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.

Depressed woman looks down
Researchers have been investigating ketamine for depression for 30 years.
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.The Conversation

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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  • Cross That Bridge – by Samuel J. Lucas

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Books of this genre usually have several chapters of fluff before getting to the point. You know the sort:

    1. Let me tell you about some cherry-picked celebrity stories that overlook survivorship bias
    2. Let me tell you my life story, the bad parts
    3. My life story continued, the good parts now
    4. What this book can do for you, an imaginative pep talk that keeps circling back to me

    …then there will be two or three chapters of the actual advertised content, and then a closing chapter that’s another pep talk.

    This book, in contrast, throws that out of the window. Instead, Lucas provides a ground-up structure… within which, he makes a point of giving value in each section:

    • exercises
    • summaries
    • actionable advice

    For those who like outlines, lists, and overviews (as we do!), this is perfect. There are also plenty of exercises to do, so for those who like exercises, this book will be great too!

    Caveat: occasionally, the book’s actionable advices are direct but unclear, for example:

    • Use the potential and power of tea, to solve problems

    Context: there was no context. This was a bullet-pointed item, with no explanation. It was not a callback to anything earlier; this is the first (and only) reference to tea.

    However! The book as a whole is a treasure trove of genuine tips, tools, and voice-of-experience wisdom. Occasional comments may leave you scratching your head, but if you take value from the rest, then the book was already more than worth its while.

    Get Your Copy of Cross That Bridge on Amazon Today!

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  • Feeding You Lies – by Vani Hari

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    When it comes to advertising, we know that companies will often be as misleading as they can get away with. But just how misleading is it?

    Vani Hari, of “Food Babe” fame, is here to unravel it all.

    The book covers many areas of food and drink advertising and marketing, and gives particular attention to:

    • Sodas (with and without sugar), and how deleterious they are to the health—as well as not even helping people lose weight, but actively hindering
    • Nutritionally fortified foods, and what we may or may not actually get from them by the time the processing is done
    • Organic food, and what that may or may not mean

    She also covers a lot of what happens outside of supermarkets, way back in universities and corporate boardrooms. In short, who is crossing whose palms with silver for a seal of approval… And what that means for us as consumers.

    A strength of this book that sets it apart from many of its genre, by the way, is that while being deeply critical of certain institutions’ practices, it doesn‘t digress into tinfoil-hat pseudoscientific scaremongering, either. Here at 10almonds we love actual science, so that was good to see too.

    Bottom line: is you’d like to know “can they say that and get away with it if it’s not true?” and make decisions based on the actual nutritional value of things, this is a great book for you.

    Click here to check out “Feeding You Lies” on Amazon and make your shopping healthier!

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  • Stop Pain Spreading

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    Put Your Back Into It (Or Don’t)!

    We’ve written before about Managing Chronic Pain (Realistically!), and today we’re going to tackle a particular aspect of chronic pain management.

    • It’s a thing where the advice is going to be “don’t do this”
    • And if you have chronic pain, you will probably respond “yep, I do that”

    However, it’s definitely a case of “when knowing isn’t the problem”, or at the very least, it’s not the whole problem.

    Stop overcompensating and address the thing directly

    We all do it, whether in chronic pain, or just a transient injury. But we all need to do less of it, because it causes a lot of harm.

    Example: you have pain in your right knee, so you sit, stand, walk slightly differently to try to ease that pain. It works, albeit marginally, at least for a while, but now you also have pain in your left hip and your lumbar vertebrae, because of how you leaned a certain way. You adjust how you sit, stand, walk, to try to ease both sets of pain, and before you know it, now your neck also hurts, you have a headache, and you’re sure your digestion isn’t doing what it should and you feel dizzy when you stand. The process continues, and before long, what started off as a pain in one knee has now turned your whole body into a twisted aching wreck.

    What has happened: the overcompensation due to the original pain has unduly stressed a connected part of the body, which we then overcompensate for somewhere else, bringing down the whole body like a set of dominoes.

    For more on this: Understanding How Pain Can Spread

    “Ok, but how? I can’t walk normally on that knee!”

    We’re keeping the knee as an example here, but please bear in mind it could be any chronic pain and resultant disability.

    Note: if you found the word “disability” offputting, please remember: if it adversely affects your abilities, it is a disability. Disabilities are not something that only happen to other people! They will happen to most of us at some point!

