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Ketamine Could Soon Be Used to Treat Suicidal Ideation

135 points by dankohn1 8y ago

deleted 8y ago
[deleted]
RankingMember 8y ago
Side note: I really like the photographic style of this article, particularly the man standing on a brick column as though on a building about to jump off, but perhaps instead standing strong having learned to cope with his negative emotions. The dark motif overall is a nice counterpoint to the ultimately uplifting, persevering tone of the article.
- a012 8y ago
  I guess the photo was shot on wet plate!? The large format lens DoF and the high contrast makes the scene scenery looks dramatic. Very well done.
  - raihansaputra 8y ago
    I was intrigued and found out more about the photographer. He was a trained photographer (worked under Annie Leibovitz) and lectured photography in the 90s. Got his medical degree in 2004 and seems like he's coming back to photos. https://www.nationalgeographic.com/contributors/a/photographer-max-aguilera-hellweg/ https://www.nationalgeographic.com/contributors/a/photograph... https://www.nationalgeographic.com/magazine/2019/01/max-aguilera-hellweg-left-photography-medicine-could-he-do-it-again/ https://www.nationalgeographic.com/magazine/2019/01/max-agui...
bfuller 8y ago
IV ketamine is already being used to treat depression. Its about $500 per treatment.
- yasp 8y ago
  Yes and I believe that nasal administration is either under FDA review or active development. Edit: For anyone suffering from suicidal ideation, I recommend trying lithium (in close consultation with your doctor).
  - rhcom2 8y ago
    Lithium was the only drug that helped me. Two weeks on it and the ideations were gone. Of course it also requires monthly blood tests, and for me being nauseous every morning but the positive effects did stay after I discontinued.
    - yasp 8y ago
      At least in my case, I didn't need to continue with the monthly blood work once my optimum level was found. Also I fortunately never experienced the nausea you mention but did experience tremors occasionally at the beginning, when trying to find the right level. Too high and they would begin to manifest.
- Brometheus 8y ago
  200 Euro in Germany
- WalterSear 8y ago
  So is intranasal ketamine.
- ketathrowaway 8y ago
  I pay $375. And at a different doctor, before I found my current one, I was paying $750.
  - atomical 8y ago
    > I pay $375. And at a different doctor, before I found my current one, I was paying $750. Most of them are charging more than $375. This is not regional pricing. There is no reason why an infusion in Albuquerque should cost half as much as an infusion in Chicago. In another comment you suggested these experts should be respected. > This isn't just my opinion, it's the consensus opinion of ketamine docs across the world. When doctors are robbing patients that may just be the beginning of impropriety...
elorant 8y ago
I thought Ketamine was considered a rape-drug and thus prohibited.
- reverend_gonzo 8y ago
  Not even remotely. You're thinking of GHB.
  - ceejayoz 8y ago
    Which, incidentally, also has perfectly legitimate medical uses - treatment of narcolepsy, anesthesia, etc.
    - bagacrap 8y ago
      As do cocaine, MDMA, shrooms, ... Science might be finally gaining the upper hand in the drug war against political forces which won the public opinion battle back in the 70s. It's much harder to convince the public drugs r bad if 95% of the "hard" drugs have medical uses.
    - crishoj 8y ago
      As well as recreational uses, for which purpose it is actually a rather benign substance when dosed correctly [1]. [1] https://hilaryagro.wordpress.com/2017/04/12/alright-lets-talk-about-ghb-a-users-guide/ https://hilaryagro.wordpress.com/2017/04/12/alright-lets-tal...
  - bagacrap 8y ago
    It is a common misconception though, perhaps bolstered by anecdotal experiences where the two drugs were confused. Larger doses of K can incapacitate you, so it's not totally off base to think it could be used in that way, but it's certainly not why it's banned by the DEA. It's banned bc of the drug war military-industrial complex.
  - elorant 8y ago
    No, I mean Ketamine. https://www.womenshealth.gov/a-z-topics/date-rape-drugs https://www.womenshealth.gov/a-z-topics/date-rape-drugs
scarcely 8y ago
It says something about our culture that suicidal urges are considered something that need to be "treated". From a logical point of view it is the decision to continue to exist that needs to be justified, simply because it is the positive performance of actions (gathering life sustaining resources etc). The suicidal person should flip the question on its head and ask the nonsuicidal person what's their justification for living. This is like asking the question, why are people poor? Ever since Adam Smith we know that poverty is the natural state, that what needs to be explained is abundance.
- IThoughtYouGNU 8y ago
  Hey. Are you alright?
- lipman 8y ago
  You're saying suicidal ideation is "the natural state"?
  - ionised 8y ago
    I think he's saying non-existence is the natural state and the decision to live and expend energy gathering resources just to survive needs to be justified, rather than be expected to justify your wish to stop existing.
    - ConceptJunkie 8y ago
      I think the counter to that is the idea that human life is inherently valuable and doesn't need to be justified.
      - zolthrowaway 8y ago
