Editorial

Group Editorial

 

Kids and Ketamine Don’t Mix

 

March 27, 2013

 

Psychiatrist Demitri Papolos boasts a new and unlikely treatment that could help children affected by a type of bipolar disorder he calls, “the fear of harm profile.” Even though diagnosing bipolar disorder in children is still controversial in the psychiatry community, the Manhattan doctor has gone a step beyond diagnosis by prescribing 12 children—ages six to 19—ketamine, a sedative better known as the club drug “Special K.”

 

Can ketamine effectively relieve fearfulness in suffering children? Papolos’s preliminary research looks promising. Should doctors give the class III controlled substance to children as young as six? We’re skeptical at best.

 

Papolos and other proponents will argue that ketamine’s sketchy reputation as a choice recreational horse tranquilizer overshadows its potential therapeutic effects. In some ways, that’s true. Ketamine has long been regarded as the optimal sedative for young patients—even infants—during dental procedures, surgery, and distressing emergency room visits. The one thing these uses all have in common? These situations usually arise only once or twice in a person’s childhood. Papolos’s patients receive a dose of the drug every day.

 

Proponents of the ketamine treatment fail to address the very possibility that should terrify parents—that children may suffer the same long-term exposure side effects as the drug’s recreational abusers. In fact, their relatively fragile developing bodies could be in for a lot worse.

 

Substance abuse researchers at the University of Maryland identify flashbacks, amnesia, and a wide range of debilitating muscle symptoms as common side effects of consistent ketamine use. Even in Papolos’s study, a brief report published last August in the Journal of Affective Disorders, he reported that a quarter of his patients “experienced memory problems” after taking ketamine for five months. Considering a staggering 67 percent of the children also experienced a “loss of balance,” these symptoms suggest that we just don’t know if children’s changing bodies will tolerate this treatment. If these side effects continue to mirror those of seasoned users, the consequences could be devastating.

 

Nonetheless, we cannot ignore Papolos’s success in quelling symptoms of bipolar disorder. Some families regard the treatment as a godsend—a last resort solution, but one that has drastically changed their child’s explosive behavior. A recent NPR story profiled 22-year-old George McCann. One of Papolos’s patients, McCann’s prescription use of ketamine has been the only fully satisfying treatment for the severe psychiatric symptoms that affected him since early childhood. Despite his satisfaction with Papolos’s treatment, McCann’s case does not represent the whole, worrisome story. McCann is an adult and can make his own informed decisions about his health care. On a more physical level, at 22, patients like McCann have bypassed the growth spurts and early learning opportunities that ketamine side-effects could endanger in younger children.

 

The dilemma of alleviating psychiatric symptoms at the price of physical health is a complicated one. No one envies the difficult choices parents of psychiatrically ill young children must make. But like any other medical treatment, doctors, patients, and families must consider the risks. Until the drug is further vetted for safety in young children, doctors should exhaust all other options—from more tried and true pharmaceuticals to holistic therapies. Because no matter how promising the results, a drug like ketamine may not be worth the possibility of physical and mental anguish later on.

 

Copyright © 2013 Copfer, Fields, Lavelle, O’Grady