’ll see this spread overseas and to other nations.”


SARAH: Dr. Arthur Caplan, from New York.



PETER: There’s good news about one of the most commonly used prescription drugs to control nausea and vomiting during pregnancy: according to a report in JAMA metoclopramide is not associated with increased risks of spontaneous abortion, stillbirth or major malformations.

SARAH: Yes: these are the conclusions of a nationwide observational study, in which the researchers gathered data on over a million pregnancies, with or without metoclopramide exposure during the first trimester. One interesting aspect is that the team analysed the rate of 20 individual malformation categories, including neural tube defects, cleft lip, cleft palate and limb reduction. Lead author Bjorn Pasternak:


Pasternak: “Previous studies that have looked at the risk of congenital malformations have mostly looked at malformations overall. This is by far the largest study on metoclopramide safety in pregnancy and we found no association between metoclopramide exposure and increased risks of any of the 20 specific malformation categories that we included, spontaneous abortion and stillbirth”


SARAH: This was Bjorn Pasternak, from Copenhagen, Denmark, didn’t want to give recommendations about metoclopramide use yet, as he thought more studies are still needed to confirm these findings.

BREVE 1 Sur fond musical

PETER: Finally, in brief: Fewer than one in 10 cases of cerebral aneurysm are actually at risk of rupture, according to a new study in Annals of Internal Medicine. Using three-dimensional imaging, researchers found that un-ruptured cerebral aneurysms were present in about 7 per cent of the 4,800 patients studied. But less than per cent of these aneurysms were assessed as being at risk for rupture based on size, shape, and location.

And …..


Using vitamin D supplementation to prevent osteoporosis is inappropriate in adults without specific risk factors for vitamin D deficiency, that’s according to a meta-analysis in The Lancet. The authors investigated whether vitamin D supplementation affects bone mineral density. They found a small benefit at the femoral neck but no effect on lumbar spine, total hip, trochanter, total body or forearm. However, other conditions may still benefit from Vitamin D.


And that’s all for now. MDFM will be back with lots more medical news next week.  So until then, from Sarah Maxwell and from me Peter Goodwin: good-bye.


Previous editions


Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)

Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)
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