        You shouldn't make this argument without supporting it in any way. Why does it have inherent value? Life doesn't have inherent value to us as a collective society. Look at livestock. We've had countless pointless wars where people die horrible deaths. Abortion is legal in many parts of the world. Humans have made tons of negative impacts on our planet like tossing literal tons of plastic in the ocean. I agree that human life is valuable, but you have to support your claim in some way. If you can't find a way to support it, then maybe the claim is wrong.
soroso 8y ago
Is the incidence of suicide lower among regular ketamine users?
- ketathrowaway 8y ago
  There is a gigantic difference in patient outcome between clinical ketamine use and recreational ketamine use. For a variety of reasons: careful dose control, having an actual doctor involved, etc. But the biggest one is the antidepressant effects of ketamine only really happen when it's administered via IV drip over a course of 45 minutes. The most common use of recreational ketamine is inhaling it, the effects come up too fast and go away too fast for the antidepressive effects to occur.
  - LaikaF 8y ago
    Insufflation is the word you're looking for. That's also untrue. IM, and IV are most faster come offs then insufflation or eating it. Though eating ketamine sucks for the amount you need. What is true about IV is you can control the amount that actually gets taken in much better.
    - ketathrowaway 8y ago
      > What is true about IV is you can control the amount that actually gets taken in much better. I agree 100% with this. Furthermore, being able to carefully control the dose and duration is paramount in getting the effects to last as long as possible.
- jokowueu 8y ago
  I've spoken with a few . Once u start getting high tollerances the anti depressive effects go away permanently .
  - ketathrowaway 8y ago
    You do not build up a tolerance to ketamine if you follow the treatment protocol, which dictates a lower dose (around 100mg, give or take for body weight), and one infusion every 3-6 weeks. Source: Been having regular infusions every 3-6 months for 3 years, and it still works for me. I can't say this enough: experience & anecdotes based on recreational ketamine use /do not apply at all/ to clinical use.
mchannon 8y ago
A loved one went through a few rounds of Ketamine IV at a recently opened clinic. It was about $400 a treatment, not covered by insurance, but administered by credentialed professionals. The experience was a bit like a dialysis clinic, where there are a bunch of beds in a room, tatami screens between the beds, and where a huge 2" diameter syringe dosing pump eases a tiny amount of Ket in the line over 15 minutes. Aside from the expense, it didn't particularly help my loved one's condition. She said it felt more like it just got her high, and not the kind of high you want. Maybe if they used a stronger dose, but those cost more as I recall. I feel there are at least three treatments one should try before Ketamine, for PTSD/Anxiety/Depression/Suicidal Ideation. • EMDR. So successful it's amazing that it's not standard fare in counseling and therapy. • Neurofeedback. The literature is equivocal at best, but the anecdata is very strong. • LSD. As our nation struggles with medical marijuana still living on schedule I, LSD similarly inhabits schedule I (where the government knows better than your doctor about there being no possible medical benefit). Studies show LSD is over 10x as successful in curing alcoholism as AA.
- thatsamonad 8y ago
  > EMDR I’ve been undergoing EMDR treatment for PTSD and it is quite amazing how well it works. You wouldn’t expect that just watching something move back and forth in front of your face (or having an electric pulse alternate between your hands) in between talking about a traumatic experience would do much, but for me it’s been the most effective thing so far after trying many different kinds of therapy and medication. I think what a lot of people need when it comes to depression/anxiety/trauma is not simply to feel better in short bursts, but rather to reframe and reprocess thoughts, feelings, and memories in such a way that they become easier to “hold” even if they don’t go away. A lot of our treatments focus on elimination rather than acceptance and reprocessing. I think of it like short-term dieting vs lifestyle changes. The former may provide a quick fix, but the latter will usually be longer lasting, healthier, and easier to sustain after the initial push.
  - slfnflctd 8y ago
    > not simply to feel better in short bursts, but rather to reframe and reprocess thoughts, feelings, and memories in such a way that they become easier to “hold” even if they don’t go away This is absolutely the gist of it. Anything that helps you do something along these lines is worth pursuing. It's about building up scaffolding around a disaster area-- not to cut off access, but to put up a useful, multipurpose firewall.
deleted 8y ago
[deleted]
bellerose 8y ago
Contrary to the belief of how it's irrational to die by suicide. I gravitate towards the theory: a rational reason exists for a person to be in a state of suicidal ideation. Thus, I question how much perception of reality is altered after medication targeting suicidal ideation. Is it the same as a person finding something else in life and triggering different behavioural patterns; where they're not envying successful suicide or death. Making me wonder if should a person be able to end their life instead if they choose or should we really have power of authority over everyone's will that wants to die? The aspects of medication against suicide makes me ponder if a person is really anything other than a machine that needs to keep on ticking until it can't function anymore.
mruts 8y ago
