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Quick depression relief?

Rating

2 Star

Quick depression relief?

Our Review Summary

This 142-word story, under the heading "Lifeline/News in Brief," is too brief and doesn't give readers much of a lifeline on information.

Using Ketamine in patients with serious, treatment-resistant depression is a novel idea. A well-designed study published in the Archives of General Psychiatry in August 2006 provides some evidence that this drug does quickly improve seriously depressed patients’ mood, at least in the short-term.

But the story does not put the results of this study in any context and overstates the application of a drug like ketamine for people suffering from depression. To claim that relief for depression “may someday be just a piNPRick away” is not just an overstatement, but technically incorrect, as the study participants received this drug intravenously. While the story does mention the study was funded by the National Institutes of Health, only the lead author of the study is cited.  Other researchers and/or clinicians (and possibly, patients) are needed to provide balance and perspective on the findings of this experimental treatment for serious, long-standing depression.

The use of ketamine would not be a long-term, sustained treatment, but a stop-gap measure for patients who are seriously depressed, have tried other medications to alleviate their depression and are at risk of self-harm or suicide. This treatment might be useful in developing medications that more quickly target areas of the brain that may cause depression. Traditional anti-depressants that target serotonin in the brain can take several days or weeks to begin working.  In patients who are seriously depressed and actively suicidal, quickly targeting receptors in the brain may reduce suicide, and help patients better engage in psychotherapies, which may in turn help them better cope with their depression.

The story mentions anti-depressants, but downplays their value, reporting "only about 50 percent of users" may be helped these medications.  This statistic is from many long-term studies of thousands of patients with varying degrees of depression.  It is misleading to compare this number to a small study in which 71% of 17 seriously depressed patients (one person dropped out of the study) reported improved mood hours after taking the drug.  Also, the headline of the story is equally misleading and needs qualification; results of this study would not be generalizable to all people with depression, especially those with less severe and shorter-duration depression.  

The story does not mention other forms of evidence-based depression treatment that would be tried prior to experimental use of a strong hallucinogenic drug, such as ketamine. Psychotherapy (talk therapy), cognitive-behavioral therapy, a combination of medication and psychotherapy, electroconvulsive therapy or other forms of depression treatment are not mentioned, but are viable, well-researched options for people with depression. 

Ketamine is sometimes used an anesthetic, but it is also a hallucinogen, sometimes used recreationally to induce feelings of euphoria and outer body experiences, so it is labeled in the U.S. a controlled drug, meaning it has potential for abuse. The story does not mention any long-term harms of this drug, or side effects noted in patients involved in the study.  The study, but not this news story, reported that there were more side effects in the group taking ketamine than placebo, and these short-term side effects included confusion, dizziness, perceptual disturbances, increased libido and euphoria (though the latter did not last beyond two hours).

As we've explained before in these reviews, trying to boil down an important study into 142 words is difficult, and this story shows how difficult and incomplete such a practice can be. 

 

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

At the time, ketamine is a Class III controlled drug, meaning it has potential for abuse and refills are limited to 5 in 6 months. We are not told the appropriate dose or cost of this treatment if it were used in patients with unrelenting depression.

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

Not Satisfactory

The story only lists the very temporary benefit of ketamine for depression in relative terms. The story only presents relative numbers and an incomplete comparison of the two numbers.  (See our primer on absolute vs. relative data.) The story reports "only about 50 percent of users" may be helped by antidepressant medications; however, this number is from many long-term studies with thousands of patients with varying degrees of depression.  It is misleading to compare this to a small study in which 71% of 17 (one dropped out of the study) seriously depressed patients reported improved mood for up to one week. Results may not be generalizable to people with less severe and shorter-duration depression.

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

Not Satisfactory

The story does not mention any harms of this drug or side effects noted in patients involved in the study. In the source article on which the story was based, there were more side effects in the group taking ketamine than placebo, and these short-term side effects included confusion, dizziness, perceptual disturbances, increased libido and euphoria (though the latter this did not last beyond two hours). 

A study of 18 people is too small to say anything meaningful about adverse effects unless most of them died.

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

Not Satisfactory

The story does not mention the design of this very small study.  The study was a randomized, double-blind crossover study, meaning that two weeks after the initial assignment and trial, the placebo group received the ketamine and the ketamine group received the placebo, which strengthens the finding that ketamine had a statistically significant immediate positive effect on mood, which may last up to seven days in people suffering serious depression.  

Also, the headline of the story is misleading and needs qualification in the story: results of this study would not be generalizable to all people with depression.

Does the story commit disease-mongering?

Satisfactory

The story does mention that this treatment might only be used in people from whom other depression treatments have failed, so there is no evidence here of disease mongering.

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

Not Satisfactory

The story does mention that the study was funded by the National Institutes of Health. However, only the lead author of the study is cited.  Other researchers and/or clinicians (and possibly, patients) are needed to provide balance and perspective on the findings of this experimental approach for serious, long-standing depression.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story mentions anti-depressants, but downplays their value  (e.g. they work in only half of people who take them and a pill must be swallowed every day). The story does not mention other forms of evidence-based depression treatment that would be tried prior to experimental use of a strong hallucinogenic drug, such as ketamine. Psychotherapy (talk therapy), cognitive-behavioral therapy, a combination of medication and psychotherapy, electroconvulsive therapy or other forms of depression treatment are not mentioned, but are viable, well-researched options for people with depression.  The story does not mention that those enrolled in this study had tried at least six anti-depressants prior to the use of ketamine.

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

Not Satisfactory

The story reports that this treatment "may someday be a piNPRick away", which is misleading as the participants in this study were given the drugs intravenously.  Also we do not know that ketamine will be used in clinical practice to treat people with intractable depression. An NIH press release reports that this medication is unlikely to be widely used to treat depression, but results from the study of ketamine may generate research for newer medications which target different receptors in the brain and provide more immediate relief for seriously depressed people. Ketamine is sometimes used an an anesthetic, but it is also a hallucinogen, used recreationally to induce feelings of euphoria and outer body experiences, so it is a controlled drug. 

Does the story establish the true novelty of the approach?

Satisfactory

The story reports that ketamine for treatment-resistant depression is still in the experimental stage, and has only been tested in a very small group of people.

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

Not Applicable

We can't be sure if the story relied solely or largely on a news release, although only the lead author of the study is cited and no additional sources are cited.

 

Total Score: 2 of 9 Satisfactory

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