Ketamine: A Promising New Treatment For Depression

Ketamine is a fast-acting liquid anesthetic used mainly by veterinarians; it's also used in human medicine, even in children, because it doesn't depress breathing.

It's also an illegal club drug, known as "special K" or "vitamin K."

The street version is usually sold in a powder form that can be snorted or mixed into drinks, or dissolved into a liquid and injected.

It acts like LSD, causing vivid hallucinations in users and a sensation of floating outside their bodies.

Researchers at Yale University have discovered that a single dose of ketamine helps the brain to form new synaptic connections between neurons and can begin to relieve depressive symptoms in a little as 40 minutes.

In contrast, Prozac and other types of antidepressants can take anywhere from two weeks to a full month before they start to demonstrate any real results, in which benefits can only be seen in about a third of patients. This new antidepressant is now being tested in Canada with promising results.

Dr. James Kennedy, director of the neuroscience research department at the Centre for Addiction and Mental Health in Toronto states that ketamine might alleviate what has been known as a “major clinical problem”. The 2 - 4 weeks that patients await relief is a critical time where devastating outcomes, such as suicide, can occur because they begin to feel more energetic but depressive symptoms remain. Not only is there hope for those with difficult to treat depression, ketamine could actually save lives.

Earlier studies involving patients with "treatment-resistant" depression have found that those given a single dose of ketamine experience rapid and significant improvement in symptoms.

In a small study published earlier this month on patients with bipolar depression, 71 per cent of participants responded to ketamine versus six per cent who responded to placebo.

In addition to being fast-acting, studies show that relief can last for 7 – 10 days, according to professor of psychiatry and neurobiology at Yale, Ronald Duman, who calls ketamine a “magic drug”.

Duman also believes that this so-called magic drug may be able to reverse the effects of stress on the brain by repairing damaged connections between neurons caused by chronic stress.

Although ketamine may not be the ideal long-term solution for treating depression, it could certainly lead to the development of similar compounds that may produce the same effect, but can be more easily administered with less potential for abuse.

"Imagine someone who is in the ER (emergency department) and is highly suicidal. It would be a way to decrease the suicidal risk" says Dr. Pierre Blier, director of mood disorders research at the Institute of Mental Health Research and Canada Research Chair in Psychopharmacology at the Royal Ottawa Mental Health Centre, who has started using ketamine on some of his patients.

Sources:
'Magic drug' gives hope to bipolar patients - Ketamine is mainly used as an anesthetic by vets but shows promise in treating depression

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Deep Brain Stimulation May Delay Alzheimer's Disease

Researchers in Toronto, Canada have developed an experimental brain surgery that may delay the progression of Alzheimer’s disease. Six subjects with Alzheimer’s disease and an average age of 61 experienced this surgery called deep brain stimulation. The subjects continued to take their Alzheimer’s medication throughout the study.

Scientists implanted “electrodes in the brain's hippocampus, which plays a role in long-term memory. The electrical conductor acts as a pacemaker-like device in the head just beneath the skin. It is connected to a battery pack in the chest.”

Consequently, the mini-mental state exam, a cognitive test, revealed that half of the participants experienced a slow-down in the degenerative effects Alzheimer’s disease has on the brain, while the other half continued to decline in a manner typical of the disease’s progression.

While this new research has produced some promising results, deep brain stimulation is not a novel idea since it has been around for decades. For instance, Dr. Andres Lozano, a neurosurgeon at Toronto's University Health Network, experimented with its effects on Parkinson’s disease without success, unfortunately.

Although not all subjects experienced positive outcomes with this surgery, 64 year old, former city counselor from Brampton, Ontario, Robert Linton, recalled vivid memories of a day he spent fishing.

"I'm with my son," Linton recalled to reporters at Toronto Western Hospital. "I could see that muskie coming right at me as I was sitting in the chair, in Technicolor". "That's the power of touching a spot in your brain. I'm sold on it."

Currently, Lozano and his research team are recruiting roughly 50 people willing to install the stimulator. The plan is to activate half of the stimulators immediately and the other half only six months later all the while participants’ knowledge of its activation will remain unknown in order to truly test the benefits of the device.

Although, the true value of this device is not yet known, the actual retail cost if this treatment became available, would be between $15,000 and $20,000 per patient with a battery life of up to five years.

At the moment, I’m unsure whether I approve of this type of treatment. For one, results are insufficient therefore there is no real proof that the surgery will benefit enough people. Secondly, I am reminded of electroconvulsive therapy and I cannot get the image of Nurse Ratched delivering shock therapy out of my head…

Deep brain stimulation tested for Alzheimer's

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The Nose Offers New Hope For Quadriplegics

Recently, Professor Noam Sobel, electronics engineers Dr. Anton Plotkin and Aharon Weissbrod and research student Lee Sela of the Weizmann Institute's Neurobiology Department, have invented a device that could allow persons with disabilities to navigate wheelchairs or communicate simply by inhaling and exhaling through the nose. In addition, this sniffing technology could be useful in assisting health surgeons or pilots perform certain procedures as their nose could act as a third hand.

