12 ms·

Ketamine for the acute treatment of severe suicidal ideation

130 points by hochmartinez 5y ago

oldstrangers 5y ago
I did a full 6 week course of ketamine therapy. It was really good, and I would recommend it if you're open minded. It's not for everyone, and the lasting (a year+) benefits aren't really measurable (maybe I'm different? maybe I'm not, maybe I've just gotten older). I'd like to go again and see if it can help with my obsessive existential dread.
- deleted 5y ago
  [deleted]
- mrwaffle 5y ago
  Absolutely, I have a partner who has had severe PTSD and went through a great month-long program, she's overcome many longstanding fears and triggers and has made huge strides in being able to feel that she is living her life once again.
  - jokowueu 5y ago
    May I recommend stellate gangelion block for PTSD . https://youtu.be/nC2fBe6U7lg https://youtu.be/nC2fBe6U7lg
  - jcims 5y ago
    I wonder what the age limit is on stuff like this. So many young folks experiencing crippling anxieties that are impacting their ability to navigate the world at an age where it's going to have longstanding ramifications for relationships and careers.
  - sshine 5y ago
    I have a close acquaintance who uses ketamine to manage depression and Complex PTSD. My experience as a bystander is that the depressive symptoms reoccur periodically regardless of the use of ketamine. The depressive symptoms seem to be caused by the PTSD, and ketamine does not seem to alleviate the PTSD. I'm saying this as a huge fan of the positive impact of ketamine. There are some symptoms that seem like they need more rewiring.
    - dwaltrip 5y ago
      C-PTSD is probably the simplest way to summarize what I’ve been dealing with (I’m not totally comfortable with the label). I’ve done 20 ketamine sessions over the past 2 years (the last one about 5 months ago). I agree with you that a lot of the immediate relief from an infusion can fade after not that long. However, combined with some of the other work I was doing there was a slow accumulation of benefits and new perspectives on life. Overall, the infusions definitely helped… it hasn’t been easy going though, and I have been continuing to work on myself. A few months ago, I finally found a therapist who I felt was actually helping me. I had tried a few different therapists in years past and it wasn’t that helpful. My current therapist uses a lot of “somatic therapy” in her work, which I think is really important. With trauma, talk alone won’t get you very far. I’ve made a lot of progress since November when I started seeing her. I think the Ketamine and the work I had been doing on my on own “prepped” me in a certain sense. Your friend might benefit from finding a good somatic therapist.
- hemloc_io 5y ago
  What's the process for this like? Been curious about the current state of psych medicine.
  - ketamine 5y ago
    Not OP I did 2 surveys and a phone consult then a baseline depression survey before my first infusion. I go to the clinic and go in my room and they give me my IV then the doctor hangs the ketamine mix bag, hooks it up and leaves. The rooms are dark and they have colored lights or a dim light. I wear an eye mask. I pay extra to receive talk therapy during the infusion so I have a therapist with me the whole time. We do a ceremony to start each infusion and set the intent just before the effects start.
  - oldstrangers 5y ago
    Depends on the place, there really isn't much regulation for it where I went. I made an appointment, signed all the papers and got started. It's very expensive ($400-$600 a week). They have a head doctor and then an anesthesiologist that handles the actual infusion.
- agumonkey 5y ago
  what about how it felt early on / during the therapy ? what about side effects also ?
  - bradly 5y ago
    There is the "trip" side affect which lasts about 30-45 minutes. Then there is some wobbly legs and slow speech for an hour or two after. I had no side-affects besides those.
    - agumonkey 5y ago
      and how does that trip feels ? just new fresh ideas ? physical sensations ? a weightlifting sensations ? colorful emotions ?
      - bradly 5y ago
        physical sensations: Yes. I often feel like a going on a journey. I've stood at the top of an endless drain pipe, holding hands with my brain, before jumping in. colorful emotions: Yes. I've gone inside a rainbow and swam in a lake of my own feelings The biggest thing you do is disconnect from your self. I've become the particles I'm made of and often lose the sense of what it is to be human or if I am human or not.
  - oldstrangers 5y ago
    The trip itself is fun. It'll get scary if you don't let yourself go, but it was really manageable. You are heavily sedated obviously, so you can't drive or do much after. Mentally its exhausting, and akin to spending all night studying. You will probably have a headache for the rest of the day.
