mental health

A notorious party drug from the ’60s is quietly becoming a treatment for depression in India

But is the price of ketamine too high?

Jeevan*, a 57-year-old man from Bengaluru who suffered from severe depression and had extreme suicidal urges, was rushed to a psychiatrist after a failed attempt at suicide. Over the next six months, Jeevan went for regular sessions of ketamine infusions. “I saw an improvement within two months and did not want to end my life, but I still had an urge to inflict self-harm,” he said. Jeevan was put on anti-depressants because of the temporary nature of ketamine. While the ketamine produced no side effects, Jeevan said, “Going through several infusions can be difficult, I was this close to addiction.”

Once known as the notorious party drug “Special K”, ketamine is a commonly-used anaesthetic for animals. Ketamine hydrochloride was patented in 1964 in Belgium, after which tests on human and animals proved its hallucinogenic properties. Once it became legally available as Ketalar, ketamine was a commonly-consumed psychotropic substance in the 1970s and 1980s, when New Age spiritualism and raves were at their peak.

Recently, the drug (which has been documented as one of the most potent ways of reaching an altered state of consciousness – affecting perception of sight and sound, and causing out-of-body experiences) has been recognised by the World Health Organisation in a study as providing insight into the puzzles and riddles of the inner self.

Breakthrough moment

Ketan Parmar, a Mumbai-based psychiatrist, described the drug’s new avatar as “a breakthrough” in psychiatric medicine. According to a paper titled Ketamine: A Light in the Darkness, authored by C Alexander Paleos and Stephen Ross, ketamine acts on a neurotransmitter system entirely distinct from the pathways which conventional Selective Serotonin Reuptake Inhibitor-based depression medication takes, involving serotonin, norepinephrine and dopamine. Ketamine, instead, works on the glutamate level. Glutamate is the major excitatory neurotransmitter for the central nervous system, and it involves all aspects of the neuronal life cycle, from migration and differentiation, to the genesis of new axons, to the survival of the neuron itself.

It has been found that depressed patients have elevated levels of glutamate in their blood and cerebrospinal fluid as compared to healthy controls, and these changes can be reversed. Under ketamine therapy, a patient receives one to five infusions, calibrated according to their receptivity. A small, harmless quantity (roughly 1 ml per kg weight of the patient) is usually given – two intravenous infusions could cost up to Rs 1,500.

Photo credit: Sander van der Wel/Flickr
Photo credit: Sander van der Wel/Flickr

For emergencies only

Doctors like Bengaluru-based psychiatrist Dr Bharat Shah advocate the treatment unequivocally, particularly for those who are suicidal. To sustain it, Dr Shah said it is necessary to continue antidepressants and therapy after infusions of ketamine have been administered to those suffering from depression, bipolar or obsessive-compulsive disorders.

“It’s a wonderful drug, agreed, and it has shown wonderful changes in patients,” Dr Shah added. “Yes, there are side effects and it is a short acting therapy, but it is ideal for patients who are in danger of taking their life and contemplating suicide. It’s an emergency drug.” As long as an anaesthetist is present along with the doctor, Dr Shah said, it is a safe option.

Whenever Shalini Mehta left from her home, she had obsessive thoughts about her children and husband dying in accidents. This left her paralysed for most of the day and she gradually had to quit her job and battle these thoughts full time. After her ketamine infusions, she only had good things to say: “It’s a very personal decision, [to opt for ] ketamine or not. It’s still experimental, and maybe we need more research.” Mehta said she is personally happy with the drug’s effects – according to her family too, there has been a remarkable improvement in her condition.

Undesirable side effects

But ketamine can also induce psychosis in healthy patients with no history of mental illness. For this reason, some psychiatrists are wary of its use. Chennai-based psychiatrist Dr Mohan Raj said the emergence of ketamine therapy was driven more by hype than evidence. “It’s a short-acting drug,” he said. “There is no sustained effect unlike SSRIs.”

At this point, ketamine therapy has not been approved by the Food and Drug Administration except as an anaesthetic. “There are possible side effects like kidney damage and high blood pressure,” Dr Mohan said.

