Health experts attack ketamine plan to tackle depression

http://www.theguardian.com/society/2014/jun/22/critics-attack-ect-ketamine-therapy-depression

Version 0 of 1.

A group of leading mental health experts has called for researchers to abandon a £1m project that would involve administering a combination of electroconvulsive therapy (ECT) and the banned recreational drug ketamine to patients. The project's aim is to test the combination as a new method of tackling depression.

However, several psychologists and psychiatrists, including the author Oliver James, say they have grave concerns about the use of the powerful mix of therapies that the research study – backed by the UK National Institute for Health Research – intends to test. They first question the safety of ECT, in which an electrical current is passed through the brain to produce an epileptic fit, an event some doctors claim improves a patient's condition. The group also argues that there is no evidence ketamine has any lasting beneficial effects.

"Participants are being told that ketamine is believed to work together with the effect of ECT to improve mood, but the evidence for the effectiveness of either treatment individually is very weak and evidence for a combined effect even weaker," said Professor John Read of Liverpool University's Institute of Psychology. There was a risk a patient could suffer severe adverse symptoms.

The main centre for administering the ECT-ketamine study is based at Manchester University, whose website claims it is the largest research study of ECT in the UK for more than 30 years. Several other centres – including clinics in Stockport, Leeds and Salford – would be involved. The project's website adds that ECT is the most effective antidepressant available. "However, it is associated with confusion and impaired cognitive function, including memory and executive function," the site acknowledges. The study's aim is to find if ketamine can reduce impairments associated with ECT and reduce a patient's depressive symptoms. "Patients who consent to take part in the study will be randomised to either receive ketamine or a placebo injection," the website adds.

But critics say, in a letter to the project's organisers and backers, that its supporters appear "to be making inaccurate statements about the risks and benefits to people who are depressed – some of them suicidally depressed – and who may therefore feel desperate enough to accept any treatment that is offered to them".

The study's critics argue that ketamine is a powerful hallucinogenic drug. Giving it to someone who then has ECT, which leaves them in a disorientated state, will increase their discomfort, they say. As David Harper, a clinical psychologist at the University of East London, pointed out: "The potential risks of combining an already risky ECT procedure with a hallucinatory drug seem very much to have been downplayed in this study." This point was stressed by James. "It is absolutely ludicrous to claim that a powerful euphoria-inducing drug like ketamine is going to be a long-term or a short-term method for controlling clinical depression," he said.

The group's other main objection is to the study's claim that ECT is safe and effective. It is sometimes associated with long-lasting cognitive dysfunction and involves a small but significant mortality risk, usually through cardiac arrest or stroke, it states. "We believe that ECT recipients should be informed of that risk," they add in their letter.