    Ask yourself: what can you do, and what can’t you do?

    For example:

    • maybe you can walk, but not normally
    • maybe you can walk normally, but not without great pain
    • maybe you can walk normally, but not at your usual walking pace

    First challenge: accept your limitations. If you can’t walk at your usual walking pace without great pain and/or throwing your posture to the dogs, then walk more slowly. To Hell with societal expectations that it shouldn’t take so long to walk from A to B. Take the time you need.

    Second challenge: accept help. It doesn’t have to be help from another person (although it could be). It might be accepting the help of a cane, or maybe even a wheelchair for “flare-up” days. Society, especially American society which is built on ideas of self-sufficiency, has framed a lot of such options as “giving up”, but if they help you get about your day while minimizing doing further harm to your body, then they can be good and even health-preserving things. Same goes for painkillers if they help you from doing more harm to your body by balling up tension in a part of your body in a way that ends up spreading out and laying ruin to your whole body.

    Speaking of which:

    How Much Does It Hurt? Get The Right Help For Your Pain

    After which, you might want to check out:

    The 7 Approaches To Pain Management

    and

    Science-Based Alternative Pain Relief

    Third challenge: deserves its own section, so…

    Do what you can

    If you have chronic pain (or any chronic illness, really), you are probably fed up of hearing how this latest diet will fix you, or yoga will fix you, and so on. But, while these things may not be miracle cures…

    • A generally better diet really will lessen symptoms and avoid flare-ups (a low-inflammation diet is a great start for lessening the symptoms of a lot of chronic illnesses)
    • Doing what exercise you can, being mindful of your limitations yes but still keeping moving as much as possible, will also prevent (or at least slow) deterioration. Consider consulting a physiotherapist for guidance (a doctor will more likely just say “rest, take it easy”, whereas a physiotherapist will be able to give more practical advice).
    • Getting good sleep may be a nightmare in the case of chronic pain (or other chronic illnesses! Here’s to those late night hyperglycemia incidents for Type 1 Diabetics that then need monitoring for the next few hours while taking insulin and hoping it goes back down) but whatever you can do to prioritize it, do it.

    Want to read more?

    We reviewed a little while ago a great book about this; the title sounds like a lot of woo, but we promise the content is extremely well-referenced science:

    The Pain Relief Secret: How to Retrain Your Nervous System, Heal Your Body, and Overcome Chronic Pain – by Sarah Warren

    …and if your issue is back pain specifically, we highly recommend:

    Healing Back Pain: The Mind-Body Connection – by Dr. John Sarno

    Take care!

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  • How the stress of playing chess can be fatal

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The death of a chess player in the middle of a match at the world’s most prestigious competition may have shocked those who view the game as a relaxing pastime. Kurt Meier, 67, collapsed during his final match in the tournament and died in hospital later that day. But chess, like any other game or sport, can lead to an immense amount of stress, which can be bad for a competitor’s physical health too.

    We tend to associate playing sport or games with good health and well-being. And there are a countless number of studies showing playing games has an association with feeling happier. While this argument is true for recreational players, the story can be different for the elite, where success and failure are won and lost by the finest margins and where winning can mean funding and a future, and losing can mean poverty and unemployment. If this is the case, can being successful at a sport or game actually be bad for you?

    Competitive anxiety

    Elite competition can be stressful because the outcome is so important to the competitors. We can measure stress using a whole range of physiological indicators such as heart rate and temperature, and responses such as changes in the intensity of our emotions.

    Emotions provide a warning of threat. So if you feel that achieving your goal is going to be difficult, then expect to feel intense emotions. The leading candidate that signals we are experiencing stress is anxiety, characterised by thoughts of worry, fears of dread about performance, along with accompanying physiological responses such as increased heart rate and sweaty palms. If these symptoms are experienced regularly or chronically, then this is clearly detrimental to health.

    This stress response is probably not restricted to elite athletes. Intense emotions are linked to trying to achieve important goals and while it isn’t the only situation where it occurs, it is just very noticeable in sport.

    The causes of stress

    It makes more sense to focus on what the causes of stress are rather than where we experience it. The principle is that the more important the goal is to achieve, then the greater the propensity for the situation to intensify emotions.

