Healthy Skepticism Can Be A Good Thing

I’m all for new breakthroughs in medical and psychiatric assessments and treatments, but I’d like to point out the need for caution and a little healthy skepticism about the level of enthusiasm for a couple of them. It’s just another way of asking ourselves if we want the truth or something beautiful.

The headline is encouraging, “More data back use of ketamine for refractory depression”, published in the June issue of Clinical Psychiatry News [1]. But the rest of the story is at link Ketamine produces quick antidepressant effect : Clinical Psychiatry News, where the study author Dr. James W. Murrough, himself says,

“Dr. Murrough acknowledged that some psychiatrists use ketamine off label for some patients with severe, refractory depression. His institution does not do so outside of trials and ‘we don’t recommend it’,” Dr. Murrough explained.” His institution could benefit financially if ketamine were approved for treatment of depression.

He also said, “Ketamine is not approved to treat depression, and it’s premature to say that it should be…” “Data are needed on the efficacy and safety of taking ketamine over time, among other research questions…”

And Dr. Carlos Zarate, MD, who does a lot of research on ketamine (and by the way is a coinventor on a patent application for using ketamine in major depression), says that the patients used in many of the studies “…differ significantly from ‘real world’ patients, who are often on complex medications regimens and have multiple psychiatric comorbidities.” Moreover, patient with unstable medical illnesses or recent substance dependence were excluded from the studies [2].

These are the patients I see in the real world.

In addition, repeated use of ketamine can be problematic because of the potential for abuse and “…its long-term effects on cognition.”

Both authors see the real value of ketamine as the elucidation of its mechanism of action and looking ahead on how this could help us produce safer, more effective antidepressants and anti-suicide agents. Despite their potential conflicts of interest, I think I would give them credit for their candor and caution.

And I got an email news feed from Psychiatric News about another new development, the FDA approval of the first medical device based on brain function to help assess attention-deficit/hyperactivity disorder (ADHD). The device is the Neuropsychiatric EEG-Based Assessment Aid (NEBA) System, which is based on EEG technology. It’s a non-invasive 15-20 minute test that calculates the ratio of two standard brain-wave frequencies, theta and beta waves, which has been shown to be higher in kids with ADHD than in those without it, according to the FDA, Psychiatric News Alert: FDA Approves Device to Help Diagnose ADHD in Children.

However, Child Psychiatrist Louis Kraus, MD, cautioned that the device can’t substitute for a careful clinical assessment by a physician. He says, “There is no one specific test that can make the diagnosis of ADHD.”

I wonder if someone or some institution could make a lot of money from the NEBA System. A little skepticism can be healthy.

References:

1. Boschert, S. (2013). More data back use of ketamine for refractory depression. Clinical Psychiatry News, IMNG Medical Media. 41.

2. Mathews, D. C. and C. A. Zarate, Jr. (2013). “Current status of ketamine and related compounds for depression.” J Clin Psychiatry 74(5): 516-517.

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