Ketamine For Depression? (Page 17)

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.

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REPORT

Honestly, if you are just trying to be obstructive, that's your business. Clearly, you haven't suffered from post-partum depression. Clearly, you haven't felt so unbelievably worthless because you couldn't take care of the baby you so desperately wanted. I tried seeking help from support groups and medication. I saw my obstetrician and she recommended psychiatric help. I pursued that avenue, but medication wasn't helping that much, and my psychiatrist recommended I speak with Dr. Brooks. He made it clear that the ketamine treatments would mostly likely help me function, but that I should continue therapy with my psychiatrist. My husband and I don't have a lot of money, and he offered us a very reasonable plan. I've done only 2 treatments and I feel human again. How dare you make such judgmental comments when you don't know what you are talking about? It was not my intention to reveal so much information about myself, and I just wanted to quietly help other women going through the same thing. How DARE you?

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@Sue Rather than being a shill, how about you be truthful?

You are right I, being male have never suffered from post-partum depression. Thats the only thing you are correct about. If you want to report on a doctor, that is highly encouraged. However, simply posting a link to a website full of dishonest statements and complete inaccuracies hurts everyone here. In fact, your initial post and reply tells me you are a marketing tool, not a real individual. Posting a shill link having it called such and the troll like response attacking it is classic shill behavior.

We want real people posting facts, their own experiences and more information, not bad marketing for fads.

Some personal information about me:
1) I have suffered with refractory depression for 35 years
2) I have suffered with PTSD for over 25 years
3) I was sexually, physically and emotionally abused by family members as a child
4) I have genetic abnormalities which preclude the use of Tri-Cyclics (examples include Dibenzepin, Desipramine), MAOIs (like (selegiline) ,SSRIs (like Fluvoxamine, Fluoxetine, Citalopram, and Sertraline) SNRIs (such as Venlafaxine Desvenlafaxine, and Duloxetine), and most other psychiatric medications.
5) I have dedicated the remainder of my life to 2 things:
5a) Getting working usable knowledge out about novel but efficacious treatments.
5b) Helping people get those treatments so they can go back to work.
6) I have seen too many people literally die before my eyes because of conditions such as the readers of this forum face
7) I have put a face to the diseases we suffer from, having given both acknowledged and anonymized interviews which are publicly available dealing with 1st hand accounts of the illnesses and disorders
8) I have a strong background in the sciences (meaning multiple degrees) which gives me a profound respect for following clinical guidelines while in trials, this is because trials are not about helping people directly, but about gathering data to prove a drug is efficacious. The sooner a drug can be proven, the sooner it can be brought to market, the sooner it can be used to help people.
9) What we in this forum have will likely kill me, it killed most of my family 2 generations ago, killed my great grandfather and many of his generation as well.
10) I have I felt rock-bottom despair.
11) I have been though the partner that tried to commit suicide.
12) I have also been through the partner who abandons you because of illness (your and theirs).
13) I have been so powerless so as to have to watch several people die because I could not do anything to help.
14) I used to be a teacher and a priest I can no longer do either, but it will not stop me from caring and trying to help those around me and across the globe.

Does any of this make me special? No. It does make me driven, it does give me experience and it makes me want to protect the community and get the best information out there to people.

I have now been brought on as a volunteer consultant and co-ordinator for a charitable foundation looking to assist people in getting phase 2 treatment by placing them with doctors who will oversee their treatment and who will help meet the financial needs of the patient and family while undergoing treatment. Again, more info when they go public which I think is Jan 1 but I am not absolutely positive about that)

So, if you want to be helpful:
Ask your doctor
a) What he charges per treatment
b) Will he be willing to extend the offer he made to you to others
c) I he willing to treat chronic/ refractory cases or just acute ones
d) Is he willing to work with outside groups for funding
e) Will he treat remote patients?
f) What protocol is he following? The standard as of this writing for chronic/ refractory cases is .5mg/kg IV over 40 minutes Ketamine 3x per week for 12-16 treatments then referral back to a psychiatrist for followup. This forum is primarily for refractory/ chronic cases not acute.
g) What insurance does he accept if any?
h) Does he require referrals?

