Elon Musk says ketamine can get you out of a ‘negative frame of mind’. What does the research say?
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X owner Elon Musk recently described using small amounts of ketamine “once every other week” to manage the “chemical tides” that cause his depression. He says it’s helpful to get out of a “negative frame of mind”.
This has caused a range of reactions in the media, including on X (formerly Twitter), from strong support for Musk’s choice of treatment, to allegations he has a drug problem.
But what exactly is ketamine? And what is its role in the treatment of depression?
It was first used as an anaesthetic
Ketamine is a dissociative anaesthetic used in surgery and to relieve pain.
At certain doses, people are awake but are disconnected from their bodies. This makes it useful for paramedics, for example, who can continue to talk to injured patients while the drug blocks pain but without affecting the person’s breathing or blood flow.
Ketamine is also used to sedate animals in veterinary practice.
Ketamine is a mixture of two molecules, usually referred to a S-Ketamine and R-Ketamine.
S-Ketamine, or esketamine, is stronger than R-Ketamine and was approved in 2019 in the United States under the drug name Spravato for serious and long-term depression that has not responded to at least two other types of treatments.
Ketamine is thought to change chemicals in the brain that affect mood.
While the exact way ketamine works on the brain is not known, scientists think it changes the amount of the neurotransmitter glutamate and therefore changes symptoms of depression.
How was it developed?
Ketamine was first synthesised by chemists at the Parke Davis pharmaceutical company in Michigan in the United States as an anaesthetic. It was tested on a group of prisoners at Jackson Prison in Michigan in 1964 and found to be fast acting with few side effects.
The US Food and Drug Administration approved ketamine as a general anaesthetic in 1970. It is now on the World Health Organization’s core list of essential medicines for health systems worldwide as an anaesthetic drug.
In 1994, following patient reports of improved depression symptoms after surgery where ketamine was used as the anaesthetic, researchers began studying the effects of low doses of ketamine on depression.
SB Arts Media/Shutterstock
The first clinical trial results were published in 2000. In the trial, seven people were given either intravenous ketamine or a salt solution over two days. Like the earlier case studies, ketamine was found to reduce symptoms of depression quickly, often within hours and the effects lasted up to seven days.
Over the past 20 years, researchers have studied the effects of ketamine on treatment resistant depression, bipolar disorder, post-traumatic sress disorder obsessive-compulsive disorder, eating disorders and for reducing substance use, with generally positive results.
One study in a community clinic providing ketamine intravenous therapy for depression and anxiety found the majority of patients reported improved depression symptoms eight weeks after starting regular treatment.
While this might sound like a lot of research, it’s not. A recent review of randomised controlled trials conducted up to April 2023 looking at the effects of ketamine for treating depression found only 49 studies involving a total of 3,299 patients worldwide. In comparison, in 2021 alone, there were 1,489 studies being conducted on cancer drugs.
Is ketamine prescribed in Australia?
Even though the research results on ketamine’s effectiveness are encouraging, scientists still don’t really know how it works. That’s why it’s not readily available from GPs in Australia as a standard depression treatment. Instead, ketamine is mostly used in specialised clinics and research centres.
However, the clinical use of ketamine is increasing. Spravato nasal spray was approved by the Australian Therapuetic Goods Administration (TGA) in 2021. It must be administered under the direct supervision of a health-care professional, usually a psychiatrist.
Spravato dosage and frequency varies for each person. People usually start with three to six doses over several weeks to see how it works, moving to fortnightly treatment as a maintenance dose. The nasal spray costs between A$600 and $900 per dose, which will significantly limit many people’s access to the drug.
Ketamine can be prescribed “off-label” by GPs in Australia who can prescribe schedule 8 drugs. This means it is up to the GP to assess the person and their medication needs. But experts in the drug recommend caution because of the lack of research into negative side-effects and longer-term effects.
What about its illicit use?
Concern about use and misuse of ketamine is heightened by highly publicised deaths connected to the drug.
Ketamine has been used as a recreational drug since the 1970s. People report it makes them feel euphoric, trance-like, floating and dreamy. However, the amounts used recreationally are typically higher than those used to treat depression.
Information about deaths due to ketamine is limited. Those that are reported are due to accidents or ketamine combined with other drugs. No deaths have been reported in treatment settings.
Reducing stigma
Depression is the third leading cause of disability worldwide and effective treatments are needed.
