Ketamine and Depression: From Despair to Hope in Hours – Carlos Zarate, NIH Clinician Scientist


>>Could you tell me how
you’ve been feeling lately?>>Pretty low.>>Pretty low? Could you say more about that?>>Well, I just feel
sad all the time.>>I’m Carlos Zarate. I’m a Principal Investigator for the National
Institute of Mental Health. And I study the pathophysiology,
or the causes, of mental illness, especially
depression and bipolar disorder. And our program is also focused
with developing new treatments that are different
from existing ones. In general, it takes
about ten weeks or so after starting an antidepressant
for about one-third of people to get substantially better. With some of our research
we’ve been looking at compounds that develop a rapid onset
of antidepressant action. Actually, we can get the
same effect within a couple of hours or even one day. And so that finding, with a drug
called “ketamine,” which taps into a neurotransmitter in the
brain, which is glutamate — it’s an excitatory
amino acid important for modulating other
neurotransmitters believed to be involved in depression —
we can modify glutamate levels and its site of action, or
its effects, very rapidly. And we believe that this would
lead to better treatments that work in hours
instead of weeks. So this research is really
only possible at a place like the Intramural Research
Program, the Clinical Center where we have these
core facilities — the imaging facilities, electrophysiological facilities
— that permit a team of experts to offer their opinions,
participate in the research. And so this high level
of collaboration, very sophisticated, where
we can really come up with, really I think, truly
interesting and amazing results within a very short
period of time. And these findings are
rapidly disseminated to our extramural collaborators. You know, people didn’t think that rapid antidepressant
effects were possible. And so all drug development was
based on looking at treatments that have antidepressant
effects, but it was expected that it would take two to six
weeks for them to kick in. But this is paradigm shifting,
where if you can get something that works in a couple
of hours or one day, then you don’t do those other
studies looking at drugs that take two to six week. Now, most people are going to
be looking at antidepressants that work within a
couple of hours or a day. If not, they’re not going
to further develop it, unless they’re radically
different in some other way. And I’m confident that in a
couple of years we’ll be able to come up with much better
treatments than we have now.

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