Ketamine For Depression? (Page 15)
(Newest replies first)

It was recommended by the members of a separate thread that one be started that directly relates to ketamine and it's use to treat depression.

If anyone besides myself would like to discuss it's use as a treatment for depression, feel free to post your questions, answers and experiences here.

This thread is an offshoot of a related one that discussed a treatment of Scopolamine for depression.

REPLY

REPORT

Deijivan,

The compound I was prescribed is 50mg.ml oral solution. The first time I took it, as I recall, I took 1.5ml, which would be 2mg/kg. The first time I took it was in the doctor's office, in semi-light, and with minimal noise. I find the lack of excess stimulation is helpful when the immediate side-effects kick in. (At home I lay on the sofa with the lights out, and some quiet ambient music) I assume the doctor's office was the location so he would be there if I had an adverse reaction, as well as to reassure me and assess the effectiveness. It took 15-30 min before I noticed anything different, and the side-effects took at least 2 hours to start passing (about 4 hours until I felt normal, the great thing was that it felt normal, not particularly depressed). The side-effects are a nuisance, in that you can't get anything else done, but I've never found them scary or worrisome.

I think it was a week later (forgive my memory, I am having thyroid problems and write this in a bit of a mental fog) that I had my next appointment. I had felt markedly better through the week, with some worsening in the last few days. While the effect was marked it was not lasting the full week, nor completely alleviating the depression at that dose. The second time I was given either 2 or 2.5ml. At the 2.5ml dose the results were more complete.

After we found that the treatment definitely worked, if was a matter of finding the best dosage and schedule for keeping the depression at bay, without it being too high or frequent (which can stop it working, or reduce effectiveness). If I remember correctly (you could look for an earlier post of mine for more accuracy and detail), my doctor said most of his patients found 2-3ml (so 100-150mg) was an effective dose, although some required a bit more.

I'm glad to hear you know a doctor and are able to try this treatment. I hope it works. From my experience, and what I have heard/read/learned about it from others, you will know within a day whether it works for you or not. If I can offer some advice, start low, be sure your reactions are fine before you consider driving (then wait a bit more), take it in a room with no lights on, in an armchair, or sitting/slouching on the sofa, put on some ambient music, and until you know how you will react (and the side effects may differ each time) have someone to look in on you. How intense, prolonged, or the type of weird effects during the first few hours does not relate to how well the treatment works. So if you find a dose that works and sometimes when you take it there doesn't seem to be as much initial sensory effects do not worry that it will be less effective in reducing/relieving depression, just enjoy having fewer side-effects.

REPLY

Was this helpful? 1

If I called anyone an addict I deeply apologize. I am not aware of doing so as I have great empathy toward them.

The point of my post was to counter a baseless accusation that my previous post was incorrect, when in fact my post was supported by scientific observations.

I did not see where you addressed the findings I noted. Although quite recent I found them rather interesting in their observation and possible mechanism of action. It grants credence to the experience and observations of many patients. Whether proven and developed over time, or otherwise explained and dismissed, it is an effect worth noting.

As for ketamine, my personal experience is rather extensive but also, by definition, personal and therefore disclosed on a need-to-know basis.

I strongly believe and support discussions of science and fact. Personal experience can inform such discussion but rarely is it authoritative.

As for personal views of others? Until your accusing post I was unaware of them. I will try to be more observant in the future. I wish you success in your studies.