No one picks electroconvulsive therapy (ECT) as a first line, though it is the gold standard of refractory treatment. Most facilities require one have failed ECT before beginning Transcranial Magnetic Stimulation (TMS). Ketamine is the obvious choice before beginning either, if one can find a doctor willing to administer the treatment and pay for it. We have seen reports as low as $250 per treatment, the average seems to be in the $650 range, plus other expenses. Some insurance will pay for ketamine treatment, some will on a case by case basis, some will not at all.

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@Bill, Sorry for the late reply, you question got a bit lost.

Treatments in the general order they are given is SSRI, SNRI, MAOI, Tri-Cyclic then the experimental ones: Ketamine/Glyx-13, LDN followed finally by the ones with big side effects like memory loss ECT Electro-Convulsive Therapy (probable memory loss the extent depends on a number of factors could be months/years typically hours/ days) and lastly TMS Transcranial Magnetic Stimulation.

The order they are generally applied has to do with side effects, 1st SSRIs (selective serotonin reuptake inhibitors) and 2nd SNRIs or NRIs (serotonin nor-epinephrin reuptake inhibitors or Norepinephrine reuptake inhibitor) have the lowest side effect to benefit ratio, they are generally widely available and are thus the first line of action. As you likely know there are several of these drugs available and they operate through just a few mechanisms. If one does not work, your doctor will likely switch you to a different one until one works. Since it can take 6 weeks to see a change and 6 months to see full effects this process can take a while (read years)

MAOIs would have been 4rd on the list, but there is really only 1 left these days (EMSAM) and it uses a transdermal delivery system to get around the really nasty side effects of the other MAOIs and so gets the #3 spot in treatment. This worked well for me, except I am allergic to the delivery media. Where SSRIs and SNRIs boost specific neuro transmitters, MAOIs work across the board. Think dialing things up to 11. Side effects are much more common than with the 1st two options but if it works, yay!

TriCyclics get the 4th spot usually. Doctors probably think they are dealing with bear skins and stone knives since they came out in the 1950's. Better side effects than oral MAOIs, worse than transdermal MAOIs pretty road spectrum and can help with a number of co-morbidities that frequently arise out of refractory depression like ADHD, GAD, OCD, OCPD etc.

Most people are going to be helped by the 1st few, and most docs are wary of the last 2. However, if you were in the group of folks helped then you wouldn't be here now would you?

If you are here chances are you have a refractory case meaning it has not responded to the above treatments or talk therapy. You may have a genetic condition (I do) or the above medications simply may not target what is wrong at the underlying source. There are 2 approaches that look promising, combined or separately at this point and act in 2 very different mechanisms:

Ketamine/GLYX-13 the original and its analog. It is thought they work by affecting the Glia cells and promoting interconnectivity in the brain. Potentially this could actually reverse the damage done physically by refractory depression. If so, and there is a lot more research left to do, then wow. What could be a silver bullet. The problem is ketamine abuse as a party/date rape drug. Thus GLYX-13 a ketamine analog without the anesthetic properties (read abuse potential) of ketamine. Glyx-13 is in early phase 2 clinical trials, it will be patented, likely expensive, but hopefully work. Problem with a clinical trial is that after the trial you no longer have access to the treatment until another trial or mass market release.

Low Dose Naltrexone The other mechanism deals with inflammation and endorphins. Naltrexone is an old drug, used to block opiates and alcohol use. However at low doses it seems to help with inflammation and promotes increased brain endorphin production as well as modulating the immune system. Right now it is harder to get a doctor to try this route than ketamine, I can only guess because it is still novel for depression. People who do not respond well to ketamine have been looking to this. The bonus is it is less than a dollar a day, super cheap comparatively and is already FDA approved in 10x the dosage to work with other conditions.

