Transcript: Using "Party Drugs" to Treat Depression | Oct 21, 2021

Nam Kiwanuka sits at the Agenda news desk. She wears a dark blue blazer over a black blouse. Her auburn hair is parted to one side. A monitor behind her shows a red lowercase ‘a’. Nam holds a pen between her fingers as she rests her hands on the desk. Papers, a cell phone, and a glass of water sit in front of her.

Text reads, “Using ‘Party Drugs’ To Treat Depression”

Nam begins,
DON'T DO DRUGS. WE'VE BEEN TOLD
THAT FOR A LONG TIME. NEW RESEARCH
INTO SO-CALLED PARTY DRUGS
SUGGESTS THE PUBLIC MESSAGING
MIGHT NEED SOME REVISION.
WITH US FOR MORE FROM HIS OFFICE
AT TORONTO WESTERN HOSPITAL
DR. ROGER MCINTYRE, PROFESSOR
OF PSYCHIATRY AND PHARMACOLOGY
AT THE UNIVERSITY OF TORONTO.
AND HEAD OF THE MOOD DISORDERS
PSYCHO PHARMACOLOGY AT THE
UNIVERSITY HEALTH NETWORK.
HELLO DOCTOR, HOW ARE YOU?

Dr. McIntyre responds,
GREAT TO BE WITH YOU.
THANKS FOR COVERING THIS VERY
IMPORTANT TOPIC.

Nam states,
WELL ONE OF THE PARTY DRUGS
THAT I JUST MENTIONED THAT WE
GREW UP BEING TOLD NOT TO DO
PARTY DRUGS AND ONE OF THOSE
PARTY DRUGS IS SOMETHING CALLED
SPECIAL K ALSO KNOWN AS
KETAMINE. WHAT IS KETAMINE?

Text reads, “Roger McIntyre, University of Toronto”

Dr. Roger McIntyre sits in front of a blank wall. He wears a dark suit over a white button-down shirt. The top button is undone. Dr. McIntyre’s grey hair is parted to one side.

Text reads, “Using ‘Party Drugs’ To Treat Depression. The Ketamine Trials”

Dr. McIntyre answers,
WELL, IT'S A GOOD QUESTION.
AND YOU ARE RIGHT IT HAS QUITE A
HISTORY.
IT WAS IN FACT AND STILL REMAINS
IN SOME PARTS OF THE WORLD
INCLUDING OURS A DRUG OF MISUSE
AND FRANKLY ABUSE.
KETAMINE IS A DRUG THAT WAS
FIRST SYNTHESIZED IN 1962.
BACK IN 1970, THE UNITED STATES
FOOD AND DRUG ADMINISTRATION
APPROVED KETAMINE AS AN
ANESTHETIC. SO, THE SHORT
ANSWER IS IT BEGAN AS AN
ANESTHETIC BUT IN THE LAST FIFTY
YEARS WE HAVE LEARNED IN
ADDITION TO BEING AN ANESTHETIC
IT'S ALSO AN ANALGESIC. IT HELPS
PAIN.
IT'S AN ANTI-INFLAMMATORY. HELPS
CONDITIONS OF INFLAMMATION AND
MORE RECENTLY WE HAVE LEARNED
IT'S AN ANTI-DEPRESSANT.
WHAT'S SO UNIQUE ABOUT KETAMINE,
ONLY DISCOVERED IN THE LAST
DECADE IS THAT IN CONTRA
DISTINCTION TO THE ANTI-DEPRESSANTS
WE HAVE HAD FOR SEVEN DECADES IT
WORKS IN ABOUT ONE TO TWO DAYS.
SO, IT'S CALLED A RAPID-ACTING
ANTI-DEPRESSANT.

Nam says,
I AM ASSUMING THAT
WOULD BE VERY IMPORTANT FOR
SOMEONE WHO MIGHT BE SUICIDAL.
BUT HOW DID THE IDEA EMERGE TO
USE KETAMINE TO TREAT
DEPRESSION?