- ketamine 5y ago
  It immediately relieved my existential dread. I fear the next infusion will be intense, however.
  - oldstrangers 5y ago
    Ohhh that's encouraging. I was supposed to go for a "booster" session ages ago but kept putting it off.
- aaaronic 5y ago
  There are treatments for that? I've never had anyone suggest anything other than therapy for it.
deleted 5y ago
[deleted]
after_care 5y ago
> Then, patients received a first 40 minute intravenous infusion of ketamine (0.5 mg/kg) or placebo 0.9% (saline solution) in addition to their current treatment. This really shouldn’t be labeled as double blind. 1.The nurse administering knew if it was placebo or active (for safety reasons). 2. It would immediately become obvious to the subject if they were injected with salt water or ketamine. 3. Within minutes it would become obvious to everyone in the room if the patient was injected with salt water or ketamine. Some trails are impossible to be double blind. That’s okay, there are other ways to address concerns of internal validity. Pretending like this trail is double blind does not address any internal validity concerns, and only raises concerns about the researchers understanding of experimental design.
- BurningFrog 5y ago
  Injecting some other psychoactive drug should work, at least for patients who have never used ketamine before. But I suspect that would take many years to get through the permitting apparatus, if it was at all possible.
  - after_care 5y ago
    Injecting someone with another psychoactive drug would not be a placebo. We would be comparing the efficacy of {other psychoactive drug} and ketamine. That's not to say this experiment has no value, it's one of the many experiments we should run to help build the case for ketamine. The classic gold standard is to randomly assign subjects to groups. Then give one group a sugar pill, give the other group the treatment pill. Neither to patient, the person administering, or the person recording the results know who got the treatment who got the placebo. This is not possible with ketamine, psilocybin, MDMA, LSD, etc. That's fine, we can still build a strong body of experimental evidence of their efficacy. It bothers me when clearly non-blind non-mask experiments are labeled as double-blinded, which we see often in this body of research, this study included.
    - phren0logy 5y ago
      There is precedent for this; it's called "active placebo." For example, I think some of the psilocybin trials used methylphenidate as an active placebo comparison condition.
archhn 5y ago
Christianity without tears?
- ketamine 5y ago
  What do you mean?
  - archhn 5y ago
    That's the description of soma in bnw.
Terry_Roll 5y ago
Some vets use Ketamine as part of a multi stage protocol for euthanising animals, other vets just use a single drug protocol but I havent established what that drug is, but it just seems all a bit refined butchery to me! Ketamine is supposed to be a disassociate drug, which I'm guessing is perhaps like an out of body experience or something. But I cant see how that can help with depression when people dont understand depression can actually be lots of things, but it has one overriding common element which is people remembering. So unless people get something like dementia where recent memories seem to fade first and the earliest memories come back, I fail to see how K can help treat depression. As for suicide ideation, well look around at what constitutes 1st world medical care! If you dont buy into the smiley faces because you might have grown up around medical professionals and heard the back office chats you might think twice about the authenticity of so called medical professionals! Not only that, its just a job for most, leave it at the door when your shift finishes, which is easier said than done especially if a dying patient seemed nice and innocent compared to an unpleasant angry dying patient. I really dont know why we dont have legal euthanasia because being experimented on in the name of science is not something I'd let others do to me if I can help it, I am aware that some argue it would be a direction towards eugenics, but that goes on already in stealth with some medical procedures.
- amelius 5y ago
  Isn't morphine overdose the best (friendliest) possible euthanizing method?
  - Terry_Roll 5y ago
