5 ms·

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 is

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.
  - ineedasername 8y ago
    I agree. I can imagine... well, I don't have to imagine, I've been there: the prospect of months or even years long carousel of medications, trying and discarding one after another, hoping to get lucky on the next try... It's awful. I'd like to see ketamine and some others in careful but wider use. (modafinil for example works wonders for me and is also fast acting, definitely keeps me functional during depressive periods)
  - freedomben 8y ago
    Yes indeed. 6 to 8 weeks is an eternity for someone who is deeply suffering. I personally think we are way too stingy with medicines these days. I also had a friend commit suicide while suffering from intense depression. He would no doubt be alive today if he had been giving what he needed right away, instead of being made to start with Prozac and then worked through a bunch of different "starter" antidepressants. Just give people what they need. There are worse outcomes than over-prescribing (death at one's own hand, for example).
    - nickbarnwell 8y ago
      Sadly, we don’t know enough about the brain to have any idea which medications are going to work or what it is people need right away. While you certainly could sedate people to the point of utter apathy by giving every shmiel who walks through the clinic doors high powered anti-psychotics it would be akin to treating a broken toe with amputation. First line treatments like sertraline and fluoxetine are used because they take time to work and have generally tolerable side-effect profiles. E.g. in the case of patients with undiagnosed bipolar disorder, you run a lower risk of triggering a manic episode.
- TheSpiceIsLife 8y ago
  Maybe ketamine is treatment of last resort, and LSD, because they’re most likely to actually work and the pharmaceutical-insurance industrial complex wants to rinse as many people through the ineffective drugs and therapies first. Maybe I’m just being cynical, but if the standard treatments were effective perhaps we mental illness wouldn’t be so prevalent. Of course, it’s complex and multifactorial, and there’s societal and cultural issues, and generational issues, we need to address too.
  - Valmar 8y ago
    Exactly my thoughts.
  - atomical 8y ago
    Check out the book Ketamine for Treatment Resistant Depression. It's a safe drug with a low incidence of serious side effects that could help a lot of patients. Researchers have shifted much of the research to Ketamine metabolites. Their reasoning is that these metabolites have a lower side effect profile than the parent compound. It has been almost 20 years of small scale ketamine trials for depression with not much to show for it. Now, they would like to explore a diversion that may be less safe than a drug with a long history of safety. I think there are a few reasons for this: 1) Depression isn't seen as a serious disease like cancer and 2) Ketamine is a cheap drug.
- ggm 8y ago
  I thought because of its rapid efficacy it was moving towards, being proposed as being a Frontline intervention to reset. SSRI are hugely problemmatical because they take time to ramp up and flush down. Mental health sometimes needs a course correct not a long-term hand on the tiller. MDMA and psylocibin likewise: brief, sharp reset goal. (That's what I read)
- atomical 8y ago
  This is very misleading. Patients are seeking out this treatment from independent clinics that do not take insurance. They don't need a referral. The biggest consideration is patient ability to pay a lump sum up front.
josephpmay 8y ago
Katamine may actually /be/ an opiate: http://slatestarcodex.com/2018/11/08/ketamine-an-update/ http://slatestarcodex.com/2018/11/08/ketamine-an-update/
- oxide 8y ago
  It is not an opiate, even if it has an affinity for the mu receptor (it may or may not) it is absolutely classified as an NMDA antagonist.
- meowface 8y ago
  It has effects on the opioid receptors but is definitely not an opiate or opioid.
tibbon 8y ago
Additionally, it appears that the different isomers have different properties potentially for anti-depressive effects. The R- isomer seems to work better for it from what I’ve read. Know what isomer you’ve got is less common from street. A lot of people prefer S+ isomer for recreation though but it doesn’t help as much
nickbarnwell 8y ago
The usage of ketamine in the trials for depression typically uses IV administration over a fairly long timespan with highly specific dosages. It is not comparable to street usage of the drug. As with any psychotropic medication, one should do their research. Psychiatrists whom I’ve spoken with seem generally excited about the prospect of more rapidly acting agents for the treatment of depressive episodes, but with the caveat that data is not there yet to draw any conclusions. And, as with every other treatment for depression, psychotherapy + medication outperforms medication alone. There remains power in the talking cure.
- raverbashing 8y ago
  > The usage of ketamine in the trials for depression typically uses IV administration over a fairly long timespan with highly specific dosages That's surprising, I would imagine that therapeutically a longer term low dosage would be more interesting (that is, not through IV, though I'm not sure how Ketamine behaves in the digestive tract)
  - senorjazz 8y ago
    > (that is, not through IV, though I'm not sure how Ketamine behaves in the digestive tract) The main problem with sustained use (abuse) of ketamine nasally are severe crippling stomach cramps (think agony, rolling around in pain screaming) and scarring of the bladder causing you to urinate every few minutes just a few drops due to bladder damage. In severe cases bladders stop functioning and in some cases removed altogether. Urban legends are these are caused by the "drip" after snorting large amounts, so if you spit the drip out you are ok. No idea how true this is, but some people swore by it
  - atomical 8y ago
    The bulk of ketamine studies have used IV administration but that doesn't mean it's more effective than sublingual. There are several studies on oral, intranasal, and sublingual ketamine with positive results. There are also several doctors including mine that are prescribing it for use at home. Also consider that many of the doctors administering ketamine by IV at $500 a pop are not psychiatrists. There is far too little written about these opportunists.

