Ketamine For Depression? (Page 18)
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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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sorry caiguise, autocorrect got me.
I meant to address the previous post to you regarding the ketamine treatment.
I've mentioned it to a couple of my Drs and they got "that look" before babbling about off label treatment etc.

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Caucuses,
Thanks for the info. Was this your psychiatrist or pain management dr that helped you find this effective treatment? What side effect(s) do you get?
I'm seeing a new pain management dr soon, fired the last one, and wonder if that's who I'd bring it up with or my psychiatrist.
How is this administered? spray? IM shot? It seems most Drs won't prescribe off label. So if it isn't something established in trials then I doubt I'll find anyone.
I've had to stop taking Lexipro recently after my second case of seratonin toxicity in 6 months. My surgeon prescribed oxycodone and flexeril for post op pain relief. Both of the drugs cannot be prescribed with Lexipro. Right now I'm on Wellbutrin which will be about the 10th anti-depressant I've tried to help with my depression/anxiety disorder. I got my second case of seratonin toxicity three days after back surgery. I had a spinal stimulator put in. Believe me, you don't want that and have to dump your Percocets 3 days post op. I was treating severe pain with Duexis (800 mg ibuprofen with an enteric coating)
My pain doc told me he " he had a brand new drug that most of my patients are getting great results from!"

Ibuprofen

I got the script filled and recognized I'd already tried them and had no success. I'd told mr miracle drug they didn't work 3 months earlier.

Now I get them precscribed again.

For post-op pain. 5 degenerative discs, three bulging and one deteriorated to thinner than a Kleenex to go with post op pain which was agony.

So I've fired my pain doc. That feels good. Haven't told him yet, gonna let him fill out the NINE pages of documents needed from him for my long term disability first.

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md,

I think you need to look at this from the physician's point of view as well. They were not trained for using ketamine to treat depression. It doesn't even fit with the ways they were taught to conceptualize the cause of depression. And most doctors only work with a subset of pharmaceuticals, with which they are familiar. I've moved a few times, and found that each new psychiatrist wanted to try something new.

As for the issues of cost and control, ketamine is a controlled substance and has value. There are people who take this for pleasure. So they are concerned that the drugs will be diverted and they will get in trouble. It is not widely used for depression, so they can't learn from colleagues. It has to be compounded, which means the pharmacy probably needs to buy more than necessary for your needs. I have no idea what happens to the chemical over time, but part of the cost may be that they need to buy 10 grams or more at a time and it loses potency within months. So you are effectively paying the cost for all that amount, as they are not likely to sell it.

I agree that the infusion system is ridiculously expensive. It is a route of administration that requires hospital space, professional monitoring, and all the non-reusable materials for a needle and drip. I get the impression that the effects are longer-lasting, but the cost beyond most people's means. I am on compounded ketamine liquid, taken either orally, or with a nasal spray(an atomizer like perfume bottles). My doctor generally prescribes tablets.

So feel free to clip the info about my experience if it will help convince your doctor to try this approach. Incidentally, I started rTMS two weeks ago, and have switched to taking the ketamine far less frequently. It was no problem switching from taking it every second day to once a week.

Incidentally the rTMS is not covered by provincial or private insurance, so I am probably going ot give up what little I had saved for retirement. Then again, rTMS in this form gave me the only year in the last 25 that was depression free, and I worry that without some viable treatment I probably wouldn't make it to retirement.

I hope you find a way to use a less expensive form, and that the treatment works for you. I hate depression, but when you come out of it you realize that the normal that most people take for granted is a wonderful thing.

Best of luck

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Used up,

I'm on year 25 of off-and-on depression. It looks as if the combination of sequential bilateral rTMS and ketamine, mirtazepine, lamotragine, and buspirone does the trick. I know how frustrating it is to keep going through try after try to find something that works. But there are new meds in the pipline and coming out. Some are quite innovative in their presumed mechanism.

So, if you can, try ketamine. From what I've read it tends to work on people whose depression is periodic and who, if they have tried ECT found that it worked. If possible, get your doctor to play with the dose and frequency of ketamine. And if that doesn't work, remember there are other options, and unless you stick around keep trying you really have no hope of a cure. So hang in there.