“I’ve heard fellow colleagues who’ve had great experiences, but it’s too early to say,” said Dr Indira J, a psychologist in Bengaluru. “There are not enough studies about it. I’m worried about patients who have a history of drug addiction having the drug administered. Addicts will go as far as they can to get that fix and no doctor should enable that.”

Narcotics talk

Photo credit: Pixabay
Photo credit: Pixabay

Bruno A is a drug controller at the Chennai zonal office of the Narcotics Control Bureau. Instead of using ketamine as an antidepressant, he suggests Ayurvedic medicine, a change in diet and exercise. “For one benefit there are nine side effects,” he said, referring to the drug.

The sentiment is echoed by drug controllers across India. Ketamine is classified under Schedule 10 of the Cosmetics Act and Schedule 2 of the Narcotic Drugs and Psychotropics Act and is strictly regulated – doctors and hospitals need licences to procure it, and the licences must be renewed every two years. The quantity must not cross 10 grams, and if it does, it can result in up to 10 years of imprisonment.

In April, Mumbai resident Vishal Puri was sentenced to 10 years in jail by the Delhi High Court for being in possession of 1.195 kg of ketamine. Since then regulations have been tightened.

Bruno has heard of ketamine’s positive effects on patients of bipolar disorder and its terrorising effects of schizophrenia on healthy patients, but maintains that pills are much safer. “The drug is being manufactured in large quantities in China and used to be in India too,” he said. “From 2010, the numbers of procurement have drastically dropped, and it is currently at its lowest in the past three years.”

The dangers of addiction are also alarming to many patients, and according to Dr Ketan Parmar, a few patients have pulled out from the treatment after one infusion citing either fears of getting addicted or fears of overwhelming, consciousness altering experiences. “I had one patient named Pandurang who wanted to receive the infusions again and again. But I had to stop it because I knew he was getting addicted to the temporary feelings that ketamine induces,” he says.

Sixteen-year-old Smruti Jain* was apprehensive as she walked into the psychiatrist’s clinic. Her mother held her hand and led her to the chair, nodding at her with a smile. “Tell him,” she said. After a year of abuse and threats from her boyfriend, Jain was numb and tired of explaining her history to psychiatrists. Treatments were expensive, therapy was expensive. Her parents were clerks and barely made enough to make ends meet. But they knew she needed help, or they could risk losing their daughter.

“I was completely broken and didn’t want any help at first, but when I felt like ending my life, I knew I could use any help I could get,” Jain said. “I was about to lose hope when I saw the bills.” The Jains had finally found refuge in an inexpensive, if experimental method.

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Ten awesome TV shows to get over your post-GoT blues

With those withdrawal symptoms kicking in, all you need is a good rebound show.

Hangovers tend to have a debilitating effect on various human faculties, but a timely cure can ease that hollow feeling generally felt in the pit of the stomach. The Game of Thrones Season 7 finale has left us with that similar empty feeling, worsened by an official statement on the 16-month-long wait to witness The Great War. That indeed is a long time away from our friends Dany, Jon, Queen C and even sweet, sweet Podrick. While nothing can quite replace the frosty thrill of Game of Thrones, here’s a list of awesome shows, several having won multiple Emmy awards, that are sure to vanquish those nasty withdrawal symptoms:

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2. Westworld

What do you get when the makers of the Dark Knight Trilogy and the studio behind Game of Thrones collaborate to remake a Michael Crichton classic? Westworld brings together two worlds: an imagined future and the old American West, with cowboys, gun slingers - the works. This sci-fi series manages to hold on to a dark secret by wrapping it with the excitement and adventure of the wild west. Once the plot is unwrapped, the secret reveals itself as a genius interpretation of human nature and what it means to be human. Regardless of what headspace you’re in, this Emmy-nominated series will absorb you in its expansive and futuristic world. If you don’t find all of the above compelling enough, you may want to watch Westworld simply because George RR Martin himself recommends it! Westworld will return for season 2 in the spring of 2018.