REPLY

Was this helpful? 0

Md in training. Sir, I do not understand why you find it necessary to keep posting and trying your best to show off your knowledge and education at the expense of "real" people's feelings and those same folk's experiences. I had hoped that you might would just let it go but apparently you just continue. Why?: I think we all agree that you are perhaps well educated and I think that is something to be proud of. Its just that it seems no matter what anyone says you are very quick to talk condescendingly any way you can to that person. I had been learning a great deal of things on this site until you walked in and basically called me and someone else drug addicts and that we exhibiting drug seeking behavior among advising us of our own stupidity and your medical models etc. For one we are all trying to learn about help for depression for most of us have not had the luxury that other s have with other types of antidepressants. From what you have said your only encounter was a clinical trial where they gave you ketamine for same. If you are fighting depression then I must apologize for I am not trying to one up anyone. I would just like it where it used to he where free flowing ideas and thoughts could be transferred. Not a forum to pick fights and show off what one knows or does not know. Its really a shame to see folks not able to obtain any information for after you have had your say people just quit writing in. Haven't you noticed that.? And if you have then you must get off on cutting other's ideas or questions or challenge them at every point along the way. I am glad you know what you do but your constant correcting of folks is not helping. I don't appreciate being called a drug addict for you can't determine that over an online post. Wow. I worked for the FBI for 24 years and they need behavior profilers like that. I am either addicted or dependent on what doctors have given me. I would just hope that you understand that the folks you are talking to here are fighting REAL battles with depression and they do not need an additional comment to spiral them worse. Thank you.

REPLY

Was this helpful? 1

I could understand how you might think that intranasal ketamine is not faster than IV ketamine. I take that to be your personal belief as you did not provide any citation of authority.

I was merely repeating the scientific findings reporting evidence that:
1. "intravenous ketamine has antidepressant effect within hours" in comparison with evidence that:
2. "intranasal ketamine has antidepressant effects within minutes".

Please see:

Lewis A. Opler, Mark G. A. Opler and Amy F. T. Arnsten. Ameliorating treatment-refractory depression with intranasal ketamine: potential NMDA receptor actions in the pain circuitry representing mental anguish. CNS Spectrums, Cambridge University Press 2015.
(doi: 10.1017/S1092852914000686)

The article cites intranasal ketamine's "ultra rapid" effects and great benefits compared to IV ketamine.

REPLY

Was this helpful? 1

Stella Said:"The nasal works very rapidly, even faster than infusions, and you are in complete control of the dose."

Absolutely false.

No IN can work faster than IV, as it must pass the mucus membranes before entering the vascular system.

Crimpshow: One of the actions of Ketamine is as an NMDAr, it is certainly not the only, nor is it the strongest available. Ketamine also works on inflammation and mono-amines as well.

REPLY

Was this helpful? 0

Chimpshow, his explanation of other drugs with the same action of Ketamine was very interesting. Thank you!

Caiguise, thanks for the tip about compounding pharmacies for production of Ketamine orally or nasally. If you know the exact dose for this type of administration, please let me know. In this case, my wife (which is doctor) can issue a recipe for compounding pharmacy.

Stella, thanks for the information!

REPLY

Was this helpful? 0

There are many psychiatrists who prescribe ketamine, or will do so if asked. I brought up the subject with my long time psychiatrist. They researched and wrote me the prescription.

The "KAN" tends to list facilities with higher prices, although there is often ample room for negotiation. Make sure you are getting doctor-client care through the entire infusion regime. It often takes 6-12 infusions to achieve several weeks of improvement.

Nasal spray ketamine can be filled by compounding pharmacies. Talk with hospice professional's to find out which have the best pricing. The intranasal spray is nice in that you can administer it in the comfort of your own home and it is only a tiny fraction of the cost of infusions.

The nasal works very rapidly, even faster than infusions, and you are in complete control of the dose. Not everyone enjoys the trippy/spacey roller coaster ride that often accompanies the infusions. Many psychiatrists believe that the strong "trip" from infusions in not a necessary component of the treatment benefit.

Maybe try both and see what works best for you. That's what I did and I'm sold on the intranasal spray ketamine for now.

REPLY

Was this helpful? 1

Deijivan,

Have you talked to a compounding pharmacy? If you can get a prescription, and they are able to order it in solid form, it can be made into capsules or a liquid suspension. I was most recently on the oral suspension, but have also taken it as a nasal spray (squirt up the nose into the sinus cavity). As far as I know, my doctor is the only one in this part of Canada who has experience with ketamine, and I believe all his patients (admittedly not that many) are on oral forms. Aside from myself, I think everybody is either on capsules, or nasal aspirators. If this information is useful, but you need more details, feel free to ask.

