My name is Lily Maddon and I'm a proud Arunda Bungelung Cargoton woman from Gadighl country. The Daily oz acknowledges that this podcast is recorded on the lands of the Gadighl people and pays respect to all Aboriginal and Torres Strait Island and nations. We pay our respects to the first peoples of these countries, both past and present.
Good morning and welcome to the Daily OS. It's Thursday, the nineteenth of October. I'm Zara, I'm Emma Gillespie.
I'm the deputy editor here at the Daily OS.
You might have noticed that we are changing up the regular lineup a bit. There has been a bit of flux in the TDA office with a few people taking leave at the same time. But I'm so glad to be joined by m today again. What are we talking about today?
Very happy to be here today because we've got a really interesting one to discuss. We're talking about a new treatment option for depression that's been popping up around the country in clinics.
The Royal Melbourne Hospital recently own opened the third public clinic in the country to offer kenemine treatment for patients with what's called treatment resistant depression. Now that's a type of depression that doesn't respond to antidepressant medication or other treatments.
Yep. So I'm chatting with Black Dog Institute researcher doctor Adam Bayes to understand what that means and how it all works next.
But first, m here's what's making headlines. US President Joe Biden has met with Israeli PM Benjamin Manetta Yahu in Tel Aviv after arriving in the country last night. A meeting with Palestinian Authority President Mahmurabas set to take place today, was canceled after hundreds of Palestinians were killed when a rocket hit a hospital in Gaza. Garz In Health Authority said the blast was caused by an Israeli air strike, while the Israeli Defense Forces blamed it on a misfire
by a group called Palestinian Islamic Jihad. On this and I quote, Biden said, based on the information we've seen to date, it appears the result of an errant rocket fired by a terrorist group from Gaza. Biden also announced one hundred million US dollars for humanitarian aid in Gaza and the West Bank.
Non fatal strangulation would become a standalone offense under new legislation tabled in Victoria on Wednesday. Intentional non fatal strangulation without proof of injury could result in up to five years imprisonment, which would rise to ten years for more serious offenses. The reforms have been tabled to protect victim survivors and hold perpetrators to account.
New laws to increase paid parental leave will be tabled in federal Parliament today. Under the proposal, paid parental leave would increase to twenty six weeks in July twenty twenty six, with incremental increases to parental leave in the years leading up to that point. The reforms were first announced by the government last year to raise paid parental leave from
eighteen weeks. New parents will also be allowed to take four weeks of concurrent leave, meaning both parents can go on paid leave at the same time from twenty twenty six. The government says it will send a strong signal that both parents play a role in caring for their children. And the good news the soccer rows have won something I had never yet heard before, the soccer ashes. It follows a two nil victory against New Zealand in London.
The Soccer Ashes is a trophy containing the ashes of cigars smoked by the captains of Australia and New Zealand after a match in nineteen twenty three. The trophy disappeared in nineteen fifty four and was rediscovered in a suburban garage earlier this year. While this story took quite the turn, the soccer Us will play their next match in Melbourne in one month. Ketamine is commonly used in medicine and
by vets as an anesthetic. It's a disassociative drug, meaning it acts on brain chemicals and it can stop the brain from interpreting pain messages. Now it's also being used to treat depression, after low doses of the drug were found to quickly and significantly improve depressive symptoms.
We know a lot of young people, a lot of TDA listeners live with depression, but for some people traditional treatment options like antidepressants therapy that doesn't always actually work. So for those people and others who might not be able to take antidepressant medication for other reasons, ketymine treatment could actually change the way mental ill health is treated
in Australia. But honestly, I had never actually heard of ketamine being used in this way before this point Zza, so you can imagine I had a lot of questions and I put those to an expert in this field. Dr Adam Bays is a Senior Research Fellow at the Black Talk Institute. He is a clinical academic psychiatrist with a special interest in mood disorders. Dr Adam Bays, Welcome to the podcast.
Thanks for having me.
First of all, what is ketamine and why is it useful in clinical settings to treat depression.