    Morphine/Heroin is supposed to physically cause respiratory depression so you stop breathing and I guess the CO2 builds up past the 30% blood saturation point by which stage it takes about 2 mins for the body to shut down. As the CO2 levels reach that 30% blood saturation point, the body becomes increasingly stimulated which is why you see people thrashing around when drowning or asphyxiating. Having done sea rescue to stop someone drowning in rough sea's, you can say goodbye to all the training water rescue people get taught and just hope the panicking person isnt as strong as you and hope your lungs are better than theirs, because they will force you under and you will ingest lots of water so you have CO2 build up which spurs you on to shore ironically. Obviously (going off things like trainspotting and peoples accounts), opiates are supposed to give you a warm fuzzy feeling as you slip into a deep sleep or unconsciousness I guess but not to sure, never done it not even in an operating theatre. MAOI's the old style anti depressants are quite sudden in that they are like an on off switch for the brain, you dont remember or feel nothing and I think they were popular with people who wanted to end it, but SSRI's have replaced them as the new anti depressant treatment but their problem is you dont sleep properly on them so they introduce their own problems, but I'm not aware of any end of life properties in SSRI's other than they ruin your sleep and send you off the rails slowly. But all the while, these chemicals still dont address the fundamental problem with depression which is remembering stuff that causes depression. Maybe depression should be treated more like PTSD, because depression seems to be an ego thing, where as talking to other people, PTSD seems to be more like what people associate as depression. For bloke's I think the bio mechanical properties of testosterone would help many with PTSD, cant comment for women though, but the risk the police and medical lot dont want is some hulk losing it so the idea isnt entertained AFAIK. Self preservation of institutions comes before everything else! Edit: I should add, once CO2 blood saturation exceeds 30% it has a noble gas effect on the body, so anyone who remembers the periodic table should remember what noble gasses are and its why compressed gas companies go to great lengths to not enable pure noble gases getting into the hands of the public. Biology and chemistry is just the mammalian equivalent of computer hacking.
ketamine 5y ago
Hello! Throwaway account for obvious reasons. I just started IV ketamine infusions at .5 mg/kg for depressions. I am not finished with my treatment yet. Ask me anything if you would like.
- glerk 5y ago
  Any issues with your bladder? Have doctors mentioned anything about the potential damage to the urinary system? This seems to be the scariest side effect.
  - chimeracoder 5y ago
    I'm not OP, but I have some relevant professional (clinical) experience here. > Any issues with your bladder? Have doctors mentioned anything about the potential damage to the urinary system? This seems to be the scariest side effect. We're lucky because ketamine has been used for decades in inpatient settings at much, much higher doses than what is being used now for psychiatric purposes, so we have a good sense of its safety profile already. Urinary tract and bladder issues are noted for long-term and frequent recreational users of ketamine, but not really for anesthetic use. The dosing schedule for psychiatric use is closer to anesthetic use than it is for recreational use. The effects also are reversible if detected early and use is ceased, so periodic but infrequent treatment is unlikely to result in long-term damage, both because it's not frequent enough to accumulate, and because you can stop if it becomes a problem.
  - rootw0rm 5y ago
    This is part of the reason MXE was developed. Love me some MXE.
    - tsol 5y ago
      It's a shame it doesn't exist anymore. It would be great for this exact purpose
  - ketamine 5y ago
    No issues (yet). I am a man and it did immediately reduce my libido. Not in the same way SSRIs did. Will be curious to see if that is a lasting effect or not.
sshine 5y ago
This suggests that ketamine is beneficial for people who are suicidal to prevent them from killing themselves. The claim that is generally made about ketamine and depression is that it can have a short-term resetting effect of someone's depressive symptoms (not necessarily at a suicidal level), making it possible to escape the black hole that otherwise can take weeks, months, years to come out of. https://www.nih.gov/news-events/nih-research-matters/how-ketamine-relieves-symptoms-depression https://www.nih.gov/news-events/nih-research-matters/how-ket...
- kuhewa 5y ago
  For bipolar or other disorders, not much of a discernible effect for depressives
- vmception 5y ago
  Its the turn it off, turn it on again treatment, for the brain
  - mattkrause 5y ago
