Capsules containing ketamine. Photo: Nicolas Asfouri/AFP
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Could ketamine stop suicide?

The drug has been proven as a reliever of suicidal thoughts. With some doctors reluctant to prescribe SSRIs, it could provide the answer.

If suicide is the question, could ketamine be the answer? Nick Clegg has suggested suicide is avoidable in a well-structured NHS, but targeting the right people remains a complex issue.

It’s not just about depression, as the case of a 65-year-old woman who made a shocking announcement to her doctors demonstrated. “I’m fed up with life, I’ve had enough,” she said. “I don’t want to live any more . . . I no longer wish to live, to see anything, hear anything, feel anything . . .”

This was shocking because the feelings were induced not by depression, but by electrical stimulation of the brain. It was an unexpected side effect of an experimental treatment for Parkinson’s disease.

Applying a current through electrodes implanted in the patient’s brain was meant to alleviate tremors; instead, it brought on suicidal thoughts within five seconds, and 90 seconds after turning it off they were gone. Then came roughly five minutes of euphoria and general larking about.

This remarkable finding, reported in the New England Journal of Medicine in 1999, was one of the first to suggest that suicide and depression are not as inextricably linked as we might imagine.

We have more recent data, too. Ten years have passed since we discovered a link between suicidal thoughts and the antidepressants known as selective serotonin reuptake inhibitors (SSRIs). Doctors became much more wary about prescribing SSRIs but the results were not as we’d hoped.

A Swedish study found that after warnings about SSRIs were issued in 2004, the suicide rate among ten-to-19-year-olds increased for five consecutive years – the largest group being those who were not prescribed antidepressants. In the US, child and adolescent suicide rates have risen by 14 per cent.

Two US-based researchers, Robert Gibbons and J John Mann, argue it is time to review the FDA warning. Writing in the Psychiatric Times, they point out that subsequent research has shown a complex relationship between suicide contemplation, depression and antidepressants. The result of the warning has not been a lower suicide rate. “Instead, we see fewer antidepressant prescriptions, an increase in youth suicides, and negative effects on human capital.”

The Parkinson’s patient’s experience – especially, perhaps, the euphoria and larking about – suggests that ketamine, the newest route to alleviating suicidal thoughts, might be more successful.

Most people know ketamine – if they know it at all – as a party drug. Though it was first developed as an anaesthetic, it can elicit euphoria at lower doses. We now know, thanks to a study published in the Journal of Psychiatric Research in December, that ketamine is also a useful reliever of suicidal thoughts.

By giving 133 patients a dose of ketamine, researchers teased apart the links between suicidal thoughts, depression and anxiety, and they found that, although ketamine does relieve depression and anxiety, its effect on suicidal ideation is far stronger than on either of these. The effect is rapid – some patients report their contemplation of suicide gone within a couple of hours. According to a report in Nature, many pharmaceutical companies are now accelerating their ketamine research.

There are plenty of wrinkles to iron out. How would we set the threshold of eligibility? And how much autonomy do we give people? Where people are under the care of the state, all means for suicide are removed from those deemed at risk. Would we sanction a ketamine shot – or a routine of ketamine shots – as a mandatory measure to be used along with removal of belt and shoelaces? Or for anyone deemed to be a danger to themselves? If Clegg gets his way, we may soon find out. 

Michael Brooks holds a PhD in quantum physics. He writes a weekly science column for the New Statesman, and his most recent book is At the Edge of Uncertainty: 11 Discoveries Taking Science by Surprise.

This article first appeared in the 23 January 2015 issue of the New Statesman, Christianity in the Middle East

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Theresa May confirms Brexit Britain out of the single market – 8 other things we learnt

The Prime Minister dropped the Brexit bombshell that we're out of the single market, and more. 

Theresa May confirmed suspicions that the UK will leave the single market after Brexit in a major speech on her objectives.

The Prime Minister said the Brexit vote was a clear message about controlling immigration, and “that is what we will deliver” – but this meant the UK could not continue following the rules of the single market

She said: I want to be clear. What I am proposing cannot mean membership of the  single market. European leaders have said many times that membership means accepting the “four freedoms” of goods, capital, services and people.

"And being out of the EU but a member of the single market would mean complying with the EU’s rules and regulations that implement those freedoms, without having a vote on what those rules and regulations are."

May also repeated that maintaining the open land border between Northern Ireland and the Republic of Ireland would be a priority, and that she wanted trade deals with the rest of the world.

But leaving the single market wasn’t the only Brexit bombshell May dropped. Here is what we learnt:

1. The single market may be replaced by a European free trade deal

The Prime Minister has ruled out a single market, but is hoping for a deal to replace it. She said: “As a priority we will pursue a bold and ambitious free trade agreement with our neighbours in Europe."

2. No more European Court of Justice

May said Brexit will end the jurisdiction of the European Court of Justice in Britain, and that “laws will be interpreted by judges not in Luxembourg but in courts across this country”.

3. Parliament will get a vote on the Brexit deal

Most MPs already expected to get a vote – as their peers in the European Parliament would get one. May confirmed this, saying: "I can confirm today that the government will put the final deal that is agreed between the UK and the EU to a vote in both Houses of Parliament, before it comes into force.."

4. EU citizens still face uncertainty

May has always been clear she wants to confirm EU citizens’ right to remain in the UK, but only if British citizens receive the same guarantee in other EU countries.

She made no further guarantees, saying: "I have told other EU leaders that we could give people the certainty they want straight away, and reach such a deal now. Many of them favour such an agreement - one or two others do not"

5. She will try to stay in the customs union

May explicitly said the UK will have to leave the EU single market, but she was far more nuanced on the customs union, which negotiates trade deals on behalf of the EU member states.

She does not want Britain to share the EU’s common commercial policy, or be bound by common external tariffs, but does want to “have a customs agreement with the EU”. This could mean the UK becoming “an associate member of the customs union”. 

6. Some payments may continue

May said that Britain voted to stop large contributions to the EU, but she stopped short of ruling them out altogether. There may be payments that are “appropriate”, she said, if there are programmes the UK wants to be part of.  

7. Brexit could be in phases

The PM said several times she wanted to reassure businesses – who are increasingly unhappy about the uncertainty ahead. She wants the negotiators avoid a “cliff edge”, but also avoid “permanent political purgatory” (something Brexiteers fear). 

May suggested a deal could be done by the time the two-year process of Article 50 ends, and this could be followed by a “phased process of implementation”.

It’s worth bearing in mind at this point that two years in EU deal-making time is extremely speedy.

8. The UK’s nuclear option: Corporate tax haven

The Chancellor Philip Hammond has already floated the idea that a disgruntled Britain could slash corporate tax in order to attract unscrupulous multinationals to its shores.

May said that the UK would be prepared to crash out without an agreement, saying “no deal for Britain is better than a bad deal for Britain”. 

In such a situation, Britain "would have the freedom to set the competitive tax rates and embrace the policies that would attract the world’s best companies and biggest investors to Britain". In other words, become an offshore tax haven. 

 

Julia Rampen is the editor of The Staggers, The New Statesman's online rolling politics blog. She was previously deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines.