7 ms·

Not ecstasy and psilocybin, but a few years ago, I met a psychiatrist who had worked in the armed forces and then alongside a crisis SWAT team. After decades of

• Natsu 6y ago
  Yes, ketamine can shut off depression like a light switch. That's really, really good for the population it works for. Of course, it can also cause psychosis. As someone who nearly got murdered in their sleep by someone on one such ketamine-caused psychosis, I think that caution is warranted when prescribing it. Waking up to take a knife away from a crying person is not something I would recommend to others. I've heard that there are studies on a metabolite of ketamine that's supposed to avoid the psycosis. I really hope that works so we get something this powerful without the downside.
  • irq 6y ago
    Without making light of your experience, the behavior you witnessed is simply not possible to induce with the dosing range used by licensed ketamine treatment clinics. So yes, too much of a good thing is bad. Ketamine clinics use doses much lower than that which is used for general anesthesia, and ketamine is used for general anesthesia all over the world on a daily basis. It's on the World Health Organization's Essential Medicines List and has a very safe 50+ year track record.
    • JulianMorrison 6y ago
      Also don't take powerful drugs off-label, with no monitoring or supervision, and expect them to do the same thing they would at controlled doses in a controlled environment.
      • ketamine__ 6y ago
        I take doctor prescribed ketamine at home. It's incredibly safe and as a bonus it's much more comfortable to be laying in your own bed.
        • Natsu 6y ago
          They let people take it at home now? We had to go into a clinic and they would monitor you the entire time. There was a couch to lay on, but not much in the way of amenities.
          • ketamine__ 6y ago
            I've been taking lozenges for over 2 years now.
      • Natsu 6y ago
        We didn't! It was a licensed esketamine trial under medical supervision for treatment-resistant depression.
    • Natsu 6y ago
      > Without making light of your experience, the behavior you witnessed is simply not possible to induce with the dosing range used by licensed ketamine treatment clinics. This was a licensed esketamine (s-ketamine) trial under medical supervision which, as you might imagine, left us excluded from the trial afterwards. So I am going to have to disagree with you regarding whether or not that is possible at theraputic doses. I realize that it's normally safe, and I hope that it helps a lot of people.
      • Judgmentality 6y ago
        > This was a licensed esketamine (s-ketamine) trial under medical supervision which, as you might imagine, left us excluded from the trial afterwards. Do you feel like the experts are being disingenuous with the safety of this drug? I am not taking sides here - I am genuinely curious of your opinion since you seem to know something others don't.
        • Natsu 6y ago
          I feel like this is probably a rare side-effect that people should know about. I hope it doesn't affect many people, and for those it does affect, that the psychosis doesn't turn out like this.
      • irq 6y ago
        Could you link the trial or any data about it? Genuinely curious.
        • Natsu 6y ago
          I don't know specifically which trial it was, but you can google for esketamine trials because that's their brand name for s-ketamine.
      • purrplexed 6y ago
        Good video on the difference between infusions and nasal, and s vs r isomers. https://www.youtube.com/watch?v=ejjAszofgvA https://www.youtube.com/watch?v=ejjAszofgvA They are essentially different drugs and may explain the reaction.
    • PragmaticPulp 6y ago
      > the behavior you witnessed is simply not possible to induce with the dosing range used by licensed ketamine treatment clinics There's a growing trend of clinics prescribing take-home lozenges. Some of them are giving patients 30 or more lozenges at a time, with the expectation that they'll use them once or twice a week. Of course, some patients take multiple doses at once. Browsing subreddits on the topic shows plenty of stories of people escalating their doses or asking for strategies to convince their doctors to prescribe more. Unfortunately, I think it's going to get worse before it gets better. Too many unscrupulous doctors are realizing the profit potential for dispensing Ketamine prescriptions in exchange for $300, 20-minute telehealth visits.
      • Natsu 6y ago
        That's terrifying. The trial we were in used esketamine dosed via inhalation. You could not take any of it home and the doctors controlled all doses. I'd be suspicious of those who wanted more and more of the drug. It made her so dizzy and sick there's no way she'd want more. I almost wonder if you can detect who is abusing it by how much they enjoy it...
  • airstrike 6y ago
    Basically the premise of the mini-series The Night Of
  • nosmokewhereiam 6y ago
    Set and setting comes from Mindset and setting. Sounds like that person wasn't using K correctly (they were abusing it). I don't feel as if your anecdote applies to many others in a controlled setting.
    • Natsu 6y ago
      You would be wrong about that, it was a licensed esketamine trial under strict medical supervision.
      • hn_asker 6y ago
        strict medical supervision is sometimes a terrifying experience. Set and setting matter but so does any drugs they are currently on. I would say that your experience is atypical.
        • Natsu 6y ago
          As I understand it, the "K hole" was terrifying, the setting for taking this was a doctor's office that let you relax on a couch afterwards.
• fossuser 6y ago
  Gary Gulman talks a bit about the relief he got from it. Unfortunately for him it was only short term relief, but it really did seem to work. He’s doing well now, so maybe that short term relief helped in some way as part of everything else.
  • purrplexed 6y ago
    Did 12 sessions, after the first session I had instant relief. Even the urge to drink was completely gone. I should have gone back in for boosters but just let it slide, mostly due to the continued cost. About 3 months later I was back into a depressive state. I was able to get out of that one on my own but I don't think it would have been possible without the ketamine treatments. It is hands down the most effective medicine to treat depression I have taken. The maintenance is the downside, however the minimal side effects are worth it.
  • ketamine__ 6y ago
    Are you saying he abandoned the therapy because of the short-term relief? Most people return to their depressed state when they stop taking their anti-depressants.
    • fossuser 6y ago
      The doc told him he wouldn’t continue it because it wasn’t helping outside of the therapy session (and each session was quite expensive).