    I'm not sure if you're kidding or not, but I do halfway-seriously subscribe to this idea. A lot of things that seem to have anti-depressive effects, ranging from sleep deprivation to TMS and ECT, seem to basically give the brain a whack in the hopes of having it recover into a "better" state.
mabbo 5y ago
> The primary outcome was the rate of patients in full suicidal remission at day 3, according to the scale for suicidal ideation total score ≤3. Analyses were conducted on an intention-to-treat basis. Question: does reducing suicidal ideation reduce suicide? I mean, it sounds like it obviously should, but we've been wrong about this before. Many heart medications to reduce cholesterol worked great at reducing cholesterol without reducing heart disease! All that said, reducing suicidal ideation is a worthy goal itself, even if it doesn't reduce suicide. I'm a full supporter of seeing this treatment move more mainstream.
datavirtue 5y ago
Doctor prescribed anti-inflammatory for a pinched nerve I have...cured mine.
olliej 5y ago
I've been getting intramuscular ketamine weekly for my severe & treatment resistant depression while working on making progress towards actual recovery. As with participants in this study I wasn't one of the lucky "I did ketamine a few times and my depression was cured" folk, but it has a huge reduction in frequency and intensity of ideation, as well as pretty much completely removing self harm. That said it's not a long term solution (because honestly its frustrating due to losing a few hours during the work week, inability to drive, etc) so I'm working with Drs to actually resolve things without regularly being stabbed :D
- standardUser 5y ago
  I wish the gap between clinical treatment and recreational use was bridged, and you could use a nasal spray on your own time a couple evenings a week instead of a daytime injection.
  - olliej 5y ago
    The nasal spray is less effective according to the clinical trials, and is patented minor variation on ketamine so is super expensive (though "hilariously" because ketamine is technically being used off label for treating depression insurance may decline coverage of the cheaper, more effective original) There's also lozenge form which I believe some clinics allow you to take at home, but not sure of the effectiveness
intenex 5y ago
The truly amazing thing here is how powerful the placebo control was, even despite the fact that as someone who's done ketamine IV treatment before, it's pretty obvious when you're on ketamine and when you're not. "At week 6, remission in the ketamine arm remained high, although non-significantly versus placebo (69.5% v 56.3%; odds ratio 0.8 (95% confidence interval 0.3 to 2.5), P=0.7)."
- after_care 5y ago
  > The truly amazing thing here is how powerful the placebo control was 1. The "placebo" received standard treatment for suicidal ideation. 2. We should expect a natural regression towards the mean. The vast majority of humans do not experience suicidal ideation in a particular day. People with suicidal ideation tend to move towards the standard human experience of not having suicidal ideation over time.
aarontait 5y ago
FYI: Johnson & Johnson patented the S(+) enantiomer of ketamine and sells it as a nasal spray called Spavato. It's been FDA approved for depression since 2019. Although Spravato costs more on paper than regular ketamine, it's often less expensive for patients since it is covered by insurance (regular ketamine treatments are considered an off-label use and are usually not covered).
- blurbleblurble 5y ago
  It's pretty awful though for a lot of people. Researchers outside of the US have published studies showing that s-ketamine has higher risk of dependency in animal experiments and lower long term efficacy for depression, like on par with placebo. If I'm remembering right there are a number of reasons for this and one of them is that r-ketamine seems to simulate neuroplasticity better, something related to BDNF in certain parts of of hippocampus I think? While it probably works for some people, it's likely dangerous for many others. Kenji Hashimoto and others have published numerous papers about this. It's not exactly under-researched. The incentives in the US are horribly misaligned. Quite honestly it's upsetting that spravato even exists and there ought to be a huge class action lawsuit about this. A few papers: https://pubmed.ncbi.nlm.nih.gov/32224141/ https://pubmed.ncbi.nlm.nih.gov/32224141/ https://pubmed.ncbi.nlm.nih.gov/26327690/ https://pubmed.ncbi.nlm.nih.gov/26327690/
  - aarontait 5y ago
    Yea, I agree. I wish there was some kind of organization that would seek FDA approval for racemic ketamine treatment of depression. It's cheap, and widely available. Unfortunately, without the incentive for a patentable product, it's unlikely to ever happen.

