Archive for the ‘Medical Research Data’ Tag

Ketamine — A New Drug Treatment For Depression?

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Credit: Koratmember at FreeDigitalPhotos.net

Remember ketamine, the old veterinary (and sometimes street) drug? Apparently it rapidly and significantly reduces anhedonia in those with treatment-resistant bipolar disorder, according to a new study.

Anhedonia, which is a lack of interest in activities that once gave a person pleasure, is a key feature of treatment-resistant bipolar disorder. According to a recent NIH-funded clinical trial, ketamine restored pleasure-seeking behavior independent of its other antidepressant properties in these patients. What’s more, it did so about 40 minutes after a single infusion, and the effect lasted as long as 14 days.

To me the most interesting part of this study is that ketamine did not act on the midbrain areas typically involved in depressive symptoms. Rather, PET scans on patients in the depressive phase of bipolar disorder showed that after ketamine infusion, there was activity in the dorsal anterior cingulate cortex (dACC). This region lies deep within the brain, resting on the medial surface of the frontal lobes. Its precise role remains somewhat elusive, though it is thought to govern conscious control of goal-directed behavior. The most recent significant study I could find on its function was a 2012 paper in Nature suggesting that the dACC is involved in optimizing behavioral adaptations to continuously evolving demands by predicting the difficulty of a task.

“Our findings help to deconstruct what has traditionally been lumped together as depression,” explained Carlos Zarate, M.D., of NIMH. “We break out a component that responds uniquely to a treatment that works through different brain systems than conventional antidepressants — and link that response to different circuitry than other depression symptoms.”

Imaging studies similar to the one just published are underway in patients with major depression, though results are not yet available. Other studies have suggested that ketamine may be exerting these effects through glutamate and dopamine pathways. Research is underway to explore easier methods of drug delivery, such as nasal spray.

Of late, ketamine has been studied for its rapid antidepressant properties, providing relief within hours rather than the weeks required for traditional medications to work. At present, ketamine is not FDA approved for treatment of depression and it is still used primarily in a veterinary setting.

Ketamine is an NMDA receptor antagonist, though it also inhibits reuptake of dopamine, serotonin, and norepinephrine. It was developed in 1962 and has been used in both humans and animals. It is categorized as a dissociative agent. It has been used for general anesthesia, sedation, and as a pain killer. Side effects include amnesia and agitation, and its street use has led to hallucinations, delirium, and death.

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World RePORT: A Worldwide Health Research Database

Credit: Stuart Miles at FreeDigitalPhoto.net

Credit: Stuart Miles at FreeDigitalPhoto.net

An article recently published in the September 12th issue of  Science discusses the necessity of creating a global map of    health R&D activities. The goal is to improve coordination  of research and create a “global observatory” for health research.

The Science article states, “How to finance research and   development where normal market forces are absent has been the focus of a number of studies organized by the World Health Organization (WHO), culminating in 2012 with a report that assessed the strengths and weaknesses of more than 100 new financing mechanisms (1). One of the issues that became clear in compiling this report was the absence of good data. There is no global health R&D map that provides a comprehensive picture of research funding, ongoing research, and results that could be used to guide the allocation of the limited available funding. Consequently, the member states of WHO have called for the establishment of a global observatory on health R&D to address this lack of information (2).”

While a truly comprehensive global health observatory is still years away, the World Health Organization recently created a database, the World Research -Portfolio Online Reporting Tool (World RePORT), which constitutes an important first step toward this goal. Released last year, the beta version of World RePORT was initially limited to research conducted in sub-Saharan Africa. However since then, a new funding organization has been added (the European & Developing Countries Clinical Trials Partnership; EDCTP) and coverage has been expanded to include NIH projects funded in 2013 and projects emanating from South Asia and East Asia/Pacific regions of the world.

As existing funders update the database with projects funded in 2013 across this expanded set of regions, the hope is that the database will help researchers build more effective networks and allow governments and donors to invest their time and money more strategically. Complete information from all ten current funders, as well as information on new organizations joining the World RePORT, will be available on the site soon.

As to the question of funding, the article explains: “As with many WHO projects of this type, it is a new activity and will require new and additional funding outside of its existing budget. A conservative estimate is that $11.5 million will be needed in the first 5 years to cover project staff and software development and to build capacity in those countries (the majority) that do not report health R&D data.”

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