This story explained how the drug ketamine is coming into vogue as a treatment for depression and suicidal behavior. It’s not focused on one new study but rather the topic in general, describing how “desperate patients are shelling out thousands of dollars for treatment often not covered by health insurance, with scant evidence on long-term benefits and risks.”
The story gave a good overview of the available evidence as well as costs, potential harms, and availability. One thing that would have made the story stronger is the inclusion of a negative patient anecdote, if one could be found, in order to balance the mainly positive anecdotes. “Bad trips” (also known as “k-holes“) are indeed a real risk that people should be aware of.
Whenever a treatment takes hold ahead of the evidence, it’s the news media’s job to cast a critical eye. In this case, depression is a major public health problem, and ketamine or some derivative of it with longer lasting benefits could prove to be an important treatment option. But at this point, people with depression and their families should be informed of the unclear safety and effectiveness as well as the inconvenience and cost of getting treated in a clinic setting.
The story said one woman paid $3,000 “so far” for her treatments and “scrambles to find a way to pay for another one” as the effects wear off.
It also reported that a “typical” treatment at one clinic “involves six 45-minute sessions over about two weeks, costing $550 each. Some insurers will pay about half of that….”
The story didn’t focus on a particular study that measured a benefit. It said: “Studies suggest that a single IV dose of ketamine far smaller than used for sedation or partying can help many patients gain relief within about four hours and lasting nearly a week or so.”
However, the story could have given readers a more detailed description of ketamine’s benefits, as measured in clinical trials.
For example, a meta-analysis of five randomized placebo-controlled trials concluded ketamine had a “large” immediate effect — measured one day after treatment — on symptoms in patients with major depressive disorder and bipolar depression. That effect fell to “medium” after seven days. The studies used various standardized rating scales to track symptoms such as reduced appetite or sleep, difficulty concentrating, sadness, and suicidal thoughts.
The story said ketamine can cause rapid increases in heart rate and blood pressure “that could be dangerous” as well as hallucinations. It quoted one expert who said the drug “can be abused, so we have to be very careful about how this is developed.”
The story mentioned “scant evidence on long-term benefits and risks,” the view that “much more needs to be known,” and an American Psychiatric Association review that noted “major gaps” in knowledge about ketamine’s long-term effectiveness and safety.
It also said “dozens of studies are underway seeking to answer some of the unknowns about ketamine including whether repeat IV treatments work better for depression and if there’s a way to zero in on which patients are most likely to benefit.”
The story also said the “strongest studies suggest it’s most useful and generally safe in providing short-term help for patients who have not benefited from antidepressants.”
The story didn’t engage in disease-mongering.
It stated the drug could provide “short-term help for patients who have not benefited from antidepressants. That amounts to about one-third of the roughly 300 million people with depression worldwide.”
The story used a range of sources. It noted that one source, Yale University psychiatrist Gerard Sanacora, PHD, MD, has worked for companies seeking to develop ketamine-based drugs.
One quibble: The story devoted substantial ink to positive anecdotes. Was the reporter able to find patients with negative experiences involving ketamine? That would be interesting to know.
The story mentioned conventional antidepressants that “target serotonin, a different chemical messenger, and typically take weeks to months to kick in — a lag that can cause severely depressed patients to sink deeper into despair.”
It also quoted an expert who said “ketamine should be a last-resort treatment for depression after other methods have failed.”
The story could have mentioned other medications to treat depression as well as psychotherapy.
The story makes it clear that ketamine is widely available for treating depression — at “about 150 US. ketamine clinics,” although it has not been approved by the FDA for that purpose.
This was an overview story looking at the topic of ketamine for depression, vs. one new study, which is when we typically expect a news story to establish what novel information was uncovered by the study. For this reason, we’ll rate it N/A.
The story does not rely on a news release.
Systematic, Criteria-Driven
The inimitable @garyschwitzer has published an opinion piece on how health journalism contributes to public health outcomes - and why the industry works the way it does.
US-centric, but Australian journos will find this helpful.
#aushealth https://t.co/zBDaOOsMGx
In the latest installment of @JAMA_current's series on the public's eroding trust in health care, @garyschwitzer calls for improving the accuracy and quality of health journalism https://t.co/kgCNz0BTgq
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