130 points by hochmartinez 5y ago

I did a full 6 week course of ketamine therapy. It was really good, and I would recommend it if you're open minded. It's not for everyone, and the lasting (a year+) benefits aren't really measurable (maybe I'm different? maybe I'm not, maybe I've just gotten older). I'd like to go again and see if it can help with my obsessive existential dread.

deleted 5y ago
[deleted]
mrwaffle 5y ago
Absolutely, I have a partner who has had severe PTSD and went through a great month-long program, she's overcome many longstanding fears and triggers and has made huge strides in being able to feel that she is living her life once again.
- jokowueu 5y ago
  May I recommend stellate gangelion block for PTSD . https://youtu.be/nC2fBe6U7lg https://youtu.be/nC2fBe6U7lg
- jcims 5y ago
  I wonder what the age limit is on stuff like this. So many young folks experiencing crippling anxieties that are impacting their ability to navigate the world at an age where it's going to have longstanding ramifications for relationships and careers.
- sshine 5y ago
  I have a close acquaintance who uses ketamine to manage depression and Complex PTSD. My experience as a bystander is that the depressive symptoms reoccur periodically regardless of the use of ketamine. The depressive symptoms seem to be caused by the PTSD, and ketamine does not seem to alleviate the PTSD. I'm saying this as a huge fan of the positive impact of ketamine. There are some symptoms that seem like they need more rewiring.
  - dwaltrip 5y ago
    C-PTSD is probably the simplest way to summarize what I’ve been dealing with (I’m not totally comfortable with the label). I’ve done 20 ketamine sessions over the past 2 years (the last one about 5 months ago). I agree with you that a lot of the immediate relief from an infusion can fade after not that long. However, combined with some of the other work I was doing there was a slow accumulation of benefits and new perspectives on life. Overall, the infusions definitely helped… it hasn’t been easy going though, and I have been continuing to work on myself. A few months ago, I finally found a therapist who I felt was actually helping me. I had tried a few different therapists in years past and it wasn’t that helpful. My current therapist uses a lot of “somatic therapy” in her work, which I think is really important. With trauma, talk alone won’t get you very far. I’ve made a lot of progress since November when I started seeing her. I think the Ketamine and the work I had been doing on my on own “prepped” me in a certain sense. Your friend might benefit from finding a good somatic therapist.
hemloc_io 5y ago
What's the process for this like? Been curious about the current state of psych medicine.
- ketamine 5y ago
  Not OP I did 2 surveys and a phone consult then a baseline depression survey before my first infusion. I go to the clinic and go in my room and they give me my IV then the doctor hangs the ketamine mix bag, hooks it up and leaves. The rooms are dark and they have colored lights or a dim light. I wear an eye mask. I pay extra to receive talk therapy during the infusion so I have a therapist with me the whole time. We do a ceremony to start each infusion and set the intent just before the effects start.
- oldstrangers 5y ago
  Depends on the place, there really isn't much regulation for it where I went. I made an appointment, signed all the papers and got started. It's very expensive ($400-$600 a week). They have a head doctor and then an anesthesiologist that handles the actual infusion.
agumonkey 5y ago
what about how it felt early on / during the therapy ? what about side effects also ?
- bradly 5y ago
  There is the "trip" side affect which lasts about 30-45 minutes. Then there is some wobbly legs and slow speech for an hour or two after. I had no side-affects besides those.
  - agumonkey 5y ago
    and how does that trip feels ? just new fresh ideas ? physical sensations ? a weightlifting sensations ? colorful emotions ?
    - bradly 5y ago
      physical sensations: Yes. I often feel like a going on a journey. I've stood at the top of an endless drain pipe, holding hands with my brain, before jumping in. colorful emotions: Yes. I've gone inside a rainbow and swam in a lake of my own feelings The biggest thing you do is disconnect from your self. I've become the particles I'm made of and often lose the sense of what it is to be human or if I am human or not.
- oldstrangers 5y ago
  The trip itself is fun. It'll get scary if you don't let yourself go, but it was really manageable. You are heavily sedated obviously, so you can't drive or do much after. Mentally its exhausting, and akin to spending all night studying. You will probably have a headache for the rest of the day.
ketamine 5y ago
It immediately relieved my existential dread. I fear the next infusion will be intense, however.
- oldstrangers 5y ago
  Ohhh that's encouraging. I was supposed to go for a "booster" session ages ago but kept putting it off.
aaaronic 5y ago
There are treatments for that? I've never had anyone suggest anything other than therapy for it.