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3. Big Little Lies

It’s a distinct possibility that your first impressions of this show, whether you form those from the trailer or opening sequence, will make you think this is just another sun-kissed and glossy Californian drama. Until, the dark theme of BLL descends like an eerie mist, that is. With the serious acting chops of Reese Witherspoon and Nicole Kidman as leads, this murder mystery is one of a kind. Adapted from author Liane Moriarty’s book, this female-led show has received accolades for shattering the one-dimensional portrayal of women on TV. Despite the stellar star cast, this Emmy-nominated show wasn’t easy to make. You should watch Big Little Lies if only for Reese Witherspoon’s long struggle to get it off the ground.

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4. The Night of

The Night Of is one of the few crime dramas featuring South Asians without resorting to tired stereotypes. It’s the kind of show that will keep you in its grip with its mysterious plotline, have you rooting for its characters and leave you devastated and furious. While the narrative revolves around a murder and the mystery that surrounds it, its undertones raises questions on racial, class and courtroom politics. If you’re a fan of True Detective or Law & Order and are looking for something serious and thoughtful, look no further than this series of critical acclaim.

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As the name suggests, AHS is a horror anthology for those who can stomach some gore and more. In its 6 seasons, the show has covered a wide range of horror settings like a murder house, freak shows, asylums etc. and the latest season is set to explore cults. Fans of Sarah Paulson and Jessica Lange are in for a treat, as are Lady Gaga’s fans. If you pride yourself on not being weak of the heart, give American Horror Story a try.

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At its heart, Empire is a simple show about a family business. It just so happens that this family business is a bit different from the sort you are probably accustomed to, because this business entails running a record label, managing artistes and when push comes to shove, dealing with rivals in a permanent sort of manner. Empire treads some unique ground as a fairly violent show that also happens to be a musical. Lead actors Taraji P Henson and Terrence Howard certainly make it worth your while to visit this universe, but it’s the constantly evolving interpersonal relations and bevy of cameo appearances that’ll make you stay. If you’re a fan of hip hop, you’ll enjoy a peek into the world that makes it happen. Hey, even if you aren’t one, you might just grow fond of rap and hip hop.

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7. Modern Family

When everything else fails, it’s comforting to know that the family will always be there to lift your spirits and keep you chuckling. And by the family we mean the Dunphys, Pritchetts and Tuckers, obviously. Modern Family portrays the hues of familial bonds with an honesty that most family shows would gloss over. Eight seasons in, the show’s characters like Gloria and Phil Dunphy have taken on legendary proportions in their fans’ minds as they navigate their relationships with relentless bumbling humour. If you’re tired of irritating one-liners or shows that try too hard, a Modern Family marathon is in order. This multiple-Emmy-winning sitcom is worth revisiting, especially since the brand new season 9 premiers on 28th September 2017.

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8. The Deuce

Headlined by James Franco and Maggi Gyllenhaal, The Deuce is not just about the dazzle of the 1970s, with the hippest New York crowd dancing to disco in gloriously flamboyant outfits. What it IS about is the city’s nooks and crannies that contain its underbelly thriving on a drug epidemic. The series portrays the harsh reality of New York city in the 70s following the legalisation of the porn industry intertwined with the turbulence caused by mob violence. You’ll be hooked if you are a fan of The Wire and American Hustle, but keep in mind it’s grimmer and grittier. The Deuce offers a turbulent ride which will leave you wanting more.

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9. Dexter

In case you’re feeling vengeful, you can always get the spite out of your system vicariously by watching Dexter, our favourite serial killer. This vigilante killer doesn’t hide behind a mask or a costume, but sneaks around like a criminal, targeting the bad guys that have slipped through the justice system. From its premier in 2006 to its series finale in 2013, the Emmy-nominated Michael C Hall, as Dexter, has kept fans in awe of the scientific precision in which he conducts his kills. For those who haven’t seen the show, the opening credits give an accurate glimpse of how captivating the next 45 minutes will be. If it’s been a while since you watched in awe as the opening credits rolled, maybe you should revisit the world’s most loved psychopath for nostalgia’s sake.

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10. Rome

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This article was produced by the Scroll marketing team on behalf of Hotstar and not by the Scroll editorial team.