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.
- ineedasername 8y ago
  I agree. I can imagine... well, I don't have to imagine, I've been there: the prospect of months or even years long carousel of medications, trying and discarding one after another, hoping to get lucky on the next try... It's awful. I'd like to see ketamine and some others in careful but wider use. (modafinil for example works wonders for me and is also fast acting, definitely keeps me functional during depressive periods)
- freedomben 8y ago
  Yes indeed. 6 to 8 weeks is an eternity for someone who is deeply suffering. I personally think we are way too stingy with medicines these days. I also had a friend commit suicide while suffering from intense depression. He would no doubt be alive today if he had been giving what he needed right away, instead of being made to start with Prozac and then worked through a bunch of different "starter" antidepressants. Just give people what they need. There are worse outcomes than over-prescribing (death at one's own hand, for example).
  - nickbarnwell 8y ago
    Sadly, we don’t know enough about the brain to have any idea which medications are going to work or what it is people need right away. While you certainly could sedate people to the point of utter apathy by giving every shmiel who walks through the clinic doors high powered anti-psychotics it would be akin to treating a broken toe with amputation. First line treatments like sertraline and fluoxetine are used because they take time to work and have generally tolerable side-effect profiles. E.g. in the case of patients with undiagnosed bipolar disorder, you run a lower risk of triggering a manic episode.
TheSpiceIsLife 8y ago
Maybe ketamine is treatment of last resort, and LSD, because they’re most likely to actually work and the pharmaceutical-insurance industrial complex wants to rinse as many people through the ineffective drugs and therapies first. Maybe I’m just being cynical, but if the standard treatments were effective perhaps we mental illness wouldn’t be so prevalent. Of course, it’s complex and multifactorial, and there’s societal and cultural issues, and generational issues, we need to address too.
- Valmar 8y ago
  Exactly my thoughts.
- atomical 8y ago
  Check out the book Ketamine for Treatment Resistant Depression. It's a safe drug with a low incidence of serious side effects that could help a lot of patients. Researchers have shifted much of the research to Ketamine metabolites. Their reasoning is that these metabolites have a lower side effect profile than the parent compound. It has been almost 20 years of small scale ketamine trials for depression with not much to show for it. Now, they would like to explore a diversion that may be less safe than a drug with a long history of safety. I think there are a few reasons for this: 1) Depression isn't seen as a serious disease like cancer and 2) Ketamine is a cheap drug.
ggm 8y ago
I thought because of its rapid efficacy it was moving towards, being proposed as being a Frontline intervention to reset. SSRI are hugely problemmatical because they take time to ramp up and flush down. Mental health sometimes needs a course correct not a long-term hand on the tiller. MDMA and psylocibin likewise: brief, sharp reset goal. (That's what I read)
atomical 8y ago
This is very misleading. Patients are seeking out this treatment from independent clinics that do not take insurance. They don't need a referral. The biggest consideration is patient ability to pay a lump sum up front.

josephpmay 8y ago

Katamine may actually /be/ an opiate: http://slatestarcodex.com/2018/11/08/ketamine-an-update/ http://slatestarcodex.com/2018/11/08/ketamine-an-update/

oxide 8y ago
It is not an opiate, even if it has an affinity for the mu receptor (it may or may not) it is absolutely classified as an NMDA antagonist.
meowface 8y ago
It has effects on the opioid receptors but is definitely not an opiate or opioid.

tibbon 8y ago

Additionally, it appears that the different isomers have different properties potentially for anti-depressive effects. The R- isomer seems to work better for it from what I’ve read. Know what isomer you’ve got is less common from street. A lot of people prefer S+ isomer for recreation though but it doesn’t help as much

nickbarnwell 8y ago

The usage of ketamine in the trials for depression typically uses IV administration over a fairly long timespan with highly specific dosages. It is not comparable to street usage of the drug. As with any psychotropic medication, one should do their research. Psychiatrists whom I’ve spoken with seem generally excited about the prospect of more rapidly acting agents for the treatment of depressive episodes, but with the caveat that data is not there yet to draw any conclusions. And, as with every other treatment for depression, psychotherapy + medication outperforms medication alone. There remains power in the talking cure.

raverbashing 8y ago
> The usage of ketamine in the trials for depression typically uses IV administration over a fairly long timespan with highly specific dosages That's surprising, I would imagine that therapeutically a longer term low dosage would be more interesting (that is, not through IV, though I'm not sure how Ketamine behaves in the digestive tract)
- senorjazz 8y ago
  > (that is, not through IV, though I'm not sure how Ketamine behaves in the digestive tract) The main problem with sustained use (abuse) of ketamine nasally are severe crippling stomach cramps (think agony, rolling around in pain screaming) and scarring of the bladder causing you to urinate every few minutes just a few drops due to bladder damage. In severe cases bladders stop functioning and in some cases removed altogether. Urban legends are these are caused by the "drip" after snorting large amounts, so if you spit the drip out you are ok. No idea how true this is, but some people swore by it
- atomical 8y ago
  The bulk of ketamine studies have used IV administration but that doesn't mean it's more effective than sublingual. There are several studies on oral, intranasal, and sublingual ketamine with positive results. There are also several doctors including mine that are prescribing it for use at home. Also consider that many of the doctors administering ketamine by IV at $500 a pop are not psychiatrists. There is far too little written about these opportunists.