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To: Used up, There seems to be so many folks I know outright suffering like yourself and I wish I had the answers, for you and us all. If the medical community walked in your shoes perhaps they would see things different and be more understanding, who knows. To me it is a damn shame when the technology and the resources ( pain meds or whatever) are available and yet they give it out and never seem to really "KEEP" you pain free,
md

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Well, I'm gonna try one more time. That's all I've got left in me. I'm an animal that's had its back stuck in a trap for over 20 years and my resistance to the pain has fallen to zero over the past few years.
I asked my PCP to give me a referral to a new pain management doc. I'll do everything I can to help that doctor get this pain controlled.
But.....
If I get another carbon copy race through the exam room while writing a script for something I've alread tried that didn't help or worse, put me on yet another "wonderful new med", then I'm done trying to live with this nonstop, almost agony, knife twisting in my spine.
I've gone from having money in savings, no debt, renting but looking for a home, tough but well-paying job to a bankrupt, almost homeless, very hopeless creature. Not a man anymore. Just a source of income for doctors, specialists, pharmaceutical companies, and insurance companies.
All in all I've invested over $200,000 in finding relief over the past 20 years. (Moderate estimate)
This bunny in the trap has no qualms or fears of the great beyond. Just looking forward to an end to the pain. I will smile a greet the Reaper with open arms.
Sure hope all of you out there find enough relief from your horrible pains to make this life worth living again.

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I really understand what you are saying about putting a bullet in his head but don't do it. And don't put one in your own either.. I can really relate to what you are saying for sometimes they need to stop and think that "we" did not ask for this type of life. You try your best and when it comes down to it the DEA is telling doctors what they can and cannot do. I thought that doctors took an oath to help people. To me they practice more of "covering their ass" as oppose to covering the well being of their patients. Its not that I am knocking doctors for when they have allowed themselves to be controlled by the DEA, insurance companies or whoever they are blaming it on this week they are allowing patients like a lot of us to slip through cracks except the cracks that they are allowing you in are potentially life threatening. Why has the time went by that we cannot sit down with out doctors and talk to them and learn from them the way we can deal with what is ahead of us. Life is hard enough without having to deal with a doctor that is controlled by a government agency telling them what to do. I have a friend that went to AA for 14 years and stayed sober yet the doctors in this area shy away from prescribing the man anything that would really help his pain. Instead they throw stuff like gabopentin or whatever at them and pray it will suffice. Well 9 out of 10 times it does not. Part of the reason that we seek out a doctor is for their knowledge of an illness and the right way to control or help the patient live their lives. And before you go pointing guns remember that the people you are dealing with find it quite easy to make predetermined judgement calls about your health instead of doing the right thing and "taking the time" needed to understand what you are going through. It makes you wonder if all these doctors are sitting their cocked and ready to find anything they can "not" to help you. Lets say you smoked a joint or ate some dog crap because you were told that would stop it from hurting. Then, most of these doctors have already been told by the long arm of drug enforcement that they are watching their prescription writings so instead of getting the help you need the doctor still takes your money yet is more worried about keeping theDEA happy than their patients is unbelievable. Perhaps if some of these drug enforcers that push physicians around had a great deal of pain themselves and had to go through it then they may understand.

