Ketamine For Depression? (Page 17)
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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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I am a 61 year old male. Have been depressed since 16 yrs old. I am now in a heavy depression and on meds. I think they are not doing any good. Can you please help me get on a ketamine study?

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To Find doctors who prescribe Ketamine for depression go to the Ketamine Advocacy Network. You will find doctors, what treatments they use and other useful information.

As for IN, it is not the ideal delivery method for sustained treatment due to a number of factors already discussed. However, you will find doctors who use it on the aforementioned Ketamine Advocacy Network.

@CAIGUISE
That is how it generally works, if you have a better model or can show a model is not valid, please share. Not certain how the current model system is a problem though and it has over a decade of use in its present form. When enough evidence exists to build a new addition, it will be added. I someone can show that a model is not needed, it will be dropped. It is similar to schizophrenia where the number of models has been expanded to 8 over the past few years as well.

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can you please tell me where to find a dr. to prescribe intranasal ketamine for depression?

Please email me at {edited for privacy}

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One problem with the larger number of models for depression is that they are still provisional, and the evidence for their role in depression mainly comes from whether treatments that seem to fit those particular explanatory model work. It is promising to see new models, largely because it means new treatments.

When you get down to the details, most types of antidepressants (pharmacologic, physiologic, and psychological/behavioral) have been discovered as side effects in other medicines/methods, followed by attempts to find similar compounds/methods with better profiles and the ability to patent..

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I followed this chat for almost a year to find information and learn from the experiences of those who used ketamine as a treatment for depression. I do this because my wife suffers from depression for 25 years. Interestingly, she is a Medical Psychiatrist and we are Brazilians. We live here in Brazil and here there are not any clinics using Ketamine Off Label. We are seriously thinking about going to the US to try this treatment. My wife has tried all kinds of antidepressant drugs and also all mood stabilizers. And nothing worked!

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To MD in training. I just wanted to thank you for your words of wisdom. I am being treated for degenerative disc disease, and then rhumatory arthritis and sebboreic arthritis. Methotrexate, Emberil, Methadone, etc, and the only two times my panels in years have been positive for coke was when I went to urgent cares and they gave me antibiotics because of big boils that came up on my legs the first time and had to be surgically removed and then again when it came up on my elbow. If I confused you by my question I apologize. Im just freaked out and don't know what to do. Just very tired of hurting and being depressed and tired of trying I guess. Thanks for your help. Thank you for your knowledge. And your time.

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Any time you go in for a drug panel they are going to ask you if you have had procedures and what medications you are taking. This is precisely because they are looking for things that might come up as the wrong drug in your body. Tell the truth, be able to document it and if you were dismissed for having a drug you did not take then the company is required by law in most localities to give you another chance or be sued themselves.

Looking at the metabolization of ketamine I found the following in a reputable journal (Journal of Analytical Toxicology, Vol. 28, July/August 2005: Urinary Excretion Rates of Ketamine and Norketamine Following Therapeutic Ketamine Administration: "Urine was collected from hospitalized children who had received ketamine as an anesthetic. Individual U/A's were collected up to 16 days after drug administration. Using the GC-MS-NCI, ketamine was present in the urine of the children from only the day of drug administration up to 2 days after drug administration, its concentrations ranged from 29 to 1410 ng/mL. Norketamine (measured in concentrations of 0.1-1442 ng/mL) was present for up to 14 days. Using the LC-MS-APCI, norketamine was present for up to 6 days after drug administration, ranging in concentrations of 2-1559 ng/mL, while ketamine was found for up to 11 days (2-1204 ng/mL). In the urine taken from one child, ketamine was not found through the entire 16-day period using both applications. The time frame for finding the analytes is highly dependent on the type of diagnostic being used and varies between individuals."

However it should be noted that ketamine for anesthesia is a much higher concentration that what is used for depression treatment. Anesthetic Ketamine is dosed between 100-200mg/kg of ideal body weight, NMDA treatment ketamine is given at 0.5mg/kg ideal body weight a factor or 200-400 less. It will be obvious to the provider which one fits the time frame you have stated in your pre-evaluation questionnaire.

@caiguise: Yes, the N-Methyl-D-aspartic acid model (also known as the Glutamate model) works closely with the Glia Cell model (Inflammation Model). They are different models however.

Simply put, the NMDA model works within neurons to inhibit Glutamate from binding while also acting on monoamines (of MAOI fame).

