Ketamine For Depression? (Page 19)

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

citygirl: i know it's hard to remain hopeful when a treatment doesn't seem to be working. ketamine is supposed to be a miracle cure for some...but not all, and accepting that I was not one of the responders was devastating. but as awful as this disease is, i know there is always hope. for you, one hope is that perhaps you are receiving placebo now and will soon be able to try the real drug (or could you be on glyx13 already but it takes longer to show an effect? i don't know too much about it). or perhaps there is another treatment that you can try next. have you tried the ketamine?

REPLY

Was this helpful? 0

Just as a reminder, most of us are here because we have refractory depression of some form. A refractory disease is a disease that resists treatment, especially an individual case that resists treatment more than is normal for the specific disease in question. Further, most of us present multiple co-morbidities: more than one symptom set.

Ketamine is only going to be really beneficial if depression is the root cause, and the depression is of the glutamate model.

If you find ketamine does not work for you, it simply means either you cannot process ketamine along the necessary paths or your depression is not of that glutamate model.

Take this as a good thing as it means you can cross another cause off the list.

REPLY

Was this helpful? 0

Thank you, Keller. That's right; I can cross one more thing off the list. (of course, my list isn't that extensive...I guess I need to read more posts to see what is working for others). Going into NYC for ketamine therapy was the first time I branched out into something beyond just going to my regular doc appts and asking what else he would like to try. It was kind of freeing in the sense of finally doing more than just "looking" outside the box (i.e, reading about alternative/off-label treatments), but actually "going" outside the box. :-)

REPLY

Was this helpful? 0

I've posted previously about Ketamine working for me. I didn't realize till your post that my depression is of the glutamate model and why Ketamine works. I've always been into working out and eating well along with taking vitamins and various work out supplements.

How can I figure what my bodies vitamin, mineral, etc...levels checked to see how I can improve my bodies "normal" amounts? Also, I've always been intrigued about going to a Doctor visit were they monitor parts of your brain and how you react to various things presented to you. Can I get these done with costing $1000+ dollars?
Or does anyone have experience with insurance companies covering these cost?

Those are not very technically correct questions, but they're real. I am bi-polar and have came along way from where I was. I don't want to stop here and be satisfied. Cognitively I have a lot of room to grow. My head just can get cleared up. I will be 30yrs soon and my wife has our first child on the way. I want to keep learning about my body to be a better me.

REPLY

Was this helpful? 1

Brain imaging is interesting and certainly important research but not directly useful for current treatment options, at least in any cost effective way.

REPLY

Was this helpful? 0

Clint, I'm glad to hear you are doing pretty well, you seem to have a good attitude about your situation and a little optimism which I think is awesome to see on a depression forum. Cheers me up anyway! On the Brain thing for a $1,000 I wouldn't bank on it - 12 stitches in the emergency room cost me $2,500. Vitaminwise, my psych recommends high dose Vitamin D if you are stuck indoors a lot.

REPLY

Was this helpful? 0

@ clint- I believe what you are interested in is a functional PET scan. If you are really interested in a full workup, I believe that a Dr. Best in Deerfield IL will give you one- for megabucks. He also offers Ketamine IM, I have received treatment from him and consider him to be a rip-off artist, but he can and will do treatment. Hope this helps. Probably any large teaching hospital-affiliated shrink would give you the testing you are interested in, all you have to do is a little investigating. Good Luck.

REPLY

Was this helpful? 0

@Jim D.
If you could please email me, I would like to discuss your experience with Iboga in more detail. Thanks.
{edited for privacy}

REPLY

Was this helpful? 1

@Clint, Sorry for the very delayed response:

Please be aware that Bi-Polar Depression AKA Manic Depression, while it has some of the same symptoms and is frequently misdiagnosed/ mistaken for/as a form of depression, is in fact a very different disease than the other forms we frequently talk about here.

Last I read, Bi-polar disorder was genetically linked to juvenile diabetes as strange as that sounds; As in: they tend to run in the same families and seem to share at least some of the same genes. However, this is neither here nor there with regards to your question.

First, you asked about cost. Just the equipment usage for an fMRI at the University of Michigan for example is $585 an hour. This does not include associated costs. However, you would have to get a doctor/ researcher to sign off on it, read the results etc etc. Total costs, self pay, are likely close to a PET scan, which for the head is ~$6,700.

As others have pointed out, this is simply not cost efficient for the average patient.

You asked about minerals/ vitamins / etc:
Something to remember here is that there are 3 different levels of minerals in your body that get measured...

Plasma levels: This is what is available to your typical tissue as any given time. It is the level in your blood plasma.