If none of the above work it is time for the gold standard of treatment. What used to be pretty barbaric, is now much less traumatic, Electro-convulsive therapy. Sedate you (unconscious) strap you down then pass a series of electrical currents through your head. It works though. The side effects are memory loss and possible personality changes, but again we are talking about a near end of the line treatment, so if it is death or ECT, I suspect the choice is obvious.

Lastly is TMS/rTMS Transcranial Magnetic Stimulation the efficacy of this is still unresolved, but it sends magnetic pulses through the brain causing depolarization and hyperpolarization of the neurons. I do not know of any insurance currently covering this treatment. It is still under investigation and has been rejected by the FDA 2x already (2007 and 2011).


There are so many factors that affect depression it is nigh impossible to cover them all. Similarly the medications and treatments listed above use at least 3 different paths for treatment and route through the body chemistry very differently. Interestingly, Ketamine/Glyx-13 may have the same effect as ECT/TMS does, but by a chemical action rather than direct action.

So, is your depression psychological in cause or psychiatric, if it is psychological, therapy plus support from an SSRI/SNRI/NRI may be a good choice. If it is temporary(acute) or mild, masking issues with a drug from above may well work until the condition is resolved. If it is ongoing damage or genetic in origin LDN/Ketamine/Glyx-13 may be the best option. There are so many factors, genetics, environment, the mind, the soul, the brain (I consider them 3 different things), chemical interaction and so on. This is why you need to find a good doctor (or team of them and to be your own treatment advocate.

All that reminds me I haven't heard back from Dr. G in Atlanta I will call him after lunch.

Bill I hope that answers at least part of your question and helps others understand why depression is such a complex issue.

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I am curious as to the sources used for information on the order of treatments? As for MAOI's, Nardil is still used. As for TMS, some insurance policies do pay.

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@Keller- There is another tx I have heard of using high-dosage Levothyroxine (used for hypothyroidism). No I do not have a protocol. I have seen one online but not computer savvy enough to post a link. If you google it you will find it. This tx is not new, but not widely known and one would have to find a cooperative Pdoc.

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There are a number of off label meds used other than T4.

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@Paula
Thanks for the info, It is commonly known that one cause of depression is hypothyroidism I would suspect that treatment with levothyroxine (t4) (or armour which is t4 and t3) is targeting those individuals. I will certainly see if I can find any info on it though if it is something else. I know when you overdose someone with hypothyroidism by giving them too much t4 they get hyperthyroidism instead which leads to a whole other slew of issues.

@CityGirl
You are correct I skipped Nardil (Phenelzine) as I was being fairly simplistic and its inclusion would have caused me to have to split MAOIs into Transdermal and Gastrointestinal absorbed MAOIs and to be completely honest if someone gets to that point I expect their doctor will cover the problems with GI MAOIs before suggesting them.

As to where the order comes from (SSRI/SNRI/NRIs before MAOIs before Tricyclics before Ketamine and so on) it is both common practice and the result of a number of surveys done with regards to diagnosis and resultant treatments. As I stated, it is normally a side effect to benefit analysis and the order of side effects before the experimental treatments is SSRI have the fewest and non-transdermal MAOIs have the highest number of side effects. You will also notice that the order of treatment also is the reverse order of development generally. MAOIs are the oldest antidepressant, the tri-cyclics were next, then the SSRIs/SNRIs. The reason for the abandonment at each generation was at least in part due to better side effects at each stage.

I would be interested to know of any insurance that pays for TMS as a standard course as my contacts at Emory and UTSW (both facilities that utilize rTMS and TMS) have stated in the recent past that they know of no insurance that will cover it. There are always exceptions to coverage, one could convince a company to pay for a non FDA approved treatment (as Emory has reported for its Ketamine treatments) but it is certainly case by case if at all.