Dr. McIntyre answers,
IT'S A FANTASTIC QUESTION.
IT'S A REALLY INTERESTING LONGER
DISCUSSION BUT REALLY THE SHORT
DISCUSSION IS THAT WE HAVE
LEARNED THROUGH OUR RESEARCH IN
MOLECULAR CONTRIBUTIONS TO
DEPRESSION AND TRAUMA AND STRESS
AS WELL AS SOME OF OUR ABILITY
TO LOOK AT ANIMAL MODELS OF
STRESS, WE’VE LEARNED THAT IN THE
BRAIN THERE IS SOMETHING WRONG
WITH WHAT WE CALL PLASTICITY.
IN OTHER WORDS THE
ABILITY--THE ABILITY OF THE
BRAIN TO ADAPT AND TO FORM NEW
BRAIN CONNECTIONS, NEW BRAIN
CELL CONNECTIONS.
THE OBSERVATION WAS MADE THAT IN
DEPRESSION AND RELATED
CONDITIONS THERE IS SOMETHING
WRONG WITH THIS FUNDAMENTAL
PROCESS. AT THE SAME TIME WHAT
WE’VE LEARNED IS THAT KETAMINE IS
ABLE TO REMEDY THIS PROCESS.
IT IS ABLE TO TARGET KEY MOLECULES,
KEY NEUROCHEMISTRY THAT
INITIATES A CASCADE OF EVENTS
THAT CORRECT THIS PROBLEM NOT IN
TWO WEEKS NOT IN SIX WEEKS BUT
WITHIN HOURS.
AND THIS PROVIDED US THE IMPETUS
FOR THE U.S. GOVERNMENT TO
ACTUALLY DEVELOP KETAMINE FOR
DEPRESSION TO BEGIN STUDIES AND
DEMONSTRATE THAT IT WORKS AND
THE FDA IN THE UNITED STATES
DECLARED KETAMINE AND DEPRESSION
A BIG BREAKTHROUGH FOR PEOPLE
WHO HAVE DEPRESSION.

Nam asks,
CAN ANYONE QUALIFY FOR
TREATMENT WITH KETAMINE?

Dr. McIntyre states,
NOT AT ALL.
KETAMINE IS A DRUG THAT SHOULD
ONLY BE GIVEN UNDER SUPERVISION
OF HEALTH CARE PROFESSIONALS WHO
HAVE THE EXPERTISE NOT ONLY IN
MENTAL HEALTH BROADLY BUT MOOD
DISORDERS MORE NARROWLY AND ALSO
INDIVIDUALS WHO HAVE EXPERTISE
IN THE IMPLEMENTATION OF KETAMINE.
WHAT WE NEED TO REALLY EMPHASIZE
AS WELL IS THAT KETAMINE COMES IN
DIFFERENT FORMULATIONS IN
DIFFERENT DELIVERY METHODS.
NOW WHAT WE DO--

Nam interrupts,
WHY IS THAT IMPORTANT TO MENTION?

Dr. McIntyre continues,
WELL, BECAUSE WE KNOW THAT
KETAMINE HAS BEEN SHOWN TO BE
SAFE AND EFFECTIVE IN ONLY A
COUPLE OF FORMULATIONS AND
ROOTS.
NOT ALL FORMULATIONS AND
ROOTS HAVE BEEN SHOWN TO BE SAFE
AND OR EFFECTIVE.
FOR EXAMPLE INTRAVENOUS KETAMINE
HAS BEEN SHOWN TO BE EFFECTIVE
IN PEOPLE WITH TREATMENT
RESISTANT DEPRESSION.
SECONDLY, WHAT IS CALLED THE S
KETAMINE WHICH IS A PART OF
KETAMINE HAS ALSO BEEN SHOWN TO
BE EFFECTIVE AS AN INTRANASAL
DELIVERY. THERE'S EMERGING
EVIDENCE THAT ORAL KETAMINE
MIGHT BE HELPFUL ALTHOUGH THE
EVIDENCE IS STILL A WORK IN
PROGRESS BUT OTHER ROUTES OF
DELIVERY LIKE TOPICAL OR
INJECTION THOSE ARE STILL NOT
RECOMMENDED.
THE KEY POINT HERE IS IT SHOULD
ONLY BE GIVEN BY PEOPLE WITH
EXPERTISE IN DELIVERING THE
TREATMENT.
THE FINAL POINT AROUND THAT IS
NOT EVERYONE IS ELIGIBLE.
FOR NOW, THE PERSONS WHO ARE
ELIGIBLE ARE PEOPLE WHO JUST
HAVEN'T HAD A GOOD OUTCOME OF
CONVENTIONAL TREATMENT.
WE USUALLY LIMIT THAT TO TWO
PRIOR TREATMENTS AND MORE
RECENTLY IN THE UNITED STATES
THE U.S. FDA HAS UPDATED THE
MONOGRAPH OR ONE OF THE
FORMULATION OF KETAMINE TO
INCLUDE REDUCING SUICIDALITY.
SO THERE ARE VERY SPECIFIC
CRITERIA, SPECIFIC BONA FIDES AND
SKILL SETS PEOPLE SHOULD HAVE
AND VERY SPECIFIC PREMISES THAT
WE SHOULD BE IMPLEMENTING.