The Glutamate model instead works based on the idea that Glia cells are inflamed and interfere with the transport of glutamate from the nerve cells.

It is very possible to have both situations as one can trigger the other. Low Dose Naltrexone is the current thought for inflammation though other anti-inflammation drugs/ compounds will also work. Most ketamine doctors however will not treat you with both at the same time as Ketamine and Naltrexone have overlaps and can interfere with one another.

One of the very large problems with depression today is the number of models that exist that are difficult to diagnose outside of simple treatment to see if they work or not. Presently we can check for the following models:

Emotional - This is the simple questionnaire given such as Hamilton/ MARDS
Hormonal - simple blood draw
Nutritional - MTHFR Frequently genetically diagnosed
Enzymatic - (CYP450) diagnostics costs about $4500 but normally include the above MTHFR analysis
Mg/Ca - Requires a spinal tap which has its own dangers.

What we do not have diagnostics for are:
Neurotransmitter (SSRI/SNRI/MAOI/Tricyclics),
Inflammation (of the Glia cells) and
NMDA (Ketamine).

It is possible to do some blood work evaluations to see if general inflammation substances are present in the blood, but this does not definitively rule out or in inflammation of the Glia cells.

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I'm wondering myself about Ketamine and the drug panels. I just had major back surgery 3 months ago where they used an enormous amount of it during the procedure. Friday I had to go in for more surgery to do some adjustments and again, Ketamine was used in my anesthesia. I was contacted by my employer Friday, while I was in hospital, that I MUST report Monday to medical for a drug panel as is required by my being out on disability for over 90 days now.

I've read Ketamine takes anywhere from 2 days to 6 weeks to metabolize and be eliminated from the body. Also, it isn't usually checked for, BUT can come up as PCP falsely; which would mean an immediate loss and discontinuation of all insurance including my disability benefits, possibly having to refund all benefits paid to date, and the stigma of being a junkie on something Ive never seen or touched. Much less taken.

I'm anxious. Also upset because I'm supposed to be in bed for the next week, yet have to go in for a drug panel by my employer. And I never touched anything that wasn't prescribed or administered by my doctors. Anyone know if I'm right or wrong about this and have any informed wisdom to share? I'm Bedridden, in pain, fuzzyheaded, and confused. Now threatened, instead of just relaxing and concentrating on healing so I can return to my life. UGH!

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Ketamine may also be useful where inflammation is a contributing factor. My understanding is that it initiates inflammation but also initiates a discontinuation of the inflammatory response.

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129,897 people reported to have side effects when taking Methotrexate. Among them, 2 people (0.00%) have reported false readings on a drug panel.

The likelihood of your taking that and coming back falsely for coke is basically uncommon. The way to counter that is to take a 2nd drug panel. For example I had my testosterone evaluated as part of a regular hormone panel and it came back in the 900's. Since I know that my T levels are normally in the 200's I challenged this immediately.

UCC 1-207 was changed in 2004 (11 years ago) to UCC 1-308 which states: "1-308. Performance or Acceptance Under Reservation of Rights. (a) A party that with explicit reservation of rights performs or promises performance or assents to performance in a manner demanded or offered by the other party does not thereby prejudice the rights reserved. Such words as "without prejudice," "under protest," or the like are sufficient.

(b) Subsection (a) does not apply to an accord and satisfaction."

I am not certain how that does anything for you.

So what is it exactly you would like someone to do for you, because I personally am confused. Part of your job as a patient is to find the best doctor you can and learn and argue your case. If you cannot do this yourself then you need to find a family member or friend willing to advocate for you and grant them at least a limited power of attorney so that they can schedule for you and talk to your doctor(s).

Ketamine is not an inexpensive option. IF ketamine works for you, understand that you will pay for 12-16 sessions between 250 and 450 per session (3000 - 7200) for the initial sessions and then pay between 361 and 650 a month to keep up treatment (treatment every 3 weeks at the cost of a single infusion 250-450 each). Ketamine is a treatment, not a cure. And as of this point no one knows how that much ketamine will affect your brain in the long run since no one has done long trials yet.

If your depression is not complex, you may want to locate yourself to where there is a clinical trial. If it is complex, then a clinical trial will likely not accept you as your inclusion would potentially skew results.

