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The new way to treat depression, anxiety and chronic neuropathic pain
Newsletter No 7 (26th November 2021)
Ketamine deserves much closer scrutiny as procognitive therapy in Alzheimer's patients.
Memantine and Ketamine are both non-competitive NMDA receptor antagonists, albeit with somewhat different pharmacological profiles. Memantine is one of the most widely prescribed drugs in Alzheimer's patients, yet there is a surprising lack of research around ketamine for this purpose. Surprising because there is good reason to believe ketamine may be more effective as a procognitive agent.
Neil Smalheiser is Associate Professor of Psychiatry at the University of Illinois School of Medicine. One of his focuses is to identify under-studied yet fundamentally important areas of research that may have 'fallen through the cracks'. The potential benefit of ketamine for Alzheimer's patients cannot be ignored. Read more in Frontiers in Aging Neuroscience.
A study published in Drug Design, Development and Therapy concluded that, in a rat model, ketamine significantly enhanced cognitive function and exhibited a neuroprotective effect against cognitive impairment.
Genetic coding before antidepressant therapy can predict response.
Ketamine is metabolized by proteins coded for by the CYP2B6 gene.
In a prospective study of 258-patients with TRD, half were subjected to pharmacogenomics testing used to guide treatment. They experienced a 53% greater improvement in symptoms and a 1.7-fold relative improvement in response compared with the control group. (Medscape)
The adaptation of therapies based on an individual’s genetic and molecular profile is one of the most promising aspects of modern medicine.
Genetic variants are valid predictors of antidepressant efficacy and could be used to provide personalized treatments.
An article published in Clinical Pschopharmacology and Neuroscience last year looks at this topic in some detail.
Ketamine and Spirituality - does the amygdala regulate religious and spiritual visions?
Reluctance to acknowledge and address ketamine-induced 'spiritual experiences', is to miss a vital opportunity to reconcile spiritual, mental and physical health.
Our patients frequently describe their ketamine experience as 'spiritual' or 'sacred' .
For many an awareness of God, positive affirmations, and sense of 'emotional security' during infusions can prove profoundly healing.
Ketamine heightens subconscious awareness, often leading to revelations and epiphanies that can be carried through into a patient's waking reality and enrich their lives.
KCSA offers outpatient ketamine infusions at the following locations:
BEDFORDVIEW (GP)
CONSTANTIA (WC)
UMHLANGA (KZN)
HILTON (KZN)
Ketamine is not contra-indicated in patients receiving benzodiazepines and/or lamotrigine, but reduced efficacy can be expected in some.
Clonazepam (Rivotril), in particular, seems to reduce the efficacy of ketamine.
Pharmacogenomic testing of patients could prove useful in providing guidance on this issue.
Should patients receiving ketamine infusions stop benzodiazepines and lamotrigine?
Specialist anaesthetist, P.J. Allen, reviewed the PHQ-9 depression rating results in 63-patients with MDD at KCSA's Umhlanga clinic.
He compared improvement in PHQ-9 scores after six-ketamine infusions in those taking benzodiazepines or lamotrigine with the average overall reduction in PHQ-9 score. His findings are consistent with more comprehensive meta-analyses.
Dr Tasneem Amod briefly discusses using drugs like ketamine 'off-label'
Dr Amod is a diplomate anaesthetist and member of The Society of Sedation Practitioners of South Africa (SOSPOSA), who practices at KCSA's Bedfordview Clinic in Gauteng. She is passionate about supporting her patients through their ketamine 'journey' and path to recovery.
In the first of a series of short videos discussing ketamine-related topics, Dr Amod explains that many drugs registered by SAHPRA in South Africa are used 'off-label' at times ie: for indications not pertinently stipulated in the package insert, but whose use is justified and supported by a substantial body of evidence. This is often the case in the field of psychiatry.
In the next newsletter..
Zimbabwean entrepreneur, radio personality and former beauty queen, Sipho Mazibuko wants to tell everyone that ketamine was her 'New Beginning.' After flying down from Zimbabwe for treatment at our Bedfordview Branch, Sipho now describes herself as: 'Super okay!' and is maintaining her maintenance infusion program. Sipho has a passion for mental health in Zimbabwe and runs a mental health NGO aiming to destigmatize mental health problems. Read more and hear from Sipho directly in our next newsletter. |
How did KCSA start in South Africa?
Ketamine Clinics of South Africa (KCSA) was founded by Dr Alan Howard, a Consultant in Emergency Medicine who returned home permanently to his native South Africa from Ireland in 2019. To read more about Dr Howard and KCSA's flagship clinic in the Natal Midlands in two informative articles published in South African Psychiatry click on the link below.
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