11 ms·

Ketamine might help prevent suicide

193 points by andrewl 8y ago

Confiks 8y ago
Great television programme, in Dutch, about using ketamine in the treatment of depression (and additionally, about using GHB in the treatment of narcolepsy): https://www.npostart.nl/dokters-van-morgen/30-10-2018/AT_2103629 https://www.npostart.nl/dokters-van-morgen/30-10-2018/AT_210...
ninjakeyboard 8y ago
I was a ketamine user for a long time. My use turned into a problem but I'm realizing that my use patterns were basically: Use, wait until depression returned, crave a cure from my depression, use. In a clinical setting I'm sure that it's very helpful but for me the "crave a cure" caused me to not getting around to dealing with my issues of depression until after I had issues with ketamine that required intervention and left me alone with depression again. I hope other people never go down that path. She is a cruel seductress and the draw of the sudden emotional changes is a lot to put on someone's psyche. If they're suffering, and then suddenly they aren't and they feel happy for the first time in a long time it's easy to make the association to powder = happy and that's a very powerful association for an animal/human psyche to put together. For most people, street ketamine would scare the shit out of them but for anyone else they might get drawn in to basically constant cycles of self medication.
- pitaj 8y ago
  How is a constant cycle of medication any different from using common antidepressants like SSRIs? Sure, it would be great if we could cure depression without drugs, but if that isn't possible, obviously medication is important for those people to be able to live good lives.
  - ninjakeyboard 8y ago
    Well in the case of an nmda receptor antagonist, the harm can be pretty high. For example, alchohol is an nmda receptor antagonist and is considered to have one of the highest social costs of any drugs.
    - pitaj 8y ago
      How does it compare to the side-effects associated with the other anti-depressants, including extreme suicidal ideation? I'm not sure what you mean by "social cost".
      - zeroxfe 8y ago
        social cost = effects on family, close friends and relatives, and occasionally society in general.
      - deleted 8y ago
        [deleted]
      - ninjakeyboard 8y ago
        The doses are acute so the side effects at reasonable doses are primary psychotomimetic effects without physical harm or other behavioral impact - it has a very short half-life and people will be basically sober by the time they leave from a treatment and the body will clear it in a day. The effects last beyond that because they cause a systemic brain change and psychological effect, not because there is a drug present.
    - knaik94 8y ago
      Alcohol is an issue mainly due to how it interacts with Gaba receptors. Alcohol (and benzodiazepienes) binding with those receptors is what causes tolerance, physical addiction and withdrawal. Nmda receptors antagonists don't cause the same kind of issues. You generally can not physically get addicted to nmda antagonists like ketamine. In fact nmda antagonists and modulators are being studied because "research suggests that N-methyl-D-aspartate (NMDA) receptor neurotransmission contributes to mediating the behavioural effects of alcohol and other drugs of abuse" https://www.ncbi.nlm.nih.gov/m/pubmed/11060803/ https://www.ncbi.nlm.nih.gov/m/pubmed/11060803/ I want to make clear that I mean physical in the biological sense. It is still possible to form an addiction to these drugs. I only mean to say that it's rare to have dangerous withdrawal effects, unlike with alcohol.
      - ninjakeyboard 8y ago
  - fragmede 8y ago
    The illicit nature of street ketamine is what sets it apart from SSRIs, for mainstream society. A random primary care physician (PCP) isn't going to send a prescription for it over to the local CVS/Walgreens pharmacy for convenient pickup over lunch. Which often means resorting to desperate measures, at heavy markup, in order to procure any amount, with an unreliable supply. Self-medication can be problematic because it's non-objective, but it can easily lead to (psychological) addiction. The brain optimizes/skips a step - not-being-depressed looks a lot like actually being happy when compared to being depressed, so then there emerges this belief that the user needs to be high on ketamine constantly, which is when it becomes a problem. GP post isn't arguing that no one should use ketamine, or any other medication that works. They are giving first-hand perspective that ketamine addiction is real, and having heard stories myself, I'm inclined to believe GP. It would be great if ketamine had to be prescribed by a doctor to avoid addiction, and that such a requirement didn't end up excluding those outside of mainstream society (often because of mental problems like, say, depression). FDA approval of ketamine for depression will go a long way to improving the situation but for now one choice is to pay some $1500/session (not covered by insurance), to a clinic run by medical professionals risking their license. (Each session uses less than $20 of ketamine, so it's quite the markup!) The other option is to buy street ketamine, which is a move of desperation, but looks a lot better than committing suicide. I don't understand the objection int the article about the possible necessity of "booster" treatments though.
    - derefr 8y ago
