Australia’s largest trial for depression treatment receives government grant

A $2.1 million grant from the federal government will pave the way to Australia’s largest clinical trial of ketamine as a new cure for major depression.

The pioneering study, led by the University of New South Wales (UNSW) builds on five years of research showing that a single dose of ketamine can reduce depressive symptoms within hours, even in treatment-resistant patients.

“The trial will allow us to examine whether the positive effects of ketamine on an individual’s depression are sustained over a longer period, using the gold standard approach for research, a randomised control trial,” according to lead researcher Professor Colleen Loo, from UNSW’s School of Psychiatry and the Black Dog Institute.

In order to determine the safety and effects of ketamine, the UNSW team will involve 200 patients who have not responded to existing medications over a four-week period. The trial recruitment is expected to start around April 2016.

According to the UNSW team, ketamine targets a key signalling chemical in the brain known as glutamate. This contrasts with other antidepressant medications, which alter different brain neurotransmitters such as serotonin and noradrenaline. Researchers believe this may be why the effects of ketamine appear distinct to those of other antidepressant drugs and is faster acting and results in more powerful effects. Earlier studies have shown that ketamine can strongly promote the growth and functioning of brain cells.

However, ketamine produces disorienting or dissociative side effects, such as out-of-body experiences, a sense of intoxication or seeing psychedelic lights, accounting for its use as a recreational drug. These effects are short lived, typically lasting half an hour after each treatment, while the beneficial mood effects persist for days.

In earlier studies conducted at the Wesley Hospital in Sydney, Loo and the researchers found that dose levels are very important in determining effectiveness and side effects, and that a more tailored approach to dosing for individual patients is important. They also discovered that the intravenous delivery of ketamine over 40 minutes, which has been used in most other trials, is not likely to be the best treatment method.

“We will continue to work very closely with clinical pharmacologists during this trial to understand the specific dosage required for each individual and the likely effects it will have,” Loo said.

In addition to depression treatment, the UNSW research team will also study the potential for ketamine to rapidly remove suicidal thoughts due to rapid improvements in mood within hours of treatment.

The UNSW research team will collaborate with The Black Dog Institute, The George Institute and mood disorders experts from around Australia including Sydney, Monash, Deakin, Western Australia and Adelaide universities, along with the University of Otago in New Zealand.

The grant received by UNSW forms part of a $630 million investment announced by the National Health and Medical Research Council, which will support more than 800 projects to find the next prevention of disease or cure around Australia.

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