Seeking medical advice about treatment for depression is wiser than taking Musk’s advice on which drugs to use.
However, Musk’s public discussion of his mental health challenges and experiences of treatment has the potential to reduce stigma around depression and help-seeking for mental health conditions.
Clarification: this article previously referred to a systematic review looking at oral ketamine to treat depression. The article has been updated to instead cite a review that encompasses other routes of administration as well, such as intravenous and intranasal ketamine.
Julaine Allan, Associate Professor, Mental Health and Addiction, Rural Health Research Institute, Charles Sturt University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Do Try This At Home: The 12-Week Brain Fitness Program
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12 Weeks To Measurably Boost Your Brain
This is Dr. Majid Fotuhi. From humble beginnings (being smuggled out of Iran in 1980 to avoid death in the war), he went on (after teaching himself English, French, and German, hedging his bets as he didn’t know for sure where life would lead him) to get his MD from Harvard Medical School and his PhD in neuroscience from Johns Hopkins University. Since then, he’s had a decades-long illustrious career in neurology and neurophysiology.
What does he want us to know?
The Brain Fitness Program
This is not, by the way, something he’s selling. Rather, it was a landmark 12-week study in which 127 people aged 60–80, of which 63% female, all with a diagnosis of mild cognitive impairment, underwent an interventional trial—in other words, a 12-week brain fitness course.
After it, 84% of the participants showed statistically significant improvements in cognitive function.
Not only that, but of those who underwent MRI testing before and after (not possible for everyone due to practical limitations), 71% showed either no further deterioration of the hippocampus, or actual growth above the baseline volume of the hippocampus (that’s good, and it means functionally the memory center of the brain has been rejuvenated).
You can read a little more about the study here:
As for what the program consisted of, and what Dr. Fotuhi thus recommends for everyone…
Cognitive stimulation
This is critical, so we’re going to spend most time on this one—the others we can give just a quick note and a pointer.
In the study this came in several forms and had the benefit of neurofeedback technology, but he says we can replicate most of the effects by simply doing something cognitively stimulating. Whatever challenges your brain is good, but for maximum effect, it should involve the language faculties of the brain, since these are what tend to get hit most by age-related cognitive decline, and are also what tends to have the biggest impact on life when lost.
If you lose your keys, that’s an inconvenience, but if you can’t communicate what is distressing you, or understand what someone is explaining to you, that’s many times worse—and that kind of thing is a common reality for many people with dementia.
To keep the lights brightly lit in that part of the brain: language-learning is good, at whatever level suits you personally. In other words: there’s a difference between entry-level Duolingo Spanish, and critically analysing Rumi’s poetry in the original Persian, so go with whatever is challenging and/but accessible for you—just like you wouldn’t go to the gym for the first time and try to deadlift 500lbs, but you also probably wouldn’t do curls with the same 1lb weights every day for 10 years.
In other words: progressive overloading is key, for the brain as well as for muscles. Start easy, but if you’re breezing through everything, it’s time to step it up.
If for some reason you’re really set against the idea of learning another language, though, check out:
Reading As A Cognitive Exercise ← there are specific tips here for ensuring your reading is (and remains) cognitively beneficial
Mediterranean diet
Shocking nobody, this is once again recommended. You might like to check out the brain-healthy “MIND” tweak to it, here:
Four Ways To Upgrade The Mediterranean Diet ← it’s the fourth one
Omega-3 supplementation
Nothing complicated here. The brain needs a healthy balance of these fatty acids to function properly, and most people have an incorrect balance (too little omega-3 for the omega-6 present):
What Omega-3 Fatty Acids Really Do For Us ← scroll to “against cognitive decline”
Increasing fitness
There’s a good rule of thumb: what’s healthy for your heart, is healthy for your brain. This is because, like every other organ in your body, the brain does not function well without good circulation bringing plenty of oxygen and nutrients, which means good cardiovascular health is necessary. The brain is extra sensitive to this because it’s a demanding organ in terms of how much stuff it needs delivering via blood, and also because of the (necessary; we’d die quickly and horribly without it) impediment of the blood-brain barrier, and the possibility of beta-amyloid plaques and similar woes (they will build up if circulation isn’t good).