It is going to be another decade before we see widespread use of ketamine analogs for depression, and they will be patented and quite expensive. Have you considered ECT? It is considered a gold standard treatment and works on about 85% of the same people that Ketamine works on. The advantage of it being a gold standard treatment is that insurance companies will pay for it.

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I just wanted to post a basic reply and hope that this reaches someone that it can help. I hate to keep being mean on the doctors but after learning that the DEA is who is controlling my pain and depression basically it makes me wonder. My drug panel was positive for coke on a U/A right after I had surgery because the methotrexate or embroil caused huge boils on my legs come up and have to be surgically removed. Well just as had hoped that was behind me then I have to take another drug panel again which is sort of funny in that I had to go to urgent care this past week and got prescribed an antibiotic for the same thing that come up on my elbow. Methotrexate can be a bad drug if it it is not taken precisely they say. Regardless, I have the best doctor I have ever had and one that understands what the heck I am going through however all the diagnostics and then another one turns up positive for coke, (Are they still putting it in coca cola for I drink them like water) (True but what ???) Thank god my doctor I think believes in me but I have about had it with drug panels. I have to take a great deal of medicine. they prescribe and get treated like dirt for suspicion that I could possible be doing coke. Please. I see my doctor once every two months and each month another U/A I cannot afford. It is demeaning, dehumanizing, and scary that I could just be thrown off of my doctor with nowhere to go. I have heard of people killing themselves over things like this and I can understand why for some doctors are naive enough to believe these results.. It is unbelievable, embarrassing, and humiliating, And all I can do is what they say.

The drug companies (and you should always read what you sign) have it worded on their own document you have to sign and it basically waives all of your rights away without a leg to stand on when you try to sue them. It does not matter how much damage they do to mine or your reputations, jobs, medical records, they can just float away like the bee that flew in the car, stung the driver, caused a 25 car pileup on the freeway and just flew out after stinging the driver and causing it all. What the drug companies are doing is getting you to sign a way off base unfair contract that does not hold them responsible for anything regardless of the damage they inflict erroneously at times I might ad. This is the only life that I and others have. I don't understand how they can write such an unbalanced and distanced contract and get away with it. I have gotten to where I sign them all without prejudice U.C.C. 1-207 which basically says that you signed it but do not warrant your name about anything the document says. In other words, you are signing but not agreeing. I understand a need to keep the medicine in the right hands and all but hello, I did not ask for these diseases I try to live with and I especially do not feel like getting treated crappy for something I do not do unless it remains in your body since college. (30 years) I don't think so. I just wondered if anyone had similar problems with their caregivers regimens for drug panels. The amount of medicines they have me on I am surprised a tennis shoe did not end up in there. I also wondered if anyone had come back positive for anything that was an error because of taking ketamine.... Any feedback would be appreciated. The only people we have to turn to about our health spends more time talking about U/A's than we do about what he is going to do about my issues. Sorry for complaining. Someone always has it worse than I. So I hope your struggles become winnable soon and good luck.

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In post 299 by Keller, some of the causes of mood disorders are listed. In post 379 Keller suggests that ketamine effectiveness is for the (NMDA or glutamate model). It may be helpful to review some of Kellar's old posts.

Also, I believe, most if no all studies on ketamine were on those with intractable depression; meaning all other treatments failed

There are now several doctors around the country using ketamine--see the directory compiled by the Ketamine Advocacy Network, and the cost/price for some have been reduced. regards, Howard

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There are definitely a number of models and theories relating to the causes and treatment of depression. The catch is that most of us do not know which one or ones best describe our own cases. So saying that ketamine is only efficacious if you have one type is not as useful as it sounds. As far as I know there are no tests for types of depression. Having an idea of whether you symptoms are more related to lack of pleasure, lack of energy, or other factors is useful for you doctor to figure out what might work, but by the time you get to the stage where ketamine is an option you've probably tried most types of anti-depressants and mood stabilizers out there..

I do not know if there is a 'type' of depression associated with ketamine. All I've heard from my doc is that in general (note, not always, but in general) it is more likely to work on people who respond well to ECT (that it reduced depression, even if it caused problems like memory loss), and whose depression is periodic (even if danged long periods).

As I am learning, it is important to think of factors other than depression. I really should have been noticing signs of thyroid problems, but assumed they were part of the depression. Mea culpa.

Best wishes to you, and hang in there.

