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Letter to the Editor: Ketamine for Depression Needs More Study

Emergency Medicine News: July 2016 - Volume 38 - Issue 7 - p 2
doi: 10.1097/01.EEM.0000488843.38821.43
Letter to the Editor

Editor:

I, like Drs. Jordana Haber and Alberto Hazan, am fascinated by the observation that ketamine could treat depression but perhaps from a different perspective. (“Ketamine Shows Promise for Depression,” EMN 2016;38[3]:1; http://emn.online/Mar16MindfulEM.) The use of an infusion of ketamine for treating depression brings back memories of a similar use of electroconvulsive therapy (ECT) and insulin coma therapy (ICT) to treat psychiatric diseases.

These modalities were recommended for treating depression and schizophrenia more than half a century ago. Manfred J. Sakel reported in 1927 that 70 percent of patients improved following ICT, and E. A. Bennett found in 1937 that as many as 90 percent improved with ECT. These levels of success are remarkably similar to 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. Ernest Hemingway also committed suicide after undergoing ECT treatment in 1961. A brief review of ICT and ECT as well as other shock therapies once popular can be found in “The History of Shock Therapy in Psychiatry” by Renato M. E. Sabbatini, PhD, at http://bit.ly/1VPW0Q1. It may also be worth reading “Meduna and the Origins of Convulsive Therapy” (Am J Psychiatry 1984;141[9]:1034) and “The Methodical Use of Hypoglycemia in the Treatment of Psychoses” (Am J Psychiatry 1994;151[6 Suppl]:240).

Paul A Janson, MD

Lawrence, MA

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