    Emotions intensify also by the degree of uncertainty and competing, at whatever level of a sport, is uncertain when the opposition is trying its hardest to win the contest and also has a motivation to succeed. The key point is that almost all athletes at any level can suffer bouts of stress, partly due to high levels of motivation.

    A stress response is also linked to how performance is judged and reported. Potentially stressful tasks tend to be ones where performance is public and feedback is immediate. In chess – as with most sporting contests – we see who the winner is and can start celebrating success or commiserating failure as soon as the game is over.

    There are many tasks which have similar features. Giving a speech in public, taking an academic examination, or taking your driving test are all examples of tasks that can illicit stress. Stress is not restricted to formal tasks but can also include social tasks. Asking a potential partner for a date, hand in marriage, and meeting the in-laws for the first time can be equally stressful.

    Winning a contest or going on a date relate to higher-order goals about how we see ourselves. If we define ourselves as “being a good player” or “being attractive or likeable” then contrasting information is likely to associate with unpleasant emotions. You will feel devastated if you are turned down when asking someone out on a date, for instance, and if this was repeated, it could lead to reduced self-esteem and depression.

    The key message here is to recognise what your goals are and think about how important they are. If you want to achieve them with a passion and if the act of achieving them leads to intense and sometimes unwanted emotions, then it’s worth thinking about doing some work to manage these emotions.

    Andrew Lane, Professor in Sport and Learning, University of Wolverhampton

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

    The Conversation

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  • Who will look after us in our final years? A pay rise alone won’t solve aged-care workforce shortages

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Aged-care workers will receive a significant pay increase after the Fair Work Commission ruled they deserved substantial wage rises of up to 28%. The federal government has committed to the increases, but is yet to announce when they will start.

    But while wage rises for aged-care workers are welcome, this measure alone will not fix all workforce problems in the sector. The number of people over 80 is expected to triple over the next 40 years, driving an increase in the number of aged care workers needed.

    How did we get here?

    The Royal Commission into Aged Care Quality and Safety, which delivered its final report in March 2021, identified a litany of tragic failures in the regulation and delivery of aged care.

    The former Liberal government was dragged reluctantly to accept that a total revamp of the aged-care system was needed. But its weak response left the heavy lifting to the incoming Labor government.

    The current government’s response started well, with a significant injection of funding and a promising regulatory response. But it too has failed to pursue a visionary response to the problems identified by the Royal Commission.

    Action was needed on four fronts:

    • ensuring enough staff to provide care
    • building a functioning regulatory system to encourage good care and weed out bad providers
    • designing and introducing a fair payment system to distribute funds to providers and
    • implementing a financing system to pay for it all and achieve intergenerational equity.

    A government taskforce which proposed a timid response to the fourth challenge – an equitable financing system – was released at the start of last week.

    Consultation closed on a very poorly designed new regulatory regime the week before.

    But the big news came at end of the week when the Fair Work Commission handed down a further determination on what aged-care workers should be paid, confirming and going beyond a previous interim determination.

    What did the Fair Work Commission find?

    Essentially, the commission determined that work in industries with a high proportion of women workers has been traditionally undervalued in wage-setting. This had consequences for both care workers in the aged-care industry (nurses and Certificate III-qualified personal-care workers) and indirect care workers (cleaners, food services assistants).

    Aged-care staff will now get significant pay increases – 18–28% increase for personal care workers employed under the Aged Care Award, inclusive of the increase awarded in the interim decision.

    Older person holding a stabilising bar
    The commission determined aged care work was undervalued.
    Shutterstock/Toa55

    Indirect care workers were awarded a general increase of 3%. Laundry hands, cleaners and food services assistants will receive a further 3.96% on the grounds they “interact with residents significantly more regularly than other indirect care employees”.

    The final increases for registered and enrolled nurses will be determined in the next few months.

    How has the sector responded?

    There has been no push-back from employer groups or conservative politicians. This suggests the uplift is accepted as fair by all concerned.

    The interim increases of up to 15% probably facilitated this acceptance, with the recognition of the community that care workers should be paid more than fast food workers.

    There was no criticism from aged-care providers either. This is probably because they are facing difficulty in recruiting staff at current wage rates. And because government payments to providers reflect the actual cost of aged care, increased payments will automatically flow to providers.

    When the increases will flow has yet to be determined. The government is due to give its recommendations for staging implementation by mid-April.

    Is the workforce problem fixed?