How exactly can our breaths achieve such feats? “The new system identifies changes in air pressure inside the nostrils and translates these into electrical signals.” Testing was completed with volunteers and quadriplegics and results proved to be very promising. The subjects were able to manoeuvre a wheelchair or play a computer game with as much ease and precision as with a mouse or joystick.

Sniffing is a precise motor skill that is controlled, in part, by the soft palate […] the soft palate is controlled by several nerves that connect to it directly through the braincase. This close link led Sobel and his scientific team to theorize that the ability to sniff -- that is, to control soft palate movement -- might be preserved even in the most acute cases of paralysis. Functional magnetic resonance imaging (fMRI) lent support to the idea, showing that a number of brain areas contribute to soft palate control. This imaging revealed a significant overlap between soft palate control and the language areas of the brain, hinting to the scientists that the use of sniffing to communicate might be learned intuitively.

From this theory, a device that measures changes in air pressure was created with a sensor that fits into the opening of the nostrils. Furthermore, an alternate version that diverts air into the nostrils was produced for patients on respirators. Interestingly, roughly 75% of those on respirators could control and operate the device.

Still, the most striking is that individuals with locked-in syndrome, a state in which their cognitive functions are intact but their bodies are completely paralyzed so that they are “locked” inside their bodies, were able to communicate effectively with their loved ones on account of this new invention. Finally, these patients were able to share their thoughts and feelings with their families for the first time in a very long time.

“One patient who had been locked in for seven months following a stroke learned to use the device over a period of several days, writing her first message to her family. Another, who had been locked in since a traffic accident 18 years earlier wrote that the new device was much easier to use than one based on blinking. Another ten patients, all quadriplegics, succeeded in operating a computer and writing messages through sniffing.”

Moreover, wheelchair navigation can be done effortlessly with this technology. A certain number of inhales or exhales instruct the chair to navigate in certain directions. Two successive sniffs will make the wheelchair advance forward and two exhales will reverse the chair. One inhale followed by an exhale will steer to the left, while an exhale followed by an inhale steers to the right.

Consequently, the technology has received such acclaim that four of the research subjects are still using the device to communicate. Researchers’ claim that this system is fairly inexpensive to manufacture, not to mention easy for people to learn and operate in comparison to other types of similar technology already in use. Yeda Research and Development Company are currently looking to develop and distribute the technology to the general public, therefore it may not be long until this technology is put to good use.

Invention Enables People With Disabilities Communicate and Steer a Wheelchair by Sniffing

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Does Meditation Really Improve Attention?

New research has studied the effects of Buddhist meditation on attention span when focusing on a specific task that requires a person to distinguish small differences on a computer screen.

"You wonder if the mental skills, the calmness, the peace that they express, if those things are a result of their very intensive training or if they were just very special people to begin with," says Katherine MacLean, who worked on the study as a graduate student at the University of California, Davis.

A group of 60 people were hand-picked from readers of Buddhist-themed magazines or via word of mouth. Half of the participants were selected to attend a 3 month meditation retreat in Colorado with the study’s co-author and meditation teacher/Buddhist scholar B. Alan Wallace, while the remainder awaited their retreat. Every subject had previously attended a minimum of three 5-10 day meditation retreats in the past.

At three points during the retreat, each participant took a test on a computer to measure how well they could make fine visual distinctions and sustain visual attention. They watched a screen intently as lines flashed on it; most were of the same length, but every now and then a shorter one would appear, and the volunteer had to click the mouse in response.

The assignment, which lasted about 30 minutes, was quite boring making focusing a difficult task. MacLean explains that this type of task is ideal for assessing meditation training since meditation is not about peaceful relaxation; rather it is more demanding to be so focused without distraction.

Evidently, subjects improved their ability to distinguish short lines from the long ones with more meditation training. The study suggests that this occurs because of the participants are more capable of sustaining their attention, which in turn improved their performance on the task at hand. “This improvement persisted five months after the retreat, particularly for people who continued to meditate every day.”

A few obvious questions come to mind regarding the reliability and validity of this study. How did the participants meditate? How did eyesight affect results of the study? Are results similar for participants that have no background in meditation? Have participants improved because of increased ability to focus via meditation or because they’ve practiced the same task again and again? Was the task always the same or did it vary? How did the improvements for those that continued to meditate after the retreat compare to those that did not?

Although the researchers have studied this same group of participants in many studies, this experiment is the most comprehensive study of intensive meditation to date. “Future analyses of these same volunteers will look at other mental abilities, such as how well people can regulate their emotions and their general well-being.”

Meditation Helps Increase Attention Span

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Omega-3 Supplements: A Promising New Treatment for Depression

A new study published in the Journal of Clinical Psychiatry has revealed that Omega-3 supplements can be an effective method of treating major depression in patients who do not have anxiety disorders.

At first glance, the efficacy of Omega-3 was not clearly demonstrated; however with further analysis it was clear that Omega-3 improved depressive symptoms as efficiently as those treated with antidepressants.