How To Reduce Your Alzheimer’s Risk ← number two on the list here
Practising mindfulness medication
This is also straightforward, but not to be underestimated or skipped over:
No-Frills, Evidence-Based Mindfulness
Want to step it up? Check out:
Meditation Games That You’ll Actually Enjoy
Lastly…
Dr. Fotuhi wants us to consider looking after our brain the same way we look after our teeth. No, he doesn’t want us to brush our brain, but he does want us to take small measurable actions multiple times per day, every day.
You can’t just spend the day doing nothing but brushing your teeth for the entirety of January the 1st and then expect them to be healthy for the rest of the year; it doesn’t work like that—and it doesn’t work like that for the brain, either.
So, make the habits, and keep them going
Take care!
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This Naked Mind – by Annie Grace
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We’ve all read about the many, many, dangers of drinking. We’ve also probably all read about how to make the change to not drinking. Put things out of sight, tell your friends, have this rule, have this excuse (for not drinking) ready to give to people who challenge you, consider a support group, and so on.
What Annie Grace offers in this #1 bestseller is different:
A blend of mostly psychology and sociology, to examine the “liminal thinking” stages that funnel us to drink in the first place… and where that leads, and how to clamber back out of the pitcher plant we weren’t necessarily aware we were sliding into.
While she kicks off citing Jung, from a psychological perspective more of this book is CBTish, as it pertains a lot to examining the process of:
- belief—held and defended, based on the…
- conclusion—drawn, often irrationally, from the…
- experience—that we had upon acting on an…
- observation—often mistaking an illusion for the underlying…
- reality
…and how we can and often do go wrong at each step, and how little of the previous steps we can perceive at any given time.
What does this mean for managing/treating alcoholism or a tendency towards alchoholism?
It means interrupting those processes in a careful, surgically precise fashion, so that suddenly… The thing has no more power over us.
Whether you or a loved one struggle with a tendency to addiction (any addiction, actually, the advice goes the same), or are just curious about the wider factors at hand in the epidemiology of addiction, this book is for you.
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An Elegant Defense – by Matt Richtel
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In a way, Richtel got the best and worst of the publication date lottery. This book, which he’d obviously been working on for however long, was published in March 2020. Yes, that March 2020. So, it obviously got a huge boost in sales that launced it to bestseller status, and/but it doesn’t actually discuss COVID at all.
What it does discuss, is—as one might expect—the immune system. Or really, the immune systems, plural, several systems working alongside each other. How we got to have such, how our immune functions work, where all the various immune cells come from and what part they play. What pathogens can do to fight and/or confuse (or even co-opt) our immune response, and what modern medicine can do to counteract the pathogens’ anti-countermeasure countermeasures. And how it can still go wrong.
The “Four Lives” promised in the subtitle are stories, and Richtel explains the immune system through specific people’s specific battles. In particular, a friend of his who had quite a remarkable battle against cancer, which was of course terrible for him, but illustrative for us.
The style of the book is very readably journalistic. The author is a Pulitzer-winning NYT journalist, and not normally a science writer. Here at 10almonds, “we like big bibliographies and we cannot lie”, and we didn’t get to enjoy that in this case. The book contained no bibliography (nor appropriate inline citations, nor equivalent footnotes). Maybe a future addition will include this.
Bottom line: there’s a lot of “science for the lay reader” here. While the lack of references is a big oversight, the book does give a very good overview of what both sides (immune response and pathogenic invasion) bring to the battle of your body.
Click here to check out Elegant Defense, and demystify immunology!
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Chickpeas vs Pinto Beans – Which is Healthier?
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Our Verdict
When comparing chickpeas to pinto beans, we picked the pinto beans.
Why?
Both are great! And an argument could be made for either…
In terms of macros, pinto beans have slightly more fiber and slightly more protein, while chickpeas have slightly more carbs, and thus predictably higher net carbs. In the category of those proteins, they both have a comparable spread of amino acods, with pinto beans having very slightly more of each amino acid. All this adds up to a clear, but moderate, win for pinto beans.
When it comes to vitamins, technically chickpeas have more of vitamins A, B3, B5, C, K, and choline, but the margins are so small as to be almost meaningless. Meanwhile, pinto beans have more of vitamins B1, B6, and E, and/but the only one where the margin is enough to really care about is vitamin E (a little over 2x what chickpeas have). So, an argument could be made either way, but we’re going to call this category a tie.
The story with minerals is similar; chickpeas have more copper, iron, manganese, phosphorus, and zinc, all with small margins, while pinto beans have more potassium and selenium, and/but also less sodium. We’d call this either a tie, or a very slight win for chickpeas.
