Brave new drug world? Esketamine approved by the FDA.

marinyork

Resting in suspended Animation
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Logopolis
So P&L hasn't had one like this for a while. Some interesting debates in the past at the time of Professor Nutt.

Basically this one has been coming for years and I'm even sort of surprised to see the day arrive. For years there has been research into ketamine and similar substances to be used as a so called antidepressant.

https://www.theguardian.com/science/2019/mar/23/ketamine-can-it-really-be-antidepressant

Many alternative articles exist, I've chosen this one as it's a mix of news reporting, cases and facts.

Groundbreaking stuff as the first licenced medication for decades in a new class of drugs (SSRIs although 'new' are decades old and many don't regard 'newer' SNRIs as a separate class). Whatever your opinion on that it uses a completely different receptor to the other five (some say four) classes of so called antidepressants.

Was licenced earlier in March. Hopefully the UK will follow in a year or two. There are other forms and similar classes in the pipeline.

I do worry about people trying to self medicate and get ketamine through illegal channels on the street or dark web, but I don't think there's very much you can do about that beyond a certain amount and this may have a very positive impact on people's lives and move us in the right direction on medication research.

Of course, it's very expensive, so it may be 5-20 years away from making a big impact on what is called Treatment Resistant Depression (which is a scarily large group of people for anyone underplaying it).
 

fossyant

Ride It Like You Stole It!
Location
South Manchester
What's your take on how effective it may be ? I certainly don't get on well with the traditional anti-depressants, for pain/depression. So much so, I won't go near them.
 
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marinyork

marinyork

Resting in suspended Animation
Location
Logopolis
What's your take on how effective it may be ? I certainly don't get on well with the traditional anti-depressants, for pain/depression. So much so, I won't go near them.
That remains to be seen. It had promising results in trials of the sorts of horrible horrible cases you hear about or people you meet from time to time. I hope it doubles efforts and opens the floodgates of other drugs that don't act directly on serotonin/noradrenaline/dopamine. My non-informed view is they may be effective because I'm sceptical of the monoamine hypothesis of depression being the ultimate final turtle. It would make sense something else such as NMDA acting medications working from what we know about chronic stress responses (which imho gets muddied by the recent focus on the psychological side the last 20 years).

The interesting bit being the rapid onset and the halo effect after. I didn't know about A&Es in America using ketamine, that is somewhat interesting to say the least as often these are very skilled people and if they are used in that setting that's somewhat interesting.

There are other potential things on the horizon. Sirukumab is one that was rheumatoid arthritis/depression that seems to be have been zapped by the authorities. That's another different mechanism. Another ketamine derived one might make it to market. There's a lot of research going on about LAC (L-acetylcarnitine) for depression/parkinson's/pain, all sorts.

Pain, horribly complicated, but interesting research on that on the horizon also particularly the above.
 

Brompton Bruce

Coffeeeeeeeee pleeeeease
Nutt and colleagues have a wider programme of research on hallucinogenics as treatment for severe depression. They are looking at LSD and psilocybin (magic mushrooms). I'm told they are all showing promise although I believe that initially they struggled with getting approval for using class A drugs in their trials. They also struggled to source the magic mushrooms - as well as making sure they knew exactly how much active ingredient was being giving to research participants.
 
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marinyork

marinyork

Resting in suspended Animation
Location
Logopolis
Nutt and colleagues have a wider programme of research on hallucinogenics as treatment for severe depression. They are looking at LSD and psilocybin (magic mushrooms). I'm told they are all showing promise although I believe that initially they struggled with getting approval for using class A drugs in their trials. They also struggled to source the magic mushrooms - as well as making sure they knew exactly how much active ingredient was being giving to research participants.
Psilocybin had research carried out on it in the 1960s before everything got banned in the early 70s.

I welcome research on it (FDA have recently lifted a roadblock), but for the purpose of this thread in the sense I'm coming from it is promising, but relatively uninteresting - it acts on several serotonin receptors, not really anything 'new' there but an extra medication on similar mechanisms is still welcome, especially for the group of patients we're talking about. If people want to talk about any new treatments they are welcome to do so.
 
U

User169

Guest
At the heart of this is a classic patent wheeze: take a racemic mixture and patent one of the enantiomers.
 
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