6 ms·

I’m sorry but you are strongly over exaggerating the (side) effects of i.v. ketamine. It’s not a dose that sends you in a K hole. It’s way less than that. Some

I’m sorry but you are strongly over exaggerating the (side) effects of i.v. ketamine. It’s not a dose that sends you in a K hole. It’s way less than that. Some get sedation and some do get dissociative symptoms which can unmask the study arm of the patient. Approximately one out of ten got at least one of those side effects. Sedation can be mimicked with midazolam, so if you use that as placebo, you get 90 % of the patients that are not obvious, which medicine they got. I do agree that a better ”placebo” would be good to use. The problem with ketamine and suicidality studies is that suicides - thankfully don’t happen very often - so we have no direct evidence that ketamine prevents suicides. Of course if it would only alleviate suffering and wouldn’t increase the rate of suicides, that would be a win too.

bradly 5y ago
Inter muscular ketamine treatments were the only thing that helped my severe treatment resistant depression that included suicidal thoughts. They definitely had strong side affects. Complete disconnection, loss of the concept of humanism, I've gone inside a rainbow, held hands with my brain, etc..
chimeracoder 5y ago
> I’m sorry but you are strongly over exaggerating the (side) effects of i.v. ketamine. It’s not a dose that sends you in a K hole. It’s way less than that. 0.5 mg/kg intravenous. For frame of reference, a small recreational dose is between 5-25 mg (insufflated[0]), and a larger recreational dose (for people targeting a "k-hole") is more like 50-100mg. For clinical depression (ie, not this study, but for a similar purpose), the fixed dose is 84mg (not weight-based). So assuming a 75kg individual, that would be a 37.5mg intravenous dose, which is definitely going to provide a noticeable effect for any ketamine-naive user (ie, someone who does not already have a tolerance for the drug from recent prior use). > The problem with ketamine and suicidality studies is that suicides - thankfully don’t happen very often - so we have no direct evidence that ketamine prevents suicides. That's not really a problem - suicidal ideation is a strong enough predictor for suicidality and mental health that it's common to use as a biomarker. In other words, nearly anything that reduces suicidal ideation is presumed to reduce suicidality (on a large scale) - it's not necessary to wait months or years to see what happens (and in fact, depending on the specifics of the study, it can be considered unethical to do so). Source: former clinical researcher and drug counselor [0] bioavailability when insufflated is significantly less than other means of ingestion
- hadmatter 5y ago
  I agree about you second point. I was too quick to make my comment and I was conflating stuff I've read about nasal esketamine, which didn't have as robust evidence behind it as i.v. ketamine. I should not write comments while holding a baby that is trying to sleep and failing at it. About the first point, I still disagree with the parent comment. The standard 0,5mg/kg ketamine is given under 40 minutes. I've seen two patients receive it. The room was dimly lit, silent and peaceful, as to not induce or exacerbate any possible dissociative or hallucinative side effects. The patients didn't report any side effects at first and later reported a little sedation. I wouldn't be a able to tell with certainty if they had received a placebo or ketamine, and certainly not within minutes. Source: psychiatrist in training Edit: I still think we need hard data about anti-suicide effect and not just surrogate markers. Variability in suicidal ideation is suggested to be a predictor of suicide attempts [1]. If ketamine first gets someone better and later on they relapse, they could, in theory, be at increased risk for suicide. More long term data is also needed about it's long term effects. Note that I do think it's a good thing that ketamine is becoming more available! I will continue to suggest it for e.g. patients with treatment resistant and severe depression. [1] https://www.sciencedirect.com/science/article/abs/pii/S0165032705001527 https://www.sciencedirect.com/science/article/abs/pii/S01650...
  - ketamine 5y ago
    Source: patient taking infusions. .5 mg/kg I was numb all over, my lips tongue and throat were numb. I melted in to the chair and felt like I was up down and sideways at the same time. You would not be able to tell immediately but I put on my blindfold within 7 minutes due to effects starting.
    - Forbo 5y ago
      I've had to vouch for four of your comments now. Looks like you account was shadow banned. Maybe contact @dang to see if they'll fix it?
    - hadmatter 5y ago
      Thanks, I appreciate your comment and experience. I agree that if one was to get those effects, one would be quite unlikely to suspect placebo. I hope you got the help you needed from ketamine.
after_care 5y ago
I don't think I am exaggerating the noticeable effects of i.v. ketamine. Patients given i.v. ketamine are advised not to operating an automobile hours after administration. This level of impairment would be noticeable to the patient and the staff administering the treatment.
- hadmatter 5y ago
  Advice not to operate an automobile is for minimizing risks. It doesn't mean that most would be unable to handle a car, although it could mean that their reaction times would be slower. The standard way to administer ketamine is to give 0,5 mg/kg under 40 minutes. It would in no way be immediately obvious to everyone in, if someone began to receive ketamine or not. At least I couldn't differentiate them at that point.
  - after_care 5y ago
    Maybe you have more experience with patients at this specific dose range than I do. I remain skeptical this could be double blind, but do have less certainty than I originally started with.
    - hadmatter 5y ago
      I do agree with your skepticity. A better study design could use midazolam as placebo. And I think a good idea would be to ask the participants amd their physicians, which one do they think they received. That would give some idea about how well the double blind design did. Also, many commenters seem to disagree with me, which I also have to be take into consideration. My n is very low as my hospital has just started ketamine treatments.
    - deleted 5y ago
      [deleted]
encoderer 5y ago
Have you had it? A friend of mine did it last week and he described it as the most intense experience of his life. He’s 40 and he has experience with other drugs. I think possibly you don’t know what you’re talking about?
- prophesi 5y ago
  You can look at the study yourself to see what dosage was administered, then compare that to user-reported experiences on erowid if you're curious. And the study itself lists out the side effects they experienced.
- adwi 5y ago
  I think possibly commercial “infusion clinics” and medical trials use different doses.
  - ketamine 5y ago
    Same dose for me. .5 mg/kg It was more intense and less intense at the same time because I did not know what to expect.
  - bradly 5y ago
    IM and IV are going to be very similar. Smaller independent psychologist will do IM while bigger clinics with nursing staff will typically use IV. At home treatments with sublingual trockies have much less side affects, but differently still noticeable. Nasal spray is the weakest with just some minor body numbing.
  - officeplant 5y ago
    Going by a friends experience, infusion clinics need to be investigated more regularly by medical professionals. Co-worker went to one for treatment and from her recollection of the event they left her in a dark room with a white noise generator while she went down the k-hole. Terrified the living shit out of her.
    - hadmatter 5y ago
dataisfun 5y ago
Umm…ketamine IV at these doses is most certainly a unique and insane experience, speaking as someone who’s done it about a dozen times for anxiety.
- ketamine 5y ago
  How often do you need maintenance? How numb does it make you. My mouth and throat being numb was very surprising.
- black_puppydog 5y ago
  Can't reply so sibling but WTF the username "ketamine" was still available... On HN ?
  - mescaline 5y ago
    It happens.
    - black_puppydog 5y ago
      lol, peak HN. XD
- bragr 5y ago
  Are you getting it all at once or as an infusion? Considering this is given as an infusion over 40 minutes, this seems to be a pretty mild dose consistent with mild analgesia and well bellow the recreation and dissociative doses based on all the charts I just pulled up, but I'm not personally experienced with K ;)
  - Perenti 5y ago
    I've had K infusions for neuropathic pain, in comparable dosage rates, for up to 7 days at a time. You certainly notice the effects of IV K. So do other people when you start to talk to a hairbrush. It's a bit draining after a few days though, and not terribly fun.
VyperCard 5y ago
I get the used dosage every three month and I can assure you, it is very noticeable. However, I have no idea how other sedations feel, so who knows if they are a good placebo. Could be.
- deleted 5y ago
  [deleted]