Petamine is a anesthetic drug that's been around for a long time. About twenty years ago, there was some pivotal studies where there was sub aesthetic doses ketamine, so smaller doses administered to patients with treatment resistant depression. So this is where patients have failed multiple trials or standard treatments oral antidepressant psychological therapies, and it was found to have both a rapid antidepressant effect and also the effect was
quite pronounced, so quite a large impact on depression. And since that time, there's been more and more research into the area of ketamine for treatment resistant depression, and it's been found to be very effective in that patient group.
What do we know about the scale of treatment resistant depression? You know, what is it that we understand about it?
Obviously, you know depression, it's a complex diagnosis and there's different sort of manifestations of depression. So there's more mild forms of depression that might be the result of life circumstances, and then all the way through to the more severe biological forms of depression where there might be a strong family history of depression. It starts need to use medications like antidepressants or other drugs, and in the severe cases, things like electroc convulsive therapy or ECT is still a
highly effective treatment. And it's probably around about a third of patients specified as having treatment resistant depression, so it's quite a high number.
Yeah, that's a really significant number. I think that will come as a surprise to a fair few of our listeners. In terms of treatment options for this difficult to treat depression, are there many options? And you've mentioned DCT, but considering that ketamine treatment is a relatively new kind of phenomenon.
There have been exciting advancements also in neurosimulations, so things like transcranial magnetic stimulation or TMS, which is very powerful magnets brought close to the skull. But ketamine is exciting in the sense that in mental health it's good to have an assortment of different options. Yeah, it just gives yet another option to get well.
A lot of.
People may have only heard of ketamine used illegally or as an anesthetic. How does this treatment work, how long does it take, and how does it differ in that clinical setting from other uses of ketamine.
We would have heard of people recreationally using ketamine, and this is because it can cause that dissociative effects and have these sort of psychoactive effects. But I guess I'm talking about it very much in a clinical medical setting, where the drug is one hundred percent pure pharmaceutical grade ketamine and it's diministered in a setting and patients are carefully screened. Patients are usually on an antidepressant as well.
It can be administered in various ways. It's either usually injected under medical supervision, or there is a form called sketamine which is intranasal spray. So the ketamine tends to have its maximal antidepressant effect the next day, and then it does tend to wear off, and so patients then have usually a second treatment. At least in the acute course, you're trying to get the patient from being in a
major depressive episode. The goal is to get them into remission where they're not no longer meeting criteria for depression. It works quite differently to standard antidepressant treatments like you know, your SSRIs or Prozac as the brand name of a famous SSRI, and these act on the serotonin system. This is the kind of feel good neurotransmitter. Ketemine actually doesn't act at least directly on serotonin, but it actually acts
on a completely different set of receptors. And I guess the other thing is, yes, it works much more rapidly than standard oral antidepressants. At least in some cases, you can see patients significantly improved the next day. So that's pretty incredible. And I think sometimes people think that the patient might be sort of getting high, it's not that.
So while they have the acute effects of ketamine and they might feel dissociated and have some kind of an unusual experience that wears off within the first hour, and they usually discharged the two hour mark and they feel completely back to you know, they don't have any kind of association, but we're talking about it's actually an antidepressant effect that's more enduring.
How is the long term or longer term success then of this treatment measured. If there's that sort of immediate relief of maybe depressive symptoms, is this a treatment that is life long for people with treatment resistant depression.
Yeah, it's a great question. I think Initially there was certainly hope that patients might, say, receive a course of ketamines, to say, a four week course for example, then they'll remain well. Certainly you do see that in some patients. Clinically, though, what we're seeing is some patients go into what we call maintenance treatments, and this might mean that they have a treatment, say every week, or maybe stretched out to every two or three weeks, which keeps them well.
As can happen with other medications. Is there a dependency over time or a resistance perhaps over time to ketamine treatment.
You can't become addicted as such to a surprise act, right ketamine. That is actually possible. While we don't tend to see that in clinical settings, it's something to be mindful of, and that's why it's also a restricted substance. We're very cautious about that because we're not wanting to create a further problem for the patient. We put a lot of time into ensuring they're not becoming dependent. It's also why ketamine is administered in the clinic.
Are there any other risks or sort of safety concerns associated with receiving the treatment?