• mrcartmenez 6y ago
  Worked for me after I had become incredibly depressed while attempting to rescue my daughter from an abuse situation (I succeeded yay!). I went from having tunnel vision, hearing music as just noise, severe dissociation etc. to being just fine and normal two hours later. Best bio-hack I’ve ever done. I personally wouldn’t use it as a recreational drug often though as it does have some known side effects from habitual use and regular drug use is always a bad idea, yes folks that includes weed and alcohol.
  • TaylorAlexander 6y ago
    Thank you for your story. I just wanted to offer an alternative view on regular drug use. I vape marijuana every day. After college I became an alcoholic after having stayed totally sober until age 21. Binge drinking college parties left me and my friends binge drinking well after college. It was bad, though I never lost a job. I’d tried marijuana several times and often felt overwhelmed with it. It would take me more than ten years to realize why those incidents happened - group pressure to take huge hits of marijuana left me feeling way too high. A deeply uncomfortable feeling. But marijuana helped me quit alcohol. I do not consider it the healthiest option nor do I recommend to anyone that they consume marijuana. But I would push back that it is always a bad idea. For my health I only vape marijuana and I keep the doses very small. I know it may still lead to health problems and I hope some day I don’t feel the need to do it. But it seems to help. I’ve stopped for weeks at a time and it’s fine. But I seem to prefer having a bit of marijuana every day. And I really don’t think that’s bad for me personally. I’m a successful robotics engineer. I worked for two years at Google X robotics while consuming marijuana daily and they filed two patents for my work during that time. Since then I’ve gone off to co-found a farming robotics organization that is about to announce our open source farming robot that I designed and built pretty much all myself. I think we should take a more open minded approach to drug use. Some people may find that certain drugs work for them. Certainly I am achieving my life goals while vaping marijuana daily. I don’t really think it’s best for me long term, but it seems to be what’s working for me now.
    • kortilla 6y ago
      It’s not clear to me from your post what the upside was for daily marijuana use is. It sounds like it kept you from reaching for the bottle, which I’m supporting of; but, what does it provide for someone who is not an alcoholic?
• coderintherye 6y ago
  The Center for Transformational Psychotherapy in SF leverages ketamine as part of their treatment, to good effect. Hopefully continued use and research will continue to mainstream its use (when appropriate).
• dialamac 6y ago
  Ketamine is a not uncommon thing in psych today. It is routinely prescribed. The problems are that it does seem for most people the effect is short lived (weeks) and psychosis is a thing (the poster below saying it’s never an issue even in pain setting is simply mistaken). The thing is that neither of these are uncommon problems for psych meds in general so ketamine shouldn’t be singled out for this, but it’s more complicated then some of the armchair docs here make it seem. There is continuing research into regimens that might minimize the tachyphylaxis, but it’s an ongoing problem.
  • Tenoke 6y ago
    >psychosis is a thing Looking through Google scholar + personal experience I don't see evidence that this is an issue for non-schizophrenics.
    • dialamac 6y ago
      You need to look harder. Schizophrenia and psychotic features are relative contraindications for use of ketamine per APA guidelines. “It is unclear whether patients with depression that is not treatment- refractory or patients with other psychiatric illnesses are ap- propriate candidates for ketamine treatment, and extreme caution must be exercised in patients with psychotic or substance use disorders.” Side-effects associated with ketamine use in depression: a systematic review, Short 2018. To summarize: A review of 60 studies found dissociation and psychotomimetic effects >70 percent of the studies at varying rates. And note that the time courses of observation were variable. Furthermore most of these studies excluded participants with psychotic features or known psychotic disorder. But for any provider considering ketamine this is literally top of the list in consideration of adverse effects.
      • Tenoke 6y ago
        This review doesn't say all that much. I just took another look at it and it merely reports what % of the studies mention those effects without effect sizes or anything of the sort. Also they clump psychotomimetic and dissociation effects together which is really weird as ketamine is a dissociative. It's literally the highest number in their analysis (72%) because dissociation is to be expected from a dissociative.
• PragmaticPulp 6y ago
  Ketamine treatment for depression doesn’t require a psychedelic experience. Many clinics prefer to keep doses low enough to avoid full psychedelic experiences. Of course, some clinics blast patients with excessive doses and send them into full-blown psychedelic trips, but it’s definitely not necessary for the anti-depressant effect. Ketamine’s effects on depression are almost certainly mediated by something other than any psychedelic effects. Ideally we’ll find a safer medication which accomplishes the same thing without disorienting the patient Unfortunately, the effects of this therapy are rather short lived. There’s a growing industry of ketamine clinics that are happy to continue charging patients for endless ketamine infusions. Some offer outpatient prescriptions of ketamine. However, repeated treatment isn’t quite as effective as tolerance develops. The best approach appears to be using ketamine as a way to kickstart more sustainable, long-term depression treatments, such as therapy programs.
  • hn_asker 6y ago
    There's a growing industry of therapy clinics that are happy to continue charging patients for endless sessions. Some offer anti-depressants and anti-psychotics. However, repeated treatment isn't quite as effective as the wrong mix of drugs are prescribed, the therapy re-enforces the trauma, and it is quite costly for patients to afford.
• joshxyz 6y ago
  I've done both back then, those stuff really changed my life perspective in terms of depth. Recreationally some of them can be misused (ketamine, extasy), but for the medically desperate I'm hella convinced these substances deserves more research.
• johnchristopher 6y ago
  I don't know. Every generalist doctor I have known got a alt phase aound 50. Homeopathiy, bach's flower, essential oils, etc. I chalk it up to "they have seen bad stuff and can't help some of their patients going through rough times and they look up for alternatives and settle for something for a few years".