Ketamine treatments are pretty expensive at a clinic. If you wanted regular Ketamine doses for depression (maybe like 1 a month?), I would just buy some online and insufflate it. Safer than a needle and just as effective. PS: Chronic Ketamine use destroys your urinary tract (I know people that wet the bed every night from too much of the stuff). Also, it might cause brain damage, but no one is really sure.
- ketathrowaway 8y ago
  This is not strictly true. Chronic ketamine ABuse can cause urinary tract problems. The doses and frequency used in a clinical session emphatically do not cause this problem. Ketamine has been in regular use since 1970 for a wide range of medical purposes. It's also been on the WHO Essential Medicines List since 1985. tl;dr - don't need to worry about urinary tract issues unless you're using the drug (1) recreationally; (2) irresponsibly
  - senorjazz 8y ago
    I only know hearsay, but the issue effects those sniffing 2-3+ grams a day, every day for extending periods. The ketamine causes internal scarring of the bladder / urinary tract (not sure which or if either), that scarring stops the organ (maybe wrong word) from expanding and contracting. So you feel like you need to piss regularly, but only a few drips come out. The damage can get so severe bladder gets removed. At the lesser end of the damage is agonising stomach cramps, no idea what the cause of this is. source: spent too long in the uk freeparty rave scene when ketamine was legal and people assumed it was completely safe due to lack of come down. Too many people ended up with severe ketamine addictions and many have to know piss through a bag
    - mruts 8y ago
      Though there hasn't been much research on it, I suspect that methoxetamine (MXE) might have the same anti-depressant effects as ketamine. Also, it doesn't have the urinary tract issues. Also, it's much much cheaper on the black market than ketamine. We're talking around 1000 (recreational) doses for $20. Compared to say 10 (recreational) doses of ketamine for maybe $50?
ketathrowaway 8y ago
(Pardon the throwaway; I try to keep my medical history private!) I started monthly ketamine treatment about 3 years ago for treatment resistant depression. It has helped me immensely. It costs me $375 per infusion. I tried 1-3 drugs from every class of antidepressant (and a few other types) before ketamine and had limited results. Ketamine, however, has been a godsend. If anyone has any questions about the treatment, the drug, its effects on me, or anything else, feel free to ask.
- nabnob 8y ago
  Is the dose administered during these sessions high enough to cause hallucinogenic effects? Could you describe what your depressive symptoms were like before/after treatment? How many sessions did it take before you saw improvement? Also, any personal insight on why it was so effective for you? Do you think it helped you view circumstances in your life in a different way (the way other hallucinogens like LSD might)?
  - ketathrowaway 8y ago
    > Is the dose administered during these sessions high enough to cause hallucinogenic effects? Yes. It isn't effective unless you get well into a hallucinogenic state. The antidepressant effect seems to be maximized by setting the dose such that you are fairly "out there", but not so far out there that you get scared, or pass out. (Ketamine is used all the time as anesthesia for surgery, and they give you a much larger dose than is used in depression treatment, because past a certain dose, you just immediately zonk out 100%. Good ketamine therapy for depression is achieved by feathering the dose between the two extremes of zero effect and passing out.) Hallucination means a lot of different things, but with ketamine it's pretty specific. It's not the kind of hallucination where you're looking around the room you're in and see things that don't exist. With ketamine you basically disconnect from the world you're in at the moment and go somewhere else entirely, in your own head. You will often not ingest input from your eyes, even if they're open. What goes on inside someone's head at this point varies wildly, I could tell you what it's like for me but not sure how much interest there is in that. I will say though that music has a profound impact on what goes on in my head during an infusion, and is a fun way of customizing the ketamine experience. I particularly love using my AirPods for this, because there are no wires and especially under ketamine, it feels like the sound is coming from inside your head, as opposed to feeling like you're wearing headphones. > Could you describe what your depressive symptoms were like before/after treatment? My depression manifest itself in extreme anhedonia, and after my 3rd infusion, I played, and enjoyed playing, a video game again, for the first time in over a year. Also, at that point in my life (3 years ago) I was going through a lot of difficult personal life problems, and dealing with those problems went from "completely insurmountable" before, to "this is shitty but I can figure it out" after. In other words, it helped me deal with my life and enjoy things again, but it didn't turn me into someone who will never experience sadness again. It doesn't mean you'll never have a bad day again, but it does mean you'll be able to handle those bad days a lot better. > How many sessions did it take before you saw improvement? The way my doctor recommended starting ketamine treatment was to have 6 doses over the course of 2 weeks (m/w/f, m/w/f), and then after that "as needed", which for me turned out to be every 4 weeks. It was after the 3rd dose in my initial course of 6 that I noticed a significant effect. > Also, any personal insight on why it was so effective for you? Do you think it helped you view circumstances in your life in a different way (the way other hallucinogens like LSD might)? I can