BIRDMAN
“Mike Shiner: A man becomes a critic when he cannot be an artist, the same way that a man becomes an informer when he cannot be a soldier.”
INTRODUCTION:
Depression takes on many forms. Unlike unipolar
depression, current antidepressant treatments and medication for bipolar depression [part of a larger condition known as bipolar disorder] are less effective and fail to properly treat depressive episodes patients with bipolar disorder experience. Roughly 1/4th of individuals who
are diagnosed with bipolar disorder have attempted at least one suicide attempt
within their lifetime. Bipolar disorder is a chronic illness that affects
the brain chemistry, causing extreme mood swings that vary in periods of time.
Symptoms
differ depending on the type of episode [Manic Episodes, “the Highs” or
Depressive Episodes, “the Lows”]. During
manic episodes [“the Highs”] individual has feelings of euphoria, abnormal
excitement, or elevated mood. Excessive talking, sleeping less than normal
amount, energetic and even feelings of agitation. They also tend to engage in
risky behavior [i.e. lavish spending, impulsive sexual encounters, or
ill-advised business decisions]. Decreased interest in activities once enjoyed,
loss of energy, difficultly sleeping [too much or very little], changes in
appetite, thoughts of death or suicide, and difficulty concentrating,
remembering, or making decisions is known as a depressive episode [“the Lows”].
[D]
Bipolar disorder [or
Manic Depression] affects 12.3 million people in the US alone and 60 million
people worldwide. Half of all patients begin seeing symptoms between the ages
of 15 and 25, but it can begin at any age. People with bipolar disorder often
also have other mental health disorders. Some people may experience mood swings
that are less extreme than a full manic episode, known as hypomania. Although
there is no cure for bipolar disorder, it’s symptoms can be controlled with a
combination of varied combination of approaches. Effective treatment plans
include medication, talk therapy/counseling, better knowledge of the condition,
and self-care strategies. [D]
The study- published in Bipolar Disorders Journal- discovered that Ketamine-
an anesthetic drug- rapidly relieves the symptoms of depression. Thoughts of
suicide in patients with bipolar disorder declined significantly within 24
hours following treatment with ketamine. With Ketamine available and continuing
research could possibly help these individuals with bouts of suicide. Although
it’s side effects include hallucinations, dissociation (a feeling of being
outside of one’s body), and is potentially addictive; researchers are using
Ketamine as a stepping stone for clues that could lead to better treatments.[D]
BACKGROUND
INFORMATION:
In the last decade, ketamine, in low doses, has been used to help people
suffering from major depression, bipolar depression, postpartum depression,
generalized anxiety, OCD, PTSD and even acutely suicidal thoughts in a matter
of hours as opposed to months. Ketamine is used to treat Major Depressive
Disorder and to alleviate depressive symptoms caused by bipolar depression.
Ketamine is a medication that was originally developed in the 1960s as a
general anesthetic. A medication with anti-suicidal properties is ketamine
(given intravenously). [C]
Before Ketamine was discovered in the 1960s, there was Lithium [medication
that has been found to be useful in dissolving uric acid crystals and later
used to treat bipolar disorder- mania and depression- since the 1800s]. It was
in 1949 when a study lead by John Cade, an Australian psychiatrist, published
his results in treating guinea pigs with lithium calmed the animals down. These
findings led to the FDA approving Lithium for the acute treatment of bipolar
disorder (mania) in 1970 and maintenance therapy. [C]
Lithium is often used by psychiatrists for their patients because of its antidepressant
properties which help their antidepressant medications work more effectively.
Lithium is the only one of two oral medications on the market available today
that have anti-suicidal properties. Patients taking Lithium should be monitored
carefully for normal thyroid and kidney function because this medication has
been known to affect these organs. Lithium and ketamine can be taken at the
same time. There is also some overlap in cell signaling pathways between
lithium and ketamine and due to this reason, there have been some theories that
this combination may increase the effectiveness of response to ketamine. [C]
RESEARCH:
Ketamine has been found to reduce depression in patients with bipolar
disorder, but what about cases where bipolar patients are clinically diagnosed
with severe suicidal thoughts? Michael F. Grunebaum, M.D., from Columbia
University Medical Center and his team tackled this feat.
The team of researchers had 16 patients with bipolar disorder to participate
in the study. Every participant that was chosen reported experiencing a major
depressive episode and significant suicidal thoughts at the time of the trial.