    An increase in wages is necessary, but alone is not sufficient to solve workforce shortages.

    The health- and social-care workforce is predicted to grow faster than any other sector over the next decade. The “care economy” will grow from around 8% to around 15% of GDP over the next 40 years.

    This means a greater proportion of school-leavers will need to be attracted to the aged-care sector. Aged care will also need to attract and retrain workers displaced from industries in decline and attract suitably skilled migrants and refugees with appropriate language skills.

    Nursing students practise their skills
    Aged care will need to attract workers from other sectors.
    nastya_ph/Shutterstock

    The caps on university and college enrolments imposed by the previous government, coupled with weak student demand for places in key professions (such as nursing), has meant workforce shortages will continue for a few more years, despite the allure of increased wages.

    A significant increase in intakes into university and vocational education college courses preparing students for health and social care is still required. Better pay will help to increase student demand, but funding to expand place numbers will ensure there are enough qualified staff for the aged-care system of the future. The Conversation

    Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice and Primary Care, The University of Melbourne

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • When Bad Joints Stop You From Exercising (5 Things To Change)

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    The first trick to exercising with bad joints is to have better joints.

    Now, this doesn’t necessarily mean you can take a supplement and magically your joint problems will be cured, but there are adjustable lifestyle factors that can and will make things relatively better or worse.

    We say “and will”, because you don’t get a choice in that part. Everything we do, every little choice in our day, makes our health a little better or a little worse in some aspect(s). But we do get a choice between “relatively better” and “relatively worse”.

    With that in mind, do check out:

    Ok, you have bad joints though; what next?

    Let’s assume you’re doing your best with the above, and/or have simply decided not to, which is your call. You know your circumstances best. Either way, your joints are still not in sufficiently good condition to be able to exercise the way you’d like.

    First, the obvious: enjoy low-impact exercises

    For example:

    • Swimming
    • Yoga (much more appropriate here than the commonly-paired “and tai chi”)*
    • Isometric exercises (i.e. exercise without movement, e.g. squeezing things, or stationary stability exercises)

    *This is not to say that tai chi is bad. But if your problem is specifically your knees, there are many movements in most forms of tai chi that require putting the majority of one’s weight on one bent leg, which means the knee of that leg is going to suffer. If your knees are fine, then this won’t be an issue and it will simply continue strengthening your knees without discomfort. But they have to be fine first.

    See also: Exercising With Osteoporosis

    Second: support your joints through a full range of motion

    If you have bad joints, you probably know that there’s an unfortunate paradox whereby you get to choose between:

    1. Exercise, and inflame your joints
    2. Rest, and your joints seize up

    This is the way to get around that damaging dilemma.

    Moving your joints through a full range of motion regularly is critical for their maintenance, so do that in a way that isn’t straining them:

    If it’s your shoulders, for example, you can do (slow, gentle!) backstroke or front-crawl or butterfly motions while standing in the comfort of your living room.

    If it’s your knees, then supported squats can do you a world of good. That means, squat in front of a table or other stable object, with your fingertips (or as much of your hands as you need) on it, to take a portion of your weight (it can be a large portion; that’s fine too!) while you go through the full range of motion of the squat. Repeat.

    And so forth for other joints.

    See also: The Most Underrated Hip Mobility Exercise (Not Stretching)

    Third: work up slowly, and stop early

    You can do exercises that involve impact, and if you live a fairly normal life, you’ll probably have to (walking is an impact exercise). You can also enjoy cycling (low-impact, but not so low-impact as we discussed in the last section) and work up to running if you want to.

    However…

    While building up your joints’ mobility and strength, it is generally a good idea to stop before you think you need to.

    This means that it’s important to do those exercises in a way that you can stop early. For example, an exercise bike or a treadmill can be a lot of use here, so that you don’t find you need to stop for the day while miles from your house.

    If you get such a device, it doesn’t even have to be fancy and/or expensive. This writer got herself an inexpensive exercise bike like this one, and it’s perfectly adequate.

    Fourth: prioritize recovery, even if it doesn’t feel like you need it

    Everyone should do this anyway, but if your joints are bad, it goes double:

    Overdone It? How To Speed Up Recovery After Exercise (According To Actual Science)

    Fifth: get professional help

    Physiotherapists are great for this. Find one, and take their advice for your specific body and your specific circumstances and goals.

    Take care!

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