Best wishes

REPLY

Was this helpful? 2

Ketamine antidepressant effects stems from the fact that it is an nmda antagonist. Ketamine is probably the strongest prescription nmda antagonist but there are others if you cannot get your hands on ketamine. Memantine and riluozole for example. But if you are willing to take a risk and go past the approved drug list there are research chemicals that are as potent as ketamine and can be obtained legally for a fraction of ketamine cost. The best example is MXE. MXE is a research chemical, not for human consumption. But... Anyways just sharing the information for those in desperate enough depression to be willing to risk such things.

REPLY

Was this helpful? 1

I believe the nasal is a lot weaker then the infusions but can be used as maintenance between infusions. I don't think the nasal alone would have great effects.

REPLY

Was this helpful? 0

@HY1V5X , I have said here before that the problem is not to buy ketamine. In Uruguay the sale is legal. In Brazil one can buy with a prescription. My wife is a doctor. The problem here in Brazil (or in Uruguay) is properly administering the ketamine as a form of treatment. No hospital or clinic accepts or makes the infusion of ketamine. This is the problem!

REPLY

Was this helpful? 1

"Who lives with severe depression for years, cannot rely solely on medical protocols to try off-label drug that is likely to help. "

Who does not takes their foolishness to their own life.

Uruguay has it legally and is next door to Brazil.

REPLY

Was this helpful? 0

Heather,

I'm curious about the difference between IV and nasal spray effects. I've been on an oral suspension and a nasal insufflator (intended to deliver it to the walls of the sinus). Both are effective, but for some reason the nasal route produces fewer immediate perceptual side effects, and a longer period of grogginess. Do you find IV and nasal spray have different initial side effects as well as the nasal seeming less potent (or is it helpful for a shorter time)?

REPLY

Was this helpful? 1

I have recently been doing IV Infusions and just started the nasal spray. I would have to say the nasal does not even compare to the experience you have with IV. The IV was expensive though at a package of 6 sessions costing $3000! I was told the nasal should be used after IV infusions as a maintenance and then followed up with quarterly infusions.

REPLY

Was this helpful? 1

Who lives with severe depression for years, cannot rely solely on medical protocols to try off-label drug that is likely to help.

I am fully in favor of the use of ketamine to treat depression, regardless of whether the person tried or not tried other treatment methods. If there is a chance, regardless of the risks, it should be attempted! Nothing can be worse than living with Depression!

Unfortunately, the cost of treatment with Ketamine off label is still high. Some people can access to this treatment, but many people can not use it, simply because they have no money for it or because they don't live in the USA.

I believe in Ketamine, but as I live in Brazil, I still don't have access to treatment off label. While the things don't change, decided to try the Memantine, which is a drug that is used for the treatment of Alzheimer's disease. My wife is already in the second week of treatment with Memantine off label and the results are encouraging!

So I suggest to those who can not continue or try the treatment of off label Ketamine, attempt to somehow experience the Memantine. Start with 5 mg per day (half a tablet) for one week. Then increase 5 mg per week until they mood stabilization and a gradual decrease of the Depression happens. It works! And the cost is much smaller than off-label treatment with Ketamine.

Moreover, it is easier to find a doctor willing to try the Memantine, because it is a drug approved by the FDA and easy to find at any drugstore. So you get rid of a**holes doctors who think you are not the right type of patient to experience Ketamine!

REPLY

Was this helpful? 2

Training MD, when I thought about you I was reminded of the Park bench in Boston where Robin Williams delivered a great exchange with Matt Damon in the movie Good Will Hunting. As well as one's motive for even writing in this room. So, hate that you feel how you do but that is your business. I sincerely hope that you are never subjected to serious pain issues that you face every time you open your eyes. It may make you feel different, who knows. Its nice to know that a doctor would just turn his nose up at someone "like" me relying on remarks made online. Wow. But I think that is the norm. You have to protect your license from folks like myself ? I guess it would be best to check out now as oppose to believing in my doctor for help. Times have really changed for I thought I should be truthful with my doctor. "I'm sure you read Oliver Twists" and that sums up the rest of my life. You all take care.

REPLY

Was this helpful? 0

@caiguise It is not your sandbox, and you are free to leave whenever you want to. Don't like what I have to say, you are free to do that also. Really doesn't make a hill of beans difference to me.

