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Main upsides of Ketamine for depression vs typical antidepressants (SSRIs, etc) - Ketamine seems to have a much larger effect size (-~0.99 [1] vs -~0.35 for ty

Main upsides of Ketamine for depression vs typical antidepressants (SSRIs, etc) - Ketamine seems to have a much larger effect size (-~0.99 [1] vs -~0.35 for typical antidepressants [2]) [If anyone spots an error, please let me know] For context, an SMD of 0.2 is small, >0.5 is medium, and >0.8 is large.[3] To me this seems to be by far the most important/interesting thing: Ketamine seems to have a much stronger antidepressant effect than our current antidepressants. - Benefits occur within hours rather than weeks - Doesn't seem to interfere with sexual function, unlike many antidepressants Main downsides of Ketamine for depression - Much more expensive and normally not covered by insurance - It's less well studied - You have to go in for additional ketamine infusions to maintain the effects, it seems roughly ~1x a month long term (The SMD for typical antidepressants seems to range from ~-0.13 to ~-0.35, with Tricyclic antidepressants slightly higher at around -~0.42.[4][5][6]) [1]: https://www.ncbi.nlm.nih.gov/pubmed/25038867 https://www.ncbi.nlm.nih.gov/pubmed/25038867 [2]: https://onlinelibrary.wiley.com/doi/pdf/10.1002/wps.20112 https://onlinelibrary.wiley.com/doi/pdf/10.1002/wps.20112 [3]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730804/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730804/ [4]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903535/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903535/ [5]: http://www.annfammed.org/content/3/5/449.full http://www.annfammed.org/content/3/5/449.full [6]: http://www.cochrane.org/CD011735/MUSKEL_selective-serotonin-reuptake-inhibitors-ssris-fibromyalgia http://www.cochrane.org/CD011735/MUSKEL_selective-serotonin-...

atomical 9y ago
It's expensive because doctors are using it to make a lot of money. The drug is cheap.
- selectodude 9y ago
  That and I bet the malpractice insurance for this kind of off-label use is going to be pretty high.
GordonS 9y ago
Anyone know why it always seems to be given as an infusion, and not any other route? If it was just about bioavailability, I guess they'd just give large oral doses. I recall reading of people self treating with ketamine off the darknet, and I imagine they are not giving themselves an infusion?
- marssaxman 9y ago
  Oral ingestion is unpopular due to inefficiency and the likelihood of stomach upset. People who are self-administering ketamine are most likely insufflating. I have friends who have reported very positive results with intramuscular injection, but most people don't have access to hygienic injection apparatus, nor any experience using it safely, so insufflation is most common.
topmonk 9y ago
> - Ketamine seems to have a much larger effect size (-~0.99 [1] vs -~0.35 for typical antidepressants [2]) [If anyone spots an error, please let me know] I've heard that 35% figure bandied about for awhile now. Does this take into account multiple SSRI's? If one took Welbutrin and it didn't work, for example, and then one decides to try Paxil, is there still a 35% chance that Paxil will work? (both Paxil and Welbutrin are SSRI's) Or is the 35% figure meaning that if one tried all the SSRI's out there, there is only a 35% chance that any of them at all will help you? I tried reading your reference, but it doesn't seem to mention this.
- anythingnonidin 9y ago
  Not sure about your questions, sorry. Perhaps try asking on reddit.com/r/askdrugnerds. And a minor correction to your comment: The ~0.35 is showing standardized mean difference which is more a measure of how much it reduces someone's depression by, as opposed to what you're asking about which is about what % of people respond to a given treatment.

atomical 9y ago

It's expensive because doctors are using it to make a lot of money. The drug is cheap.

selectodude 9y ago
That and I bet the malpractice insurance for this kind of off-label use is going to be pretty high.

GordonS 9y ago

Anyone know why it always seems to be given as an infusion, and not any other route? If it was just about bioavailability, I guess they'd just give large oral doses. I recall reading of people self treating with ketamine off the darknet, and I imagine they are not giving themselves an infusion?

marssaxman 9y ago
Oral ingestion is unpopular due to inefficiency and the likelihood of stomach upset. People who are self-administering ketamine are most likely insufflating. I have friends who have reported very positive results with intramuscular injection, but most people don't have access to hygienic injection apparatus, nor any experience using it safely, so insufflation is most common.

topmonk 9y ago

> - Ketamine seems to have a much larger effect size (-~0.99 [1] vs -~0.35 for typical antidepressants [2]) [If anyone spots an error, please let me know] I've heard that 35% figure bandied about for awhile now. Does this take into account multiple SSRI's? If one took Welbutrin and it didn't work, for example, and then one decides to try Paxil, is there still a 35% chance that Paxil will work? (both Paxil and Welbutrin are SSRI's) Or is the 35% figure meaning that if one tried all the SSRI's out there, there is only a 35% chance that any of them at all will help you? I tried reading your reference, but it doesn't seem to mention this.

anythingnonidin 9y ago
Not sure about your questions, sorry. Perhaps try asking on reddit.com/r/askdrugnerds. And a minor correction to your comment: The ~0.35 is showing standardized mean difference which is more a measure of how much it reduces someone's depression by, as opposed to what you're asking about which is about what % of people respond to a given treatment.