Same with nurses (some of them) compassion and understanding do not exist in their vocabulary and they actually exhibit signs of jealousy that a certain patient is being prescribed narcotics. The whole medical community at times seem to have the idea that " ahhh,,, your not in that much pain" . Jesus, where does it end. I wish I had a t shirt that said HELLO, dope addicts have pain just like folks that aren't!!!!! If anyone thinks that folks in pain are just overreacting and trying to find drugs then they have not ever been in pain in their lives. Don't they understand that none of us choose this crap?????? I don't know about others but I would rather be shot myself than have to live in this pain filled life but before I do that I would have to exhaust every channel I could in finding a doctor that honest gave a damn about your well being. And then be prepared for their childish pill counts, U/A's or any other "control" measures they can find for they feel we are selling our meds I guess. when I read your post it saddened me for I know in a way how you feel. All I can say is start calling different doctors until you find one that will actually shut their mouth and "LISTEN" to you about your health. Your the important issue here and doctors have just stepped aside and allowed government agencies scrutinize their judgement. I wish there was a way to speak with you re this but I do not know how to offer address on here to talk. Just please don't pick up those guns for when you do someone normally gets shot. You don't need that on top of the rest of this crap. Im nothing but an old man and tired as it seems you are of being told how we are feeling when they do NOT really know. Everyone is NOT alike but they are important as you are and their feelings as well. Hang in their and hopefully some help will be in your future soon if you start driving at it hard. And understand that these metaphors are as screwed as they come. When an animal is in unbearable pain they at least put him out of his misery if they can't fix them. Why do they have to treat us so different. And why do doctors allow the DEA to tell them how to treat their own patients. War on drugs my rear end. Our CIA has been the largest H for Vietnam and Coke Distributors for S America that have ever played the game and they do so to fund their covert ops around the world. Not caring that their products spills right out on to the streets of the United States and harms our citizens and then thrown them in jail for using them. Oliver North had a lot more he could have stated about Barry Seals C-123 loaded down with coke that came right to the US streets but since they are involved in their cloak of National Security it gives them the right to sell their drugs, screw up lives and them jail people for using them. The same way I could never understand if marijuana were so illegal why did the govt always allow the sale of rolling papers and bongs etc. Double standards for everything and I wish there would be enough of us that have just had enough.

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You may want to chart the type and extent of response to each of those meds. Antidepressants can work in different ways. If you track partial responses and non-responses it might help you and your doctor figure out how your depression is related to production/uptake/use of serotonin and/or dopamine and/or norepinephrine and/or the glutamate system.

Best wishes. I hope you quickly find a treatment that works, and remember that they are still coming up with new treatments. Do not give up.

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My PCP sent me to a pain management clinic about 6 months ago for my chronic back pain (degenerative, bulging discs, stenosis, facet syndrom etc) that's been bad for about 20 years and got severe last year.
Their Dr. immediately cut my hydrocodone script in half. I was on 120 a month of the 5/325's. He said they would closely monitor my pain needs and adjust if needed.
I've had 3 RF denervements that didn't help, and just got a spinal stimulator in late December. It's not healed in place so the setups never stay right for more than a day.
I been to about 12 visits now and every time I try to tell him I'm limited to bed and in a 5-7 pain level all the time he just gets upset with how fast I go through my meds.
Did I mention I only see him for about 60 seconds during these visits?
When I forcefully told him about my pain levels he angrily told me his hands were tied by the new DHEC rules and they would pull his license if it even appeared that he was over medicating me. Then he shouted at me that HE DOESN'T HAVE TO WRITE A SCRIPT FOR 1 SINGLE PILL!
This was in the hall in front of about 5 staff members and patients.
I'm starting a complaint form but that won't solve my problem. I'm in constant pain and seen about a dozen doctors. They have prescribed dozens of non-narcotic meds, twice I've had to call an ambulance when the meds turned out to be contraindicated. Now they cut back more on the one relief I've had. As far as I'm concerned my life is over. I have no family to leave behind and no hope for the future, just pain and poverty. Oh yeah, I am in the middle of bankruptcy due to all the medical bills.
On February 9 I see "him" again and will tell him my condition again. If he treats me the same way (stand up as I'm answering his first question and start moving to the door) I will go out to the middle of the office and put a bullet through the base of my brain.
It's the only pain management option I really have left.

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Thank you for the lesson in paragraph creation. My rants are that doctors such as perhaps yourself get so regulated by DEA that do not have the education or knowledge that you possess when it comes to treating your patients however every one of you bend over to Drug Enforcement Badges telling you limits on treating your patients. Since it appears I am in the dark about business then perhaps the public should just go to the DEA for healthcare and treatment since they regulate most physicians anyway.

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Formatting paragraphs are your friend.

