This story reported on a preliminary study looking at whether the drug ketamine might be a potential treatment for adolescent depression. The story refrained from disease-mongering and quantified the scope of the observed benefits.
However, the headline and lead were misleading in stating that teens who took the drug had improvements in their depression. The word “promise” used in the headline wasn’t borne out by the data. In fact, the study wasn’t designed to offer reliable evidence that the drug offers a benefit. Caveats about the study were included only toward the end of the story, and readers were left in the dark about ketamine’s potential for misuse and its potential side effects. Costs were also missing.
Adolescent depression is a widespread problem, and a substantial number of adolescents don’t respond successfully to drugs that are currently available. Given high public interest in an effective alternative, news reports should refrain from encouraging false hopes when it comes to early-stage research. That means emphasizing appropriate caveats with the quality of evidence and refraining from making claims that aren’t borne out by the data.
In addition, potential harms should be spelled out, particularly when it comes to the unknown effects of long-term use on developing brains and bodies.
There was no mention of the costs of ketamine infusions, which can be expensive. A quick internet search yields costs of between $400 to $800 per infusion. Therefore, the six infusions used in this study would cost a family $2,400 to $4,800. And since ketamine is not FDA-approved for treating depression, insurance companies probably wouldn’t cover it. Given the heightened concern that parents feel for their adolescents suffering from depression that doesn’t respond to conventional drug treatments, information on the costs presented by this new approach is warranted.
The story did the bare minimum, pointing to “an average decrease of 42 percent” in criteria contained in a depression assessment tool. It also stated that five of the 13 participants “met the criteria for response and remission” and three of those were still in remission after six weeks, with the remaining two relapsed within two weeks.
The story would have served readers better by emphasizing those figures higher up and spelling out what “response and remission” mean in terms of a patient’s symptoms.
The story brushed over significant potential harms, including the potential for misuse. It stated that researchers “found that the treatment was well tolerated,” and contained a quote stating “we still don’t know about the long-term safety.”
According to the research paper, there were some issues the story ignored. Three participants became nauseous during the infusions, while two others experienced dysphoria (profound unease). One participant reported hand pain from the intravenous site that persisted for several days.
Also, with any invasive procedure — even infusions — there is always the risk of infections.
But most importantly, ketamine use requires considerable caution. It is now considered a misused recreational drug and some research indicates it can cause complications when used long-term.
It seems such cautions are particularly warranted due to the existence of clinics where ketamine is used off-label to treat depression.
Caveats about the weaknesses of this study should have been far higher. Instead, they were relegated to the second half.
Only halfway down were readers finally told that the drug was tested on just just 13 adolescents. Even further along were readers told that the study “was limited by its small sample size, so future research will be needed to confirm these results.”
The story didn’t mention that the study wasn’t blinded and didn’t include a control group taking a placebo. The study itself reported that its design “precludes conclusion that the results are due to drug effect,” and yet that is exactly the suggestion the headline and the lead made to readers.
No apparent disease mongering here.
The story quoted a researcher unaffiliated with this study. We could find no conflicts of interest.
The nature of this study was to investigate the potential use of ketamine as an alternative to other drug treatments. Participants had to have tried at least two previous drug approaches without success before they could qualify for inclusion in this study. So therefore, there clearly were alternatives considered and the story mentioned them.
The story would have benefited from a wider discussion of the treatment of adolescent depression, including the role of psychotherapy.
The story called ketamine “a popular recreational drug and a useful medical anesthetic.” It could have added that while ketamine is an FDA-approved drug for years and is widely available at medical facilities, it hasn’t been approved by regulators for use as an antidepressant.
In addition, Johnson & Johnson has said it is close to seeking FDA approval of a ketamine derivative called esketamine, which would be taken as a nasal spray.
The story missed the real significance of this study, which is that it appears to be the first published on the use of ketamine for depressed teens. At least one other study on this topic is underway.
Unfortunately, the headline and lead wrongly focused on a possible benefit — which is impossible to show from this extremely skimpy data — rather than the fact that this is an initial glimpse of an area of emerging research.
In sum, using ketamine for adolescent depression is definitely novel and bears coverage, but the optimistic assertions in the headline and lead aren’t supported by the data.
It does not appear that the story relied on a news release.