      > A random primary care physician (PCP) isn't going to send a prescription for it over to the local CVS/Walgreens pharmacy for convenient pickup over lunch. Most GPs won't write you a scrip for ADHD medication on a whim, either, but I wouldn't describe Vyvanse as "illicit." They just "know what they don't know" and so don't trust their own evaluation of you and think you should get a professional evaluation by a specialist (i.e. a psychiatrist, in this case.) They're usually perfectly willing to continue prescribing after you've gotten a previous scrip from a psychiatrist, though. I suspect ketamine would be much the same, except that you'd need to get your scrip filled at the pharmacy of an inpatient hospital (since that's where they'd have it in stock), rather than the corner store. It's the same story as, say, methamphetamine. Scheduled drug—but that doesn't mean you can't just get a prescription and get it filled. It's a lot of work to get that prescription (since methamphetamine is also a last-line treatment), but once you have it, any hospital pharmacy should have some in stock.
UI_at_80x24 8y ago
I suffer from serious depression. I have tried to kill myself. It comes and goes in waves. I was able to try an experimental ketamine treatment in the hospital. 3 doses administered via IV every-other day. (Monday, Wednesday, Friday) The first and third were failures for me. Nurses talking in the OR completely distracted me and "stole" my awareness. But the second one was perfect. I was able to feel nothing. I was able to shut off my mind and enjoy the single most peaceful moment of my life. As time & work permit I plan on doing this again. Especially now that I know I need to be blindfolded and have ear-plugs in. (this sounds dramatic, but it's what works for me) It hasn't cured my depression, but it has given me hope. And that's more then I have ever had.
- pitaj 8y ago
  I hope you get the help you need.
- sbenitoj 8y ago
  I can’t recommend The Body Keeps the Score by Bessel Van Der Kolk enough, I wish this book had been out 10 years ago before my mom took her life. Nonetheless, it’s been instrumental in helping me alleviate my anxiety and depression. I read it a year ago and I can’t imagine going back to the way I felt then. Specifically I’ve done two forms of therapy — EMDR and Somatic Experiencing — that were recommended (among many others) in the book.
  - comboy 8y ago
    Seems to have really good reviews. Is it something worth reading for somebody without a depression or a trauma? Any insight that stuck with you the most? I'm sorry about your mom.
    - sbenitoj 8y ago
      I honestly read the book just because I consider myself an autodidact and student of human nature and it sounded interesting. While reading I realized that the traditional psychotherapy I’d done since my mother’s suicide was mostly just a way to cope with the tragedy rather than to heal from it (coping is still better than nothing though IMO). I’d say it’s still worth reading to better understand the people around you who seem to act in almost objectively “illogical/irrational” ways, even when presented with better solutions. Even though such behavior is typically self-destructive, this book helped me to see the “logic” of it (Eg some obese women are obese because they were abused as children and they unconsciously overeat/eat junk food to make themselves fat and unattractive to potential abusers, so without resolving that issue no amount of healthy nutrition knowledge will help them, they’ll always regress). It’s also given me more empathy for those around me, instead of feeling like they’re doing things “to me” I’ve been able to keep the bigger picture in mind and realize that people mistreating you is typically just a sign that they have unresolved issues themselves (that doesn’t mean you just let it happen without saying anything, but the increased empathy helps me handle the situation better).
theptip 8y ago
It's very interesting that the most impactful and potentially revolutionary psychiatric drugs currently in trials are both illegal recreational drugs, MDMA and Ketamine. I do wonder how many regular users of these drugs are (consciously or subconsciously) self-medicating, vs. purely using hedonistically. Although I can imagine the line is quite blurry. Scott Alexander has talked about these drugs from a psychiatrist's perspective; his article on Ketamine gives a lot more technical speculation about its mode of action, plus links to academic papers, for anyone that's interested in digging more: http://slatestarcodex.com/2018/11/08/ketamine-an-update/ http://slatestarcodex.com/2018/11/08/ketamine-an-update/
- BurningFrog 8y ago
  > It's very interesting that the most impactful and potentially revolutionary psychiatric drugs currently in trials are both illegal recreational drugs History will not be kind to the War on Drugs. Aside from the millions of lives it directly destroyed, it also set back several fields of science 50 years.
  - deleted 8y ago
    [deleted]
- pitaj 8y ago
  Don't forget about psilocybin.
- empath75 8y ago
  I was absolutely self medicating with mdma to deal with childhood trauma but it was also a hell of a lot of fun. Interestingly I brought up child abuse on an email list I was on with people I met in the rave scene many years ago and literally all of them had a history of it. I had no idea. We never really talked about it even when we were taking mdma and having deep conversations but almost everyone said the mdma helped them deal with it.
- lstodd 8y ago
  I wonder what would happen if they stumble upon Alexander Shulgin's research on phenetylamines and tryptamines. What other most impactful and potentially revolutionary revelations await us there ...
alexnewman 8y ago
I hate providing any negative news for stuff that works for people butt... More and more trials are showing that if you block ampa, ketamine's acute depression curative properties are completely diminished. Aka, it might work, but it's probably not the right drug https://clinicaltrials.gov/ct2/show/NCT02911597 https://clinicaltrials.gov/ct2/show/NCT02911597 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5487269/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5487269/
- xfitm3 8y ago
  Personal ancedote: I know someone who has tried this treatment and it has worked for them. First time I’ve heard about ampa blocking.