answer this in two parts. First, one reason it is effective for me is because I don't take any other drugs that conflict with ketamine. Regular benzodiazepine use, or opiate use, or lamictal (this list is not exhaustive) significantly impact the effectiveness of the treatment. Lamictal completely kills the effectiveness. I had just started on lamictal treatment a month prior to discovering ketamine treatment, and had to come off it for 10 days before starting. Same with benzos. Second, and this is just my personal theory about my own experience, I think one thing ketamine does that helps me is to get my mind out of ruts. The experience of ego death, or near ego death, that I get with ketamine feels like a complete reset for the problems my brain was relentlessly focusing on before. Afterwards, I still care about those problems, but obsessing over the negative parts of my life abates significantly. I would say that before, my focus on the negative vs positive was quite lopsided to the negative, to the point that I rarely noticed / felt the positives. Whereas now, the two are much more balanced. I still lean a bit towards the negative, but just a bit. One more personal anecdote: Before ketamine, I was dating a lot, but almost out of desperation because of how extremely lonely I felt, rather than because I was being thoughtful/intentional/patient about finding a great partner. The ladies I dated picked up on this quite easily, and it lead to a lot of negative outcomes. And each negative outcome felt like the world ending, which made things worse. A few months after starting ketamine I tried dating again, and it went so much better. I wasn't as desperate, and I took the time to figure out who I was and what I really wanted, and what I offered. It still took a while before I found the right partner for me, about one year after starting ketamine treatments, but we're happily married!
jokowueu 8y ago
This is J&J's S-ketamime NOT racemic ketamin Racmic is better
- ketathrowaway 8y ago
  This has been my experience too. None of the ketamine-based drugs have been as effective as regular ketamine. That said, drug companies will not seek to get regular ketamine FDA approved because they can't patent it. So this is the only way they will go through the process of FDA approval. I hope it leads to regular ketamine being FDA approved for treating depression because only then will it be covered by insurance.
- WalterSear 8y ago
  The literature points to R-ketamine, on it's own, appearing to have stronger antidepressant effect, with less of the disassociative effects. AFAICT, it's not patentable, so nobody would pay for the trials.
  - jokowueu 8y ago
    This is very true . R-ketamine holds most of the benefit but some of the metabolites of s-ketamine also do contribute to the positive effects . Regarding patents . It is possible to patent an ROA method just like what j&j did with s-ket
faissaloo 8y ago
I'm very much concerned that rather than traditional psychotherapy where a person has to confront the issues and trauma of their life we're moving towards the idea that if you drug someone enough they won't commit suicide. I should also point out that the anecdote given makes reference to Prozac, a prescription drug which some users have claimed has caused their suicidal ideation.
- ZeroFries 8y ago
  A drug that actually works is far preferable. Talk therapy is expensive, hard work, tough to scale, and it's difficult to find a qualified therapist who is right for you.
- gnulinux 8y ago
  Sorry, but this bizarre. Psychotherapy is just one tool in the toolbox against treating mental illnesses. If there is evidence this drug helps treating mental illnesses, what's the reason not to use it? This is not some alternative medicine that is offered instead of or in addition to scientific practice. This is part of the usual treatment that involves psychotherapy, if it's useful. There is nothing inherently bad with drugs; you don't hesitate to use drugs when your liver chemistry breaks, why hesitate it when your brain chemistry breaks?
  - nickbarnwell 8y ago
    The problem is that the effect sizes for most anti-depressants is quite small and the role of pharmaceutical companies in advancing their use has been quite a bit larger. The difference between psychotherapy and medication and psychotherapy alone is small. I would also point out that dialysis, chemotherapy, etc are also quite expensive, time consuming, and difficult to scale. We still consider them valid, life-saving treatments.
    - cc-d 8y ago
      >The problem is that the effect sizes for most anti-depressants is quite small and the role of pharmaceutical companies in advancing their use has been quite a bit larger. The difference between psychotherapy and medication and psychotherapy alone is small. Ketamine is not your traditional SSRI. You're making the same error as the other poster in grouping all "antidepressants" under the same umbrella, which is particularly egregious when discussing ketamine.
starpilot 8y ago
FYI - Kaiser Permanente is running some ketamine in clinics in California. If your insurance is Kaiser, this might be a low-cost option.
throwawayWGBiFc 8y ago
I've never used ketamine, but I did take hallucinogenic doses of dextromethorphan (DXM, a dissociative hallucinogen, the same class of drugs as ketamine) a few times in college. I have mild depression, and for several days to a week after each DXM trip, I felt very energized and creative, with all of my depressive symptoms gone. I'm not surprised that ketamine helps depression in some people. I sometimes consider microdosing DXM for depression and also general productivity. Of course, don't take any medical advice from anonymous online posts.

