Madelin Manso wanted to die. Just like designer Kate Spade and celebrity chef Anthony Bourdain.
But instead of reaching for the noose, she grabbed a lifeline in a drug that club kids used to take to get high.
The 56-year-old South Miami woman opted for one of the unorthodox treatments increasingly available for clinical depression. By taking ketamine — an anesthetic better known by some during its club heyday as Special K — she solved decades of suffering.
“I went in not wanting to live one more second and I came out like a new person,” Manso said. “It was a miracle. When I woke up the next day … I was smiles from ear to ear.”
So, in the week that followed the high-profile suicides of Spade and Bourdain, Manso wanted to get out the message that there is another path for the many who can’t find relief through traditional medication.
Researchers and doctors say the treatment of depression in on the cusp of a profound period of innovation. It includes treatments such as ketamine and transcranial magnetic stimulation — stimulating the brain with a magnetic field.
Some psychiatrists also are touting hallucinogenics. Before magic mushrooms and LSD took root in the counterculture of the 1960s — inspiring art, politics, philosophy and “Sgt. Pepper’s Lonely Hearts Club Band” — hallucinogenics were considered by researchers as a viable treatment for mental illness.
While antidepressants revolutionized the treatment of mental health for millions, it is time to move on from a Prozac nation where one in 10 people take such pills with often mixed results, researchers and doctors say.
Suicide rates in the United States have increased 24 percent in the past two decades, as a Palm Beach Post health column detailed June 8. The reason, experts say, is untreated depression or medication failure.
Medications didn’t work
Since her teens, Manso sought relief for her bipolar disorder, an illness known for deep depression and rousing mania. She moved from antidepressants to mood stabilizers to anti-psychotics. No medication worked very long. Sometimes she ended up in a hospital.
“I went through so many medications. I would always have to change them,” Manso said “The medication wouldn’t have the right effect or it had side effects. It would take months to find the right one. I ended up depressed most of the time.”
Manso got her treatment at Ketamine Health Centers, which recently opened a branch in West Palm Beach. Her doctor said she isn’t the only patient he has witnessed make a remarkable recovery.
“When they come in, they are in one of the worst states they have ever been, but after the treatment, they say the cloud has been lifted,” said Dr. Raul Cruz. “A lot of patients who come in have suicide ideation, and that isn’t a population you want to play around with, and ketamine has been very effective.”
He said ketamine seems to have triumphed over it’s “bad rap” as a recreational drug when users would take so much of it they became catatonic on the dance floor — lost in a “K-hole.”
And it’s just not magnets, magic mushrooms and Special K. Scientists at Scripps Florida in Jupiter are looking to develop new medications that eschew targeting neurotransmitters in the brain.
One of the aspects of modern pharmacology for mental illness is that it’s trial-and-error and that the medicines take time to be effective. For many, like Manso, they never really work.
“When you have a bone broken, you go and have an X-ray and it tells you what’s wrong. With mental illness, there are so many causes. You have all sorts of different options,” said Kirill Martemyanov, co-chair of the department of neuroscience at Scripps’ Florida campus.
While traditional antidepressants target particular neurotransmitters that release chemicals regulating mood — serotonin, dopamine, norepinephrine — the research marshaled by Scripps targets a new biology: a particular protein in the brain that is found at high levels among those who suffer depression.
Why do we get depressed?
The reason for all of this depression and anxiety is evolutionary.
Humans, quite frankly, weren’t meant to live like this. Studies of existing hunter-gather cultures, like in Papua New Guinea, find no trace of depression. Experts say the depression epidemic in the modern world is a result of the prolonged stress of the rat race.
Other researchers opine that human ancestors who suffered anxiety and depression didn’t venture far from the cave. They stayed home and made babies, passing on their traits for fretting. The gene pool of their braver cave brethren, on the other hand, became lunch for a saber-toothed tiger.
Yet, nature is a cruel trickster. The very trait that once kept us alive is now killing us, with suicides nearing 45,000 in the United States last year. Many more choose to self-medicate. For those in pain, medical science can’t catch up soon enough.
For scientists, like Martemyanov, the disconcerting part of this new era of alternative treatment is that with “hallucinogenic mushrooms and ketamine, we have no idea how the magic works. You have an effective drug, but we don’t know what is the mechanism.”
There are other barriers as well.
Hallucinogenic psilocybin mushrooms are still considered an illegal Schedule I drug and practitioners have worked surreptitiously to treat patients, as shown in a recent New York Times Magazine cover story. Research shows hallucinogens activate a serotonin receptor that can lead to the alterations of consciousness reported routinely by those who ingest the drug.
A theory, the article states, is that psilocybin interrupts the circuitry of self-absorbed thinking pronounced in depressed people, breaking depression’s grip.
Ketamine, a longtime knockout drug used in surgery, is not covered by medical insurance when it is used to treat depression or other ailments for which it has not been approved.
TMS, or magnetic treatment, has been accepted as a treatment for depression by the Food and Drug Administration and is covered by insurance if patients meet certain criteria.
So, why do they work? Whether mushrooms, ketamine or magnets, practitioners often describe the process as rebooting the brain.
In this sense, these treatments are having a similar outcome to electric shock therapy. Despite its dastardly portrayal in everything from “One Flew Over the Cuckoo’s Nest” to “Mad Men,” ECT has changed dramatically since the 1960s and has become a highly effective treatment for depression but with caveats: it requires sedation and postoperative care. It also has the side effect of memory loss.
Jupiter psychiatrist Dr. Edward Zawadzki said the pulsing magnets of TMS do the same thing, activating neurons in the brain’s dorsolateral prefrontal cortex by forcing them to fire and release their mood-altering chemicals. He compares it to working out a knee or a shoulder during physical therapy after surgery.
“You are bombarding the depression area of the brain, kind of forcing it to wake up,” Zawadzki said.
The amazing part of TMS is that it taps into the fact that — yes, “The Matrix” was right about this — humans are electrical chemical beings. The heart operates on electrical impulses and the brain is no different.
The magnetic coils are placed on the patient’s head for 20- or 30-minute treatments that take place several times a week for about a month. The machine sounds similar to an MRI, with the typical click sounds, but not as loud. Some patients feel tired afterward — because the brain is literally working out, Zawadzki said.
The psychiatrist has seen the same remarkable recovery in TMS patients as Cruz does with ketamine. People who cry on a daily basis can again engage with life.
“We’ve seen patients suffering from severe chronic depression really make a remarkable turnaround,” he said. “They end up going to their children’s baseball games. They see improvement in their relationships. Some are able to go back to work.”
These treatments are becoming more available across the country. A decade ago, a U.S. resident had to fly to Canada and pay thousands out of pocket to get TMS.
Unlike TMS, ketamine treatment is not covered by insurance. The one-hour, $600 infusions are administered intravenously at a doctor’s office and follow-ups — boosters — are needed on a case-by-case basis.
Cruz, of Ketamine Health Centers, says the theory is that ketamine works on a different neurotransmitter than antidepressant medication, called glutamate, which is present in great quantities in the brain.
“This glutamate is a neurotransmitter that hadn’t been looked at for mood disorders, but now they are finding that it possibly has more to do with the mood than anything else,” he said.
The treatment is so popular that the FDA reports a shortage of ketamine.
When it comes to psychiatry, Cruz said it appears that every half-century there is a revolution in treatment. The revolution is now, he said.
“I feel this is a paradigm shift in how we view and treat depression,” he said. “We might be entering a new golden age of how we approach this disease since it’s been the same way for the last 50 years by targeting the same neurotransmitters. It’s exciting.”