- derefr 8y ago
  IIRC (I forget where I read this), ketamine does one thing pharmacokinetically, but its main metabolites—norketamine and dehydronorketamine—have their own entirely-different pharmacokinetics (which aren't just less-potent versions of ketamine's.) I don't know about "not the right drug"; but it might turn out to be considered a pro-drug.
- rhcom2 8y ago
  This is important. I was considering a ketamine study but based on the results of naltrexone + ketamine I'm much more cautious and will wait for further studies.
DanBC 8y ago
This isn't a particularly good article. Psychiatrists in the UK are cautiously optimistic about ketamine, and things like TCMS, but they're worried about the widespread off-label prescribing in the US, especially when that's decoupled from other measures such as talking therapy or psycho-social interventions. > The suicide rate has been rising in the United States since the beginning of the century, [...] And yet no new classes of drugs have been developed to treat depression (and by extension suicidality) in about 30 years, since the advent of selective serotonin reuptake inhibitors like Prozac. Lack of access to new drugs is common across countries, yet many countries have seen falling rates of suicide. What's different about the US? > After her suicide attempt, Louise’s psychiatrist suggested she try ketamine. She agreed, and received an infusion intravenously. Within hours, her sense of well-being improved. The hospital discharged her. Back home, she discovered that going to the market was no longer a “herculean task.” Getting her car washed wasn’t an insurmountable chore. “Life was better,” she said. “Life was doable.” This is exactly the kind of thing that was being said about prozac - these are wonder drugs that make you better than well, and the current drug licencing rules are outdated because Prozac should be available to everyone not just ill people. Ketamine will end up being moderately useful to some people. It will save a few lives. It's probably not a wonder drug. The article makes no mention of the low risk paradox. Most people who die by suicide will have been assessed as low risk of death by suicide shortly before they died. I'm curious if these people would be given ketamine or not. And that's the people who were seen by MH professionals before they died. > Here’s a sobering fact: Some studies indicate that suicide risk peaks soon after patients have been discharged from a medical facility. This is a well known phenomena, which is why NCISH in the UK includes this in their ten ways to improve safety in MH services https://sites.manchester.ac.uk/ncish/ https://sites.manchester.ac.uk/ncish/ "Patients discharged from psychiatric in-patient care should be followed up by the service within two to three days of discharge. A care plan should be in place at the time of discharge."
- derefr 8y ago
  > Lack of access to new drugs is common across countries They didn't say "new drugs", they said "new classes of drugs." The point they were trying to make was that innovation (by big-pharma researchers, at least) in the anti-depressant space has stalled.
Simulacra 8y ago
I suffer from depression and anxiety. I take medication for it but the one thing that has helped more than anything has been cannabis. Unfortunately it's also hindered me quite a bit. I'm intrigued by this study but also suspicious... It seems a lot of "illicit" substances are being touted as possible depression aides, such as shrooms and MDMA.
- chimen 8y ago
  Same stuff basically minus the cannabis. Honest question: did you check your hormone levels? Especially the testosterone and thyroid? I was browsing youtube couple of months ago when I came across this podcast [1] and everything that this guy talked about seemed like it was everything that I'm experiencing. I went ahead and checked my hormones. Sure enough I'm low on testosterone with a measure of 3.2 where the lower limit is 9.6 with the upper of 23 so I'm just 30%~ of the lower limit. It may be a long shot but the chemistry checks out and I will give it a try. [1] https://www.youtube.com/watch?v=_wlvoWASBD4&t=395s https://www.youtube.com/watch?v=_wlvoWASBD4&t=395s P.S. Just read your bio so testosterone might be out of the question, still...check your hormones :)
- empath75 8y ago
  Not sure why that should be surprising since unlike most anti depressants, club drugs have an immediate and dramatic effect.
- magic_beans 8y ago
  Maybe I wasn't able to use cannabis moderately enough, but as my tolerance grew and I had to take more and more to feel the effects, my depression and anxiety got much, much worse.
- sibeliuss 8y ago
  These "illicit" substances work. I can only speak for myself, but the amount depression that can be caused from anxiety is enormous, and then there's MDMA, which provides a reference point for life without it -- which in turn reduces the depression. Life changing, but it was also in a therapeutic setting with all the proper controls.
lostgame 8y ago
I want to warn folks that the quality of street ketamine wildly varies and is not a suitable alternative to these kinds of treatments. I have had on and off issues with dependency on this substance mainly due to my issues with depression and anxiety. If anything, it works too well for these issues, and it’s incredibly easy to get used to the relief from the constant onslaught of struggle that these types of illnesses cause, just as I imagine an opiate would be relieving for someone with chronic pain. I would urge a sense of critical importance to the understanding that the exciting part of these treatments is that in combination with psychotherapy they could cure, not treat these issues. Unlike someone with chronic pain, it can be used, along with certain other properly-applied psychedelics like LSD, to help train the psyche into functioning without it. It’s not, however, something for everyone, and while it worked for me, please excercise extreme caution in using this substance or recommending it to others. I’ve had friends who did it for years and still killed themselves. Two of them. So at the end of the day, I urge everyone with even the deepest-seated mental issues like this - this kind of change has to come from within, and any benefits an external tool provides should be for dedicated moments of healing and/or a focus on the mind, and, for lack of a better word, spirit. I can create a throwaway email account to answer any questions anyone may have. Please don’t hesitate to reach out if you, or anyone close to you has problems with this substance.