Tissue levels: This is what your body has for use in a particular organ.

Brain/ synapse levels: Your brain and spinal column are semi-isolated from the rest of your body by what is frequently called the blood/ brain barrier. Plasma/ serum levels influence brain/ synapse levels, but your body still has to transport it across the barrier. Presently, there is no good way to measure levels inside your brain for most vitamins and minerals.

If you are willing to try some experiments on yourself, try this:
Stop drinking any diet drinks and artificial sweeteners
Take Calcium Citrate and Magnesium Citrate in a 2 to 1 ratio. For an average sized man look at taking 800mg a day. But wait you say the RDA is only 400mg a day. True but several studies have shown that patients with major depression have a high Ca to Mg ratio in their cerebrospinal fluid (too little Mg for the Ca present)
Take a sublingual B-Complex tablet.

Take the Calcium and Magnesium at least 45 minutes before any iron containing foods.

Try this for 6 weeks in addition to what your doctor has prescribed.

Why should this work?
Magnesium fits into the Glutamate model for depression quite nicely. There are several papers dealing with the subject and it hits the same damaged spots as Ketamine does.

Avoid MSG, in fact avoid anything with Glutamate or Aspartates in them. Remember, this is an experiment to see if you fit the model and if you are deficient.

Excess amounts of magnesium can cause stomach upset / mild diarrhea. If you find this the case for you, back off on both Calcium and Magnesium.

REPLY

Was this helpful? 1

@ Keller

Thank you for the information. I just realized I have taken various supplements with Aspartates in them. Many different workout supplements. So in theory, I've been making things worse for myself.

So try Take Calcium Citrate and Magnesium Citrate in a 2 to 1 ratio and a sublingual B-Complex tablet as well?

REPLY

Was this helpful? 0

@Clint,
That is the theory, and you want 800+mg of Magnesium. Citrate is the most common of the ones to look for. If you have exercise supplement, you may find Magnesium Taurate more available.

Avoid magnesium glutamate, magnesium aspartate and magnesium oxide, as previously stated, in fact try to avoid any foods or substances containing members of the aspartates and glutamates.

In theory, if your depression is of the Glutamate model (which is the form Ketamine best treats) then there is a strong likelihood you are Magnesium deficient in your cerebrospinal fluid. By getting sufficient Mg to your system, you can help protect the NMDA receptors that are damaged in the Glutamate model depression cycle. There still exists the issue of repairing the damage that has been done, and Ketamine (and possibly its analogues) theoretically does/do that.

Standard disclaimers apply:
There are many models for depression, Glutamate is one of them.
Depression has many causes, you should work with a professional who is trained and knowledgable in the subject field. Personally I recommend that said professional be your primary care doctor or a psychiatrist. I am neither, and I am not licensed to practice either field in my state, your state, or any state.
If there was a one size, one treatment fits all solution, we would not be having this conversation. Yada Yada.

REPLY

Was this helpful? 1

Keller.... please write a book!

REPLY

Was this helpful? 1

Thanks for the info. I've been google searching like crazy to figure out a game plan for better food choices. I've always made efforts to stay low sugar and incorporated many parts of Tim Ferriss "Slow Carb 4 hour body" diet.

Do you have any websites you can suggest regarding what foods to avoid?

I'm taking this all as personal opinion and not certified medical advise. Thanks for all of this info. Look forward to tracking my progress.

REPLY

Was this helpful? 0

Keller,
I understand that you aren't providing "official medical advice", and I don't know just how far your considerable knowledge goes, but since I did not respond to ketamine, the supplements you just mentioned probably wouldn't be that beneficial for me. Do you have any other advice on supplements for someone like me? I know there is some evidence that 600mg of chromium/day has some possible merit. I was going to try that next, but wondered if you had any additional thoughts. Thanks for any advice you might have!

REPLY

Was this helpful? 0

@stillhopeful Not responding to ketamine means you either are not metabolizing Ketamine properly (less likely) or your depression does not follow the Glutamate/ NMDA model (more likely), so given the magnesium issue is likely related to the same model, you are right, it would likely not be beneficial to you.

To quote a 2010 study "A basic understanding of the underlying disease processes in depression is lacking"

So we go back to what models do we know of and which one fits best:

Inflammation: There is a link between inflammation, immune response and depression.

Possible solutions: Diet: AKA the Anti inflammation food pyramid... As much as I commit the 'genetic fallacy" by rejecting an idea solely on the fact it has been shown on Dr. Oz, The Anti-inflammation diet is very close to the so called Mediterranean Diet. If your family has any roots in the Mediterranean area, I doubly recommend trying this diet. It is low on foods that trigger inflammation and the production of cytokines.

