3 ms·

> even occasional usage can cause untreatable ulcerative cystitis, a.k.a. Ketamine Bladder Syndrome. You'd have to stretch the definition of "occasional" to ma

> even occasional usage can cause untreatable ulcerative cystitis, a.k.a. Ketamine Bladder Syndrome. You'd have to stretch the definition of "occasional" to make this statement supportable. Clinical studies on the topic focus on chronic heavy users, whose usage far surpasses the dosing used by the median recreational user and typically persists for years. (In fact, most studies focus on recreational users who are using near-clinical levels, which is an order of magnitude more than the typical recreational dose, and doing so with regularity). While it's possible that occasional use can cause issues, it's far from established fact, and the widespread usage of large doses of ketamine in inpatient settings for decades without reports of issues for those users would actually suggest otherwise.

mahathu 4y ago
> (In fact, most studies focus on recreational users who are using near-clinical levels, which is an order of magnitude more than the typical recreational dose, and doing so with regularity). Is that so? For ambien it's the opposite, usually the recreational dosage can be a lot higher for some users than a clinical dosage (5 or 10mg)
- chimeracoder 4y ago
  > Is that so? For ambien it's the opposite, usually the recreational dosage can be a lot higher for some users than a clinical dosage (5 or 10mg) Correct. What you are saying is true for almost all drugs: recreational doses are typically higher than clinical doses. Ketamine is the exception. The recreational dose for a ketamine-naive user[0] is somewhere between 5-20mg. The clinical dose for depression is 86mg (not a typo), which is sometimes doubled, and the clinical dose for anesthetic purposes (which is what ketamine is mostly used for) is between 500mg-1g. The latter is IM injection, so it's also much more bioavailable than the first two (ie, the effective dose differential is even higher). Of course, regular users develop a tolerance and heavy chronic users of ketamine can do more. But that's due to tolerance, not representative of the typical baseline recreational dose. (If they were to need ketamine for inpatient anesthetia, they would need absolutely massive doses for it to be effective). It's hard to overstate how unusual ketamine is in this regard! It's very difficult to find an example of another drug that is frequently used both recreationally and clinically (by different groups of people) for which the standard clinical dose is 10x the standard recreational dose. [0] "naive" is not a judgmental term; it's the clinical term used to describe a user who has no prior experience with the drug, or who has no baseline tolerance (ie, whose prior usage is far enough in the past that it is no longer relevant).
  - csnover 4y ago
    > Correct. What you are saying is true for almost all drugs: recreational doses are typically higher than clinical doses. Ketamine is the exception. To clarify: my understanding is that ketamine acts as a dissociative hallucinogen at lower doses and an anaesthetic at higher doses, so taking a higher dose will just knock someone out instead of giving them the dissociative/hallucinogenic effects. > The clinical dose for depression is 86mg (not a typo), which is sometimes doubled, and the clinical dose for anesthetic purposes (which is what ketamine is mostly used for) is between 500mg-1g. The latter is IM injection, so it's also much more bioavailable than the first two (ie, the effective dose differential is even higher). Ketamine is normally dosed based on body weight[0]. For depression IV, the dose is 0.1–0.75mg/kg/40mins, most commonly 0.5mg/kg/40mins. Clinical use in IM seems to be less consistent, with some clinicians using the same range and others doubling it, so the 86mg could be used for a wide range of body weights. [0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023575/table/T1/?report=objectonly https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023575/table/T... [1] https://www.psychiatrist.com/jcp/depression/ketamine-for-depression-dosing-administration-and-duration/ https://www.psychiatrist.com/jcp/depression/ketamine-for-dep...
    - chimeracoder 4y ago
      > Ketamine is normally dosed based on body weight[0]. For depression IV, the dose is 0.1–0.75mg/kg/40mins, most commonly 0.5mg/kg/40mins If we're being specific, the FDA-approved treatment of ketamine for depression is a fixed 84mg dose. It is not adjusted for body weight. (I did invite irony by saying that it wasn't a typo - it's 84 and 56 for redoing, not 86 and 54).
      - csnover 4y ago
        Thanks for the clarification! Since you’d mentioned IM administration it didn’t cross my mind that you were talking about Spravato. That typo is regrettable, but unimportant to your point that the nasal spray does indeed use two fixed doses.

mahathu 4y ago

> (In fact, most studies focus on recreational users who are using near-clinical levels, which is an order of magnitude more than the typical recreational dose, and doing so with regularity). Is that so? For ambien it's the opposite, usually the recreational dosage can be a lot higher for some users than a clinical dosage (5 or 10mg)

chimeracoder 4y ago
> Is that so? For ambien it's the opposite, usually the recreational dosage can be a lot higher for some users than a clinical dosage (5 or 10mg) Correct. What you are saying is true for almost all drugs: recreational doses are typically higher than clinical doses. Ketamine is the exception. The recreational dose for a ketamine-naive user[0] is somewhere between 5-20mg. The clinical dose for depression is 86mg (not a typo), which is sometimes doubled, and the clinical dose for anesthetic purposes (which is what ketamine is mostly used for) is between 500mg-1g. The latter is IM injection, so it's also much more bioavailable than the first two (ie, the effective dose differential is even higher). Of course, regular users develop a tolerance and heavy chronic users of ketamine can do more. But that's due to tolerance, not representative of the typical baseline recreational dose. (If they were to need ketamine for inpatient anesthetia, they would need absolutely massive doses for it to be effective). It's hard to overstate how unusual ketamine is in this regard! It's very difficult to find an example of another drug that is frequently used both recreationally and clinically (by different groups of people) for which the standard clinical dose is 10x the standard recreational dose. [0] "naive" is not a judgmental term; it's the clinical term used to describe a user who has no prior experience with the drug, or who has no baseline tolerance (ie, whose prior usage is far enough in the past that it is no longer relevant).
- csnover 4y ago
  > Correct. What you are saying is true for almost all drugs: recreational doses are typically higher than clinical doses. Ketamine is the exception. To clarify: my understanding is that ketamine acts as a dissociative hallucinogen at lower doses and an anaesthetic at higher doses, so taking a higher dose will just knock someone out instead of giving them the dissociative/hallucinogenic effects. > The clinical dose for depression is 86mg (not a typo), which is sometimes doubled, and the clinical dose for anesthetic purposes (which is what ketamine is mostly used for) is between 500mg-1g. The latter is IM injection, so it's also much more bioavailable than the first two (ie, the effective dose differential is even higher). Ketamine is normally dosed based on body weight[0]. For depression IV, the dose is 0.1–0.75mg/kg/40mins, most commonly 0.5mg/kg/40mins. Clinical use in IM seems to be less consistent, with some clinicians using the same range and others doubling it, so the 86mg could be used for a wide range of body weights. [0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023575/table/T1/?report=objectonly https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023575/table/T... [1] https://www.psychiatrist.com/jcp/depression/ketamine-for-depression-dosing-administration-and-duration/ https://www.psychiatrist.com/jcp/depression/ketamine-for-dep...
  - chimeracoder 4y ago
    > Ketamine is normally dosed based on body weight[0]. For depression IV, the dose is 0.1–0.75mg/kg/40mins, most commonly 0.5mg/kg/40mins If we're being specific, the FDA-approved treatment of ketamine for depression is a fixed 84mg dose. It is not adjusted for body weight. (I did invite irony by saying that it wasn't a typo - it's 84 and 56 for redoing, not 86 and 54).
    - csnover 4y ago
      Thanks for the clarification! Since you’d mentioned IM administration it didn’t cross my mind that you were talking about Spravato. That typo is regrettable, but unimportant to your point that the nasal spray does indeed use two fixed doses.