I am consistent. On one hand I describe my philosophy of psychiatric care, on another I describe the current philosophy of psychiatric care. They are two different things. I can say though that many of the dangerous complainers in this conversation are going to have to seek a 3rd option because they are not going to get medical treatment that they want from either the most common kinds of doctors, or from the model based doctors (such as my upcoming residency group) because the risk does not justify the effort/return. Doctors, outside of sanitariums/ residency clinics do not tend to help people in spite of the patient. I will finish my residency and already have to turn away people who will not fight me to get them well, why am I going to put people who want help out on the street looking for help to help someone like 'used up' or 'md' ?The answer is I am not going to, unless I am one of those residency type doctors. you say "As for your insulting of other people; if you can't play nicely get out of the sandbox. People are looking at this bbs because they (or someone they care about) is suffering. How would you feel if you were depressed, looking for help, and ran into someone who gets his jollies kicking people when they are down? " I say you are full of fecal matter. I don't get my jollies on kicking people down and have never put anyone down on this board. I have pointed out that they are behaving like a drug seeker and that this is why they are not getting help.

You go on being offended by my comments though, when they finally listen to me, someone being honest with them, they will be able to find a doctor to help them, be it with ketamine or some other drug. While they listen to your prattle, they continue to be in pain and suffer. So which one of us is kinder? Me. Which one is nicer? You. Your niceness is helping them to continue suffering though

REPLY

Was this helpful? 0

Caiguise:
Sir, I'm just a stupid old man but wanted desperately to say this. During a long life, one can perhaps hear a lot of BS. And then somehow, as if the clouds open up, the turbulence stops and after a lot of debate one person, at one moment stands up and speaks the words of truth basically in 2 of 3 sentences that should put an end to all future debates. Reminds me of a town hall meeting somewhere during the Clinton administration where folks were standing in lines to ask the President a question regarding the drug situation. This sweet african american lady stood up and stated to the whole crowd that we do not have a drug problem in this country; people have serious problems that quite often result in drug abuse. Wow, and that to me said it all. So did you. Take care guys, Keep up the fight.

REPLY

Was this helpful? 0

MDinTraining,

If you are planning to use a utilitarian model to justify treatment you might want to consider that if it was a simple matter of applying an algorithm there would be little need for physicians. Statistical truths are just probabilities, they don't apply in all cases, and people with treatment resistant depression are already statistical outliers.

Your comments also seem not to fit your earlier statements about different disease models. One benefit of going to a different doctor is that the model that informs their prescribing behaviour may be different (consciously or subconsciously). If your current doctor does not believe in the new electromagnetic treatments, simply because they don't fit with their way of understanding depression, I don't think you will have much luck convincing them to try. Despite all the talk about 'evidence based' medicine and it not being based on theories, people have to form theories, or at least beliefs, groupings, or a way of understanding the world. Nobody crosses the road thinking through the physics of it each time; we learn to make assumptions from previous experience or how we were taught to think.

So while I would agree that risk-aversion is one important factor causing doctors not to try patients on ketamine, I would also argue that many physicians simply are not willing (or unable) to challenge their own belief systems enough to include some of the more novel treatments. I have friends who are psychiatrists of various flavours, and many of them believed absolutely that rTMS could not work because they could not fit it into a neurotransmitter model. Ketamine challenges the models that are still used by many physicians, and this means the burden of proof they require to believe it works is significantly higher than for drugs that fit into there conceptual schema.

As for your insulting of other people; if you can't play nicely get out of the sandbox. People are looking at this bbs because they (or someone they care about) is suffering. How would you feel if you were depressed, looking for help, and ran into someone who gets his jollies kicking people when they are down?

And to everyone reading this, hold in there. Eventually you will find something that works. If it is ketamine, that's great. It may not be available, it may not be a good choice for you, and it may not work for you. If not, there are other options and new treatments in the pipeline. Just hang in there.

REPLY

Was this helpful? 2

@Caiguise, correct I have been on an analog, the trial has yet to be published so I cannot say the name simply due to an NDA. Hopefully the trial will be complete soon and I can talk about it. I have also done data collection and statistics for a ketamine trial, that (plus other published accounts) is where most of my statistical data comes from.

If someone was offended by my reply, they need to get over it.

