May 28, 2020
Although new knowledge about the brain’s reward circuitry has provided insight into the biology of addiction, this has not yet resulted in new treatments. In animal models of addiction, it has been possible to therapeutically modify reward circuits using techniques that alter gene expression or switch individual neurons or groups of them “on” and “off.” But such experiments, which involve genetic engineering and surgical interventions in the brain, are not directly translatable in human subjects.
Looking for novel approaches, researchers at Columbia University and the New York State Psychiatric Institute have taken another path. In separate randomized clinical trials reported in the American Journal of Psychiatry, they have combined an existing form of therapy that has so far proven only modestly beneficial in addiction with an experimental therapy that has been neither validated nor approved for use in addiction.
The existing therapy involves behavioral modification. The experimental therapy is a drug—a single, low-dose infusion of the anesthetic ketamine. It has repeatedly shown its power to act rapidly (within hours) as an antidepressant in individuals who haven’t responded to other forms of depression therapy. A chemical derivative of ketamine called esketamine received FDA approval last year for use in treatment-resistant major depression.
In the two trials they designed, the Columbia team, led by Elias Dakwar, M.D., and Edward Nunes, M.D., and including BBRF 2000 Independent Investigator Frances R. Levin, M.D., employed ketamine—at a sub-anesthetic dose, given a single time—in patients with cocaine and alcohol addictions who were also receiving behavioral therapies.
Read the full article here.