Yeah, look there are, and I think like any medication you know, has a side effect profile, and keta means no different. So some of the key things that we monitor for. There can be blood pressure increases, certainly acutely as well. Patients you can become dissociated, unsteady on their fee. Then in the long run I mentioned risk of dependence. Ketamine can irritate the bladder and sometimes ketamine can affect
the liver. You know, ketamine services that are out there, they should be monitoring for accus and cumulative cyber effects.
I noted that at least in the clinic that recently opened in Melbourne, that young people are excluded under twenty fives are excluded from accessing the treatment. I guess this ties into kind of broader questions about barriers to access, you know, cost, who can access it, so you know the kind of demand versus that.
I mean generally it's eighteen and over purely because there's more data on the safety and effectiveness in that age group. I know that there has been a big multisensor study looking at ketamine and younger people that have depression. You mentioned cost. It's a big one because ketamine is it's sort of in this interesting zone where it's you've got the two formulations. The anesthetic who's been around for fifty years or Medica have a kind of license and they
have indication. It still remains only licensed for anesthesia. If it's administered for anything other than anesthesia, it's it's off label. Then there's the new formulation, which is intranasal s ketamine, so it's a variant of ketamine. But that has been TGA approved in Australia. But the issue is it's not covered by the PBS yet. There's a period of time where the drug companies have to make a case to
the government, you know, will you subsidize this drug. So patients can certainly go out and you know, they see their psychiatrist. Their psychiatrists might recommend the internasales ketamine, but it's anywhere between six to eight hundred dollars per dose.
Wow.
So and the usual dosing, as I said, is twice per week initially for the first four weeks. So that's that's a big cost, right ENRMS. That's sixteen hundred dollars or more per week per week, and that's because it's not on the PBS. The other thing is when you go and see a doctor, most things have an item So for example, if you go and have your appendix removed, there'd be a sort of item number. Medicare reimburses you
or covers that. Right. So for ketamine treatment, which as I explained, you know it involves coming in to the clinic there, you monitored, you've seen by a psychiatrists. Is two hours of monitoring, and you discharge. There's no item number for that, not just the drug, but for the whole process. There's no item number. So again, all of that clinical time is paid for out of pocket by
the patient. So at the moment we are in a situation where, other than there's a few public clinics where it's sort of subsidized by whatever funds the hospital might have, the patient pays out of.
Pocket waiting for that magic number.
Yeah, it's a big issue really because you know, it speaks to you know, inequality and equity, and particularly I guess younger people are less likely to have the funds.
Do you think there's any stigma associated with the idea or the reputation of ketamine that may have impacted access.
I think there is some stigma in the sense of certainly, whenever I read a newspaper article, or at least up until a few years ago, it would always say horse tranquilizer, which is I always found a bit sensationalist because ketamine is used as a regular anesthetic in human It was.
Only researching for this podcast that I realized that horse tranquilizer wasn't the original purpose.
It's a bit sensationalist. And whereas ketamine is used day in, day out in surgeries, it's used in children for the purposes of anesthesia, I guess the recreational use, et cetera. It has become a bit more controversial. But you know, it's a medicine like any other medications, and if you just look at the science, it does seem to be effective in treatment resistant depression. But if you get opioids and things like that, pain medications are misused, So any
drug really can be misused. But I think the key thing is for us in mental health is providing access to it in such a way that's safe. It's in a controlled setting, it's not going to be diversion to recreation users, and it's not going to cause further problems for patients.
Your colleague, Professor Colleen lou She described accessibility to be the next challenge for the treatment. Where do you see ketamine treatment moving in Australia in the next five to ten years.
Yeah, that's an excellent question. Look, I think the accessibility question really it's getting this MBS item number. The Medicare item number is going to be critical. If that gets up, that will mean a broader section of the community can access the treatment. I imagine it will become rolled out into public mental health. Obviously, there need to be an infrastructure there and all the appropriate training and all the
knowledge that goes into this. Because it is quite a specialized treatment, it will become more mainstream for treatment resistant depression. There is enough data now to say that it's effective and safe. I think it'll be also getting it out into regional senses as well. That'll be exciting to see it rolled out and available to more people.
I think that was a really interesting chat. I know I learned a lot from it. If you did, too, send it to a friend. It might be a conversation starter. You never know. Have a great day, and we'll be back again tomorrow