- ineedasername 8y ago
  Very valid points. But keep in mind that ketamine therapy is generally considered a treatment of last resort, for refractory depression, often after even treatments like ECT have failed.
  - fragmede 8y ago
    From the article: > Dr. Michael Grunebaum, a Columbia psychiatrist who studies ketamine, thinks the drug should no longer be relegated to a last-line treatment.
  - penagwin 8y ago
    I find this argument interesting. Going through depression myself, waiting for an SSRI to be effective 6 - 8 weeks feels impossible if you want to end it all RIGHT NOW. That's kinda the point of suicide, is to end the pain ASAP. Here's the thing, the SSRI didn't work out for me, now I'm going to try another medication, another 6 weeks before it's fully effective (It's not an SSRI though). I don't know if I can wait that long. I still haven't gotten to other tiers of treatment in terms of medication - Antipsychotics, rMAOIs, etc. Point is: I'm not sure a tiered approach for medication works well for everyone with depression, it's too time sensitive.
deleted 8y ago
[deleted]
roguecoder 8y ago
As a long-term treatment it's being considered as an alternative to electroconvulsive therapy, not SSRIs. It is still a dangerous drug with potential side effects, but that power to harm is exactly what doctors are exploiting to help. For deeper dives into mechanisms, Mayo is doing interesting research into the biomarkers for ketamine responsive versus non-responsive patients: https://www.mayoclinic.org/medical-professionals/psychiatry-psychology/news/ketamine-exploring-continuation-phase-treatment-for-depression/mac-20430307 https://www.mayoclinic.org/medical-professionals/psychiatry-...
NPMaxwell 8y ago
Weird factoid about Ketamine: it seems to require being paired with the smell of a male to work: https://www.scientificamerican.com/article/sex-matters-in-experiments-on-party-drug-mdash-in-mice/ https://www.scientificamerican.com/article/sex-matters-in-ex...
- oliveshell 8y ago
  In mice. (Just pointing out that, as useful as rodent studies are, this isn’t a result that can be generalized to people.)
  - NPMaxwell 8y ago
    Have you seen any tests of this with people? Or heard any first hand witnessing about ketamine and males? I hear it is considered a drug to take when going to clubs. Which reminds me of another quirky result: caffeine promotes wakefulness in fruit flies: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2757164/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2757164/ Without specific selective pressures, traits persist through species
    - oliveshell 8y ago
      No, but from the article you linked: “Gould doubts that the sex of the person administering the drug affects how well it works in a depressed patient, but it's never been tested.“ It seems to be related to stress response, which the mice were experiencing in the presence of male handlers. One would assume the same issue isn’t present in humans unless they become anxious and stressed when men are around. That said, it does have interesting implications for the drug’s relationship with stress; e.g., it might have stronger subjective effects in folks with high stress or stimulation levels at the time of administration.
crazy_monkey 8y ago
Putting people in a medically induced coma also prevents suicide.
deleted 8y ago
[deleted]
stevespang 8y ago
This is WAY old news.
8bitsrule 8y ago
IBT non-synthetic mescaline would prove to be a better choice. Medicinal on this continent for a thousand years.
alexashka 8y ago
I think the article is confusing someone who's at the tail end of their life, and no longer interesting in continuing, with depression among people who'd otherwise go on to live a radically different life. The two are not the same and treating anyone who is done with living as depressed or needing psychiatric intervention is short sighted. I'm all for helping people who want help. Some people don't want help - they just don't want to break the hearts of those who care about them. Suicide is not some grave sin and there is no God watching over us. It'd help to realize some folks get dealt a hand they don't want to play out to the bitter end. The stigma around somebody choosing to act as they see fit, including suicide, really needs to be released. Not so much for the folks who go through with it, but for those around them, that feel guilt, shame and all kinds of negative emotions as a result. I do wonder if normalizing suicide as an option would cause exploitation based systems to implode. Imagine those miserable sweatshop workers. If they said you know what - I'd rather die than live like this, they'd actually have leverage to significantly improve their living conditions.
napban 8y ago
I remember covering this topic in a poster presentation at medical school. It's a perennial news article that, despite popping up on an annual basis, is always presented as a crazy new idea. The fact that ketamine is a street drug makes it a prime topic for click-bait articles. It's a case of the usual bad science in media. NYT is no better a source to cite for medical topics than the Daily Mail is for Computer Science!

