Pah. The Ketamine Fast Track approval feels a bit like a bad joke. See Scott Alexander's recent blog post here: https://slatestarcodex.com/2019/03/11/ketamine-

Pah. The Ketamine Fast Track approval feels a bit like a bad joke. See Scott Alexander's recent blog post here: https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescription/ https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescr... Really wish they'd have gone for Arketamine. To quote in part from above: "Another possibility is that everyone made a huge mistake in using left-handed ketamine, and it’s right-handed ketamine that holds the magic. Most previous research was done on a racemic mixture (an equal mix of left-handed and right-handed molecules), and at least one study suggests it was the right-handed ketamine that was driving the results. Pharma decided to pursue left-handed ketamine because it was known to have a stronger effect on NMDA receptors, but – surprise! – ketamine probably doesn’t work through NMDA after all. So there’s a chance that this is just the wrong kind of ketamine – though usually I expect big pharma to be smarter than that, and I would be surprised if this turned out to be it. I don’t know if anybody has a right-handed ketamine patent yet." I don't think that quite covers it, tho. Personally, I suspect Esketamine, as the part of racemic Ketamine that causes hallucinations exhibits an 'antidepressant' effect similar to the one weakly associated with psychedelics, i.e. more by granting new high level psychological insight than via some low level neurological effect - whereas I'd speculate Arketamine causes the documented 'magic' and RAPID next-day antidepressive effect of racemic Ketamine. Which makes me suspect we'd probably do well doing the same thing done with some other stereoisomeric medications such as for example in the case of Adderall, which has a ratio of Dexamphetamine to Levo Amphetamine of 3:1(viz., 75% Dex, 25% Levo): Figure out the optimal ratio of the two stereoisomers (to each other) for depression treatment.