Ketamine for Depression, 3: Does Chirality Matter?

Ketamine is a racemic mixture of the enantiomers R-ketamine and S-ketamine (esketamine). S-ketamine has greater analgesic and anesthetic effects than R-ketamine and is less likely to cause psychotomimetic and other adverse effects. There is therefore an emerging interest favoring the use of S-ketamine over racemic ketamine when the drug is used for analgesia or anesthesia. This article examines preclinical and clinical literature on the antidepressant properties of S-ketamine. Animal data suggest potential advantages for R-ketamine over S-ketamine. Case reports, case series, and some small randomized controlled trials suggest that single or repeated intravenous infusions (0.2-0.4 mg/kg) or intranasal administrations (28-84 mg) of S-ketamine have antidepressant action in patients with medication-refractory depression and that the observed benefits are similar in magnitude to the antidepressant benefits reported with racemic ketamine. However, there are no direct comparisons between S-ketamine and either R-ketamine or racemic ketamine in depressed patients; therefore, it is not possible to make an informed choice when considering the enantiomers and the racemate for the indication of depression.

Circumstances of initiation into new-type drug use among adults in Shanghai: are there differences by types of first new-type drug used?

BACKGROUND: This study investigated circumstances of initiating new-type drug use among adult new-type drug users and differences among those who first used methamphetamine, ecstasy and ketamine. METHODS: A total of 276 participants were recruited, using respondent-driven sampling (RDS) from nine seeds recruited through NGOs, social workers and outreach workers in Shanghai, China. RESULTS: Methamphetamine was the most frequently reported first new-type drug used (37.1%), followed by ecstasy (35.6%) and ketamine (20.0%). 38.7% of participants initiated new-type drug use before the age of 21 years. 47.8% knew at initiation that club drugs can be harmful. Most were introduced to new-type drug use by friends, spouses or boy/girlfriends. The three most common reasons for initiation were curiosity, peer influence, and wishing to dull one's emotions. Those first using methamphetamine were more likely to be female, have a monthly individual income less than 3000 Yuan (approx. $476), initiate use at 21 years or older and at private setting than those first using ecstasy and ketamine. CONCLUSIONS: There is an urgent need for drug education efforts in China to raise awareness of the harms of new-type drugs, as well as to increase knowledge about the paradox of new-type drug effects. Drug prevention and intervention programs should be tailore to target populations and their social context.

WHO expert committee on drug dependence.

This report presents the recommendations of a WHO Expert Committee responsible for reviewing information on psychoactive substances to assess the need for their international control. The report contains a summary of the Committee's evaluations of gamma-hydroxybutyric acid (GHB) and ketamine. GHB was recommended to be rescheduled from Schedule IV to Schedule II of the Convention on Psychotropic Substances. The report also discusses the nine substances that were pre-reviewed: dextromethorphan, tapentadol, N-benzylpiperazine (BZP), 1-(3-trifluoromethylphenyl) piperazine (TFMPP), 1-(3-chlorophenyl)piperazine (mCPP), 1-(4-methoxyphenyl)piperazine (MeOPP), 1-(3,4-methylenedioxybenzyl)piperazine (MDBP), gamma-butyrolactone (GBL), and 1,4-butanediol (1,4-BD). Of these, tapentadol, BZP, GBL and 1,4-BD were recommended for critical review. Issues identified for consideration at future Expert Committee meetings are also listed. Furthermore, the report discusses the use of terms, the use of pharmacovigilance data for the assessment of abuse and dependence potential, balancing medical availability and prevention of abuse of medicines manufactured from controlled substances, and improving the process for substance evaluation.

Analgesia y sedación para endoscopia digestiva superior diagnóstica e intervencionista en pediatría / Analgesia and sedation for diagnostic and interventional upper gastrointestinal endoscopy in pediatrics

La endoscopia digestiva superior es parte integrante fundamental de la práctica de la gastroenterologíapediátrica. Debe ser realizada por personas con experiencia en este tipo de procedimiento. La posibilidad de brindar una adecuada sedación y analgesia de forma segura y efectiva garantiza la estabilidad y comodidad del paciente por lo que se considera como un componente importante del procedimiento. En los últimos años hay un mayor uso de la sedación para este tipo de procederes. En Cuba, se realizan a diario más de mil endoscopías semanales, alrededor del 19% corresponde a pacientes pediátricos. Llevarlos a cabo con éxito, no es solo obtener resultados valiosos para el diagnóstico y la investigación; sino también, es tener al paciente sedado, sin dolor, dispuesto a incorporarse con rapidez a su tarea de jugar y estudiar.

Digestive endoscopy is an important tool in the practice of pediatric gastroenterology. It should be realized by experienced endoscopist. The possibility of a proper sedation and analgesia in a safe and effective waygarantees the stability and and comfort of the patient. It is considered an important component of the procedure. In the recent past years there is an increase in the sedation for endoscopy. In Cuba, more than athousand endoscopies are done dayli. 19% of them are done in pediatric patients. To do the procedure successfully is not only to have a proper diagnosis; it is also to have the patient properly sedated, without pain and ready to play and to go back to school.

WHO Expert Committee on Drug Dependence.

This report presents the recommendations of a WHO Expert Committee responsible for reviewing information on dependence-producing drugs to assess the need for their international control. The first part of the report contains a summary of the Committee's evaluations of seven substances (dronabinol, oripavine, buprenorphine, butorphanol, ketamine, khat and zopiclone). The report also discusses the substances that were pre-reviewed (gamma-hydroxybutyric acid and tramadol) and recommended gamma-hydroxybutyric acid for critical review at a future meeting. Two substances (gamma-butyrolactone and 1,4-butanediol) were identified for future pre-review). The second part of the report discusses the guidelines for the WHO review of dependence-producing psychoactive substances for international control. It includes sections on amending the current guidelines, interpretation of specific aspects of the guidelines and access to information necessary for the evaluation of substances. The final section considers other matters including activities of the EMCCDA, the use of pharmacovigilance data, promotion of education and information on the appropriate use of psychoactive drugs and the impact of international control on medical availability of substances.