Nam asks,
SO ONCE IT IS DETERMINED
THAT SOMEONE QUALIFIES FOR THIS
TREATMENT CAN YOU WALK US
THROUGH WHAT THAT LOOKS LIKE?

Dr. McIntyre replies,
THE PERSON HAS TO BE ASSESSED
BY MENTAL HEALTH CARE PROVIDER
WITH EXPERTISE IN THE AREA. AND
ONCE THEY ARE DEEMED ELIGIBLE
AND THEY UNDERSTAND THE RISKS
AND BENEFITS, TYPICALLY WHAT WE
DO AT OUR CENTRE, THE CANADIAN
RAPID TREATMENT CENTRE IS WHAT
WE DO IS WE GIVE THEM BETWEEN
FOUR TO SIX INFUSIONS OVER A
PERIOD OF TWO TO THREE WEEKS
TYPICALLY. AND WHAT THEY DO THEY
COME TO THE TREATMENT CENTRE
THEY RECEIVE AN INFUSION JUST
SHY OF AN HOUR FORTY-FIVE
MINUTES OR SO AND THEN THEY HEAD
HOME WITH A LOVED ONE OR FAMILY
MEMBER.
SO, IT'S A BIT LIKE GOING FOR A
MEDICAL PROCEDURE SO TO SPEAK.
AFTER FOUR TO SIX TREATMENTS WE
THEN SIT DOWN AND TAKE I GUESS
YOU COULD SAY A TALLY WHERE ARE
WE.? HAVE WE HAD SOME BENEFIT?
IF THE BENEFIT IS THERE WHAT ARE
THE NEXT STEPS?
NOT EVERYONE BENEFITS.
NOT EVERYONE BENEFITS.
BUT MANY PEOPLE DO.
AND MUCH MORE THAN AS A
RESPONDING TO OUR DRUGS THAT
WE HAVE.
ON A SEPARATE NOTE BUT RELATED
PSYCHIATRY HAS HAD THE SAME
TYPE OF MEDICATION TO
TREAT DEPRESSION FOR SEVEN
DECADES.
THE MID-1950S WHEN WE HAD THE
FIRST OF THE SO-CALLED PROZAC
TYPE DRUGS FOR DEPRESSION.
AND WE HAVE REALLY BEEN IN A BIT
OF A CUL-DE-SAC QUITE FRANKLY.
SOME PEOPLE DO VERY WELL WITH
THESE MEDICINES BUT MOST PEOPLE
DON'T DO WELL ENOUGH.
SO, WE FELT THE CLARION CALL WAS
NOW. WE NEED TO DO THINGS
DIFFERENTLY.
PEOPLE WITH MENTAL ILLNESS
DESERVE TO HAVE THEIR HEALTH
BACK NOW.
AND SO WE SAID THIS IS A NEW
DIRECTION WE WILL TAKE.
IT DOESN'T HELP EVERYONE BUT
CERTAINLY HELPS MANY PEOPLE.
NOW FOR MOST PEOPLE WE SEE
WHAT WE HAVE ALSO ENCOURAGED
THEM IS TO CONSIDER
PSYCHOTHERAPY OR COUNSELLING.
THE BEST PRACTICES AND
DEPRESSION IS NOT JUST ABOUT
GIVING A MEDICINE; IT'S OFTEN
THE CASE THAT WE CAN IDENTIFY
SKILLS, IDENTIFY TACTICS AND
STRATEGIES TO IMPROVE OUR
QUALITY OF LIFE BY INTEGRATING
TALK THERAPY WITH KETAMINE.
THAT'S AFTER THE TREATMENT NOT
DURING.
YOU CAN'T REALLY MEANINGFULLY
ENGAGE PSYCHOTHERAPY IN THE
MOMENT WHILE YOU ARE GETTING
KETAMINE BUT IT'S AFTER THE
TREATMENT ONCE THEIR DEPRESSION
IS SIGNIFICANTLY IMPROVED.