deleted 5y ago

[deleted]

after_care 5y ago

> Then, patients received a first 40 minute intravenous infusion of ketamine (0.5 mg/kg) or placebo 0.9% (saline solution) in addition to their current treatment. This really shouldn’t be labeled as double blind. 1.The nurse administering knew if it was placebo or active (for safety reasons). 2. It would immediately become obvious to the subject if they were injected with salt water or ketamine. 3. Within minutes it would become obvious to everyone in the room if the patient was injected with salt water or ketamine. Some trails are impossible to be double blind. That’s okay, there are other ways to address concerns of internal validity. Pretending like this trail is double blind does not address any internal validity concerns, and only raises concerns about the researchers understanding of experimental design.

BurningFrog 5y ago
Injecting some other psychoactive drug should work, at least for patients who have never used ketamine before. But I suspect that would take many years to get through the permitting apparatus, if it was at all possible.
- after_care 5y ago
  Injecting someone with another psychoactive drug would not be a placebo. We would be comparing the efficacy of {other psychoactive drug} and ketamine. That's not to say this experiment has no value, it's one of the many experiments we should run to help build the case for ketamine. The classic gold standard is to randomly assign subjects to groups. Then give one group a sugar pill, give the other group the treatment pill. Neither to patient, the person administering, or the person recording the results know who got the treatment who got the placebo. This is not possible with ketamine, psilocybin, MDMA, LSD, etc. That's fine, we can still build a strong body of experimental evidence of their efficacy. It bothers me when clearly non-blind non-mask experiments are labeled as double-blinded, which we see often in this body of research, this study included.
  - phren0logy 5y ago
    There is precedent for this; it's called "active placebo." For example, I think some of the psilocybin trials used methylphenidate as an active placebo comparison condition.

archhn 5y ago

Christianity without tears?

ketamine 5y ago
What do you mean?
- archhn 5y ago
  That's the description of soma in bnw.

Terry_Roll 5y ago

Some vets use Ketamine as part of a multi stage protocol for euthanising animals, other vets just use a single drug protocol but I havent established what that drug is, but it just seems all a bit refined butchery to me! Ketamine is supposed to be a disassociate drug, which I'm guessing is perhaps like an out of body experience or something. But I cant see how that can help with depression when people dont understand depression can actually be lots of things, but it has one overriding common element which is people remembering. So unless people get something like dementia where recent memories seem to fade first and the earliest memories come back, I fail to see how K can help treat depression. As for suicide ideation, well look around at what constitutes 1st world medical care! If you dont buy into the smiley faces because you might have grown up around medical professionals and heard the back office chats you might think twice about the authenticity of so called medical professionals! Not only that, its just a job for most, leave it at the door when your shift finishes, which is easier said than done especially if a dying patient seemed nice and innocent compared to an unpleasant angry dying patient. I really dont know why we dont have legal euthanasia because being experimented on in the name of science is not something I'd let others do to me if I can help it, I am aware that some argue it would be a direction towards eugenics, but that goes on already in stealth with some medical procedures.

