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Ketamine lifts mood quickly in bipolar disorder

Rating

2 Star

Ketamine lifts mood quickly in bipolar disorder

Our Review Summary

Instead, the headline leaps with optimism about lifting mood quickly. The story quoted no outside sources, gave no cost information, no uncritical evaluation of the evidence, offered limited comparison with alternative therapies, and limited discussion of the potentially harmful effects of putting a sizeable percentage of the population struggling with depression onto a highly addictive narcotic.

 

Why This Matters

On this topic, we need more stories taking a broader view of evaluating current and future treatment options for depression.  And doing a better job of evaluating the sometimes limited evidence for new claims.

Three other points of interest:

  • Why did  the NIH choose to issue a news release on this study? 
  • The news release chose the high-end estimate for prevalence saying "About 4 percent of Americans will develop bipolar disorder in their lifetimes."  The range is typically estimated to be 1 – 4% of the population.
  • It’s interesting that it took 3 years to recruit and conduct this 2-week study in only 18 people.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

No mention of costs. Our medical editor on this story advises that ketamine is not particularly expensive. However, it is administered by infusion so there will be costs associated with adminstration.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story tosses in a few numbers, but it uses them in such a way that they make the benefits seem more impressive than they really are. An honest approach would have been to start with the 18 patients and then give the absolute number of all patients who benefited, did not, or suffered side effects. Instead, the story says, for example, that " Six percent responded to placebo." That’s roughly one person. One person versus the 12 who responded to the drug. Whether this ratio would shrink or expand in a larger, controlled study is never discussed with any other scientists.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story does not quantify the potential harms. In fact, it minimizes the potential harms by saying there were no "serious adverse events," while listing side effects that included anxiety, feeling woozy or loopy, headache, and dissociative symptoms, meaning a temporary sense of disconnection from reality." People on ketamine may have a different perception of what is serious.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The evidence is not so much evaluated as danced around. The story gets credit for saying in the lead that this is a "small study." But the headline sets the tone of the story: "Ketamine lifts mood quickly in bipolar disorder." This is the same thing that happened, by the way, the last time a ketamine study was published, four years ago to the month. Then, too, 18 people were studied. And, apparently, seven people were studied in the trial before that. Check out this Boston Globe story from 2006, and you’ll feel like you just read the same story, although at least the Globe pulled together some outside sources.

Besides not reminding a general news audience of the limitations of drawing conclusions from a study of 18 people, one of the big limitations not emphasized was the very short followup time of the study.

Does the story commit disease-mongering?

Not Satisfactory

The press release did more disease mongering than the story. But the story does paint a scary picture, even raising the specter of suicide. "Right now, medications available for treating either major depression or bipolar illness can take weeks, or even months, to work, notes Dr. Carlos A. Zarate Jr. of the National Institutes of Health in Bethesda, Maryland, one of the researchers on the study. And as a person waits for their medications to kick in, he added, they will continue to have difficulty working and coping with social and family life; they may even be having thoughts of suicide." This is a borderline case.

Without additional context or some actual numbers explaining how many people have severe depression that is unresponsive to existing drugs or other therapies, the effect is disease mongering.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

This story needed independent voices to comment on the size of the study, the study design, the potential harmful effects, etc.

Does the story compare the new approach with existing alternatives?

Satisfactory

The story clearly conveys that these patients had tried many treatments. What is unclear is at least 2 things: 1) although these patients had tried many treatments over their lifetime history of bipolar disease, to enter this study they need to fail 1 adequate course of an antidepressant and 1 trial of a mood stabilizer – so while they appear to have recently failed on average 7 drugs, this is not true and the story is misleading in this respect.

Nonetheless because of the mention that was made of alternative approaches, we’ll give the story the benefit of the doubt.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story makes it clear that ketamine is not currently widely prescribed for depression but that it is available for other purposes, thereby lending itself to off label use. 

Does the story establish the true novelty of the approach?

Satisfactory

No inordinate claims of novelty were made.  The story mentioned some previous research on the drug.  It did not discuss the fact that, if the Boston Globe story mentioned above is to be believed, a total of 43 patients have been studied over 10 years in federally funded ketamine research.  Nonetheless, we’ll give the story the benefit of the doubt.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The quotes from Zarate are fresh – clearly not from a news release.

Total Score: 4 of 10 Satisfactory

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