Doctors charge 350 for a ketamine infusion that costs 50 dollars for the Ketamine because they also have to:
-Pay a nurse to watch you,
-Prep for an audit because Ketamine has not been approved yet
-Pay the rent/ utilities/ advertising / overhead in general
-Pay for the disposable supplies like IV Bags
-Pay malpractice insurance
-Pay for numerous other miscellaneous expenses
-Pay off that practice loan
-Pay off their college loan
-Actually make a profit.

Think about this before you go off on a rant: If Ketamine worked for everyone and you could sell it at a 700% markup that was pure profit with no oversight, why would any doctor not prescribe it?

If it is as you describe, then why not go find a doctor who does not prescribe it and go into business with them and make a fortune selling IV infusions at 'only' $300 a pop?

Medical supplies are only part of the issue. Like driving a car. In the US it is estimated the cost of operating a car is ~58c per mile. Even when gas was $4.00 a gallon, that only equates to 16c per mile if you got 25mpg. Where do the other costs come from? Depreciation, maintenance, insurance, time etc. Same thing with a doctors office.

Otherwise take the $4200 that 12 iv transfusions would cost and fly first class to Uruguay where drugs are legal w/o a scrip and do it cheaper then spend the rest on a vacation. Or sponsor a medical student through school...

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Hello All, I just popped in and read some of the posts that are appearing such as one person stated a doctor/preacher told him that the depression was from his contribution to the sins. Good lord I hope he is not from my home town. To whomever wrote that I say your depression is real. I am sorry for what you are going through. All my life I have heard bible pushers and the like talk sins from a podium as if they were Abbi Hoffman b****ing about the war in Vietnam. And as much as I appreciate Abbi's once strong voice I often wonder why in the hell they would ever allow someone like that get in front of a microphone. Perhaps cutting their tongue off would be the thing. Depression is real. We all deal with it in our own way and by god if intranasal ketamine or plain old horse s*** in a bucket helps then by all mean give it to people. Whoever posted that about the i**** with a megaphone please forget that. No one has ever walked in any one else's shoes and until they do where do they get off saying crap like that. Life is hard enough on a daily basis without some creep selling lies at a homecoming. There are a lot of folks that believe depression stems from a filthy life and to these geniuses I ask what does your life provide you. We are all individuals. We are all on a quest it seems. And I honestly believe that perseverance of a partitioned thought process that reaches a goal or objective is of importance. IE We strive to build our dreams and if we direct that energy in the right way it happens. Even with all the greedy s***heads that have shifted to the word "contractor" and "1099" instead of and opposed to shake my hand and allow me to be an "employee" they believe in and think they are worth the 7.65% of your social security they have to pay instead of using the word outsourcing like a Chinese restaurant. Ive owned companies and the employees were my number one asset for without their intelligence, along with the ability to utilize their strong points they made my company what it was. Nowadays men say they are opening a business when all they are engulfed in is creating a liability if you get hurt on their sites. Not fair. If an employer cares about the people that make his business possible they need to show it by treating their employees like the men they deserve to be treated like. To subsidize my last request is to ask these doctors performing these "pricy" "infusions" for thousands of dollars you make me growl. A 40 cc 10% bottle of intranasal compound should be around 49.00 US. I don't know why these clinics have to make outrageous profits from infusions. Possibly because ketamine is cheap and they have to justify their high prices somehow. Why can't we all work together without a motive of profit to give good folks in our country an inexpensive solution to their depression instead of inventing some story line as to why an infusion would be better. Only for the clinic offering it. As for all the physicians that do not know about this drug I find that inexcusable. Doctors should know all about different regimens of different things when the SOS clearly isn't working. I thought Doctors wanted to get their patients better as opposed to massaging the shoulders of the Drug Enforcement Administration and their need to allocate budgets. Some doctors are saying now that 4 to 6 month of pain meds is all one needs. Something tells me these talkers are not going through what I see a lot of folks are as well as myself or there minds would change drastically. Again DEA, if you have systemic lupus please consider that pain meds and any med at the discretion of a licensed doctor should be a palette to help as oppose to control. And one last thing. Myself and a great deal of the folks in this room I have seen only want to live their life the best way they can carve out for themselves. To try to harm or regulate a provider or doctor's viewpoints please make damn sure your college education outweighs the doctors in medical concerns as oppose to the law. The only ones you are hurting is ourselves.

