...don't even ignore 'em.
-- Samuel Goldwyn

Wednesday, August 09, 2006


TV News might get all steamy and call this a "medical breakthrough." Even though the research trial was conducted with only eighteen (18) severely, chronically depressed patients, including those who got the placebo.

The test involved giving (I repeat) severely depressed patients a carefully measured shot of ketamine, a commonly used anesthetic. The positive result came, said the lead investigator, Dr. Carlos A. Zarate of the U.S. Government's National Institute of Mental Health within two hours. (Here's how Medpage, an info service for doctors, covered the NIMH press release.)

Now, there are many qualifications and cautions to deliver with the usual miracle cure report, not the least of which is that this study involved a very small sample -- eighteen. But as this sort of news moves through the hyperactive--and highly commercial--health media network, those details will no doubt get lost amid rapid speech, small print and unfamiliar medical words.

And it's also likely to get lost in the investigating scientist's career-advancing hype:

Dr. Zarate said experimenting with novel approaches was crucial because the current crop of antidepressant drugs worked slowly and weakly, if at all, for millions of patients.

--NYTimes.com story

Is this true? Some studies upon which Dr. Zarate may be basing his brag, like this one, say things like this:

Although efficacy studies suggest equal potency among antidepressant treatments, their effectiveness in clinical practice appears more variable, particularly in that the newer antidepressants may be less effective in either more severe depression or the melancholic subtype of depression.

Again, they're talking about severe depression. but this study is getting publicity from the likes of ABC-TV, Fox News, and Forbes -- the latter for alert stock analysts, no doubt, who will not necessarily become severely depressed as a result of getting this news.

"Slowly and weakly" means that Prozac, Zoloft, Cymbalta and others take four to six weeks of daily doses, gradually ramped up over time for safety, to achieve effective levels of the drug in your blood in order to relieve depression.

[Full disclosure: About ten years ago, Zoloft relieved my own fairly mild depression after about six weeks, after I attended a depression screening event at a hospital auditorium, and my doc prescribed it without bothering to run blood tests on me--"I can either run tests or start treating you". Several years later a new doc had a hunch, ran tests and discovered my thyroid was underperforming, which probably triggered my depression. It was a time of intense marketing among competing drug companies, and the docs were cooperating, as they're wont to do--it's the way the system works. I'm happy I was helped. But it was expensive, and I've come to distrust the pharma-medical industrial complex. Zoloft cost me and my insurers a lot of money, when Synthroid (thyroid replacement), which costs pennies a pill, could have done the job. A blood test could have saved us thousands.]

Most interestingly, ketamine is a common enough brain drug to have made it to the street--it's known to be a popular "club drug." Chemical athletes love the side effects. Great, now the NIMH is injecting science into the mix. How much do you suppose the street price of this party popper will now jump?

Am I biased--over the top? I don't think so. Will you be asking your doctor if ketamine is right for you? How do you suppose we're going to get the pharma genie back in the phial, when FDA and NIMH are part of the marketing formula?

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