Nam adds,
AND IF WE ARE WONDERING
WHAT IT FEELS LIKE ONE PATIENT
TO DESCRIBE THEIR EXPERIENCE
AFTER A SERIES OF KETAMINE
SESSIONS AS NOT A TEMPORARY
CHANGE BUT A SHIFT IN WHO I AM,
HOW I APPROACH THE WORLD AND MY
FEELINGS TOWARDS MY OWN
EMOTIONS.
DO WE UNDERSTAND WHAT IS
HAPPENING IN A PATIENT'S BRAIN
OR BODY THAT IS CREATING THIS
CHANGE?

Text reads, “Using ‘Party Drugs’ To Treat Depression. Resetting the Brain”

Dr. McIntyre replies,
IT'S A REALLY EXCITING NEW
DEVELOPMENT IN PSYCHIATRY.
WHAT WE HAVE NOW LEARNED IS IN
THE BRAIN OF PEOPLE WHO ARE
EXPERIENCING DEPRESSION THERE IS
SOMETHING THAT'S NOT QUITE RIGHT
WITH WHAT WE CALL THE FUNCTIONAL
CONNECTIVITY.
AS A METAPHOR THINK ABOUT THE
MOTHERBOARD ON YOUR PERSONAL
COMPUTER, YOUR PC. ITS A GROUP
OF NETWORKS AND CIRCUITS.
YOUR ENTERTAIN NO DIFFERENT.
THE BRAIN IS WIRED CONNECTED
THROUGH CIRCUITS AND NETWORKS.
IT IS THE BRAIN OF PEOPLE WITH
DEPRESSION THERE IS SOMETHING
WRONG WITH THE MICROANATOMY AS
WELL AS THE FUNCTIONAL
INTERACTION OF THESE CIRCUITS.
WHAT'S SO INTERESTING IS SOME OF
THESE CIRCUITS ARE RESPONSIBLE
FOR OUR ABILITY TO THINK
CLEARLY, OUR ABILITY TO LOOK
FORWARD TO THE FUTURE, OUR
ABILITY TO THINK POSITIVELY AND
TO ENGAGE OUR LIVES.
SOME OF THESE CIRCUITS WHICH IS
SO INTERESTING, HAVE BEEN THE KEY
TARGET OF KETAMINE AND RELATED
PRODUCTS.
AND WHAT'S SO INTERESTING IS IT'S
NOW BEEN SHOWN THAT WHEN YOU
BENEFIT FROM A TREATMENT LIKE
KETAMINE IN THE VERY NEAR TERM
THAT IS WITHIN A COUPLE OF
TREATMENTS THAT ABNORMAL BRAIN
CIRCUIT CONNECTIVITY RESETS.
A BIT LIKE RESETTING YOUR PC,
YOUR COMPUTER.
AND THEN THE PERSON WHO IS
EXPERIENCING DEPRESSION AT THE
SAME TIME SAYS YOU KNOW I FEEL
LESS DEPRESSED.
I FEEL LESS NEGATIVE.
I DON'T RUMINATE AS MUCH.
MY MIND IS MUCH MORE CLEAR.
SO IT REALLY IS ABOUT RESETTING
THE CIRCUITRY AND THE NETWORKS
THAT SUBSERVE THE SYMPTOMS
OF DEPRESSION.
WE DIDN'T HAVE THIS TECHNOLOGY
TWENTY YEARS AGO. THE MRIS,
THE TYPE OF IMAGING CAPABILITY
WE HAVE TO SUS ALL THIS OUT.
IT'S NOT ONLY INFORMED THE
ACADEMIC'S UNDERSTANDING BUT
INFORMING NEW TREATMENTS.
WE ARE LOOKING AT OTHER NEW
TREATMENTS THAT ALSO CAN REACH
RESET THESE CIRCUITS IN
A RAPID WAY.