Modulating the immune response: AKA Low-Dose Naltrexone (LDN): Nancy Sajben Md out of Pain San Diego is doing some great work here and keeps an excellent resource list. She treats patients with Ketamine and with LDN for depression and has said that anyone failing Ketamine she would try on LDN. I have used LDN and it has provided some benefit for me personally. I am working on a video for youtube for the Muscadine Foundation on how to prep it for people who do not have a compounding pharmacy available. I will try to remember to post a link here so you all can see it and give your feedback.

I assume you have already tried and failed to respond to current SSRIs, SNRIs, Tri-cyclics and MAOIs, and further that you have had your hormones tested and they are in the normal range and that you do not snore (A common symptom of sleep apnea which can cause symptoms similar to depression)

I picked up literature on 3 novel treatments today during a massive 2.5 hour session with one of my doctors today, but have not had time to scan and listen to it. 2 Novel SSRIs, a bunch of updated CYP450 research and a novel NDMA/Glutamate med with off label uses. Give me a bit of time to digest the new data, see if/ where it fits and to read back your previous posts.


@Clint I will see if I can't answer your question on foods to avoid for your model fairly quickly. If I have not posted something in a couple (literally 2) days ping me. I have bad days a couple of days after I have to get out because of my agoraphobia.

@CityGirl, hopefully I can help myself and others through here and Muscadine, If I get well enough to write a book, actually have something useful to say and find a publisher be sure to check the dedications. I will owe a lot to the giants I stand on the shoulders of and my fellow depressees (I think that should be a word ;) ) Plus I expect you to keep kicking my butt.

REPLY

Was this helpful? 1

Keller,
Thanks so much for the info!!! I will look into it further. I have atypical MDD (diagnosed) and avoidant personality disorder (self-diagnosed). I have tried multiple meds in the past. Paxil CR worked for me when I first started on meds; but then its efficacy wore out and since then (late 90's), I've been on many things that worked little or some, but never providing complete relief. Currently I'm on Emsam, Provigil, Abilify, Deplin, and just starting Levoxyl. I also take a host of supplements, but not sure if they're doing anything. I did for a time try a no sugar, no flour diet, and that did seem to help my depression to some degree. Anyway, thanks so much for the info and for all the help you're providing to others on this site!!

REPLY

Was this helpful? 0

Keller,

I just realized that Naltrexone is methadone. My doc said that the people who respond to opiates with an uplifted mood are those who would respond to methadone or suboxone. Opiates do not have that effect on me. And also, I forgot to mention before that I have had my hormone levels checked and I don't snore (unless i have a head cold :-))

REPLY

Was this helpful? 0

@Stillhopeful,

No Naltrexone is Naltrexone hydrochloride
Methadone is Methadone Hydrochloride

Naltrexone is an opioid antagonist used frequently in alcoholics and opioid addiction treatment to block the pleasurable effects of alcohol and opioids. Naltrexone blocks the opioid receptor site, but does not activate it.

Naltrexone in low doses (low dose naltrexone is commonly 4.5mg/day) is sometimes used at the end of Methadone treatment to help reset the brains threshold levels for opioids which are frequently altered by long term abuse.

Methadone and Buprenorphine/Suboxone are similar (to each other) in that they are both opioids and are frequently given to people as a long term replacement for other opioids as they are not as deleterious.

So naltrexone blocks the receptor, Methadone and Buprenorphine/ Suboxone weakly activate it (compared to other opioids)

Now, you mention not responding to opioids. The truth is, and bear with me because this gets a little bit complicated, everyone responds to opioids. HOWEVER, about 27% of people have genetic variations in the gateway system that breaks down the drugs people take and converts them into something our bodies respond to.

There are 4 classifications: Very high metabolizers
High metabolizers
Normal metabolizers
Low/non-metabolizers

Our livers are, amongst other things, factories for a family of enzymes commonly called Human Cytochrome P450 AKA CYP450.

Our genes have the information encoded in them to manufacture these enzymes. However, and I am simplifying here, Some people may have 3 copies, 2 copies, 1 copy or a damaged copy of this information/ blueprint. If you have 3 copies, you would be a Very high metabolizer, 2 copies High metabolizer, 1 copy makes a normal metabolizer, and a damaged copy is a Low/ non-metabolizer.

Codeine for example, is not immediately useful to the body as a pain killer. It must first be converted into something else, so we call Codeine a 'Pro-Drug'. Not Pro as on professional, but pro as in before. Codeine is converted into Morphine in the liver by an enzyme called CYP(450) 2D6, another enzyme then breaks down the Morphine and out it goes.