Adding up the sections gives for a very modest win for pinto beans, but as we say, an argument could be made for either.
Certainly, enjoy both!
Want to learn more?
You might like to read:
- Chickpeas vs Black Beans – Which is Healthier?
- Kidney Beans vs Fava Beans – Which is Healthier?
- What Matters Most For Your Heart? Eat More (Of This) For Lower Blood Pressure
Take care!
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How to Be Your Own Therapist – by Owen O’Kane
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Finding the right therapist can be hard. Sometimes, even just accessing a therapist, any therapist, can be hard, if circumstances are adverse. Sometimes we’d like therapy, but want to feel “better prepared for it” before we do.
Owen O’Kane, a highly qualified and well-respected psychotherapist, wants to put some tools in our hands. The premise of this book is that “in 10 minutes a day” one can give oneself an amount of therapy that will be beneficial.
Naturally, in 10 minutes a day, this isn’t going to be the kind of therapy that will work through major traumas, so what can it do?
Those 10 minutes are spread into three sessions:
- 4 minutes in the morning
- 3 minutes in the afternoon
- 3 minutes in the evening
The idea is:
- To do a quick mental health “check-in” before the day gets started, ascertain what one needs in that context, and make a simple plan to get/have it.
- To keep one’s mental health on track by taking a little pause to reassess and adjust if necessary
- To reflect on the day, amplify the positive, and let go of the negative to what extent is practical, in order to rest well ready for the next day
Where O’Kane excels is in explaining how to do those things in a way that is neither overly simplistic and wishy-washy, nor so arcane and convoluted as to create more work and render the day more difficult.
In short, this book is a great prelude to (or adjunct to) formal therapy, and for those for whom therapy isn’t accessible and/or desired, a great way to keep oneself on a mentally healthy track.
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Toasted Chick’n Mango Tacos
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Tacos aren’t generally held up as the world’s healthiest food, but they can be! There’s so much going on in this dish today, healthwise, in a good way, that it’s hard to know where to start. But suffice it to say, these tacos are great for your gut, heart, blood sugars, and more.
You will need
For the chickpeas:
- 1 can chickpeas, drained
- 1 tbsp ras el-hanout*
- 1 tsp red pepper flakes
- ½ tsp MSG or 1 tsp low-sodium salt
- Extra virgin olive oil
*You can easily make this yourself; following our recipe (linked above in the ingredients list) will be better than buying it ready-made, and if you have strong feelings about any of the ingredients, you can adjust per your preference.
For the tahini sauce:
- ⅓ cup tahini
- 2 tbsp apple cider vinegar
- 2 tbsp finely chopped fresh dill
- ¼ bulb garlic, minced
- 1 tsp red pepper flakes
- ½ tsp black pepper, coarse ground
It may seem like salt is conspicuous by its absence, but there is already enough in the chickpeas component; you do not want to overwhelm the dish. Trust us that enjoying these things together will be well-balanced and delicious as written.
For the mango relish:
- ½ mango, pitted, peeled, and cubed
- 2 tsp apple cider vinegar
- 2 tsp cilantro, finely chopped (substitute with parsley if you have the “cilantro tastes like soap” gene)
- 1 tsp red pepper flakes
For building the taco:
- Soft corn tortillas
- Handful of arugula
- 1 avocado, pitted, peeled, and sliced
- ½ red onion, sliced
Method
(we suggest you read everything at least once before doing anything)
1) Heat a sauté pan with a little olive oil in; add the chickpeas and then the rest of the ingredients from the chickpea section; cook for about 5 minutes, stirring frequently, and set aside.
2) Combine the tahini sauce ingredients in a small bowl, stirring in ¼ cup water, and set aside.
3) Combine the mango relish ingredients in a separate small bowl, and set aside. You can eat the other half of the mango if you like.
4) Lightly toast the tortillas in a dry skillet, or using a grill.
5) Assemble the tacos; we recommend the order: tortillas, arugula, avocado slices, chickpeas, mango relish, red onion slices, tahini sauce.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Eat More (Of This) For Lower Blood Pressure
- Our Top 5 Spices: How Much Is Enough For Benefits? ← we hit all five today! Yay!
- An Apple (Cider Vinegar) A Day…
- Coconut vs Avocado – Which is Healthier?
- Lettuce vs Arugula – Which is Healthier?
Take care!
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