Nam responds,
FOR PEOPLE LIVING WITH DEPRESSION
AND ANXIETY DAY-TO-DAY
EVENTS ARE VERY CHALLENGING.
AND HERE’S A METAPHOR FROM
NUEROSCIENTIST MENDEL KAELIN
EXPLAINING HOW
PSYCHEDELICS CAN HELP PEOPLE
WITH DEPRESSION AND MENTAL
SUFFERING. HE DESCRIBES:

Text reads, “Stuck in Patterns of Painful Thought. Think of the brain as a hill covered in snow, and thoughts of a sled gliding down that hill. As one sled after another goes down the hill a small number of main trails will appear in the snow. And every time a new sled goes down, it will be drawn into preexisting trails almost like a magnet. In time, it becomes more and more difficult to glide down the hill or any other path or in a different direction.
Think of psychedelics as temporarily flattening the snow. The deeply worn trails disappear, and suddenly the sled can go in other directions, exploring new landscapes, and, literally, creating new pathways.”

Nam asks,
IS IT A FEELING THAT KETAMINE
CAN ALSO HELP THOSE SUFFERING
FROM DEPRESSION GET OUT OF
THOSE WELL-WORN TRAILS?

Dr. McIntyre responds,
THAT WAS SO BEAUTIFULLY
WRITTEN BY THE AUTHOR AND REALLY
RESONATES BECAUSE WHAT I HAVE
HEARD OVER TWENTY YEARS FROM
PEOPLE WHO SUFFER FROM
DEPRESSION THOUSANDS AND
THOUSANDS OF PEOPLE THAT I HAVE
MET IS EXACTLY WHAT THAT AUTHOR
WAS GETTING AT.
PEOPLE ARE STUCK IN THIS REEL,
THIS RUMINATION, THIS
NEGATIVISTIC REEL, THIS VICIOUS
CYCLE THAT THEY JUST CAN'T SEEM
TO BREAK AND THEY FEEL VERY
HELPLESS.
THEY FEEL VERY HOPELESS ABOUT
THAT.
AND WHAT WE HAVE NOW LEARNED
IS THAT'S NOT JUST SOME
PSYCHOLOGICAL PHENOMENON.
THAT IS THE RESULT OF THE
ABNORMALITY. SOMETHING WRONG
IN THAT BRAIN CIRCUIT THAT YOU
AND I DEPEND ON TO CONTROL OUR
THOUGHTS, TO HAVE EXECUTIVE
CONTROL OF OUR THOUGHTS.
WHAT WE CALL IN THE BUSINESS
COGNITIVE FLEXIBILITY. AND
WHAT HAPPENS WHEN YOU TAKE
KETAMINE IN THE NEAR TERM YOU
GET A CORRECTION OF THE CIRCUIT
AND THE PERSON FEELS A GREATER
SENSE OF AGENCY A GREATER SENSE
OF CONTROL OVER THAT COGNITIVE
FLEXIBILITY. SO WE ALWAYS HAVE--
EVERYONE HAS NEGATIVE THOUGHTS
BUT WHEN YOU HAVE THE ABILITY TO
TURN IT OFF.
WE HAVE THE ABILITY TO ENGAGE
OTHER WAYS OF THINKING AND
RELATING AND THAT VERY HUMAN
FUNCTION IS IMPAIRED IN DEPRESSION
AND WHAT HAPPENS WHEN YOU GIVE
PEOPLE KETAMINE THEY GAIN THAT
CONTROL. A SENSE OF AUTONOMY
OVER THEIR THINKING AND WE HEAR
THIS REPEATEDLY FROM PEOPLE.
SO, I THINK THAT IS THE CASE.
MOREOVER, THAT'S NOT JUST HELPING
PEOPLE IN THE NEAR TERM GETTING
DEPRESSION LIFTED BUT ALSO IT
HELPS TO ENGAGE IN
PSYCHOTHERAPY, ENGAGE IN THEIR
LIVES. IT'S OBVIOUSLY VERY
DIFFICULT TO ENGAGE IN
YOUR LIFE IF YOU ARE HELD RANSOM
TO THIS VERY NEGATIVISTIC
PROCESS.
MEDICATIONS FOR DEPRESSION ARE
NOT HAPPY PILLS BUT WHAT THEY DO
IS RESET THE CIRCUITS AND THE
NETWORKS WHICH ALLOWS THE
INDIVIDUAL TO THEN ENGAGE OTHER
PARTS OF THE BRAIN THIS THEY
WOULD NEED TO ENGAGE TO
HAVE A MORE POSITIVE, MORE
VIRTUOUS CYCLE GOING FORWARD.