You can handhold folks all you want to. It will make them feel better, it will not help them get better though by enabling bad behavior. What will help them get better is to reply to "what do we have to do to get treatment" by pointing out why doctors are refusing to treat them.

If someone shows up and demands a drug, or tells their doctor "I have tried every antidepressant" etc these are warning signs of drug seeking behavior.

EVEN IF THEY ARE TRUE.

Instead, if you want a doctor to take a risk, you need to be able to show the risk is worth while.

NO I DO NOT MEAN FINANCIALLY ONLY

Risk has many factors, if I had my license and I risk additional oversight to help patient A, how many other patients do I harm because now I cannot help them?

Ketamine is not a cure. If I had a license, I could easily farm someone from now till the analogs hit the market. $150 pharama fee to write a ketamine script? Easy money and you will come back every month to refill that script then go to a compounding pharmacy and get your $100 ketamine nasal spray. If doctors just wanted to make money that is what they could do.

INSTEAD The idea is to help as many people as best as one can. Some people (philosophers) describe this as utility, maximum benefit for the maximum number of people. It is something I personally believe in. It also means doctors have to look at a patient's history, how well documented is it? If it is not well documented a doctor has to develop that documentation. Have they tried at least 3 different families of SSRIs? No? Put them on them see if one works. That doesn't work, so you move to SNRIs as adjuncts, Maybe add L-Methylfolate. When that doesn't work maybe you switch to Emsam (an MAOI patch). Have they had their hormones checked? No? Send them to an endocrinologist. Are they a snorer? Refer them to a pulmonologist. You try the standard cures first, once everything has been documented as not working you start to look at other possibilities.

Does a patient even fit the ketamine profile? Some drugs are bad for certain conditions. Example, if the patient has ADHD and is taking medication for it, you do not generally want to put them on ketamine. I was just in a forum reading about induced schizophrenia by combining amphetamines and ketamine.

When patients jump from Dr to Dr, it resets their treatment. True, it can take a while to find a good fit so some bouncing is going to happen. I happened to find my first appointment card with my psychiatrist last week. I have been with her for 9 years next month. She will not prescribe me ketamine. Why? Because I have more experience with the trials than she does. None of my professors will prescribe me ketamine (not that I would ask them, as it is a conflict of interest). If I wanted Ketamine desperately I would have to go 250 miles to the closest doctor who uses it.

Wonder why 'used up' can't get help? Self sabotage. Lash out all you want to, but it harms you not me. Keep acting like an entitled everyone is trying to beat me down individual, and you will never find anyone to help you. Why? Because all you are doing is attacking people who try to help you. Why am I going to put my practice/license/other patients at risk to help 1 patient who is likely going to attack me, not in spite of, but because of my efforts to help them? It is simply not going to happen.

REPLY

Was this helpful? 0

I will go to the states to take ketamine treatment for depression. Ketamine is probably a great pill for depression, as ...

34 REPLIES

## What is Cispin? ## Cispin is a common misspelling for the antidepressant called Zispin SolTab. Active Ingredient: Mir...

3 REPLIES

My friend was prescribed Haldol for depression. My friend suffers from being addicted to Perocets, and because he was go...

1 REPLY

My Son went to the Dr. for anxiety and depression, pristiq created more problems for him, panic attacks, insomnia, loss ...

13 REPLIES

Has anyone started taking Rexulti, if so how is it going so far. I just started 1 mg today and will phase out abilify? #...

8 REPLIES

After being on every imaginable antidepressant over the past twenty-five years and undergoing ect, I have found that Rit...

4 REPLIES

This thread is to discuss Ibogaine as a means to treat Depression and Pain Management, including, but not limited to, an...

34 REPLIES

DOES ANYONE KNOW A MD WHO PRESCRIBES SUBOXONE FOR DEPRESSION IT HELPS ME TREMENDOUSLY ## HAVE YOU FOUND A DOC TAT WILL W...

2 REPLIES

is colozapam for anxiety and depression ? ## The pill in description is Clonazepam; which is a benzodiazepine derivative...

2 REPLIES

anyone with experience using riluzole for treatment resistant depression ## Hello, Pance! How are you? I've not take...

1 REPLY