4 ms·

Access to cutting edge mental health treatment, such as ketamine and estketamine for TRD, are really only available in the US. Also, if you look at the treatmen

Access to cutting edge mental health treatment, such as ketamine and estketamine for TRD, are really only available in the US. Also, if you look at the treatment, coverage, and support for ADHD it's clear the US has always been ahead of other nations. Related: Global Perspectives on ADHD: Social Dimensions of Diagnosis and Treatment in Sixteen Countries (2018)

falcolas 6y ago
WRT ADHD support, I can’t say I believe this. With our medications being on controlled substances lists, and all the (ironically incredibly ADHD unfriendly) hoops we have to jump through just to get those meds, it’s kinda hard to believe that everyone else in the world is somehow worse than that.
- swebs 6y ago
  You'd be surprised https://en.wikipedia.org/wiki/Methylphenidate#Legal_status https://en.wikipedia.org/wiki/Methylphenidate#Legal_status
  - falcolas 6y ago
    Per that link, it's only illegal in Russia (which is fucked up) but it's pretty close to identical to how the US handles it in every other listed country.
- atemerev 6y ago
  ADHD person here, who lived in 6 countries, including the US (the other 5 are Russia, Italy, Denmark, Spain, and Switzerland). Getting ADHD stimulant medications is way easier in the US than elsewhere. Here in Switzerland, for example, adult ADHD was even started to be recognized only since 2011. No immediate release formulations are legal here, only extended release. Even though Novartis, a Swiss company, is the producer of Ritalin. You can't get Ritalin in Switzerland, as it is an immediate release drug. In Russia, _all_ stimulant drugs are banned (and ADHD usually is not even recognized as a valid diagnosis). As is you can get to prison there if you take your Ritalin with you.
  - cpursley 6y ago
    Strattera is legal in Russia (its a slightly different class of drug)
- kayodelycaon 6y ago
  I live in Ohio. ADHD meds are not that difficult to get. There’s some frustrating paperwork but that’s literally it. Any doctor can prescribe stimulant medication. Bipolar medication on the other hand, many of my bipolar friends in Europe have difficulty getting proper medication, much less proper treatment. In the US, the only issue I had was finding a psychiatrist and therapist who was available. The problem is cost. If I had ended up getting sent to inpatient treatment (nearly happened), the bill would have been huge.
  - DanBC 6y ago
    > Bipolar medication on the other hand, many of my bipolar friends in Europe have difficulty getting proper medication, much less proper treatment. It's hard to have a conversation when you talk about "europe", where there are a dozen different healthcare systems. Here in the UK treatment (including medication) is easily available to anyone who needs it.
  - falcolas 6y ago
    The lady who runs "How To ADHD" on YouTube recently discussed her issues in getting a prescription after moving. A slice of the challenges she faced: - Few psychiatrists/doctors were willing to prescribe meds to an adult. - You can't call to check on availability of Schedule II medications from pharmacies, you have to query in person, and many require a prescription before they'll answer. - Insurance often requires pre-approval to pay for the meds - another hoop and another delay. - You can only ever get one month prescription at a time (with no refills), and have to contact your doctor every month. Not too early, not too late. Any one of these issues can be tough when you have an executive function disorder (poor short term memory, poor awareness of time, etc.), and especially if you run out of your meds and are fighting yourself just to do basic self care.