You may encounter a doctor who is 70+ years old and practiced when TriCyclics were brand new so uses MAOIs as a first line, you may find a doctor who is just in love with tricyclics and uses them as a front line etc etc. But GENERALLY it will go with the electives then emsam then tri's then nardil. Tricyclics have a very wide range of drug interactions and GI MAOI's require substantial diet changes else you risk a hypertensive crisis.

There is a LOT of information any doctor uses before prescribing a medication including responses to previous medication, family history age, gender, etc. All of those things can cause shifts in the order of treatment. "Drug G" may be perceived (or actually) work better for "Symptom Set B". so if a Doctor sees Symptom Set B he may start with Drug G as opposed to Drug A.

A classic example is someone who is a smoker. Probably the goto drug of choice for a smoker with depression is going to be Bupropion because it is also commonly used to work with smoking cessation. Cymbalta is commonly added to that mix as well as a co medication. On the other hand if someone shows signs of OCD they will probably go with a mainline SSRI like Luxox, Prozac or Zoloft then if those do not work jump straight to Anafranil (clomipramine).

So I was simply speaking in terms of refractory depression with no co-morbidities. Heck using my own situation I started on Lithium (they though I was bipolar due to a family history of bi-polar) then on to some anti seizure meds like Valproic acid and such. Of course drugs like Prozac did not exist in the market back then and Tri's would have killed me with the 2nd dose (I am missing a liver enzyme that breaks them down). It was not till the '90s that docs started giving me SSRI's the 00's for SNRIs trying to find something that worked. But I am pretty much the poster child for worst genetics ever with regards to psychiatric medications.

Did I cover your concern, or did I miss it completely?

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@Paula, @CityGirl etc I have some replies currently awaiting moderation for you both. Seems every time I get wordy it has to be "reviewed" I am not ignoring anyone.

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@Paula I bet this is what you found (or something similar to it) ncbi.nlm.nih.gov/pubmed/15724143

Talking about 340mcg of l-thyroxine (yeah that's pretty darned high) on a small set of women. Though it looks as though it is specifically being investigated for the depression resulting from Bi-polar disorder, still pretty interesting. Fortunately the side effects for woman of high dose thyroid hormone are not as detrimental as they are to men. I will have to add it to my reading list of treatments. Thanks again.

This post may or may not appear before my original reply.. we shall see.

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@Keller, Thanks for taking long time to respond to my question, I do agree with you Depression seems very complicated issue, and that way I'm struggling so much and frustrated may be like a lot on this forum.
All my friends and family members, said it is in my heads, I can get out of this bad situation if I want to, even sometime I think same way, what is wrong with me why I can not be like everyone around me!!!
I'm about 55 Years I was working and having family all my life till seven years ago, I been in depression in and out for 5 times and each depression last for 8-10 month. Now I'm financially strapped, no friends left, lost most if not all my works, and no insurance not even disability, and it is very hard for me to grasp all medications options. I did have very bad experience with a lot of pdoct, now i'm on Lexapro 20mg every day for almost month prescribed by Int Doc (in the past zolft,effxor).
I'm not sure when I got better was it my situation or the med which gave some relief for few month.
I have still children to take care of , but i'm very tired and confused about my situation ( it very hard to get out of bed), tired all day, and I keep postponing and task even a small one till later.
Thanks again @Keller, I do appreciate you help and knowledge and experience , i hope you could shed some lights

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@Keller,
I'm not sure If I have Depression , or Bipolar,so may be you could help with that too
My main problem now I do not have any energy to perform any task of job.

Thanks

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@Paula, @citygirl if you have any input I do appreciate any help.

@John, @lahelp, @David we have not heard from you for long time,I hope you guys doing well, would you guys please share with us where you with your medication, IV, of Nasal treatment.

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@Bill, I wish I could accurately diagnose anyone from a short text blurb. I would be able to help a lot of people and probably make a lot of money in the process. However, no doctor could do such, and I am neither a doctor nor licensed to treat patients in your state.

I bet we have all been through the friends and family saying its all just in your head, you can choose to be better etc. For some people that is true, for many others it is not.

