5 posts tagged “Research study”

Can ketamine help when antidepressants don’t? A closer look at the off-label drug that’s in the spotlight

Posted 5 months ago by

You may have seen ketamine making headlines recently as a promising drug therapy for treatment-resistant depression, or “TRD.” (What’s TRD? Health care professionals define it as receiving at least two different antidepressants– for at least six weeks in a row, and at an adequate dosage – but experiencing less than a 50% improvement in depressive symptoms.)

So, how does it work and what does the research show so far? Get the facts below — plus find some helpful insight on side effects and more from PatientsLikeMe members who have tried ketamine.

Let’s back up — what is ketamine?

Ketamine has been around since the 1960s, and over the years it has been used as an anesthetic, treatment for some types of pain and a sedative in certain instances. It’s also been abused as a “party drug” due to its hallucinogenic high. But in the 2000s, researchers discovered that ketamine could also have rapid antidepressant effects — in as little as 24 hours — for those with TRD when administered in a small, single dose IV infusion.

A number of clinical trials have since linked the effects of ketamine with improvement in symptoms of major depressive disorder (MDD), as researchers continue to find the optimal dose and the best administration routes (like potentially a nasal spray). Ketamine continues to be studied further in other mood disorders like PTSD and OCD with a focus on its long-term safety.

How does ketamine work?

Researchers are still figuring out the specifics, but the drug seems to affect receptors in the brain, including two called NMDA and AMPA:

  • Ketamine stimulates the AMPA receptor, which increases levels of the protein BDNF (brain-derived neurotrophic factor). This protein helps form new neurons and synapses in the brain, which is thought to improve certain mood conditions such as MDD.
  • Ketamine also blocks the NMDA receptor, which in turn causes an increase in glutamate levels (glutamate is an important neurotransmitter in the brain) and results in a cascade of positive neurobiological changes.
  • Both of these pathways and possibly others that still aren’t fully understood are related to the way ketamine works as an antidepressant.

The research looks promising…

There are currently several ongoing clinical trials involving ketamine and MDD and PTSD — and here’s a breakdown of what other recent research has found:

  • One Cochrane review looked at 25 randomized controlled trials involving ketamine’s effects on brain receptors in people with severe depression. It found that while other antidepressants can take 6 to 8 weeks to become effective, ketamine may offer rapid effects in comparison to a placebo. The authors noted that the initial studies are small and there’s uncertainty about how long ketamine’s effects last.
  • Another 2016 study of 14 patients with TRD found that after 3 weeks of twice-weekly ketamine infusions, 7 (50%) experienced remission from suicidal thoughts. Two of these 7 people maintained remission for 3 months.
  • There isn’t quite as much data about the use of ketamine to treat PTSD, but one trial that has been published showed a significant reduction in PTSD symptoms.

The patient perspective: Real-world reviews of ketamine

  • “I am currently receiving IV racemic ketamine once every 2-2.5 weeks at a 0.5mg/kg dose,” says one PatientsLikeMe member. “I haven’t been successful at spacing treatments further out than once every three weeks and 2-2.5 weeks seems to be the sweet spot for me, and I don’t have significant crashes.”
  • Another member says, “Ketamine has saved my life. After failing so many medication trials and ECT, I thought I had run out of options. I am so lucky to be able to access this treatment.”
  • “I am currently receiving IV ketamine 0.5mg/kg every other week in an outpatient setting,” says one member. “I am feeling very well, probably better than I ever have in my life. Ketamine has been a game changer for me.”

Ketamine’s long-term effectiveness

Despite positive findings on ketamine’s rapid effectiveness, researchers are unsure if the antidepressant effects are sustained beyond two weeks and what the consequences of relapse are. Take one PatientsLikeMe member’s experience:

“I received ketamine as part of a clinical trial. Within 24 hours I felt like ‘myself’ again and was able to experience pleasure and internalize positive experiences. The effects lasted about 9 days and then all my previous symptoms returned.”

Side effects, cost, and other things to consider

Ketamine is currently only FDA-approved for surgical anesthesia, so it must be prescribed off-label (not for its intended use). And because it’s off label, it must be administered by a specialty clinic, which means it may not be covered by insurance and can come with a hefty price tag at $400-$800 per infusion. Learn more about available clinical trials here (and be sure to talk to your doctor before changing anything about your treatment regimen).