    - ketamine__ 6y ago
      > Few psychiatrists/doctors were willing to prescribe meds to an adult. Never had an issue with this and I have frequently switched doctors. I'd suggest finding a prescribing nurse practitioner. It's hard to find a psychiatrist without waiting six months for the first appointment. > You can't call to check on availability of Schedule II medications from pharmacies, you have to query in person, and many require a prescription before they'll answer. I drop three prescriptions off at a time. Or it's called in and then I call for refills. If they don't have it in stock they can probably order it. > You can only ever get one month prescription at a time (with no refills), and have to contact your doctor every month. Not too early, not too late. I've had five or six psychiatrists. All of them prescribe 3 months in advance after the prescription is stabilized.
tokai 6y ago
>Access to [...] estketamine Not true. https://www.bmj.com/content/367/bmj.l7069 https://www.bmj.com/content/367/bmj.l7069
- ketamine__ 6y ago
  That article doesn't specify if it's actually available to patients in the UK. Is it?
erdos4d 6y ago
There is endless ketamine in Germany, just go hang out by the bathroom at any techno club and someone will be by to take your order.
DanBC 6y ago
> such as ketamine and estketamine for TRD, are really only available in the US Go careful here. Ketamine infusion is a pretty heavy duty intervention and patients require careful monitoring while taking the infusion and for a short term afterwards. In the UK we're looking at 1:1 nurse:patient ratios, delivered in ECT suites. In the US the way increased access has been achieved is by dropping down the nurse:patient ratio and delivering it in wider settings. It's a more risky way to deliver the treatment. We know that in the US there's already a problem of "doctor shopping" -- going around doctors until you find one willing to prescribe ketamine / eskatamine. This is normally associated with harmful prescribing, although it's too early to say if that's the case with these meds. EDIT to add: There are cultural differences here. The US sees access to medication as being the same as access to treatment. The UK sees it as over-medication with at best ineffective treatment, and at worst treatment that causes harm.
- ketamine__ 6y ago
  > Go careful here. Ketamine infusion is a pretty heavy duty intervention and patients require careful monitoring while taking the infusion and for a short term afterwards. I've been taking ketamine lozenges at home for 2+ years now. Ketamine is a very safe drug. It is used in pediatrics and on the WHO's list of essential medicines. It's hard to find any fatalities directly attributed ketamine in the literature. The infusion therapy you speak of has been used to rob patients blind. Before I found a doctor that would prescribe I was on target to waste 10k a year. And that's not even considering the wasted time of appointments in the clinic. > We know that in the US there's already a problem of "doctor shopping" -- going around doctors until you find one willing to prescribe ketamine / eskatamine. This is normally associated with harmful prescribing, although it's too early to say if that's the case with these meds. Doctor shopping refers to going to different doctors to get more medication or to divert the prescription for profit. If one is depressed and seeks treatment from a researcher and doctor in another city or state it is not doctor shopping because of the underlying medical condition. Seeking help is not a crime. Nevertheless, could you please post proof that there is a problem since you made that claim?
  - httpsterio 6y ago