Bi-polar aka Manic Depression frequently exhibits at least 2 phases. The depressed phase and the manic phase. People with bi-polar disorder do not all show both sides nor do they necessarily show either side to the same degree. So one person may show mostly manic tendencies, another person severe depression and hypo-mania still another depression and full blown mania.

Manic symptoms trend to excessive energy, poor judgement and lack of concentration, so someone with ADD and depression could be miscategorized as bi-polar thats why a doctor and a number of tests along with a complete history are very beneficial if not necessary.

If you live in the US, most counties have a county mental health service. The price is frequently based on income so that should help some. Something else to consider is that with your age and the fact that you are male you could easily have a hormone problem. You could have low testosterone or low thyroid, or both. Either one could mimic the symptoms you list. Your pdoc can test for either or both. Has your hair changed of late if you are balding, testosterone is likely not a problem, if you are thin, thyroxine may not be an issue. Have you noticed any changes to your skin such as dryness or flaking? So many avenues.

I would check those two first, they are both common problems in aging men and are cheap to test and fix.

If both come back in range, then I would look at psychiatric meds. Have you ever had to take pain killers like opiods? If so did they relieve pain like the doctor said they would or did you have to take more/ they had no effect. If they did not act like the doctor said they would you may have “Genetic Opioid Metabolic Defect” (GOMD) which also affects psychiatric meds.

OK I suspect I am already on the path of giving you too much information. Tell a pdoc what you said about energy, depression, any changes in your libido, skin, hair etc and see if they will run a thyroid profile and testosterone panel. That is where I would start for a 50+ year old man. Rule out the easy cheap stuff first.

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Hi @Everyone I just got this link in my inbox.

tomahaiku.com/youre-not-depressed-youre-selfish

"You're not depressed. You're selfish.
“Why do you stay in prison when the door is wide open?”
Depression is not real. It is something that exists in people's minds. It can not be seen or touched or identified by sight or spirit in the real word. It's all in people's heads. Psychiatrists, in stereotypical attempts to make what they do look relevant, identify endless causes for depression, and for each cause there is an unnecessarily complex solution. My contention is that there is but one true cause, and it has to do with your centre"

It seems the writer did not suffer any depression like the rest of us on this forum.

I would like to know what you think about this article ?

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Thanks @Keller for taking the time to answer my question.

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@bill you are welcome.

Please do us a favour though and don't post links to site like what you got in your inbox. The text is fine, but at the best having a link in a depression related forum will result in stupid sites getting ranked higher.

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@Keller - Thanks for letting me and everyone else know about links.

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@Bill- the advice I was reading from your link (did not go to the link) sounds like it is from a charlatan and total jacka**. People who have never been depressed DO NOT UNDERSTAND! I have had many problems with family especially because they think if I just do this or that, I could be better. They blame ME for being sick. I have lost my career, my home, my marriage, my children and my family does not give me any emotional support. I literally have HATRED for these a**holes who say that some magical thing they want to sell you is the 'cure'. This is a medical problem, like Cancer, like Diabetes! It is not your fault!! We need medicine and compassion, just like any other illness. I wish you the best, I know how you feel. I wouldn't wish Depression on my worst enemy because the stigma and misunderstanding has not gone away.

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@Bill you have my sympathies, I have experienced somewhat similar symptoms. I was particularly struck by you families unhelpful attitude but remember you can get a little moral support on the forums. I have found it helpful to push myself to maintain at least a couple of outside relationships - loneliness and isolation are for many of us a very heavy burden.
I just want you are not alone and wish you better times for the future.

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Hi, a quick update on my status. I had been put on nasal ketamine 40 mg every three days. Saw my doc yesterday and reported little or no positive benefits. He changed the regimen to a daily dose. I took a dose last night and about two hours later did feel better. I was able to go out to the the Casino and socialize for the first time in three months. So maybe it is working, I certainly want to catch a break 2013 has been a lost year for me, think I spent most of it in bed!

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