Researchers at the University of Otago are recruiting for a novel trial, combining use of the drug ketamine with a proven form of psychotherapy, in the hope that people with treatment-resistant depression can stay well for longer.
The study is seeking 60 patient recruits from Christchurch and Dunedin for whom regular anti-depressant therapy has repeatedly failed – so-called “treatment-resistant depression”.
Half the participants will receive an eight-week course of ketamine alone; the other group will receive ketamine in conjunction with Behavioural Activation Therapy (BAT).
Dr Ben Beaglehole
Study investigator Dr Ben Beaglehole, a Senior Lecturer in the Christchurch campus’s Department of Psychological Medicine, says while injectable ketamine has a lot of promise as an anti-depressant, the drug’s positive effects are, unfortunately, only short-term.
“Ketamine is probably the most exciting new treatment for a generation, but its positive effects fade away within days or weeks of treatment ending, making it ineffective for routine care for treatment-resistant patients,” Dr Beaglehole says.
“Many studies on ketamine as a treatment for depression have also focused on injections, which can lead to a strong dissociative reaction or a ‘trip’.
“However, in our study, participants will be given ketamine as a liquid to swallow, which will work more slowly, be easier to tolerate and lessen the ‘trip’ effect.”
The anesthetic drug has been used legally by doctors in Aotearoa New Zealand since the 1950’s for sedation and pain relief, but classified as an illegal drug for recreational use since the 1980’s.
Dr Beaglehole says the ketamine in this trial will be given in a tightly controlled setting to minimise concerns about its abuse potential, alongside concerns it can lead to bladder issues and possible memory side effects.
He says the addition of BAT is pivotal and the most important aspect of this trial.
“BAT is aimed at activating people with depression, targeting the inactivity which is often part and parcel of the disease, as a means of getting them moving both emotionally and physically to encourage a lift in mood.
“We chose BAT because it’s an easily accessible and affordable solution for people to embed into their daily lives,” Dr Beaglehole says.
The three-year Health Research Council of New Zealand study is seeking volunteers aged 18 to 65 with treatment-resistant depression – people for whom two different types of anti-depressant medication, used at the correct dosage for more than 6 weeks, have not worked.
All participants will receive ketamine twice weekly for 8 weeks, with half also receiving BAT for 8 weeks. Both groups will be monitored for a further 12 weeks after treatment finishes to see if BAT helps to maintain improvements to mood once ketamine treatment ends.
“The study may be a bit of a roller-coaster, due to the fact that if participants do respond, we are not in a position to continue their ketamine after the trial ends,” Dr Beaglehole warns.
“People will need to be prepared that if they have a positive response, their mood may deteriorate once the ketamine treatment stops.”
Dr Beaglehole hopes the use of BAT in this trial will result in people with treatment-resistant depression feeling emotionally stronger than before.
“Depression is the most common mental illness worldwide and one of the most burdensome health problems globally.
“If this trial is effective and can be proven to help delay relapse, it will give genuine hope to people with treatment-resistant depression, and support clinicians more widely in their community use of the drug,” Dr Beaglehole says.