amelius 5y ago
Isn't morphine overdose the best (friendliest) possible euthanizing method?
- Terry_Roll 5y ago
  Morphine/Heroin is supposed to physically cause respiratory depression so you stop breathing and I guess the CO2 builds up past the 30% blood saturation point by which stage it takes about 2 mins for the body to shut down. As the CO2 levels reach that 30% blood saturation point, the body becomes increasingly stimulated which is why you see people thrashing around when drowning or asphyxiating. Having done sea rescue to stop someone drowning in rough sea's, you can say goodbye to all the training water rescue people get taught and just hope the panicking person isnt as strong as you and hope your lungs are better than theirs, because they will force you under and you will ingest lots of water so you have CO2 build up which spurs you on to shore ironically. Obviously (going off things like trainspotting and peoples accounts), opiates are supposed to give you a warm fuzzy feeling as you slip into a deep sleep or unconsciousness I guess but not to sure, never done it not even in an operating theatre. MAOI's the old style anti depressants are quite sudden in that they are like an on off switch for the brain, you dont remember or feel nothing and I think they were popular with people who wanted to end it, but SSRI's have replaced them as the new anti depressant treatment but their problem is you dont sleep properly on them so they introduce their own problems, but I'm not aware of any end of life properties in SSRI's other than they ruin your sleep and send you off the rails slowly. But all the while, these chemicals still dont address the fundamental problem with depression which is remembering stuff that causes depression. Maybe depression should be treated more like PTSD, because depression seems to be an ego thing, where as talking to other people, PTSD seems to be more like what people associate as depression. For bloke's I think the bio mechanical properties of testosterone would help many with PTSD, cant comment for women though, but the risk the police and medical lot dont want is some hulk losing it so the idea isnt entertained AFAIK. Self preservation of institutions comes before everything else! Edit: I should add, once CO2 blood saturation exceeds 30% it has a noble gas effect on the body, so anyone who remembers the periodic table should remember what noble gasses are and its why compressed gas companies go to great lengths to not enable pure noble gases getting into the hands of the public. Biology and chemistry is just the mammalian equivalent of computer hacking.

ketamine 5y ago

Hello! Throwaway account for obvious reasons. I just started IV ketamine infusions at .5 mg/kg for depressions. I am not finished with my treatment yet. Ask me anything if you would like.

glerk 5y ago
Any issues with your bladder? Have doctors mentioned anything about the potential damage to the urinary system? This seems to be the scariest side effect.
- chimeracoder 5y ago
  I'm not OP, but I have some relevant professional (clinical) experience here. > Any issues with your bladder? Have doctors mentioned anything about the potential damage to the urinary system? This seems to be the scariest side effect. We're lucky because ketamine has been used for decades in inpatient settings at much, much higher doses than what is being used now for psychiatric purposes, so we have a good sense of its safety profile already. Urinary tract and bladder issues are noted for long-term and frequent recreational users of ketamine, but not really for anesthetic use. The dosing schedule for psychiatric use is closer to anesthetic use than it is for recreational use. The effects also are reversible if detected early and use is ceased, so periodic but infrequent treatment is unlikely to result in long-term damage, both because it's not frequent enough to accumulate, and because you can stop if it becomes a problem.
- rootw0rm 5y ago
  This is part of the reason MXE was developed. Love me some MXE.
  - tsol 5y ago
    It's a shame it doesn't exist anymore. It would be great for this exact purpose
- ketamine 5y ago
  No issues (yet). I am a man and it did immediately reduce my libido. Not in the same way SSRIs did. Will be curious to see if that is a lasting effect or not.

sshine 5y ago

This suggests that ketamine is beneficial for people who are suicidal to prevent them from killing themselves. The claim that is generally made about ketamine and depression is that it can have a short-term resetting effect of someone's depressive symptoms (not necessarily at a suicidal level), making it possible to escape the black hole that otherwise can take weeks, months, years to come out of. https://www.nih.gov/news-events/nih-research-matters/how-ketamine-relieves-symptoms-depression https://www.nih.gov/news-events/nih-research-matters/how-ket...

kuhewa 5y ago
For bipolar or other disorders, not much of a discernible effect for depressives
vmception 5y ago
Its the turn it off, turn it on again treatment, for the brain
- mattkrause 5y ago
  I'm not sure if you're kidding or not, but I do halfway-seriously subscribe to this idea. A lot of things that seem to have anti-depressive effects, ranging from sleep deprivation to TMS and ECT, seem to basically give the brain a whack in the hopes of having it recover into a "better" state.