193 points by andrewl 8y ago

Great television programme, in Dutch, about using ketamine in the treatment of depression (and additionally, about using GHB in the treatment of narcolepsy): https://www.npostart.nl/dokters-van-morgen/30-10-2018/AT_2103629 https://www.npostart.nl/dokters-van-morgen/30-10-2018/AT_210...

ninjakeyboard 8y ago

I was a ketamine user for a long time. My use turned into a problem but I'm realizing that my use patterns were basically: Use, wait until depression returned, crave a cure from my depression, use. In a clinical setting I'm sure that it's very helpful but for me the "crave a cure" caused me to not getting around to dealing with my issues of depression until after I had issues with ketamine that required intervention and left me alone with depression again. I hope other people never go down that path. She is a cruel seductress and the draw of the sudden emotional changes is a lot to put on someone's psyche. If they're suffering, and then suddenly they aren't and they feel happy for the first time in a long time it's easy to make the association to powder = happy and that's a very powerful association for an animal/human psyche to put together. For most people, street ketamine would scare the shit out of them but for anyone else they might get drawn in to basically constant cycles of self medication.

pitaj 8y ago
How is a constant cycle of medication any different from using common antidepressants like SSRIs? Sure, it would be great if we could cure depression without drugs, but if that isn't possible, obviously medication is important for those people to be able to live good lives.
- ninjakeyboard 8y ago
  Well in the case of an nmda receptor antagonist, the harm can be pretty high. For example, alchohol is an nmda receptor antagonist and is considered to have one of the highest social costs of any drugs.
  - pitaj 8y ago
    How does it compare to the side-effects associated with the other anti-depressants, including extreme suicidal ideation? I'm not sure what you mean by "social cost".
    - zeroxfe 8y ago
      social cost = effects on family, close friends and relatives, and occasionally society in general.
    - deleted 8y ago
      [deleted]
    - ninjakeyboard 8y ago
      The doses are acute so the side effects at reasonable doses are primary psychotomimetic effects without physical harm or other behavioral impact - it has a very short half-life and people will be basically sober by the time they leave from a treatment and the body will clear it in a day. The effects last beyond that because they cause a systemic brain change and psychological effect, not because there is a drug present.
  - knaik94 8y ago
    Alcohol is an issue mainly due to how it interacts with Gaba receptors. Alcohol (and benzodiazepienes) binding with those receptors is what causes tolerance, physical addiction and withdrawal. Nmda receptors antagonists don't cause the same kind of issues. You generally can not physically get addicted to nmda antagonists like ketamine. In fact nmda antagonists and modulators are being studied because "research suggests that N-methyl-D-aspartate (NMDA) receptor neurotransmission contributes to mediating the behavioural effects of alcohol and other drugs of abuse" https://www.ncbi.nlm.nih.gov/m/pubmed/11060803/ https://www.ncbi.nlm.nih.gov/m/pubmed/11060803/ I want to make clear that I mean physical in the biological sense. It is still possible to form an addiction to these drugs. I only mean to say that it's rare to have dangerous withdrawal effects, unlike with alcohol.
    - ninjakeyboard 8y ago
- fragmede 8y ago
  The illicit nature of street ketamine is what sets it apart from SSRIs, for mainstream society. A random primary care physician (PCP) isn't going to send a prescription for it over to the local CVS/Walgreens pharmacy for convenient pickup over lunch. Which often means resorting to desperate measures, at heavy markup, in order to procure any amount, with an unreliable supply. Self-medication can be problematic because it's non-objective, but it can easily lead to (psychological) addiction. The brain optimizes/skips a step - not-being-depressed looks a lot like actually being happy when compared to being depressed, so then there emerges this belief that the user needs to be high on ketamine constantly, which is when it becomes a problem. GP post isn't arguing that no one should use ketamine, or any other medication that works. They are giving first-hand perspective that ketamine addiction is real, and having heard stories myself, I'm inclined to believe GP. It would be great if ketamine had to be prescribed by a doctor to avoid addiction, and that such a requirement didn't end up excluding those outside of mainstream society (often because of mental problems like, say, depression). FDA approval of ketamine for depression will go a long way to improving the situation but for now one choice is to pay some $1500/session (not covered by insurance), to a clinic run by medical professionals risking their license. (Each session uses less than $20 of ketamine, so it's quite the markup!) The other option is to buy street ketamine, which is a move of desperation, but looks a lot better than committing suicide. I don't understand the objection int the article about the possible necessity of "booster" treatments though.
  - derefr 8y ago
    > A random primary care physician (PCP) isn't going to send a prescription for it over to the local CVS/Walgreens pharmacy for convenient pickup over lunch. Most GPs won't write you a scrip for ADHD medication on a whim, either, but I wouldn't describe Vyvanse as "illicit." They just "know what they don't know" and so don't trust their own evaluation of you and think you should get a professional evaluation by a specialist (i.e. a psychiatrist, in this case.) They're usually perfectly willing to continue prescribing after you've gotten a previous scrip from a psychiatrist, though. I suspect ketamine would be much the same, except that you'd need to get your scrip filled at the pharmacy of an inpatient hospital (since that's where they'd have it in stock), rather than the corner store. It's the same story as, say, methamphetamine. Scheduled drug—but that doesn't mean you can't just get a prescription and get it filled. It's a lot of work to get that prescription (since methamphetamine is also a last-line treatment), but once you have it, any hospital pharmacy should have some in stock.

