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Devil is in the details, the fact that the author remembers their state of mind is odd. Because currently most of the clinics co-administer a benzodiazepine (mi

Devil is in the details, the fact that the author remembers their state of mind is odd. Because currently most of the clinics co-administer a benzodiazepine (midazolam) with ketamine, which actually is used for its amnesiac effects. Also, although assumed to be transformational, there are now indicators that ketamine’s anti-depressive effects might be tied to the opioid system of the brain, rather than the psychedelic, altered-state experiences, which most patients don't remember anyway. Finally, the article peculiarly omits if they have been in ongoing ketamine therapy since that time frame. Phrasing neither denies or confirms this; > In May 2021, 15 years after dropping out of high school, five years after beginning ketamine treatment, I graduated from college. Don't get me wrong, I'm happy that they have found a treatment that works, and it might as well be rational to use this therapy to ratchet out of a deep disease state. But we also need a balanced account of the durability of the effects, its downstream consequences and therefore a better idea of its mechanism of action. Without such an account, uppers like amphetamines and cocaine would also be considered to "treat" depression, except for terribly short durations and with unsustainable side-effects. To what degree ketamine is different, we are yet to find out.

in3d 5y ago
Huh? Most clinics definitely do not co-administer benzodiazepines. What’s your reference to patients not remembering their experiences? What’s your reference to ketamine being tied to the opioid system? Never heard that. In fact there is a lot of research that shows it works differently. Honestly, your comment seems totally misinformed. It’s like you’re just confusing ketamine with some other drug.
- acituan 5y ago
  > Most clinics definitely do not co-administer benzodiazepines. You're welcome to call and conduct your own survey, I have no way to document mine for you. Clinics don't tend to detail their procedures at this level online but I found a random internet one for you: https://www.universityhealthsystem.com/~/media/files/clinical-pathways/ketamine-administration-guideline-080114.pdf?la=en https://www.universityhealthsystem.com/~/media/files/clinica.... You should check page 8, item b "Prior to administration of the first bolus, patients will receive midazolam 1 mg IV push." > What’s your reference to patients not remembering their experiences? That's what versed (midazolam) specifically does. It is used in other outpatient procedures like endoscopies too. > What’s your reference to ketamine being tied to the opioid system? Never heard that. Literally the first Google result for "ketamine opioid" is https://med.stanford.edu/news/all-news/2018/08/ketamines-antidepressive-effects-tied-to-opioid-system-in-brain.html https://med.stanford.edu/news/all-news/2018/08/ketamines-ant.... There is tons of other primary research too. > Honestly, your comment seems totally misinformed. Sorry to hear you feel that way but I know what I am talking about. I wish you researched a bit more on your own before writing your comment.
  - in3d 5y ago
    > Literally the first Google result for "ketamine opioid" is https://med.stanford.edu/news/all-news/2018/08/ketamines-ant https://med.stanford.edu/news/all-news/2018/08/ketamines-ant.... There is tons of other primary research too. Read the responses to this paper. It has been pretty much debunked. As summarized here: https://onlinelibrary.wiley.com/doi/full/10.1111/pcn.12902 https://onlinelibrary.wiley.com/doi/full/10.1111/pcn.12902 “ However, there has been much debate about this paper.217-221 In contrast, pilot data from Yale University demonstrated that pretreatment with naltrexone did not affect the antidepressant actions of ketamine in patients with depression and alcohol use disorder.222-224 Further clinical trials using a large sample size are needed to better understand whether opioid receptor activation is necessary for ketamine’s antidepressant actions in patients with depression. Recently, we reported that naltrexone did not block the rapid-acting and sustained antidepressant effects of ketamine in a CSDS model or LPS-induced inflammation model.225 If opioid receptors are implicated in the antidepressant actions of ketamine, (S)-ketamine must be more potent than (R)-ketamine in animal models of depression. Therefore, the opioid receptor system might not play a role in ketamine’s antidepressant actions.225”
    - acituan 5y ago
      > Read the responses to this paper. It has been pretty much debunked. I'm impressed with your transition from "I've never heard research on ketamine's opioid activity" to "it is pretty much debunked". I suggest you read a bit more and watch for confirmation bias.

in3d 5y ago

Huh? Most clinics definitely do not co-administer benzodiazepines. What’s your reference to patients not remembering their experiences? What’s your reference to ketamine being tied to the opioid system? Never heard that. In fact there is a lot of research that shows it works differently. Honestly, your comment seems totally misinformed. It’s like you’re just confusing ketamine with some other drug.

acituan 5y ago
> Most clinics definitely do not co-administer benzodiazepines. You're welcome to call and conduct your own survey, I have no way to document mine for you. Clinics don't tend to detail their procedures at this level online but I found a random internet one for you: https://www.universityhealthsystem.com/~/media/files/clinical-pathways/ketamine-administration-guideline-080114.pdf?la=en https://www.universityhealthsystem.com/~/media/files/clinica.... You should check page 8, item b "Prior to administration of the first bolus, patients will receive midazolam 1 mg IV push." > What’s your reference to patients not remembering their experiences? That's what versed (midazolam) specifically does. It is used in other outpatient procedures like endoscopies too. > What’s your reference to ketamine being tied to the opioid system? Never heard that. Literally the first Google result for "ketamine opioid" is https://med.stanford.edu/news/all-news/2018/08/ketamines-antidepressive-effects-tied-to-opioid-system-in-brain.html https://med.stanford.edu/news/all-news/2018/08/ketamines-ant.... There is tons of other primary research too. > Honestly, your comment seems totally misinformed. Sorry to hear you feel that way but I know what I am talking about. I wish you researched a bit more on your own before writing your comment.
- in3d 5y ago
  > Literally the first Google result for "ketamine opioid" is https://med.stanford.edu/news/all-news/2018/08/ketamines-ant https://med.stanford.edu/news/all-news/2018/08/ketamines-ant.... There is tons of other primary research too. Read the responses to this paper. It has been pretty much debunked. As summarized here: https://onlinelibrary.wiley.com/doi/full/10.1111/pcn.12902 https://onlinelibrary.wiley.com/doi/full/10.1111/pcn.12902 “ However, there has been much debate about this paper.217-221 In contrast, pilot data from Yale University demonstrated that pretreatment with naltrexone did not affect the antidepressant actions of ketamine in patients with depression and alcohol use disorder.222-224 Further clinical trials using a large sample size are needed to better understand whether opioid receptor activation is necessary for ketamine’s antidepressant actions in patients with depression. Recently, we reported that naltrexone did not block the rapid-acting and sustained antidepressant effects of ketamine in a CSDS model or LPS-induced inflammation model.225 If opioid receptors are implicated in the antidepressant actions of ketamine, (S)-ketamine must be more potent than (R)-ketamine in animal models of depression. Therefore, the opioid receptor system might not play a role in ketamine’s antidepressant actions.225”
  - acituan 5y ago
    > Read the responses to this paper. It has been pretty much debunked. I'm impressed with your transition from "I've never heard research on ketamine's opioid activity" to "it is pretty much debunked". I suggest you read a bit more and watch for confirmation bias.