Ketamine in its present form is decidedly not ideal for depression treatment, but probably a tradeoff often worth considering compared to the risks of severe and enduring depression. Amine neurotransmittor reuptake inhibitors have quite substantial problems associated with them too (there we arguably really have had a case of the mistaken and excessive wonder-drug status you allude to).
The true excitement of ketamine-based depression treatment is perhaps more in that it is something different. It quickly affects the problematic state, by some mechanism which appears to be quite different from the now "classical" antidepressants. That has potential both as a basis for more refined drugs and more importantly to better understand the real mechanisms underpinning depression.
Ketamine has been a party drug for quite a while now, and as far as I know, hasn't been shown to be particularly dependency-inducing, though low-dose ketamine over the long term might be (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236511/)
Also, as far as I know, ketamine treatment isn't intended as an ongoing medication, like an SSRI, but as a treatment for acute episodes of depression. I might be wrong about that; webmd says, "For treatment-resistant depression, patients usually get the nasal spray twice a week for 1 to 4 weeks; then once a week for weeks 5 to 9; and then once every week or 2 after that." However, the use-cases I know about (from talking to researchers studying it) is as an intervention to prevent suicide during severe depression (since it's relatively fast acting).
As always, its a cost-benefit calculation, that should be carefully made in consultation with a professional. The cost of severe depression can be quite high.
At Lumin Health, we treat about 80% of our patients with esketamine, and the rest with ketamine (generally only if they don't meet esketamine criteria). After the initial course, patients tend to find a good balance of ongoing care that helps treat their particular depression / depressive symptoms. This happens less with ketamine since it tends to be prohibitively expensive to continue care (upwards of $1k/month).
There is a long-term trial now in its 4th year with esketamine (https://clinicaltrials.gov/ct2/show/NCT02782104). I'm not sure how much has been published yet, but early data I saw supported immediate relief and long term benefit over the 4 years.
In terms of it being a sinister ploy by pharma, it's definitely priced higher than its ketamine generic counterpart, but for the vast majority of our patients, ketamine treatment out of pocket (since its not covered by insurance) is absolutely unaffordable, and pursuing the insurer-covered version of treatment is a high-value option.
A lack of physical dependence should not be interpreted as addiction-proof. Nobody is physically dependent on gambling, for example, but gambling addiction is prevalent.
The fact that two drugs both can be used as an anesthetic doesn't tell you very much besides that, especially when comparing across different drug classes.
For example, cocaine and novocaine are both anesthetics that belong to the same drug class, and yet they have radically different risk profiles, despite both being commonly used in outpatient medical settings.
Ketamine is in a completely different category of drugs from cocaine and novocaine, which are also totally different from opiates.
It's a fallacy to assume that ketamine would be subject to the same issues as opiates just because both happen to be usable as anesthetics.
People on these type of drugs long term end up with severe memory issues, fogfy brained all the time, and if its ketamine add in a completely obliterated bladder.
I dont think this is an idea that can be dismissed trivially as a fallacy.
"Opiates are dangerous and they are anesthetics; therefore ketamine is dangerous because it's an anesthetic" is, literally, a textbook logical fallacy.
If you'd like to argue that ketamine is dangerous based on some other reasoning, go ahead, but that doesn't change the fact that OP's logic is prima facie fallacious.
> Ever met an nmda receptor agonist addict?
I used to work in drug counseling, so, yes.
Except that I never made that exact argument. Textbook strawman fallacy.
Sure, but it's also a fallacy to assume that nothing bad can happen in the long-term just because it appears promising in the short-term. I wasn't saying it's gonna happen the same exact way as it did with heroin (of course it won't, it's not an opiate), I was just making an example of a drug that happened to appear benign and promising, but have serious unforeseen consequences in the long term.
Ketamime has already been widely used for decades, in much larger doses than whats being discussed. We're not talking "short-term" here.
> I was just making an example of a drug that happened to appear benign and promising, but have serious unforeseen consequences in the long term.
Even that is a misrepresentation of the history of heroin. I guess it could appear that way if you take the Bayers advertising materials at face value (but hopefully you're not doing that). The dangers of opiates - and of morphine derivatives specifically - were well established by the time heroin was released.
When heroin was first discovered, it was hailed as a wonder-drug, and it was also considered an effective treatment for severe depression. However, after some time, people realized that its addictive properties and high range of potential tolerance make it backfire pretty badly after a certain amount of (ab)use.
Can we be sure that a similar thing won't happen with ketamine?