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I wanted to message a member directly but I think it's edited out..
Thank u! For responding. I have tried suboxone with minimal results.

I just have a feeling this will work for me. I called the compound pharm. In Illinois and they won't even tell me who prescribes it!#!!

I just want to know who prescribes the nasal.ketamine in illinois....it's unbelievable that this is so top secret :(

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The doctor who suggested god punishes sinners with depression should lose his or her license. I am glad you did not buy into that.

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Kaiser San Fransisco has a Ketamine clinic. I know because my psychiatrist is referring me there. Kaiser Oakland is setting one up.

Strange how secret it is. Does NOT come up on any web search.

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"Any idea of dosage in the inhaler?"

It depends on ideal body weight your doctor will need to decide what protocol he wants to use and go with that. That information can typically be found by going to clinicaltrials.gov searching for ketamine, finding a ketamine study then contacting that study for their protocols.

I am not trying to be round about, but the reason for the current clinical trials of IN Ketamine is in fact to determine dosage per ideal kg of body weight. It will also show certain other factors that affect dosing.

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Thanks NWV. I Find that disappointing that they have to be made 1 at a time.
Any idea of dosage in the inhaler?
This is new territory for me. Usually I take the "anti depressant " prescribed but noticed a profound sensitivity to the widely prescribed "safe" drugs when mixed accidentally with a usually safe medication like Tramadol or others.
Two stays in ICU and I'm seriously looking to find an answer. (Besides praying for God to forgive my sins that have caused this devil into my mind) as one preacher/doctor suggested as I was in ICU.

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There is no brand name for ketamine inhalers, the doctor writes a prescription and a compounding pharmacy makes them 1 off.

If your doctors want to know more, have them contact the ketamine advocacy network, or one of the research sites or clinicaltrials.gov. Ketamine nasal, iv, im, oral has not yet been approved (and may never be because of glyx-13) for the treatment of depression. That does not mean it doesn't work, it is simply still in clinical trials.

Serotonin syndrome is very uncommon and results when a patient or doctor mixes to many/much anti depressants. Example: the patient only takes his meds 2 times a week instead of every day but takes 3 pills on that one day but even that is hard to get serotonin syndrome from because of the half lives involved. The only way to get it is either due to a failure of your doctor and pharmacist resulting to a massive overdose or reaction with another med OR abuse by the patient OR in very rare cases a particularly strange combination of liver enzymes that would allow the pro drug to move to the active drug, but not allow the active drug to be metabolized.

There was a guy here, who was working for an educational/ funding group but he seems to have up and left for reasons undisclosed, so your best bet again is the ketamine advocacy network and clinical trials.gov

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Hi,
I'm very interested to see how things are progressing with the nasal Ketamine treatment.
I live in South Carolina and have no easy way to get to any doctors in that area to seek treatment.
I've been on the usual Paxil, Zoloft, Lexipro type medications with some help with depression and anxiety. Unfortunately, these drugs have so many dangers associated with them (most of all Serotonin Toxicity/poisoning) of which I've been hospitalized twice. These antidepressives are dangerous if mixed with just about any other medication and doctors have no understanding of these risks.

My question is, what brand name, if any, does the inhaler go by? My pain management doctor and psychiatrist both would like to know more. Are they just Ketamine inhalers? What brand name and dosage are you on? We need to get the word out to the East Coast where we are still in the stone age of prescribing Advil for broken bones and Tramadol with Cymbalta for chronic pain (these sent me to the ER where they assumed flu due to my 104+ degree fever and muscle tremors.)

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Kris,
I'm curious, have you ever tried Buprenorphine? I've been battling severe chronic major depression for the past 30 plus years(the past 10 have been the worst). I've tried over 25 different antidepressants, ECT and TMS, but the response I've gotten from Buprenorphine is the best so far.

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