Ideal antidepressant medication should act quickly, cause fewer side effects and should treat almost all depressive patients with similar efficacy. But current antidepressants are far cry from above ideals.
Antidepressants medications are the most common way to treat depression. Unfortunately around 60% of patients are considered to have resistant depression and antidepressants have delayed action. These patients suffer from depressive symptoms even with medications. One of the reasons for this situation is that scientists and doctors do not exactly know the mechanism of depression in the human brain.
Most of the antidepressants currently in use are developed from molecules identified purely due to chance. For an example imipramine (Tofranil) is the first antidepressant developed. It was identified as having anti-depressant properties purely due to chance and brilliant observation of Roland Kuhn. Imipramine was first tried in patients with schizophrenia. But there was no effect on most of the patients. But a subgroup of patients who had depressive symptoms improved with this medication. It was noted by Kuhn and further studies were performed.
In fact, almost all the antidepressants currently in use have similar efficacy to imipramine. Newer antidepressants have improved tolerability and reduced side effects profile, but without any improved efficacy.
In addition, all the antidepressants have to be taken more than one week to get the antidepressant effect. This is one of the major drawbacks in current antidepressant medications.
Newer rapid acting antidepressant medication
Ketamine is a widely used anesthetic medication. In addition, it is a drug of abuse and in streets it is known as Special K. It was known to cause hallucinations and various psychiatric manifestations. In addition, Ketamine is a powerful Glutamate agonist in the brain.
Now growing clinical trial data suggest Ketamin has quick antidepressant effect. In fact it treats depression within 72 hours. In addition, it seems to be effective against resistant depression that is not responding to medications and ECT (Electro convulsive therapy). But Ketamine is used only in expert centers.
This effect of Ketamine opens a new door to the identifying true mechanism behind depression. When it is identified, newer antidepressants can be developed with very quick action, efficacy and fewer side effects profile.