Hello and welcome to Health Professional Radio. I’m your host Neal Howard, glad that you could join us here today. Depression affects 16 million Americans. Now 1 in 6 of those Americans takes a psychiatric drug, one-third don’t respond to treatment. Our guest is here to talk with us about Ketamine as an alternative. Welcome to the program Dr. Steve Levine. Thank you so much for having me. I know you’re a board-certified psychiatrist and also the Founder of Actify Neurotherapies. Talk about your background for just a minute. I love to. Thank you. So yes, I’m a psychiatrist by training and actually, a pretty traditional one. My training really focused on being a psychotherapist first and a medication prescriber second. So when I started in private practice all over a decade ago, most of what I was doing, most of how I was spending my time was the traditional 50-minute therapy hour. But as a prescribing physician and psychiatrist, I was of course writing prescriptions sometimes but I really was not very thrilled, I wasn’t too proud of our menu of options because the number that you cited, one-third of people who receive treatment for depression are going to have any response with traditional antidepressants. And with some of the quote unquote newer medicines that have come out over the past decade or two, they’re really not particularly new, they’re either just rewarmed, reworked versions of the same old thing and those are medicines like the SSRIs like Prozac or they are repurposed medicines, things used typically for conditions like schizophrenia, they’re antipsychotic medicines that are now being used for depression. Beyond that, options really are things like “Electroconvulsive Therapy”, ECT which while I’m a proponent of it, it’s a very effective treatment, can be a pretty difficult thing for people to accept, it can be a very intimidating procedure. So that’s the mindset I was in and I can go into the story during this interview but the short version is that my attention was drawn to research at that time on the use of the very old medicine, Ketamine which was developed in the early 60s as a general anesthetic. But this research which started in earnest in the mid 90s at Yale was using small fractional doses of Ketamine which is a medicine that was developed in the first place to be the safe one because it has this remarkable safety profile. So these studies were using a small fractional dose of this very safe medicine and folks who were quite ill who had had severe depression for decades and had tried countless treatments beforehand were having very strong responses by both their own and the clinicians, the researchers’ measures within hours of a single exposure. And this made a big impact on me and maybe I wonder why aren’t we using this and so that was start of pushing me towards taking a different direction in my career and starting to use this medicine given as an intravenous procedure clinically and it was seeing the remarkable results of that that caused me to then further develop this practice and to Actify Neurotherapies which is now 10 locations from coast to coast. Are you treating any other symptoms, antisocial types disorders? The first studies were specifically for depression both unipolar major depression, what most people is typically called “Depression” as well as bipolar depression, the depressed phase of bipolar disorder. But since then, there’s been more research for other indications and that is Post-Traumatic Stress Disorder or PTSD, Obsessive-Compulsive Disorder OCD, the specific symptom of suicidal thinking regardless of the other diagnosis. Ketamine is really a wonderful anti suicide drug which is probably something to spend a moment on because for all the other treatments we have available for depression or for anxiety disorders, they take a long time to work and they also don’t necessarily specifically treat suicides. And so it’s really a unique and special and important thing that here we have a medicine that can potentially work so quickly again specifically against the symptom like suicidal thinking where of course every minute counts. As far as suicidal thinking and working as fast as you say that it does, what do you think was the biggest barrier to awareness other than not running the studies? What was it that made it from the 60s till here recently in using Ketamine as an alternative? The lag and time itself isn’t necessarily unusual. Most medicines that we have truly has many possible applications and so for any given medicine, that’s FDA-approved for one indication, there’s probably 9 more that we’re not using it for. So that’s not that unusual. People started talking about the potential antidepressant properties of Ketamine as of the 70s and so why the lag from then until the 90s probably a few things, number one that was really the time when the field was moving towards the Serotonin affecting medicines and this this really flawed hypothesis is depression which is the “Monoamine Hypothesis” with the chemical imbalance theory which really doesn’t hold any water. But that’s where the field was going and so they developed the MAIOs and the Tricyclic Antidepressants and hen the SSRIs and now these newer designer SSRIs. So that’s really where all the research went where all the dollars went. With Ketamine first of all, it’s always had an interesting patent history. This is actually a lot of lore around that and it really shaped, it shaped how people consult for the pharmaceutical industry because the guy who originally synthesized it actually stole the patent and the company to buy it back for him. So the ownership of the rights to Ketamine have long been murky and then in the past few decades, it’s just been cheap and generic anyway. And so nobody’s really had a big financial interest in pursuing it. So now that this awareness is being raised, what about the cost-effectiveness for the patient themselves? It depends how you look at it. Right now because it’s an off-label use of the medicine meaning it’s FDA-approved for one indication but we are using it for another that’s evidence-based but not FDA-approved. Because of that, most insurance companies don’t pay for this treatment directly. There are some that are starting to very interestingly Kaiser Permanente which has a huge presence on the West Coast in Northern California now offers this to their members in 8 locations. So there is some precedent set for direct reimbursement but if it’s not directly covered out-of-pocket for a patient, it can be expensive. For a payer relative to what they pay for other treatments, it’s actually quite cost effective and that’s why insurers are starting to look at this more closely and consider covering it. But an interesting thing that’s happening in parallel is that the pharmaceutical industry has really started to notice this and they’re realizing that there’s only so long that people are going to tolerate a lack of innovation and treatments that take too long and have too many unacceptable side effects. And so it’s actually had a huge impact on research and development because there are now multiple products and a good percentage of the entire pipeline for depression treatment that is now focused on creating new products, new drugs that share properties with Ketamine. They’re trying to make the new Ketamine. Now, we’d like to get some more information about your practice and about the use of Ketamine as an alternative antidepressant. Where can we go online and get some more information about what you do? You can go to our website, it’s www.actifyneuro.com for an independent source of information, from an advocacy group there’s the Ketamine Advocacy Network, they’re also a great source of information. Dr. Steve Levine, it’s been a pleasure talking with you today. I’m hoping you’ll come back and give it some more information as things progressed with Ketamine. It’s my pleasure. Thank you Neal. You’ve been listening to Health Professional Radio. I’m your host Neal Howard. 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