bradly 5y ago

Inter muscular ketamine treatments were the only thing that helped my severe treatment resistant depression that included suicidal thoughts. They definitely had strong side affects. Complete disconnection, loss of the concept of humanism, I've gone inside a rainbow, held hands with my brain, etc..

chimeracoder 5y ago

> I’m sorry but you are strongly over exaggerating the (side) effects of i.v. ketamine. It’s not a dose that sends you in a K hole. It’s way less than that. 0.5 mg/kg intravenous. For frame of reference, a small recreational dose is between 5-25 mg (insufflated[0]), and a larger recreational dose (for people targeting a "k-hole") is more like 50-100mg. For clinical depression (ie, not this study, but for a similar purpose), the fixed dose is 84mg (not weight-based). So assuming a 75kg individual, that would be a 37.5mg intravenous dose, which is definitely going to provide a noticeable effect for any ketamine-naive user (ie, someone who does not already have a tolerance for the drug from recent prior use). > The problem with ketamine and suicidality studies is that suicides - thankfully don’t happen very often - so we have no direct evidence that ketamine prevents suicides. That's not really a problem - suicidal ideation is a strong enough predictor for suicidality and mental health that it's common to use as a biomarker. In other words, nearly anything that reduces suicidal ideation is presumed to reduce suicidality (on a large scale) - it's not necessary to wait months or years to see what happens (and in fact, depending on the specifics of the study, it can be considered unethical to do so). Source: former clinical researcher and drug counselor [0] bioavailability when insufflated is significantly less than other means of ingestion

