People's Pharmacy: Surprising drug for severe depression

Q: I participated in two clinical trials of ketamine for depression. The infusion was not pleasant, but a few hours later, my depression was mysteriously lifted. It was as though someone carefully cleaned, polished and rejuvenated every cell in my brain. It was not a feeling of being high; it was completely different from anything I had ever experienced in my entire life.

Unfortunately, it only lasted a few days. When it went away, the return to life as I had always known it was horrible. They told me upfront that it is a clinical trial and the drug is not available for depression treatment. But it is a Food and Drug Administration-approved medication. Any M.D. could prescribe it, but no one has been willing to administer it.

I have felt closer to suicide at times since I found out how good other people feel every day. I hope ketamine will soon be approved for severe depression.

A: Major depression like yours is challenging to treat. It can take weeks for current antidepressants to start working. Clinical trials reveal that only about a third of patients achieve good results, even after optimal therapy (American Journal of Psychiatry, November 2006).

Ketamine (Ketalar) is a unique injectable anesthetic that has been used in surgery since the early 1970s. More recently, scientists have been studying ketamine for the treatment of major depression.

Preliminary studies suggest that ketamine may relieve severe depression within hours for up to two-thirds of those with treatment-resistant depression (Clinical Pharmacology and Therapeutics, February 2012). This is still very much an experimental approach that has not been approved by the FDA. Most doctors are probably reluctant to prescribe ketamine for depression because the effect is short-lived and the drug can cause hallucinations and changes in heart rate and blood pressure.

Q: To diagnose my appendicitis a few years ago, I had a CT scan with contrast. When my energy didn't return after the surgery and my weight started dropping rapidly, I underwent tests that resulted in a diagnosis of Graves' disease.

I was facing losing my thyroid either by surgery or radiation when, for no apparent reason, I began gaining weight and my thyroid tests came back to normal.

Evidently either the radiation or the iodine used in the contrast CT caused a temporary hyperthyroid condition. If I had not taken a longer time than usual to decide between surgery and radiation, I would not have a thyroid and would be on medication for the rest of my life.

Could the iodine or the radiation have caused this?

A: A new study in the Archives of Internal Medicine (Jan. 23, 2012) suggests iodine-containing contrast material used in CT scans and cardiac catheterizations is linked to a higher risk of thyroid disease. Either hyperthyroidism (Graves' disease) or hypothyroidism might develop.

People undergoing imaging tests with contrast should have their thyroid function carefully monitored afterward.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them c/o King Features Syndicate, 300 W. 57th St., 15th floor, New York, NY 10019, or via their website: http://www.peoplespharmacy.org

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People's Pharmacy: Surprising drug for severe depression