How could Australia treat treatment-resistant depression?

Key points

• Depression is usually treated using selective-serotonin reuptake inhibitors [SSRIs], cognitive behavioural therapy [CBT] or interpersonal therapy

• Some people who live with depression find that existing forms of support do not change symptoms which impact their mood and ability to function

• Ketamine has a reputation as a dissociative anesthetic in veterinary medicine and as a recreational or ‘street’ drug, but clinical trials show promising results

More than one in five subjects of a University of New South Wales [UNSW] clinical trial reported ‘total remission’ for symptoms of depression. The study was a collaboration between six academic clinical mood disorder units in Australia and one in New Zealand and was backed by the Australian National Health and Medical Research Council [NHMRC].

Notably, a third of all participants in the double-blind clinical trial who received the ketamine treatment — as opposed to the placebo — in bi-weekly infusions, reported improvement in depressive symptoms.

Colleen Loo, Professor of Psychiatry at the University of New South Wales and the Black Dog Institute, is an internationally renowned expert on electroconvulsive therapy (ECT) and ketamine treatment. Professor Loo said the 20 percent remission rate was “[…] actually quite good.”

“We found that in this trial, ketamine was clearly better than the placebo — with 20 percent reporting they no longer had clinical depression compared with only two percent in the placebo group,” she said.

“This is a huge and very obvious difference and brings definitive evidence to the field, which only had past smaller trials that compared ketamine with placebo.”

People who had previously received ECT were included in the month-long trial, with 179 participants receiving infusions twice a week — although neither those administering the placebo/ketamine were aware of which was which, hence ‘double-blind.’

The chosen placebo — midazolam — also has sedative qualities, in order to ensure the net benefit results of ketamine treatment were distinct from other similar chemical properties. Prior to the UNSW study, saline had often been relied upon as a placebo, which yielded results which were foundational, but not transformative.

“Because there are no subjective effects from the saline, in previous studies it became obvious which people were receiving the ketamine and which people received placebo,” Professor Loo said.

“In using midazolam — which is not a treatment for depression, but does make you feel a bit woozy and out of it — you have much less chance of knowing whether you have received ketamine, which has similar acute effects.”

The research results were also monumental for those worried about the financial burden that treatment may pose for psychosocial disability, emotional distress stemming from internalised ableism or for people experiencing mental health concerns. 

“With the S-ketamine nasal spray, you are out of pocket by about $1200 for every treatment by the time you pay for the drug and the procedure, whereas for generic ketamine, you’re paying around $300 to $350 for the treatment including the drug cost,” the professor added.

Researchers concluded that their results should serve as a catalyst for Medicare item inclusion, which could subvert the $800 per dose price for patented ketamine treatment. Should the treatment used in the trial be included under Medicare for the treatment of unwavering resistant depression, efficient, generic ketamine doses may be available for as little as $5.

If you or someone you know is experiencing emotional distress or mental health crises, please refer to the following channels of support and know that you’re not alone.

Lifeline: 13 11 14   lifeline.org.au

Suicide Call Back Service: 1300 659 467   suicidecallbackservice.org.au

Beyond Blue: 1300 224 636   beyondblue.org.au/forums

MensLine Australia: 1300 789 978   mensline.org.au