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LETTERS TO THE EDITOR: Ketamine May Have Other Uses, Too

Emergency Medicine News: June 2016 - Volume 38 - Issue 6 - p 4
doi: 10.1097/01.EEM.0000484529.10430.2b
LETTERS TO THE EDITOR

Editor:

I am fascinated by the observation Drs. Alberto Hazan and Jordana Haber made in their article but perhaps from a different perspective. (Mindful EM: “Ketamine Shows Promise for Depression,” EMN 2016;38[3]:1; http://emn.online/Mar16MindfulEM.)

The use of a ketamine infusion for treating depression brings back memories of a similar use of electroconvulsive therapy (ECT) and insulin coma therapy (ICT) as treatment for psychiatric diseases. These modalities were recommended for treatment of depression and schizophrenia more than half a century ago. Sakel reported in 1927 that 70 percent of patients improved following ICT, and Bennett reported in 1937 that 90 percent improved after ECT. These levels of success are remarkably similar with those currently reported for ketamine infusion.

Those therapies were eventually found to be less impressive than initially reported and have been largely abandoned today. If history teaches us anything, it is that initial results are often misleadingly positive, even skewed, and it is only longer observation that finally discloses the true value and the deleterious effects of a novel therapy. Wisdom would suggest that final judgment and general acceptance of ketamine for treating psychiatric illness await more and longer experience.

Among those who did not benefit from ICT was James Forrestal, the first U.S. Secretary of Defense who committed suicide in 1949, and Ernest Hemingway who underwent ECT treatment at the Mayo Clinic but committed suicide in 1961.

A brief review of ICT and ECT as well as other “shock” therapies once popular can be found at http://bit.ly/1VPW0Q1.

Paul A. Janson, MD

Lawrence, MA

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