UI_at_80x24 8y ago

I suffer from serious depression. I have tried to kill myself. It comes and goes in waves. I was able to try an experimental ketamine treatment in the hospital. 3 doses administered via IV every-other day. (Monday, Wednesday, Friday) The first and third were failures for me. Nurses talking in the OR completely distracted me and "stole" my awareness. But the second one was perfect. I was able to feel nothing. I was able to shut off my mind and enjoy the single most peaceful moment of my life. As time & work permit I plan on doing this again. Especially now that I know I need to be blindfolded and have ear-plugs in. (this sounds dramatic, but it's what works for me) It hasn't cured my depression, but it has given me hope. And that's more then I have ever had.

pitaj 8y ago
I hope you get the help you need.
sbenitoj 8y ago
I can’t recommend The Body Keeps the Score by Bessel Van Der Kolk enough, I wish this book had been out 10 years ago before my mom took her life. Nonetheless, it’s been instrumental in helping me alleviate my anxiety and depression. I read it a year ago and I can’t imagine going back to the way I felt then. Specifically I’ve done two forms of therapy — EMDR and Somatic Experiencing — that were recommended (among many others) in the book.
- comboy 8y ago
  Seems to have really good reviews. Is it something worth reading for somebody without a depression or a trauma? Any insight that stuck with you the most? I'm sorry about your mom.
  - sbenitoj 8y ago
    I honestly read the book just because I consider myself an autodidact and student of human nature and it sounded interesting. While reading I realized that the traditional psychotherapy I’d done since my mother’s suicide was mostly just a way to cope with the tragedy rather than to heal from it (coping is still better than nothing though IMO). I’d say it’s still worth reading to better understand the people around you who seem to act in almost objectively “illogical/irrational” ways, even when presented with better solutions. Even though such behavior is typically self-destructive, this book helped me to see the “logic” of it (Eg some obese women are obese because they were abused as children and they unconsciously overeat/eat junk food to make themselves fat and unattractive to potential abusers, so without resolving that issue no amount of healthy nutrition knowledge will help them, they’ll always regress). It’s also given me more empathy for those around me, instead of feeling like they’re doing things “to me” I’ve been able to keep the bigger picture in mind and realize that people mistreating you is typically just a sign that they have unresolved issues themselves (that doesn’t mean you just let it happen without saying anything, but the increased empathy helps me handle the situation better).

theptip 8y ago

It's very interesting that the most impactful and potentially revolutionary psychiatric drugs currently in trials are both illegal recreational drugs, MDMA and Ketamine. I do wonder how many regular users of these drugs are (consciously or subconsciously) self-medicating, vs. purely using hedonistically. Although I can imagine the line is quite blurry. Scott Alexander has talked about these drugs from a psychiatrist's perspective; his article on Ketamine gives a lot more technical speculation about its mode of action, plus links to academic papers, for anyone that's interested in digging more: http://slatestarcodex.com/2018/11/08/ketamine-an-update/ http://slatestarcodex.com/2018/11/08/ketamine-an-update/

BurningFrog 8y ago
> It's very interesting that the most impactful and potentially revolutionary psychiatric drugs currently in trials are both illegal recreational drugs History will not be kind to the War on Drugs. Aside from the millions of lives it directly destroyed, it also set back several fields of science 50 years.
- deleted 8y ago
  [deleted]
pitaj 8y ago
Don't forget about psilocybin.
empath75 8y ago
I was absolutely self medicating with mdma to deal with childhood trauma but it was also a hell of a lot of fun. Interestingly I brought up child abuse on an email list I was on with people I met in the rave scene many years ago and literally all of them had a history of it. I had no idea. We never really talked about it even when we were taking mdma and having deep conversations but almost everyone said the mdma helped them deal with it.
lstodd 8y ago
I wonder what would happen if they stumble upon Alexander Shulgin's research on phenetylamines and tryptamines. What other most impactful and potentially revolutionary revelations await us there ...

alexnewman 8y ago

I hate providing any negative news for stuff that works for people butt... More and more trials are showing that if you block ampa, ketamine's acute depression curative properties are completely diminished. Aka, it might work, but it's probably not the right drug https://clinicaltrials.gov/ct2/show/NCT02911597 https://clinicaltrials.gov/ct2/show/NCT02911597 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5487269/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5487269/

xfitm3 8y ago
Personal ancedote: I know someone who has tried this treatment and it has worked for them. First time I’ve heard about ampa blocking.
derefr 8y ago
IIRC (I forget where I read this), ketamine does one thing pharmacokinetically, but its main metabolites—norketamine and dehydronorketamine—have their own entirely-different pharmacokinetics (which aren't just less-potent versions of ketamine's.) I don't know about "not the right drug"; but it might turn out to be considered a pro-drug.
rhcom2 8y ago
This is important. I was considering a ketamine study but based on the results of naltrexone + ketamine I'm much more cautious and will wait for further studies.