135 points by dankohn1 8y ago

deleted 8y ago

[deleted]

Side note: I really like the photographic style of this article, particularly the man standing on a brick column as though on a building about to jump off, but perhaps instead standing strong having learned to cope with his negative emotions. The dark motif overall is a nice counterpoint to the ultimately uplifting, persevering tone of the article.

a012 8y ago
I guess the photo was shot on wet plate!? The large format lens DoF and the high contrast makes the scene scenery looks dramatic. Very well done.
- raihansaputra 8y ago
  I was intrigued and found out more about the photographer. He was a trained photographer (worked under Annie Leibovitz) and lectured photography in the 90s. Got his medical degree in 2004 and seems like he's coming back to photos. https://www.nationalgeographic.com/contributors/a/photographer-max-aguilera-hellweg/ https://www.nationalgeographic.com/contributors/a/photograph... https://www.nationalgeographic.com/magazine/2019/01/max-aguilera-hellweg-left-photography-medicine-could-he-do-it-again/ https://www.nationalgeographic.com/magazine/2019/01/max-agui...

bfuller 8y ago

IV ketamine is already being used to treat depression. Its about $500 per treatment.

yasp 8y ago
Yes and I believe that nasal administration is either under FDA review or active development. Edit: For anyone suffering from suicidal ideation, I recommend trying lithium (in close consultation with your doctor).
- rhcom2 8y ago
  Lithium was the only drug that helped me. Two weeks on it and the ideations were gone. Of course it also requires monthly blood tests, and for me being nauseous every morning but the positive effects did stay after I discontinued.
  - yasp 8y ago
    At least in my case, I didn't need to continue with the monthly blood work once my optimum level was found. Also I fortunately never experienced the nausea you mention but did experience tremors occasionally at the beginning, when trying to find the right level. Too high and they would begin to manifest.
Brometheus 8y ago
200 Euro in Germany
WalterSear 8y ago
So is intranasal ketamine.
ketathrowaway 8y ago
I pay $375. And at a different doctor, before I found my current one, I was paying $750.
- atomical 8y ago
  > I pay $375. And at a different doctor, before I found my current one, I was paying $750. Most of them are charging more than $375. This is not regional pricing. There is no reason why an infusion in Albuquerque should cost half as much as an infusion in Chicago. In another comment you suggested these experts should be respected. > This isn't just my opinion, it's the consensus opinion of ketamine docs across the world. When doctors are robbing patients that may just be the beginning of impropriety...

elorant 8y ago

I thought Ketamine was considered a rape-drug and thus prohibited.

reverend_gonzo 8y ago
Not even remotely. You're thinking of GHB.
- ceejayoz 8y ago
  Which, incidentally, also has perfectly legitimate medical uses - treatment of narcolepsy, anesthesia, etc.
  - bagacrap 8y ago
    As do cocaine, MDMA, shrooms, ... Science might be finally gaining the upper hand in the drug war against political forces which won the public opinion battle back in the 70s. It's much harder to convince the public drugs r bad if 95% of the "hard" drugs have medical uses.
  - crishoj 8y ago
    As well as recreational uses, for which purpose it is actually a rather benign substance when dosed correctly [1]. [1] https://hilaryagro.wordpress.com/2017/04/12/alright-lets-talk-about-ghb-a-users-guide/ https://hilaryagro.wordpress.com/2017/04/12/alright-lets-tal...
- bagacrap 8y ago
  It is a common misconception though, perhaps bolstered by anecdotal experiences where the two drugs were confused. Larger doses of K can incapacitate you, so it's not totally off base to think it could be used in that way, but it's certainly not why it's banned by the DEA. It's banned bc of the drug war military-industrial complex.
- elorant 8y ago
  No, I mean Ketamine. https://www.womenshealth.gov/a-z-topics/date-rape-drugs https://www.womenshealth.gov/a-z-topics/date-rape-drugs

scarcely 8y ago

It says something about our culture that suicidal urges are considered something that need to be "treated". From a logical point of view it is the decision to continue to exist that needs to be justified, simply because it is the positive performance of actions (gathering life sustaining resources etc). The suicidal person should flip the question on its head and ask the nonsuicidal person what's their justification for living. This is like asking the question, why are people poor? Ever since Adam Smith we know that poverty is the natural state, that what needs to be explained is abundance.

