39 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. 0.

> 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.
- Perenti 5y ago
  It sounds like those patients were in a very nice calm place. During my K infusions (30-50mg/hr for 7 days) for chronic neuropathic pain I was in a single room in a hospital. There was enough to see and hear that the mind took them and ran with them. I had a fight with a shower curtain because it said I wasn't clean yet. I had conversations with my toothbrush and hairbrush. It took 24 hours for my daughter's reporting that a puppy had died to make sense. And I'm not drug naive by a very long shot. On my 2nd infusion there was an older gentleman across the hall from me who had never had anything stronger than scotch whiskey. He was not having a good time at all. 7 days falling in and out of the K-hole while hallucinating is not as much fun as it sounds.
perardi 5y ago
As an occasional recreational drug user: yes, the dosages listed above are spot on. Just for an anecdotal data point.

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.
Perenti 5y ago
It sounds like those patients were in a very nice calm place. During my K infusions (30-50mg/hr for 7 days) for chronic neuropathic pain I was in a single room in a hospital. There was enough to see and hear that the mind took them and ran with them. I had a fight with a shower curtain because it said I wasn't clean yet. I had conversations with my toothbrush and hairbrush. It took 24 hours for my daughter's reporting that a puppy had died to make sense. And I'm not drug naive by a very long shot. On my 2nd infusion there was an older gentleman across the hall from me who had never had anything stronger than scotch whiskey. He was not having a good time at all. 7 days falling in and out of the K-hole while hallucinating is not as much fun as it sounds.

perardi 5y ago

As an occasional recreational drug user: yes, the dosages listed above are spot on. Just for an anecdotal data point.