Nam states,
IN OUR FINAL MINUTE HERE,
I STILL REMEMBER
WATCHING A VIDEO IN HIGH SCHOOL
THIS IS YOUR BRAIN, THIS IS YOUR
BRAIN ON DRUGS AND WE WERE TOLD
DRUGS LIKE KETAMINE OR MDMA OR
PSYCHEDELICS COULD RUIN YOUR
LIFE. NOW THEY ARE BEING USED IN
CLINICAL SETTINGS TO POTENTIALLY
SAVE LIVES.
HOW SHOULD WE UNDERSTAND THIS
SHIFT TOWARD USING THINGS LIKE
MDMA AND PSYCHEDELICS TO
HELP US TO BE WELL?

Text reads, “Using ‘Party Drugs’ To Treat Depression. This is Your Brain on Drugs 2.0”

Dr. McIntyre replies,
I THINK THE MESSAGE IS THAT
EVERY DRUG IS POTENTIALLY
HARMFUL. IN FACT,
PLACEBO IS POTENTIALLY HARMFUL.
I CRINGE WHEN I HEAR PEOPLE SAY
TO ME OH, THERE IS THIS NEW
MEDICATION FOR SUCH AND SUCH.
IT HAS NO SIDE EFFECTS.
THAT'S INTERESTING PLACEBO HAS
RATE OF SIDE-EFFECTS APPROACHING
50 TO 75%. HOW IS IT SO MAGICAL.
EVERYTHING HAS SIDE EFFECTS,
EVERYTHING HAS SAFETY CONCERNS.
AND THE FIRST JOB OF MEDICINES IS
DON'T HURT ANYBODY.
OUR JOB IN CLINICAL MEDICINE AND
CLINICAL RESEARCH IS TO FIND OUT
WHETHER THERE IS A BENEFIT THAT
CAN OVERSHADOW THE RISK WHEN
IMPLEMENTED UNDER APPROPRIATE
CIRCUMSTANCES.
SO I STRONGLY RECOMMEND PEOPLE
DON'T USE KETAMINE FOR
DEPRESSION UNLESS THEY ARE
TAKING IT AT A CENTRE THAT
SPECIALIZED IN DOING IT.
THAT BEING SAID, WE KNOW THAT
MANY DRUGS HAVE HAZARDS AND
DRUGS LIKE KETAMINE DOES HAVE
HAZARDS IF IT'S NOT USED
ACCORDINGLY.
YOU RECEIVE SAGE ADVICE AT YOUR
SCHOOL.
OBVIOUSLY, YOU WENT TO A GOOD
SCHOOL AND YOUR SCHOOL GAVE YOU
GREAT ADVICE.
THAT ADVICE STILL STICKS.
BUT THE TAKE-AWAY IS IS THERE A
BENEFIT THAT CAN OVERSHADOW THE
RISK AND FOR EACH INDIVIDUAL
PATIENT THAT THE DIFFERENT
CALCULATION.

Nam says,
DR.MCINTYRE, THANK YOU FOR
SPENDING TIME WITH US.
WE APPRECIATE YOUR INSIGHTS ON
THIS TOPIC.

Dr. McIntyre responds,
GREAT TO BE WITH YOU. THANK YOU.

Text reads, “Using ‘Party Drugs’ To Treat Depression. Produced by: Eric Bombicino @ebombicino”

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