IThoughtYouGNU 8y ago
Hey. Are you alright?
lipman 8y ago
You're saying suicidal ideation is "the natural state"?
- ionised 8y ago
  I think he's saying non-existence is the natural state and the decision to live and expend energy gathering resources just to survive needs to be justified, rather than be expected to justify your wish to stop existing.
  - ConceptJunkie 8y ago
    I think the counter to that is the idea that human life is inherently valuable and doesn't need to be justified.
    - zolthrowaway 8y ago
      You shouldn't make this argument without supporting it in any way. Why does it have inherent value? Life doesn't have inherent value to us as a collective society. Look at livestock. We've had countless pointless wars where people die horrible deaths. Abortion is legal in many parts of the world. Humans have made tons of negative impacts on our planet like tossing literal tons of plastic in the ocean. I agree that human life is valuable, but you have to support your claim in some way. If you can't find a way to support it, then maybe the claim is wrong.

soroso 8y ago

Is the incidence of suicide lower among regular ketamine users?

ketathrowaway 8y ago
There is a gigantic difference in patient outcome between clinical ketamine use and recreational ketamine use. For a variety of reasons: careful dose control, having an actual doctor involved, etc. But the biggest one is the antidepressant effects of ketamine only really happen when it's administered via IV drip over a course of 45 minutes. The most common use of recreational ketamine is inhaling it, the effects come up too fast and go away too fast for the antidepressive effects to occur.
- LaikaF 8y ago
  Insufflation is the word you're looking for. That's also untrue. IM, and IV are most faster come offs then insufflation or eating it. Though eating ketamine sucks for the amount you need. What is true about IV is you can control the amount that actually gets taken in much better.
  - ketathrowaway 8y ago
    > What is true about IV is you can control the amount that actually gets taken in much better. I agree 100% with this. Furthermore, being able to carefully control the dose and duration is paramount in getting the effects to last as long as possible.
jokowueu 8y ago
I've spoken with a few . Once u start getting high tollerances the anti depressive effects go away permanently .
- ketathrowaway 8y ago
  You do not build up a tolerance to ketamine if you follow the treatment protocol, which dictates a lower dose (around 100mg, give or take for body weight), and one infusion every 3-6 weeks. Source: Been having regular infusions every 3-6 months for 3 years, and it still works for me. I can't say this enough: experience & anecdotes based on recreational ketamine use /do not apply at all/ to clinical use.

mchannon 8y ago

A loved one went through a few rounds of Ketamine IV at a recently opened clinic. It was about $400 a treatment, not covered by insurance, but administered by credentialed professionals. The experience was a bit like a dialysis clinic, where there are a bunch of beds in a room, tatami screens between the beds, and where a huge 2" diameter syringe dosing pump eases a tiny amount of Ket in the line over 15 minutes. Aside from the expense, it didn't particularly help my loved one's condition. She said it felt more like it just got her high, and not the kind of high you want. Maybe if they used a stronger dose, but those cost more as I recall. I feel there are at least three treatments one should try before Ketamine, for PTSD/Anxiety/Depression/Suicidal Ideation. • EMDR. So successful it's amazing that it's not standard fare in counseling and therapy. • Neurofeedback. The literature is equivocal at best, but the anecdata is very strong. • LSD. As our nation struggles with medical marijuana still living on schedule I, LSD similarly inhabits schedule I (where the government knows better than your doctor about there being no possible medical benefit). Studies show LSD is over 10x as successful in curing alcoholism as AA.

thatsamonad 8y ago
> EMDR I’ve been undergoing EMDR treatment for PTSD and it is quite amazing how well it works. You wouldn’t expect that just watching something move back and forth in front of your face (or having an electric pulse alternate between your hands) in between talking about a traumatic experience would do much, but for me it’s been the most effective thing so far after trying many different kinds of therapy and medication. I think what a lot of people need when it comes to depression/anxiety/trauma is not simply to feel better in short bursts, but rather to reframe and reprocess thoughts, feelings, and memories in such a way that they become easier to “hold” even if they don’t go away. A lot of our treatments focus on elimination rather than acceptance and reprocessing. I think of it like short-term dieting vs lifestyle changes. The former may provide a quick fix, but the latter will usually be longer lasting, healthier, and easier to sustain after the initial push.
- slfnflctd 8y ago
  > not simply to feel better in short bursts, but rather to reframe and reprocess thoughts, feelings, and memories in such a way that they become easier to “hold” even if they don’t go away This is absolutely the gist of it. Anything that helps you do something along these lines is worth pursuing. It's about building up scaffolding around a disaster area-- not to cut off access, but to put up a useful, multipurpose firewall.

deleted 8y ago

[deleted]

bellerose 8y ago

Contrary to the belief of how it's irrational to die by suicide. I gravitate towards the theory: a rational reason exists for a person to be in a state of suicidal ideation. Thus, I question how much perception of reality is altered after medication targeting suicidal ideation. Is it the same as a person finding something else in life and triggering different behavioural patterns; where they're not envying successful suicide or death. Making me wonder if should a person be able to end their life instead if they choose or should we really have power of authority over everyone's will that wants to die? The aspects of medication against suicide makes me ponder if a person is really anything other than a machine that needs to keep on ticking until it can't function anymore.