falcolas 6y ago

WRT ADHD support, I can’t say I believe this. With our medications being on controlled substances lists, and all the (ironically incredibly ADHD unfriendly) hoops we have to jump through just to get those meds, it’s kinda hard to believe that everyone else in the world is somehow worse than that.

swebs 6y ago
You'd be surprised https://en.wikipedia.org/wiki/Methylphenidate#Legal_status https://en.wikipedia.org/wiki/Methylphenidate#Legal_status
- falcolas 6y ago
  Per that link, it's only illegal in Russia (which is fucked up) but it's pretty close to identical to how the US handles it in every other listed country.
atemerev 6y ago
ADHD person here, who lived in 6 countries, including the US (the other 5 are Russia, Italy, Denmark, Spain, and Switzerland). Getting ADHD stimulant medications is way easier in the US than elsewhere. Here in Switzerland, for example, adult ADHD was even started to be recognized only since 2011. No immediate release formulations are legal here, only extended release. Even though Novartis, a Swiss company, is the producer of Ritalin. You can't get Ritalin in Switzerland, as it is an immediate release drug. In Russia, _all_ stimulant drugs are banned (and ADHD usually is not even recognized as a valid diagnosis). As is you can get to prison there if you take your Ritalin with you.
- cpursley 6y ago
  Strattera is legal in Russia (its a slightly different class of drug)
kayodelycaon 6y ago
I live in Ohio. ADHD meds are not that difficult to get. There’s some frustrating paperwork but that’s literally it. Any doctor can prescribe stimulant medication. Bipolar medication on the other hand, many of my bipolar friends in Europe have difficulty getting proper medication, much less proper treatment. In the US, the only issue I had was finding a psychiatrist and therapist who was available. The problem is cost. If I had ended up getting sent to inpatient treatment (nearly happened), the bill would have been huge.
- DanBC 6y ago
  > Bipolar medication on the other hand, many of my bipolar friends in Europe have difficulty getting proper medication, much less proper treatment. It's hard to have a conversation when you talk about "europe", where there are a dozen different healthcare systems. Here in the UK treatment (including medication) is easily available to anyone who needs it.
- falcolas 6y ago
  The lady who runs "How To ADHD" on YouTube recently discussed her issues in getting a prescription after moving. A slice of the challenges she faced: - Few psychiatrists/doctors were willing to prescribe meds to an adult. - You can't call to check on availability of Schedule II medications from pharmacies, you have to query in person, and many require a prescription before they'll answer. - Insurance often requires pre-approval to pay for the meds - another hoop and another delay. - You can only ever get one month prescription at a time (with no refills), and have to contact your doctor every month. Not too early, not too late. Any one of these issues can be tough when you have an executive function disorder (poor short term memory, poor awareness of time, etc.), and especially if you run out of your meds and are fighting yourself just to do basic self care.
  - ketamine__ 6y ago
    > Few psychiatrists/doctors were willing to prescribe meds to an adult. Never had an issue with this and I have frequently switched doctors. I'd suggest finding a prescribing nurse practitioner. It's hard to find a psychiatrist without waiting six months for the first appointment. > You can't call to check on availability of Schedule II medications from pharmacies, you have to query in person, and many require a prescription before they'll answer. I drop three prescriptions off at a time. Or it's called in and then I call for refills. If they don't have it in stock they can probably order it. > You can only ever get one month prescription at a time (with no refills), and have to contact your doctor every month. Not too early, not too late. I've had five or six psychiatrists. All of them prescribe 3 months in advance after the prescription is stabilized.

tokai 6y ago

>Access to [...] estketamine Not true. https://www.bmj.com/content/367/bmj.l7069 https://www.bmj.com/content/367/bmj.l7069

ketamine__ 6y ago
That article doesn't specify if it's actually available to patients in the UK. Is it?

erdos4d 6y ago

There is endless ketamine in Germany, just go hang out by the bathroom at any techno club and someone will be by to take your order.

DanBC 6y ago

> such as ketamine and estketamine for TRD, are really only available in the US Go careful here. Ketamine infusion is a pretty heavy duty intervention and patients require careful monitoring while taking the infusion and for a short term afterwards. In the UK we're looking at 1:1 nurse:patient ratios, delivered in ECT suites. In the US the way increased access has been achieved is by dropping down the nurse:patient ratio and delivering it in wider settings. It's a more risky way to deliver the treatment. We know that in the US there's already a problem of "doctor shopping" -- going around doctors until you find one willing to prescribe ketamine / eskatamine. This is normally associated with harmful prescribing, although it's too early to say if that's the case with these meds. EDIT to add: There are cultural differences here. The US sees access to medication as being the same as access to treatment. The UK sees it as over-medication with at best ineffective treatment, and at worst treatment that causes harm.

ketamine__ 6y ago
> Go careful here. Ketamine infusion is a pretty heavy duty intervention and patients require careful monitoring while taking the infusion and for a short term afterwards. I've been taking ketamine lozenges at home for 2+ years now. Ketamine is a very safe drug. It is used in pediatrics and on the WHO's list of essential medicines. It's hard to find any fatalities directly attributed ketamine in the literature. The infusion therapy you speak of has been used to rob patients blind. Before I found a doctor that would prescribe I was on target to waste 10k a year. And that's not even considering the wasted time of appointments in the clinic. > We know that in the US there's already a problem of "doctor shopping" -- going around doctors until you find one willing to prescribe ketamine / eskatamine. This is normally associated with harmful prescribing, although it's too early to say if that's the case with these meds. Doctor shopping refers to going to different doctors to get more medication or to divert the prescription for profit. If one is depressed and seeks treatment from a researcher and doctor in another city or state it is not doctor shopping because of the underlying medical condition. Seeking help is not a crime. Nevertheless, could you please post proof that there is a problem since you made that claim?
- httpsterio 6y ago