Can a nasal spray treat depression and prevent suicide?

Almost two decades ago, researchers discovered that an FDA-approved anesthetic drug had the ability to relieve severe depression and suicidal thoughts within hours.

Sounds like a godsend for the mental health community, right?

There were some problems, though. This drug was known as a “party drug” with huge potential for abuse. Also, it required a doctor to administer it intravenously.

But more studies, including a 2010 Yale University study, once again proved the effectiveness of this drug as an antidepressant that could save lives.

Now, nearly a decade later, it might be headed to your local pharmacy, pronto…

Ketamine: The next anti-depressant?

First developed in 1962 as a general anesthesia, ketamine was approved by the FDA in 1970 and was used as a field anesthetic during the Vietnam War.

But in 1999, the Drug Enforcement Administration placed ketamine on their list of Schedule III drugs, due to its abuse as a hallucinogenic drug.

Around the same time, in 2000, the first research was done into ketamine as an antidepressant. Astoundingly, subjects who received ketamine injections showed significant improvement in depressive symptoms within 72 hours.

Over the next decade nearly a dozen more studies followed, all demonstrating that ketamine injections provided relief from major depressive symptoms, including suicidal thinking, within a matter of hours.

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Coming to a pharmacy near you?

Now, after almost twenty years, this drug is on the fast-track to approval…

Just this month (April 2018), Janssen Pharmaceuticals, a subsidiary of Johnson & Johnson, completed Phase II trials of esketamine, a nasal-spray form of ketamine.

A Phase II trial is designed to offer preliminary possibilities for use, not proof that a drug is either safe or that it works well enough to bring to market.

Still, the FDA has already designated esketamine as a “breakthrough therapy”, a designation meant to speed up the review and approval of new drugs. (Breakthrough therapy status is not granted voluntarily. It must be requested by a drug company by the end of their Phase II trials).

Let’s slow down a minute…

Despite esketamine’s power to prevent suicide in people who are in crisis, doctors have issued some precautions…

First is the use of esketamine as an “off-label” drug. (Off-label use means prescribing a drug for uses not approved by the FDA).

Using drugs off-label in mental health treatment is a common practice, but it is usually done with great care and attention to possible adverse reactions.

“We haven’t had large-scale trials. We don’t know how much or how often it should be given for it to be effective or safe,” says James Murrough, an assistant professor of psychiatry and neuroscience at the Icahn School of Medicine at New York’s Mt. Sinai Hospital.

Secondly, it’s a short-term solution as research shows esketamine’s effects last only a few days or, at most, a few weeks. It may be best used during a time of heightened suicide risk, as an interim solution, since most antidepressants take a few weeks to become effective.

Even if the FDA does approve esketamine for the treatment of depression, doctors caution about the need to prescribe it with a clear treatment plan and diligent monitoring. After all, it is considered a hallucinogenic with the potential for abuse — and pharmaceutical greed has taken us down that path before…

The risks of fast-tracking

In an editorial in the American Journal of Psychiatry, twenty members of the Journal’s editorial board cite the opioid painkiller oxycodone (OxyContin) as an example of what can happen when drugs like this are rushed to market…

Purdue Pharma finally stopped selling oxycodone to doctors just this year. But, since 1995, Perdue has made at least $35 billion from the sale of the drug that it marketed aggressively, dismissing the threat of addiction it posed.

According to the National Survey on Drug Use and Health, more than seven million Americans have abused OxyContin during the same twenty-year period. In fact, the drug is widely blamed for setting off the opioid crisis we face today.

Pharma Intelligence Informa, a group that specializes in competitive research for drug companies, predicts that sales of esketamine could reach about $2.5 billion by the year 2024, a fact not lost on Johnson & Johnson.

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No easy answer

It would appear this new drug holds as much hope as it does concern for severely depressed people. But if we learn anything from history — it’s that drugs are not always the answer.

Don’t get me wrong… there are times when psychiatric medications are necessary to save lives, and anyone taking such medication shouldn’t stop without consulting with their doctor.

The problem, as my colleague Jenny Smiechowski revealed recently, is that medications are quick fixes rather than long-term solutions. They can help when a mental health emergency arises, but they shouldn’t be the crux of every mental health recovery plan.

In fact, people who take antipsychotics, anti-anxiety medications and antidepressants often do worse in the long-term than people with the same mental illnesses who don’t take these medications.

Fortunately, nutrition — specifically, unusually high-dosing of micronutrients — is showing promise at helping to treat and prevent serious mental health issues. You can read more about the science behind how nourishing the brain could heal mental illness, here.

You can also rest assured that fast-tracking wholesome food won’t carry negative side effects, and 60 to 80 percent of people respond to micronutrients for mental health issues. Perhaps for many suffering with depression, this long-term solution, coupled with short-term medication, will bring relief.