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Just to note the single usage is described in: aacp.com/Pages.asp?AID=11629&issue=February_2014

It is only a single usage however. To date only one clinical trial has been performed, by James Murrough of Mount Sinai School of Medicine from 2001 to 2014 you can find the abstract here: ncbi.nlm.nih.gov/pubmed/24821196?dopt=Abstract

Note that this study was for a very short term (2 days), not for ongoing therapy and did report a 44% success rate.

For the time being, on what is an experimental procedure, the standard for long term care is IV, not IM, IN or Oral

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I found a study of the use of Ketamine Intranasal made by a psychiatrist (Patricia Clark, MD, MPH) in North Carolina. In this study the doctor describes the correct dosage and how the inhaler should be done in a compounding pharmacy.
Here's what she said: "A compounding pharmacy prepared the intranasal ketamine 10% solution using 100 mg of ketamine per 1 mL of preserved (with benzalkonium chloride) water. Each spray or actuation provided 0.1 mL of ketamine solution, which delivered 10 mg of ketamine per spray inhalation".

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The Ketamine protocol is 12-16 infusions of .5mg/kg ideal weight 2-3 times per week, followed by an infusion every 3 weeks of the same. It is not a cure, it is an ongoing treatment.

Remember, there are several causes for depression, only if you happen to fall under the model that Ketamine follows or a closely related one it is not going to be efficacious.

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Hello I tried ketamine before, but its effects never kept. 1 week and I never felt it fixed my depression. by the way I heard somebody was helped by ayahuasca in this thread. so now I'm looking for ayahuasca in usa. there are many places that carry ayahuasca but I'm not sure which one is most reliable. somebody teach me please.

certainly ketamine works a little bit. i feel it. But effects never keep long hours.

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I'm not sure if this info will help, but I thought I should mention...

One of the things I learned while my psychiatrist has been working out a dosage and schedule that worked, was that if the period between doses was too frequent, it became less effective. The effect was less at a lower dose. From his comments it seemed to be a normal problem. I'm not sure how frequently you take your meds, but have you considered whether taking it less frequently might actually improve its efficacy? I know this might not be possible if you are taking ketamine mainly for pain, but thought it worth mentioning. I guess the other way of thinking about this is that the period between when your inhaler runs out and when you can use the new one may seriously bite, but it also may help make the antidepressant effects continue to be potent.

I really enjoyed hearing from someone who has kept trying for so many years and finally found something that seems to be working. I hope things stay good. Best Wishes.

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To Caiguise, Thank you for the most intellectual and mindful way in which you can really see the big picture and understand the dynamics more than anyone I have spoken with regarding this physician's included sir. I wish you more than well in your struggle as your text is one of experience and to say what you did about "oh, so this is what normal people get to feel like everyday" is dead on my friend. I realize how frustrated at the system I get a great deal and it nice to know there is someone around like yourself to say maybe look at it this way. I just know that I have fought this debilitating s*** since the 4th grade and I am almost 56. No bad parents to blame it on, it just happened. Never fitting in. Not ever being good enough and then something called intranasal ketamine gets prescribed me for pain and wallah, all of a sudden a 46 year old depression basically goes away. Yet, I must be developing a tolerance for when I run out it kicks me into a depression in a couple days. I will never understand why a doctor wants to give you "almost" enough but never really enough. Its like you said and the way I feel for once is that it's my life and if I have found a way to forge ahead without 50 damn pieces of luggage around my back for the first time in all those years then by god let me. I would rather live my last years without this depressive behavior if there is something that works and to regulate it to the point they are means to me they know nothing about what this fog does to a person. Every now and then its nice for the days to be clear. Thanks Caiguise.

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Unless they are actively doing research, pain docs are not going to write prescriptions for your depression. Likewise, psychiatrists are not going to write prescriptions for pain management. To keep things going... your cardiologist will likely not set your broken arm either.

See the pattern?

If you want to try ketamine for depression, you had better be able to show which model you fit into, and it had better be the NMDA/ Glutamate model, and that doctor had better be up to date on the current research.

That is 3 things you are not doing presently.

For a list of doctors currently prescribing ketamine for depression, go to the ketamine advocacy network and search by zip code. Those are doctors who know about Ketamine, the risks, benefits etc and so can guide you. If you go to another doctor you risk being seen as someone drug seeking for an abusable party/ rape drug.

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