mabbo 5y ago

> The primary outcome was the rate of patients in full suicidal remission at day 3, according to the scale for suicidal ideation total score ≤3. Analyses were conducted on an intention-to-treat basis. Question: does reducing suicidal ideation reduce suicide? I mean, it sounds like it obviously should, but we've been wrong about this before. Many heart medications to reduce cholesterol worked great at reducing cholesterol without reducing heart disease! All that said, reducing suicidal ideation is a worthy goal itself, even if it doesn't reduce suicide. I'm a full supporter of seeing this treatment move more mainstream.

datavirtue 5y ago

Doctor prescribed anti-inflammatory for a pinched nerve I have...cured mine.

olliej 5y ago

I've been getting intramuscular ketamine weekly for my severe & treatment resistant depression while working on making progress towards actual recovery. As with participants in this study I wasn't one of the lucky "I did ketamine a few times and my depression was cured" folk, but it has a huge reduction in frequency and intensity of ideation, as well as pretty much completely removing self harm. That said it's not a long term solution (because honestly its frustrating due to losing a few hours during the work week, inability to drive, etc) so I'm working with Drs to actually resolve things without regularly being stabbed :D

standardUser 5y ago
I wish the gap between clinical treatment and recreational use was bridged, and you could use a nasal spray on your own time a couple evenings a week instead of a daytime injection.
- olliej 5y ago
  The nasal spray is less effective according to the clinical trials, and is patented minor variation on ketamine so is super expensive (though "hilariously" because ketamine is technically being used off label for treating depression insurance may decline coverage of the cheaper, more effective original) There's also lozenge form which I believe some clinics allow you to take at home, but not sure of the effectiveness

intenex 5y ago

The truly amazing thing here is how powerful the placebo control was, even despite the fact that as someone who's done ketamine IV treatment before, it's pretty obvious when you're on ketamine and when you're not. "At week 6, remission in the ketamine arm remained high, although non-significantly versus placebo (69.5% v 56.3%; odds ratio 0.8 (95% confidence interval 0.3 to 2.5), P=0.7)."

after_care 5y ago
> The truly amazing thing here is how powerful the placebo control was 1. The "placebo" received standard treatment for suicidal ideation. 2. We should expect a natural regression towards the mean. The vast majority of humans do not experience suicidal ideation in a particular day. People with suicidal ideation tend to move towards the standard human experience of not having suicidal ideation over time.

aarontait 5y ago

FYI: Johnson & Johnson patented the S(+) enantiomer of ketamine and sells it as a nasal spray called Spavato. It's been FDA approved for depression since 2019. Although Spravato costs more on paper than regular ketamine, it's often less expensive for patients since it is covered by insurance (regular ketamine treatments are considered an off-label use and are usually not covered).

blurbleblurble 5y ago
It's pretty awful though for a lot of people. Researchers outside of the US have published studies showing that s-ketamine has higher risk of dependency in animal experiments and lower long term efficacy for depression, like on par with placebo. If I'm remembering right there are a number of reasons for this and one of them is that r-ketamine seems to simulate neuroplasticity better, something related to BDNF in certain parts of of hippocampus I think? While it probably works for some people, it's likely dangerous for many others. Kenji Hashimoto and others have published numerous papers about this. It's not exactly under-researched. The incentives in the US are horribly misaligned. Quite honestly it's upsetting that spravato even exists and there ought to be a huge class action lawsuit about this. A few papers: https://pubmed.ncbi.nlm.nih.gov/32224141/ https://pubmed.ncbi.nlm.nih.gov/32224141/ https://pubmed.ncbi.nlm.nih.gov/26327690/ https://pubmed.ncbi.nlm.nih.gov/26327690/
- aarontait 5y ago
  Yea, I agree. I wish there was some kind of organization that would seek FDA approval for racemic ketamine treatment of depression. It's cheap, and widely available. Unfortunately, without the incentive for a patentable product, it's unlikely to ever happen.