hadmatter 5y ago
I agree about you second point. I was too quick to make my comment and I was conflating stuff I've read about nasal esketamine, which didn't have as robust evidence behind it as i.v. ketamine. I should not write comments while holding a baby that is trying to sleep and failing at it. About the first point, I still disagree with the parent comment. The standard 0,5mg/kg ketamine is given under 40 minutes. I've seen two patients receive it. The room was dimly lit, silent and peaceful, as to not induce or exacerbate any possible dissociative or hallucinative side effects. The patients didn't report any side effects at first and later reported a little sedation. I wouldn't be a able to tell with certainty if they had received a placebo or ketamine, and certainly not within minutes. Source: psychiatrist in training Edit: I still think we need hard data about anti-suicide effect and not just surrogate markers. Variability in suicidal ideation is suggested to be a predictor of suicide attempts [1]. If ketamine first gets someone better and later on they relapse, they could, in theory, be at increased risk for suicide. More long term data is also needed about it's long term effects. Note that I do think it's a good thing that ketamine is becoming more available! I will continue to suggest it for e.g. patients with treatment resistant and severe depression. [1] https://www.sciencedirect.com/science/article/abs/pii/S0165032705001527 https://www.sciencedirect.com/science/article/abs/pii/S01650...
- ketamine 5y ago
  Source: patient taking infusions. .5 mg/kg I was numb all over, my lips tongue and throat were numb. I melted in to the chair and felt like I was up down and sideways at the same time. You would not be able to tell immediately but I put on my blindfold within 7 minutes due to effects starting.
  - Forbo 5y ago
    I've had to vouch for four of your comments now. Looks like you account was shadow banned. Maybe contact @dang to see if they'll fix it?
  - hadmatter 5y ago
    Thanks, I appreciate your comment and experience. I agree that if one was to get those effects, one would be quite unlikely to suspect placebo. I hope you got the help you needed from ketamine.

after_care 5y ago

I don't think I am exaggerating the noticeable effects of i.v. ketamine. Patients given i.v. ketamine are advised not to operating an automobile hours after administration. This level of impairment would be noticeable to the patient and the staff administering the treatment.

hadmatter 5y ago
Advice not to operate an automobile is for minimizing risks. It doesn't mean that most would be unable to handle a car, although it could mean that their reaction times would be slower. The standard way to administer ketamine is to give 0,5 mg/kg under 40 minutes. It would in no way be immediately obvious to everyone in, if someone began to receive ketamine or not. At least I couldn't differentiate them at that point.
- after_care 5y ago
  Maybe you have more experience with patients at this specific dose range than I do. I remain skeptical this could be double blind, but do have less certainty than I originally started with.
  - hadmatter 5y ago
    I do agree with your skepticity. A better study design could use midazolam as placebo. And I think a good idea would be to ask the participants amd their physicians, which one do they think they received. That would give some idea about how well the double blind design did. Also, many commenters seem to disagree with me, which I also have to be take into consideration. My n is very low as my hospital has just started ketamine treatments.
  - deleted 5y ago
    [deleted]

encoderer 5y ago

Have you had it? A friend of mine did it last week and he described it as the most intense experience of his life. He’s 40 and he has experience with other drugs. I think possibly you don’t know what you’re talking about?

prophesi 5y ago
You can look at the study yourself to see what dosage was administered, then compare that to user-reported experiences on erowid if you're curious. And the study itself lists out the side effects they experienced.
adwi 5y ago
I think possibly commercial “infusion clinics” and medical trials use different doses.
- ketamine 5y ago
  Same dose for me. .5 mg/kg It was more intense and less intense at the same time because I did not know what to expect.
- bradly 5y ago
  IM and IV are going to be very similar. Smaller independent psychologist will do IM while bigger clinics with nursing staff will typically use IV. At home treatments with sublingual trockies have much less side affects, but differently still noticeable. Nasal spray is the weakest with just some minor body numbing.
- officeplant 5y ago
  Going by a friends experience, infusion clinics need to be investigated more regularly by medical professionals. Co-worker went to one for treatment and from her recollection of the event they left her in a dark room with a white noise generator while she went down the k-hole. Terrified the living shit out of her.
  - hadmatter 5y ago

dataisfun 5y ago

Umm…ketamine IV at these doses is most certainly a unique and insane experience, speaking as someone who’s done it about a dozen times for anxiety.

ketamine 5y ago
How often do you need maintenance? How numb does it make you. My mouth and throat being numb was very surprising.
black_puppydog 5y ago
Can't reply so sibling but WTF the username "ketamine" was still available... On HN ?
- mescaline 5y ago
  It happens.
  - black_puppydog 5y ago
    lol, peak HN. XD
bragr 5y ago
Are you getting it all at once or as an infusion? Considering this is given as an infusion over 40 minutes, this seems to be a pretty mild dose consistent with mild analgesia and well bellow the recreation and dissociative doses based on all the charts I just pulled up, but I'm not personally experienced with K ;)
- Perenti 5y ago
  I've had K infusions for neuropathic pain, in comparable dosage rates, for up to 7 days at a time. You certainly notice the effects of IV K. So do other people when you start to talk to a hairbrush. It's a bit draining after a few days though, and not terribly fun.

VyperCard 5y ago

I get the used dosage every three month and I can assure you, it is very noticeable. However, I have no idea how other sedations feel, so who knows if they are a good placebo. Could be.

deleted 5y ago
[deleted]