The experiment studied 432 male and female subjects with major depression over a period of 8 weeks, from October 2005 to January 2009. Each day of the study, half of the participants were given three capsules of OM3 Emotional Balance, a fish oil supplement which contains 1050 mg of eicosapentaenoic acid (EPA) and 150 of docosahexaenoic acid (DHA). The remaining participants took three identical capsules containing sunflower oil, which was flavored with fish oil to maintain the anonymity of the placebos. Researchers ensured a double-blind effect where neither subject nor researcher could identify either group.

“In contrast with typical clinical studies designed to assess the effectiveness of antidepressants, this study included a high proportion of patients with complex and difficult-to-treat conditions, including patients resistant to conventional antidepressant treatments and patients also suffering from an anxiety disorder. The aim was to assess the value of Omega-3 supplementation in a group of individuals more like those treated in outpatient clinics.”

Statistics show that roughly 11% of men and 16% of women in Canada are likely to suffer from major depression at some point in their lives. Currently, depression is listed as the world’s fourth leading cause of death and it is anticipated that it could be the second by the year 2020.

“Epidemiological and neurobiological studies have suggested that a relative deficit in polyunsaturated fatty acids of the Omega-3 group may predispose individuals to psychological disorders such as depression.”

Supplements are likely to be more attractive alternatives to the many patients with depression that cease pharmacotherapy after only a few months because of their fear of stigmatization or side effects. These alternatives need to be more adequately studied so that new treatments may be developed. Ideally, additional research directly comparing Omega-3 with conventional antidepressants could speed up the process toward more effective treatments for depression.

Treating Depression With Omega-3: Encouraging Results from Largest Clinical Study

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Supreme Court Ruling A Victory?

In recent news, the Supreme Court of Canada has made a historic ruling that will allow administrative tribunals to find Charter violations and resolve legal disputes using the Charter of Rights and Freedoms.

“The Canadian Charter of Rights and Freedoms is a bill of rights entrenched in the Constitution of Canada. The Charter guarantees certain political rights to Canadian citizens and civil rights of everyone in Canada from the policies and actions of all levels of government. It is designed to unify Canadians around a set of principles that embody those rights. The Charter was signed into law by Queen Elizabeth II of Canada on April 17, 1982.”

Mr. Paul Conway, who has been detained on a psychiatric ward for 27 years for sexual assault and assaulting a police officer in the 70s, asked the Ontario Review Board to release him and affirm his rights under the Charter. However, the board rejected his request because they did not have jurisdiction to rule under the Charter of Rights and Freedoms.

“The Ontario Review Board annually reviews the status of every person who has been found to be not criminally responsible or unfit to stand trial for criminal offences on account of a mental disorder. The Ontario Review Board is established under the Criminal Code of Canada. The Board is made up of judges, lawyers, psychiatrists, psychologists and public members appointed by the Lieutenant Governor in Council.”

Now, the Supreme Court ruled in favour of allowing administrative tribunals to apply the Charter in their fields of expertise. The ruling opened up the possibility for an array of litigation issues between patients and institutions that can be heard at almost any tribunal in the country. Moreover, the Charter will likely be used by many others in various circumstances, such as by prisoners to execute their rights for special privileges, by parents to dispute school policies and by employees to contest against job conditions.

“Systemically, one can speculate as to the infinite potential of far-reaching implications for the masses. This decision may protect their rights, but my own situation remains status quo. I am locked in the system. I would like to live productively and pro-actively in the community. But, for me, the beat goes on”, says Mr. Conway.

On the surface it seems that prisoners with mental illness will benefit, but many experts see this as a setback. As Kristin Taylor, a CAMH lawyer explains that this “will bring new complexities to the process.” It may take longer for cases to be heard and completed, thereby delaying the process for others. “Richard O’Reilly, a psychiatrist at London’s St. Joseph’s Health Centre, predicted that Charter issues will swamp hearings that are routinely held to consider patient consent, capacity and treatment plans.” However, all sorts of, what might appear to others, as minor Charter rights issues will likely clog up the judicial process.

In addition, June Conway-Beeby, executive director of Ontario Friends of Schizophrenics, believes that patients and their families will be negatively affected by this ruling and states: “It is a only a victory for lawyers, who – from what I have observed recently in many court cases – do not understand the reality of severe mental illnesses”.

Of course this seems like quite the victory from a legal standpoint. “David Baker, a Toronto disability-rights litigator, agreed that the ruling will be very useful at tribunals that are responsible for meting out state benefits – such as reimbursement for medical treatment outside Canada, or special education programs in public schools.”

Besides the legal ramifications this entails, where is Mr. Conway now?

“I was put in an area of high supervision and confinement,” he said. “They stopped taking me into the community. I haven’t had fresh air and sunshine for almost a year now. I feel ostracized and separated and alienated. The system hates me. The system is vindictive.”

He also plans to keep fighting the law while refusing medication as part of his treatment, which may have already freed him…

Legal victory was historic, but plaintiff remains in psychiatric ward
Canadian Charter of Rights and Freedoms
Ontario Review Board

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