mruts 8y ago

Ketamine treatments are pretty expensive at a clinic. If you wanted regular Ketamine doses for depression (maybe like 1 a month?), I would just buy some online and insufflate it. Safer than a needle and just as effective. PS: Chronic Ketamine use destroys your urinary tract (I know people that wet the bed every night from too much of the stuff). Also, it might cause brain damage, but no one is really sure.

ketathrowaway 8y ago
This is not strictly true. Chronic ketamine ABuse can cause urinary tract problems. The doses and frequency used in a clinical session emphatically do not cause this problem. Ketamine has been in regular use since 1970 for a wide range of medical purposes. It's also been on the WHO Essential Medicines List since 1985. tl;dr - don't need to worry about urinary tract issues unless you're using the drug (1) recreationally; (2) irresponsibly
- senorjazz 8y ago
  I only know hearsay, but the issue effects those sniffing 2-3+ grams a day, every day for extending periods. The ketamine causes internal scarring of the bladder / urinary tract (not sure which or if either), that scarring stops the organ (maybe wrong word) from expanding and contracting. So you feel like you need to piss regularly, but only a few drips come out. The damage can get so severe bladder gets removed. At the lesser end of the damage is agonising stomach cramps, no idea what the cause of this is. source: spent too long in the uk freeparty rave scene when ketamine was legal and people assumed it was completely safe due to lack of come down. Too many people ended up with severe ketamine addictions and many have to know piss through a bag
  - mruts 8y ago
    Though there hasn't been much research on it, I suspect that methoxetamine (MXE) might have the same anti-depressant effects as ketamine. Also, it doesn't have the urinary tract issues. Also, it's much much cheaper on the black market than ketamine. We're talking around 1000 (recreational) doses for $20. Compared to say 10 (recreational) doses of ketamine for maybe $50?

ketathrowaway 8y ago

(Pardon the throwaway; I try to keep my medical history private!) I started monthly ketamine treatment about 3 years ago for treatment resistant depression. It has helped me immensely. It costs me $375 per infusion. I tried 1-3 drugs from every class of antidepressant (and a few other types) before ketamine and had limited results. Ketamine, however, has been a godsend. If anyone has any questions about the treatment, the drug, its effects on me, or anything else, feel free to ask.

nabnob 8y ago
Is the dose administered during these sessions high enough to cause hallucinogenic effects? Could you describe what your depressive symptoms were like before/after treatment? How many sessions did it take before you saw improvement? Also, any personal insight on why it was so effective for you? Do you think it helped you view circumstances in your life in a different way (the way other hallucinogens like LSD might)?
- ketathrowaway 8y ago
  > Is the dose administered during these sessions high enough to cause hallucinogenic effects? Yes. It isn't effective unless you get well into a hallucinogenic state. The antidepressant effect seems to be maximized by setting the dose such that you are fairly "out there", but not so far out there that you get scared, or pass out. (Ketamine is used all the time as anesthesia for surgery, and they give you a much larger dose than is used in depression treatment, because past a certain dose, you just immediately zonk out 100%. Good ketamine therapy for depression is achieved by feathering the dose between the two extremes of zero effect and passing out.) Hallucination means a lot of different things, but with ketamine it's pretty specific. It's not the kind of hallucination where you're looking around the room you're in and see things that don't exist. With ketamine you basically disconnect from the world you're in at the moment and go somewhere else entirely, in your own head. You will often not ingest input from your eyes, even if they're open. What goes on inside someone's head at this point varies wildly, I could tell you what it's like for me but not sure how much interest there is in that. I will say though that music has a profound impact on what goes on in my head during an infusion, and is a fun way of customizing the ketamine experience. I particularly love using my AirPods for this, because there are no wires and especially under ketamine, it feels like the sound is coming from inside your head, as opposed to feeling like you're wearing headphones. > Could you describe what your depressive symptoms were like before/after treatment? My depression manifest itself in extreme anhedonia, and after my 3rd infusion, I played, and enjoyed playing, a video game again, for the first time in over a year. Also, at that point in my life (3 years ago) I was going through a lot of difficult personal life problems, and dealing with those problems went from "completely insurmountable" before, to "this is shitty but I can figure it out" after. In other words, it helped me deal with my life and enjoy things again, but it didn't turn me into someone who will never experience sadness again. It doesn't mean you'll never have a bad day again, but it does mean you'll be able to handle those bad days a lot better. > How many sessions did it take before you saw improvement? The way my doctor recommended starting ketamine treatment was to have 6 doses over the course of 2 weeks (m/w/f, m/w/f), and then after that "as needed", which for me turned out to be every 4 weeks. It was after the 3rd dose in my initial course of 6 that I noticed a significant effect. > Also, any personal insight on why it was so effective for you? Do you think it helped you view circumstances in your life in a different way (the way other hallucinogens like LSD might)? I can answer this in two parts. First, one reason it is effective for me is because I don't take any other drugs that conflict with ketamine. Regular benzodiazepine use, or opiate use, or lamictal (this list is not exhaustive) significantly impact the effectiveness of the treatment. Lamictal completely kills the effectiveness. I had just started on lamictal treatment a month prior to discovering ketamine treatment, and had to come off it for 10 days before starting. Same with benzos. Second, and this is just my personal theory about my own experience, I think one thing ketamine does that helps me is to get my mind out of ruts. The experience of ego death, or near ego death, that I get with ketamine feels like a complete reset for the problems my brain was relentlessly focusing on before. Afterwards, I still care about those problems, but obsessing over the negative parts of my life abates significantly. I would say that before, my focus on the negative vs positive was quite lopsided to the negative, to the point that I rarely noticed / felt the positives. Whereas now, the two are much more balanced. I still lean a bit towards the negative, but just a bit. One more personal anecdote: Before ketamine, I was dating a lot, but almost out of desperation because of how extremely lonely I felt, rather than because I was being thoughtful/intentional/patient about finding a great partner. The ladies I dated picked up on this quite easily, and it lead to a lot of negative outcomes. And each negative outcome felt like the world ending, which made things worse. A few months after starting ketamine I tried dating again, and it went so much better. I wasn't as desperate, and I took the time to figure out who I was and what I really wanted, and what I offered. It still took a while before I found the right partner for me, about one year after starting ketamine treatments, but we're happily married!