And what about side effects? In short, more data and research is needed. But here’s what other members who have tried ketamine for MDD have said:

  • “The worst side effect is nausea, but I receive ondansetron before the infusion and that helps significantly. I have only had one ‘bad trip’ or ‘K-hole’ while getting the infusion, but it quickly subsided.”
  • “I have found that during an infusion, external stimuli intensifies and I can get quickly overwhelmed. To avoid this, I always wear headphones and have music that is very familiar to me playing, and I typically have my eyes closed for much of the time. This also mitigates most of the perceptual disturbances that might occur during an infusion. I am a person who does not like feeling out of control, so I limit my exposure to external stimuli and that helps significantly.”

Have you tried ketamine or been involved in a ketamine clinical study? Join or sign in to PatientsLikeMe to jump in the conversation today.

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Spill the beans: How do caffeine and Parkinson’s disease interact?

Posted 5 months ago by

Do you crave that cup (or more) of joe each day? Or a spot of tea or chunk of chocolate? Research about caffeine and Parkinson’s disease (PD) has been all over the map. What have studies shown? And what’s the PatientsLikeMe community’s take on caffeine and its effects when you’re living with PD? Take a peek.

Mixed findings on symptom relief

Past research showing that moderate caffeine intake may help protect against PD (particularly in men) has turned on a steady drip of studies about other caffeine/PD connections or interactions.

A small-scale 2012 study published in the journal Neurology found that moderate amounts of caffeine may help improve motor symptoms of Parkinson’s disease. But the study was relatively short (three weeks) and small (61 patients), so researchers concluded that there should be a larger long-term trial on caffeine and PD.

The lead researcher, Ronald Postuma, M.D. (an associate professor of neurology at McGill University Health Center in Montreal), conducted a follow-up study on a larger scale — involving 121 participants for up to 18 months — and the results of the September 2017 study did not uphold the findings of the 2012 study.

“Caffeine made no difference to Parkinson’s,” he says, noting that the results of the 2012 study made a bigger splash than intended. “The news media picked it up, and all of a sudden I’ve got all of my patients drinking coffee, which I never intended,” Dr. Postuma tells WebMD. “We always have to verify things.”

New findings on caffeine as a biomarker

Another recent caffeine/PD study that’s created a buzz is one published in January 2018 in Neurology that shows caffeine could be a biomarker of PD, meaning it could be a possible predictor or diagnostic blood test down the road, if more research pans out.

In the Japanese study involving 139 people (men and women, both with and without PD), those with Parkinson’s disease had significantly lower levels of caffeine and related byproducts in their blood, even when consuming the same amount of caffeine (the equivalent of about two cups of coffee per day).

But the study also had limitations, including the fact that people with severe PD weren’t a part of the research, and all participants were taking PD medication (so these drugs could possibly affect caffeine metabolism).

The Michael J. Fox Foundation called the study’s findings “very intriguing” and is reportedly working on a “rapid replication” of the research.

What’s the takeaway from all this research?

The Parkinson’s Foundation sums it up like this: “The bottom line from all of the available research is that the epidemiologic link between caffeine and a potential lower risk of developing Parkinson’s disease is not likely related to a symptomatic effect. If you have Parkinson’s, drinking coffee will not worsen your symptoms, in most cases… Consumption of coffee or tea seems to reduce the risk of developing Parkinson’s. Once you have been diagnosed with Parkinson’s disease, no matter how much time you spend in a coffee shop, you can no longer alter your risk profile.”

Among the general population, drinking coffee appears to have at least a few health perks. Nutrition experts at Harvard University say that, in addition to lowering the risk for PD, drinking coffee appears to protect against type 2 diabetes and liver cancer, and it’s generally a good beverage choice for healthy people (as long as it’s not loaded with fat/cream and sugar, interrupting sleep, or causing tremors — which can occur even in healthy people who consume too much caffeine).

Keep in mind that caffeine levels vary by brand and type of drink (for example, espresso and mocha drinks contain more). Talk with your health care team about your caffeine intake, timing with medications, and any symptoms you think may be associated with it.

Join PatientsLikeMe today to connect with others on topics like this (logged-in members can access the following links)! See what members with PD are saying about:

Some members have found that caffeine makes their tremors worse, while others say they’re not sure how it affects them (and besides, they’ll never give up their “morning joe”). A few have mentioned that they’ve tweaked their routine — having a bit of coffee only after they’ve taken their medication.

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