DanBC 8y ago

This isn't a particularly good article. Psychiatrists in the UK are cautiously optimistic about ketamine, and things like TCMS, but they're worried about the widespread off-label prescribing in the US, especially when that's decoupled from other measures such as talking therapy or psycho-social interventions. > The suicide rate has been rising in the United States since the beginning of the century, [...] And yet no new classes of drugs have been developed to treat depression (and by extension suicidality) in about 30 years, since the advent of selective serotonin reuptake inhibitors like Prozac. Lack of access to new drugs is common across countries, yet many countries have seen falling rates of suicide. What's different about the US? > After her suicide attempt, Louise’s psychiatrist suggested she try ketamine. She agreed, and received an infusion intravenously. Within hours, her sense of well-being improved. The hospital discharged her. Back home, she discovered that going to the market was no longer a “herculean task.” Getting her car washed wasn’t an insurmountable chore. “Life was better,” she said. “Life was doable.” This is exactly the kind of thing that was being said about prozac - these are wonder drugs that make you better than well, and the current drug licencing rules are outdated because Prozac should be available to everyone not just ill people. Ketamine will end up being moderately useful to some people. It will save a few lives. It's probably not a wonder drug. The article makes no mention of the low risk paradox. Most people who die by suicide will have been assessed as low risk of death by suicide shortly before they died. I'm curious if these people would be given ketamine or not. And that's the people who were seen by MH professionals before they died. > Here’s a sobering fact: Some studies indicate that suicide risk peaks soon after patients have been discharged from a medical facility. This is a well known phenomena, which is why NCISH in the UK includes this in their ten ways to improve safety in MH services https://sites.manchester.ac.uk/ncish/ https://sites.manchester.ac.uk/ncish/ "Patients discharged from psychiatric in-patient care should be followed up by the service within two to three days of discharge. A care plan should be in place at the time of discharge."

derefr 8y ago
> Lack of access to new drugs is common across countries They didn't say "new drugs", they said "new classes of drugs." The point they were trying to make was that innovation (by big-pharma researchers, at least) in the anti-depressant space has stalled.

Simulacra 8y ago

I suffer from depression and anxiety. I take medication for it but the one thing that has helped more than anything has been cannabis. Unfortunately it's also hindered me quite a bit. I'm intrigued by this study but also suspicious... It seems a lot of "illicit" substances are being touted as possible depression aides, such as shrooms and MDMA.

chimen 8y ago
Same stuff basically minus the cannabis. Honest question: did you check your hormone levels? Especially the testosterone and thyroid? I was browsing youtube couple of months ago when I came across this podcast [1] and everything that this guy talked about seemed like it was everything that I'm experiencing. I went ahead and checked my hormones. Sure enough I'm low on testosterone with a measure of 3.2 where the lower limit is 9.6 with the upper of 23 so I'm just 30%~ of the lower limit. It may be a long shot but the chemistry checks out and I will give it a try. [1] https://www.youtube.com/watch?v=_wlvoWASBD4&t=395s https://www.youtube.com/watch?v=_wlvoWASBD4&t=395s P.S. Just read your bio so testosterone might be out of the question, still...check your hormones :)
empath75 8y ago
Not sure why that should be surprising since unlike most anti depressants, club drugs have an immediate and dramatic effect.
magic_beans 8y ago
Maybe I wasn't able to use cannabis moderately enough, but as my tolerance grew and I had to take more and more to feel the effects, my depression and anxiety got much, much worse.
sibeliuss 8y ago
These "illicit" substances work. I can only speak for myself, but the amount depression that can be caused from anxiety is enormous, and then there's MDMA, which provides a reference point for life without it -- which in turn reduces the depression. Life changing, but it was also in a therapeutic setting with all the proper controls.

