What If You Took The "Trip" Out Of Ketamine?
12:10 Share

This message comes from ShipBob. Selling on your e-commerce website, in retail stores, or through online marketplaces, ShipBob fulfills orders from these platforms and more to make omni-channel inventory management and fulfillment easy. Go to ShipBob.com for a free quote. You're listening to Shortwave from NPR.

Hey, Short Wavers. Regina Barber here. I'm talking with one of our producers, Rachel Carlson, who's been reporting a series on psychedelics and related drugs. Hey, Rachel. Hi, Gina. So in our last episode, we talked about how drugs like psilocybin and ketamine are raising all these questions about the

the limits of what we know about our brains and how we experience reality. Definitely check out that episode if you missed it, but also this one will make sense without it. Rachel, you touched on one thing in that episode that we're going to go a little deeper on today, and that's the challenge of studying these drugs. Exactly. So when we're talking about how drugs like psychedelics and ketamine work, or if they work at all, what the heck are we actually talking about? There's the drug, there's the trip.

And then there's all these non-drug factors, meaning the stuff at the beginning, like the expectations you set, the hope you have, the lessons you learned.

This is Dr. Boris Heifetz. He's an anesthesiologist and neuroscientist at Stanford University. And he told me that researchers have been wondering for a while if the trip that comes with a lot of psychedelics, this journey or experience, is really important. Or if it's just this unnecessary byproduct when it comes to making people feel better. So a lot of people actually have been talking about this for years. Like, well, what if you just knock someone out?

What if you eliminated experience during a psilocybin trip or during one of these drugs in this broad class in which I'll include ketamine for a variety of reasons? So that's exactly what Boris did. So today on the show, the creative ways some researchers are trying to navigate research on drugs like psychedelics and ketamine. They're asking, is it the drugs themselves making people feel better?

or everything else that comes with them. We'll even hear from a patient about her experience. I'm Rachel Carlson. And I'm Regina Barber. You're listening to Shortwave, the science podcast from NPR. Support for NPR and the following message come from Betterment, the automated investing and savings app. CEO Sarah Levy shares how Betterment utilizes tech tools powered by human advice. Betterment is here to help customers build wealth their way.

And we provide powerful technology and complete human support where technology can deliver ease of use and affordability. And the people behind that technology can provide advice and guidance.

Learn more at Betterment.com. Investing involves risk. Performance not guaranteed. This message comes from Amazon Health. Have you ever gotten sick on a very expensive, very non-refundable family trip? Amazon One Medical has 24-7 virtual care, so you can get help no matter where you are. And with Amazon Pharmacy, your meds can get delivered right to your hotel, fast.

It's kind of like the room service of medical care. Thanks to Amazon, health care just got less painful. OK, Rachel, so when people say drugs like psychedelics and ketamine can help treat different conditions, there could be a few things happening. Any beneficial effects of the drug could be related to one, simply mentally and therapeutically preparing to take a drug like a psychedelic drug.

Two, the experience of actually taking it like the trip. Or three, the effect of the drug itself on a person's brain, right? Right. Or Gina, it could be a combination of all of these things or others. And it's pretty hard to parse out. But Boris tried to disentangle all of these factors in a 2023 study he did on ketamine and depression. That was out in the journal Nature.

So to do this, they used anesthesia. And in Boris's trial, they looked at 40 patients who were already scheduled to have some kind of basic surgery and go under anesthesia. All the patients also had a history with major depression. Okay.

And Boris told them that while they were under anesthesia, they would either be getting an infusion of ketamine or saline. Based on research in animal models, scientists think that ketamine works by binding to this specific receptor in the brain. It's called the NMDA receptor. But what also happens there is that it can give people this kind of dissociative feeling, like they're separated from their own bodies. And for anyone listening who also doesn't know what it is, ketamine isn't a psychedelic like LSD or LSD-AIDS.

psilocybin, mushrooms, those seem to work on different receptors in the brain. But like you said, Rachel, ketamine can kind of have like similar effects to psychedelics depending on like the dose a person takes. Yeah, it is not a psychedelic, but it does kind of get thrown into this psychedelic related bucket because it can have sort of similar-ish effects depending on how much a person takes. And

And so the idea with Boris's study was that by putting patients under anesthesia, it might help solve this big problem that most studies of psychedelics and ketamine have. Right, because patients usually, like, know if they've gotten the drug or the placebo. Yeah, if someone gives you LSD, you are probably going to know. Yeah.

So I spoke to one of the participants in this study. Hi, my name is Cindy Dahlman. Cindy had an ongoing relationship with depression. Off and on, probably since I was a teenager.

Yeah, I think the awareness of it didn't come to me until I was probably in my 30s. I'm 61 now. She's from Santa Cruz in California. She told me she felt like she should be enjoying her life in the sun, outside, by the beach. But it wasn't in my head. And I was spending more time indoors, sleeping. Felt like a truck stuck in the mud.

Before the trial, Cindy told me she didn't know anything about ketamine. Okay.

Okay, so these patients like Cindy are going like under anesthesia for their surgeries, and then they either get ketamine or they don't. Exactly. And Gina, another thing Boris told me is really important here is that we've known for a long time that after people go under anesthesia, their mood often gets a bit low. So things like depression can get worse. Wow. And in a group of patients who were already suffering from depression, that's what Boris says they expected to see. Yeah.

at least in the group that didn't get ketamine. And what about Cindy? So Cindy got the drug, she got ketamine, but remember, she didn't know that, and neither did Boris or the other researchers. Okay, okay. So what happened when she woke up? Here she is. Not like Snow White and the Little Birds, you know, happy as the day. But I did have a little bit of a bluebird on the windowsill kind of feeling, the joyfulness of...