Now, if you do not get analgesia from opioids, such as is the case with myself, you likely have a condition known as GOMD (Genetic Opioid Metabolic Defect).

Why is this important in a discussion about Ketamine for depression?

As it turns out, the vast majority of psychiatric medications use the same liver enzyme pathways as Opioids: CYP2D6, CYP3D4, CYP1A2, etc. If you take a medication that requires it be converted via CYP3D4, and you do not have enough/any CYP3D4 it will not work for you.

In fact, if you have problems with CYP3D4 none of these below will likely work for you: Tricyclic Compounds: Amitriptyline (Elavil), CLOMIPRAMINE (Anafranil), Imipramine (Tofranil), Cyclobenzaprine (Amrix, Flexeril and Fexmid)

SSRIs: Citalopram (Celexa, Cipramil), Norfluoxetine (a metabolite fluoxetine[Prozac], Sertraline (Zoloft, Lustral)

Other Antidepressants: Mirtazapine (Remeron), Venlafaxine (Effexor), Trazodone (Oleptro), Buspirone (Buspar)

The current thought is that Ketamine is processed via CYP2A6, CYP2C19, CYP3A4, CYP2B6, and CYP2C, but human trials I do not think have been run yet.

-----Too Long / Didn't Read Version -----
1) methadone and naltrexone are not the same thing
2) about 1 in 4 to 5 people process medications differently from the normal
3) There are about half a dozen (5 really CYP1A2, CYP2B6, CYP2C19, CYP 2D6, CYP3A4,5,7) paths that psychiatric meds do use.
4) If you do not respond to a medication in one of the Line #3 pathways because you have #2 it is called GOMD (Genetic Opioid Metabolic Defect)
5) There are some drugs, called antagonists, that can mimic the condition in #2 this is called Phenotypical Opioid Metabolic Defect
6) Ketamine uses a different set of paths than most other psychiatric medications.
7) There are at least 8 different possible root causes for depression.
8) The current model for Ketamine use in depression (NMDA or Glutamate Model) covers only 1 of those root causes.
9) Low-Dose Naltrexone covers a different model (inflammation/ immune response)
10) It is possible to have 1 or more root causes manifest as a symptom to another root cause: So if you have NMDA, you might develop inflammation/ immune response as a symptom or vice versa.
11) Treating both the root causes and the symptoms may well be required in refractory cases (cases that resist treatment [like ours])

REPLY

Was this helpful? 2

@stillhopeful Long post incoming, as usual I got the "Your post was saved but needs to be reviewed before appearing on the site." message so bear with the moderation system.

@everyone else: Still going through the new materials will update ASAP

REPLY

Was this helpful? 0

Hello, I was reading your posts here and decided to give my two cents worth. I have been in a depressed status most of my adult life. Sometimes worse than others. Currently, I am being treated for pain from several mitigating factors. Degenerative disc disease, rheumatory arthritis, and seborrhea arthritis. I was too stubborn to go on disability for I desperately want to work and take care of my family. My doctor tried nasal ketamine spray on me and I was hesitant at first to try it but I did. Two things happened. One, when my pain got uncontrollably bad it really helped but after using it for a week or two something remarkable happened to me. It made the depression I have fought since I was 15 basically disappear. I had been in pain for so long I had not gotten anywhere but basically stuck in the bed. All I wanted was my life back. Ketamine gave me my life back but my doctor who prescribes me these narcotics has never wanted to give me quite the amount that I need. I am so tired of having things taken away or cut back on because they may think I have a problem with something. I discussed the success I was having with the nasal spray and how much my life was returning. I was able to get back to work and felt that my life was starting to get back on track. I went from being stuck in the bed not taking care of my family to getting appointed the Exec VP of a real estate acquisition firm. In my first month I was able to make over 11,000.00 that enabled me to start putting food on my families table. It was the first time in over 15 years that I was actually proud of myself. My doctor started cutting back the amounts of the nasal spray and now the depression is starting to creep back in. I am starting to not care about doing anything anymore and I don't know what to do. My question to this group is one- is 40 ml of ketamine nasal spray every 20 days asking for too much when it was giving me my life back.?? Two, is there a Physician out there or near to North Carolina that can help me before I sink back into the nightmare I had been in for so long. I don't understand why when something was working the way that compounded medicine was they would want to cut back on it. It does not seem to be addictive in my opinion for when I run out I just run out. Now that I have been cut back on things are slowly starting to get back to the way they were. Allowing that to happen is something I don't think I can face enough. I do not want disability. I do not want to take medicine but for goodness sake if something is working why do they have to go and mess with it?? If anyone knows where I can get any help from a Dr. with this will they please let me know. Thanks

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