Resilience enhancing drugs - good news or another can of worms?

Resilience enhancing drugs - good news or another can of worms?

Dr Rebecca Brachman from Columbia University NY is a preventative psychopharmacologist. Wow! That’s an interesting new concept. She is a pioneer in the field of developing drugs to enhance resilience and prevent mental illness.

In this TED Talk … 

….Dr Brachman  discusses the development of what is referred to as a new class of drugs that have been shown in her research to prevent PTSD and depression in mice.  She compares these pre-exposure drugs to vaccination, another area surrounded by controversy.

Let’s imagine these drugs do work in humans without significant side effects……

A whole lot of questions arise:

When should they be used? Dr Brachman mentions disaster intervention and aid workers. That makes sense. We can predict that they will experience considerable trauma in their deployment. Military people on deployment fit into the same category of predictable trauma so there’s another place for the drugs to be used, possibly routinely.

Wouldn’t it be wonderful if we could prevent all that PTSD and depression!

So what’s the can of worms?

This kind of predictable trauma accounts for only about 10% of PTSD in our community. We know that most PTSD in Australia stems from largely unpredictable trauma - domestic abuse, motor vehicle accidents, sexual assault, complex childhood trauma, bullying and harassment, adverse experience as a refugee or an Indigenous person – the list goes on.

What do we do with these drugs under these more common circumstances?  Will we be expected to prescribe them for everybody? Will trauma and abuse have to be tolerated because its psychological sequelae are no longer so severe? Should we give them to detainees, so we don’t have to change the way we treat them?

Will the absence of prescribing these drugs for people, young and old, who might be exposed to trauma – in the school yard say, or because they drive a motor vehicle, or because they are a woman in a potentially violent relationship (or even just because they are a woman) - become another lucrative space for litigation?

What is this drug?

Interesting that in her TED Talk Dr Brachman does not mention that the drug being used in her research is Ketamine, an old fashioned veterinary anaesthetic causing a recent stir as more evidence emerges in clinical trials of its efficacy in the temporary treatment of severe depression, and a drug much abused on the street (where it is often referred to as Special K) for its property of creating an out-of-body, near death experience  and a dreamlike state.  

Are we moving in the right direction with this research?

What do you think?

 

References:

Alcohol and Drug Foundation Drug Fact – Ketamine https://adf.org.au/drug-facts/ketamine/

Talking Drugs – Ketamine https://www.talkingdrugs.org/uk-ketamine-treatment-access-hindered-by-drug-laws

Ketamine treatment knowns and unknowns Prof Colleen Loo and Dr Adam Baynes  – originally published in MJA Insight Jan 2019  https://www.blackdoginstitute.org.au/news/news-detail/2019/01/14/ketamine-for-depression-knowns-and-unknowns

List of Dr Brachman’s publications (you might need to click on the research tab and scroll down)  https://www.researchgate.net/profile/Rebecca_Brachman

 

 


Dr Jan Orman

Jan is Sydney GP, private psychological medicine practitioner in Sydney’s inner west and a GP educator for Black Dog Institute.

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