Each was randomly assigned to receive a single dose of either ketamine or
midazolam, a sedative that has not been found to alleviate symptoms of
depression.
Within 24 hours after treatment, thoughts of suicide dramatically decreased
in participants who received ketamine than those who received midazolam. The
decline in suicidal thoughts, improved their memory in the process. More
research is needed with favorably a larger clinical trial to be tested to
further evaluate ketamine’s effects on suicidal thoughts associated with
bipolar disorder. [A]
Another study lead by Joshua Kantrowitz, MD, an assistant professor of
psychiatry at Columbia University, to conduct a small study of 8 patients diagnosed with bipolar depression. Although ketamine's antidepressant effects are fast acting they last only for a short period of time. So by adding two already existing medications along with ketamine could extend ketamine's effects, reducing symptoms of depression and suicidal thoughts in patients. [B]
Each patient was randomly given one of commonly prescribed medications known to treat bipolar depression. Out of the 8 participants, 4 were given the drug Latuda [a medication approved for bipolar depression], 2 were given a combination of Zyprexa and Prozac, and the last 2 were only given Seroquel. [B]
Each patient was randomly given one of commonly prescribed medications known to treat bipolar depression. Out of the 8 participants, 4 were given the drug Latuda [a medication approved for bipolar depression], 2 were given a combination of Zyprexa and Prozac, and the last 2 were only given Seroquel. [B]
After 4 weeks, there was no improvement seen in the participants. Then, they were given ketamine. The next day they were given D-cycloserine [medication typically used in the treatment of tuberculosis]. This lasted for eight weeks. Unlike most antidepressants on the market that target the brain’s serotonin pathway, ketamine and D-cycloserine target the brain’s NMDA receptors (NMDAR). [B]
RESULTS:
A small pharmaceutical company, NeuroRx, Inc., is developing a staged
treatment approach involving ketamine administration followed by a combination,
known as Cyclurad, of D-cycloserine and lurasidone, to maintain the effect of
ketamine. Although the Columbia study is the second human study demonstrating the
antidepressant effect of D-cycloserine, it is the first one to use the
combination of D-cycloserine and lurasidone following ketamine infusion. [B]
Ketamine reduced suicidal thoughts
in bipolar disorder within 24 hours in a small randomized trial. People with bipolar disorder who were experiencing
significant suicidal thoughts saw those thoughts decline within 24 hours after
a single dose of ketamine. [A]
When participants were given a combination of ketamine and D-cycloserine,
there was a 50% reduction in signs of depression and a 75% decline in thoughts
of suicide. [Results reported in the Journal of Clinical Psychiatry]. It
was also observed that D-cycloserine helped to maintain the benefits of the
ketamine over the eight-week period of which the study lasted. [B]
CONCLUSION:
Patients with bipolar disorder who feel stable with their lithium medication and overall treatment who continue to experience depressive episodes, ketamine seems like another option to help with these episodes. Although many of the side effects of ketamine are transient and tend to dissipate within a couple of hours after treatment. With its fast acting and lower side effects of sub-anesthetic doses than standard psychiatric treatments, ketamine can be a good alternate option. [C]
For manic patients, lithium in addition to depakote and tegretol are considered the best and standard treatment for bipolar patients. Medications like latuda and seroquel are also used but have higher levels of risks for side effects. Ketamine is certainly not a substitute for
lithium in the treatment of mania, but ketamine will usually dramatically
improve symptoms in those with bipolar depression by providing a safe, low-risk
option with high reward potential. [C]
Links:
http://www.latuda.com/bpd/what-is-bipolar-depression.html
[D]
*Please note! These images are not mine. They were found on various tumblr, pinterest, google image sites! If any are yours please let me know so that I can give you credit for them! Also the people in the images have no relation to the diseases, illnesses, or cancers I write about. Thanks so much & enjoy~
Quotes found on: imdb.com/birdman
Images found on: filmscreencaps.com/ birdman
*Please note! These images are not mine. They were found on various tumblr, pinterest, google image sites! If any are yours please let me know so that I can give you credit for them! Also the people in the images have no relation to the diseases, illnesses, or cancers I write about. Thanks so much & enjoy~
Quotes found on: imdb.com/birdman
Images found on: filmscreencaps.com/ birdman
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