lostgame 8y ago

I want to warn folks that the quality of street ketamine wildly varies and is not a suitable alternative to these kinds of treatments. I have had on and off issues with dependency on this substance mainly due to my issues with depression and anxiety. If anything, it works too well for these issues, and it’s incredibly easy to get used to the relief from the constant onslaught of struggle that these types of illnesses cause, just as I imagine an opiate would be relieving for someone with chronic pain. I would urge a sense of critical importance to the understanding that the exciting part of these treatments is that in combination with psychotherapy they could cure, not treat these issues. Unlike someone with chronic pain, it can be used, along with certain other properly-applied psychedelics like LSD, to help train the psyche into functioning without it. It’s not, however, something for everyone, and while it worked for me, please excercise extreme caution in using this substance or recommending it to others. I’ve had friends who did it for years and still killed themselves. Two of them. So at the end of the day, I urge everyone with even the deepest-seated mental issues like this - this kind of change has to come from within, and any benefits an external tool provides should be for dedicated moments of healing and/or a focus on the mind, and, for lack of a better word, spirit. I can create a throwaway email account to answer any questions anyone may have. Please don’t hesitate to reach out if you, or anyone close to you has problems with this substance.

ineedasername 8y ago
Very valid points. But keep in mind that ketamine therapy is generally considered a treatment of last resort, for refractory depression, often after even treatments like ECT have failed.
- fragmede 8y ago
  From the article: > Dr. Michael Grunebaum, a Columbia psychiatrist who studies ketamine, thinks the drug should no longer be relegated to a last-line treatment.
- penagwin 8y ago
  I find this argument interesting. Going through depression myself, waiting for an SSRI to be effective 6 - 8 weeks feels impossible if you want to end it all RIGHT NOW. That's kinda the point of suicide, is to end the pain ASAP. Here's the thing, the SSRI didn't work out for me, now I'm going to try another medication, another 6 weeks before it's fully effective (It's not an SSRI though). I don't know if I can wait that long. I still haven't gotten to other tiers of treatment in terms of medication - Antipsychotics, rMAOIs, etc. Point is: I'm not sure a tiered approach for medication works well for everyone with depression, it's too time sensitive.

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roguecoder 8y ago

As a long-term treatment it's being considered as an alternative to electroconvulsive therapy, not SSRIs. It is still a dangerous drug with potential side effects, but that power to harm is exactly what doctors are exploiting to help. For deeper dives into mechanisms, Mayo is doing interesting research into the biomarkers for ketamine responsive versus non-responsive patients: https://www.mayoclinic.org/medical-professionals/psychiatry-psychology/news/ketamine-exploring-continuation-phase-treatment-for-depression/mac-20430307 https://www.mayoclinic.org/medical-professionals/psychiatry-...

NPMaxwell 8y ago

Weird factoid about Ketamine: it seems to require being paired with the smell of a male to work: https://www.scientificamerican.com/article/sex-matters-in-experiments-on-party-drug-mdash-in-mice/ https://www.scientificamerican.com/article/sex-matters-in-ex...

oliveshell 8y ago
In mice. (Just pointing out that, as useful as rodent studies are, this isn’t a result that can be generalized to people.)
- NPMaxwell 8y ago
  Have you seen any tests of this with people? Or heard any first hand witnessing about ketamine and males? I hear it is considered a drug to take when going to clubs. Which reminds me of another quirky result: caffeine promotes wakefulness in fruit flies: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2757164/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2757164/ Without specific selective pressures, traits persist through species
  - oliveshell 8y ago
    No, but from the article you linked: “Gould doubts that the sex of the person administering the drug affects how well it works in a depressed patient, but it's never been tested.“ It seems to be related to stress response, which the mice were experiencing in the presence of male handlers. One would assume the same issue isn’t present in humans unless they become anxious and stressed when men are around. That said, it does have interesting implications for the drug’s relationship with stress; e.g., it might have stronger subjective effects in folks with high stress or stimulation levels at the time of administration.

crazy_monkey 8y ago

Putting people in a medically induced coma also prevents suicide.

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stevespang 8y ago

This is WAY old news.

8bitsrule 8y ago

IBT non-synthetic mescaline would prove to be a better choice. Medicinal on this continent for a thousand years.

alexashka 8y ago

I think the article is confusing someone who's at the tail end of their life, and no longer interesting in continuing, with depression among people who'd otherwise go on to live a radically different life. The two are not the same and treating anyone who is done with living as depressed or needing psychiatric intervention is short sighted. I'm all for helping people who want help. Some people don't want help - they just don't want to break the hearts of those who care about them. Suicide is not some grave sin and there is no God watching over us. It'd help to realize some folks get dealt a hand they don't want to play out to the bitter end. The stigma around somebody choosing to act as they see fit, including suicide, really needs to be released. Not so much for the folks who go through with it, but for those around them, that feel guilt, shame and all kinds of negative emotions as a result. I do wonder if normalizing suicide as an option would cause exploitation based systems to implode. Imagine those miserable sweatshop workers. If they said you know what - I'd rather die than live like this, they'd actually have leverage to significantly improve their living conditions.

napban 8y ago

I remember covering this topic in a poster presentation at medical school. It's a perennial news article that, despite popping up on an annual basis, is always presented as a crazy new idea. The fact that ketamine is a street drug makes it a prime topic for click-bait articles. It's a case of the usual bad science in media. NYT is no better a source to cite for medical topics than the Daily Mail is for Computer Science!