jokowueu 8y ago

This is J&J's S-ketamime NOT racemic ketamin Racmic is better

ketathrowaway 8y ago
This has been my experience too. None of the ketamine-based drugs have been as effective as regular ketamine. That said, drug companies will not seek to get regular ketamine FDA approved because they can't patent it. So this is the only way they will go through the process of FDA approval. I hope it leads to regular ketamine being FDA approved for treating depression because only then will it be covered by insurance.
WalterSear 8y ago
The literature points to R-ketamine, on it's own, appearing to have stronger antidepressant effect, with less of the disassociative effects. AFAICT, it's not patentable, so nobody would pay for the trials.
- jokowueu 8y ago
  This is very true . R-ketamine holds most of the benefit but some of the metabolites of s-ketamine also do contribute to the positive effects . Regarding patents . It is possible to patent an ROA method just like what j&j did with s-ket

faissaloo 8y ago

I'm very much concerned that rather than traditional psychotherapy where a person has to confront the issues and trauma of their life we're moving towards the idea that if you drug someone enough they won't commit suicide. I should also point out that the anecdote given makes reference to Prozac, a prescription drug which some users have claimed has caused their suicidal ideation.

ZeroFries 8y ago
A drug that actually works is far preferable. Talk therapy is expensive, hard work, tough to scale, and it's difficult to find a qualified therapist who is right for you.
gnulinux 8y ago
Sorry, but this bizarre. Psychotherapy is just one tool in the toolbox against treating mental illnesses. If there is evidence this drug helps treating mental illnesses, what's the reason not to use it? This is not some alternative medicine that is offered instead of or in addition to scientific practice. This is part of the usual treatment that involves psychotherapy, if it's useful. There is nothing inherently bad with drugs; you don't hesitate to use drugs when your liver chemistry breaks, why hesitate it when your brain chemistry breaks?
- nickbarnwell 8y ago
  The problem is that the effect sizes for most anti-depressants is quite small and the role of pharmaceutical companies in advancing their use has been quite a bit larger. The difference between psychotherapy and medication and psychotherapy alone is small. I would also point out that dialysis, chemotherapy, etc are also quite expensive, time consuming, and difficult to scale. We still consider them valid, life-saving treatments.
  - cc-d 8y ago
    >The problem is that the effect sizes for most anti-depressants is quite small and the role of pharmaceutical companies in advancing their use has been quite a bit larger. The difference between psychotherapy and medication and psychotherapy alone is small. Ketamine is not your traditional SSRI. You're making the same error as the other poster in grouping all "antidepressants" under the same umbrella, which is particularly egregious when discussing ketamine.

starpilot 8y ago

FYI - Kaiser Permanente is running some ketamine in clinics in California. If your insurance is Kaiser, this might be a low-cost option.

throwawayWGBiFc 8y ago

I've never used ketamine, but I did take hallucinogenic doses of dextromethorphan (DXM, a dissociative hallucinogen, the same class of drugs as ketamine) a few times in college. I have mild depression, and for several days to a week after each DXM trip, I felt very energized and creative, with all of my depressive symptoms gone. I'm not surprised that ketamine helps depression in some people. I sometimes consider microdosing DXM for depression and also general productivity. Of course, don't take any medical advice from anonymous online posts.