What about the other patients? So in the group that did get ketamine, 60% of those patients felt better the day after surgery. And most of those people had stayed better when the researchers checked on them two weeks later. Wow.

So for context, Gina, this is much faster than something like Prozac or Zoloft, which could take at least a month to see results and has to be taken every single day. Right. So Boris says they figured, OK, ketamine works even under anesthesia. So even if the patient doesn't know that they actually got it. So so it wasn't just Cindy who felt better. Boris told me about a different patient, not Cindy. He also talked to. This was like her, you know.

And, like, fifth, like, cancer surgery. Like, this has been a recurrent cancer. He saw this patient a couple days after her surgery. She was almost, like, dancing. This was, you know, someone who had, like, a lot of stuff in their belly, like, still had drains, bandages. She was, like, you know, it was infectious. I thought to myself at the time, like, if she didn't get ketamine, like, I'm quitting. Like, I don't know, like, or even, I mean, in retrospect, it was more, like, I want to know what, like, what we did so we could do it again. And...

She was in the placebo group. So statistically, there was no difference between people who got ketamine and people who got placebo. Boris told me the people who got placebo... They got so much better. They were indistinguishable from the patients who got ketamine. And even Cindy, who did get ketamine and did feel like it helped her depression symptoms, told me she thought about whether it was really the drug that helped her or other parts of the study. Like, what was it that really made her feel better?

I was so stripped raw emotionally that I was so grateful for everybody's participation in my wellness journey. You know, even now, a little bit of love leaks out of my eyes, but it's because of gratitude.

So you're saying that even though she got ketamine, her feeling better could also have been like related to these other parts of the experience, like working closely with Boris and like feeling like people are actually like listening to her. Exactly. And she told me that she wondered like how far would it take other people who were struggling with something like depression if they just had this same kind of support that she got from Boris and her surgery team. Yeah. But who doesn't respond to love and kindness, right? Yeah.

Boris told me that a lot of patients seem to think that if they felt better, they probably got ketamine, even if they didn't, which to him points to this expectation or hope that patients might have about being in a study where they might get some kind of drug at all.

You know, it was a lot of the same reactions. Like, well, I, you know, I can't explain it either. But this, it's important. It's, you know, I got better. In some cases, they stayed better. But that could have just been the placebo effect. Yeah, I mean, that's what Boris is saying. And what he really emphasized to me is that placebo can sort of be seen as this fake thing or a sign of failure in a study. But there's science supporting its effectiveness. It can actually change our brain chemistry. But people often see it as this imaginary treatment.

Imaginary is like something that doesn't exist. This is a real thing. And placebo has real biology behind it. And it is one of the most valuable treatments we have in medicine, full stop. Wow. It's like that expectation. And this brings us back to the question you asked earlier, like, do we even need placebo?

Right. So Boris tackled this question with anesthesia. He came away feeling like maybe these other factors are really important. And a lot of people in the field argue this.

Other researchers are focusing on creating new drugs altogether, ones that work like psychedelics but don't have a trip at all. Wow. David Olson is one of these researchers. He's a chemical neuroscientist at UC Davis, and he says neuropsychiatric disease is a huge problem globally. We're talking in the neighborhood of a billion people.

And if the drug needs to be administered in the clinic under the supervision of multiple healthcare professionals, we're just never going to be able to reach all those patients. So, Gina, let's go back to our big question here. Why might drugs like psychedelics or ketamine help people? Is it because of the way they could alter the brain or the trip or experience that comes with them? Yeah. David's saying forget the trip. He's betting on their chemical and biological effect.

A lot of his research is focused on creating new psychedelics and even drugs that are inspired by psychedelics, but he says could be more accessible and safer since lots of people can't take psychedelics. Right. And researchers still don't really know the long-term effects of taking these drugs. Fortunately, that's what medicinal chemists are very good at. They can take a chemical structure and tweak it just a little bit to improve its properties.

Okay, wait, wait. So he's like re-engineering these drugs and taking out the trip. That's one aspect of his work. So we'll get into this process tomorrow on Shortwave. I can't wait. Thank you so much, Rachel, for bringing us this reporting. Thanks, Gina.

I produced this episode with Burleigh McCoy. It was edited by our showrunner Rebecca Ramirez and Jeff Brumfield. Tyler Jones checked the facts. Kwesi Lee was the audio engineer. Special thanks to John Hamilton, Brent Bachman, Johanna Sturgey, and our incredible standards team. Beth Donovan is our senior director, and Colin Campbell is our senior vice president of podcasting strategy. I'm Rachel Carlson. I'm Regina Barber. Thank you for listening to Shortwave, the science podcast from NPR.

This message comes from Capella University. At Capella, you'll learn relevant in-demand skills you can apply in the workplace right away. A different future is closer than you think with Capella University. Learn more at capella.edu.

This message comes from Synchrony Bank, who wants to inspire you to keep dreaming. Not the elevator plummeting, being chased by something, waking up in a cold sweat kind of dreaming. They're talking about the goal setting, retirement planning, sail off into the sunset kind of dreaming. The ones that start with saving smart. Open an account with a great rate in five minutes or less in the Synchrony Bank app and dream on. Go to synchrony.com slash NPR. Member FDIC.

99% of the U.S. population lives within listening range of at least one public media station. And everyone can listen to NPR podcasts free of charge. That means you get completely unpaywalled access to stories, prize-winning reporting, and shows that represent the voices in every corner of the country. Hear the bigger picture every day on NPR.