Ketamine For Depression? (Page 21)
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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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REPORT

I'm a 9/11 responder and have been suffering from severe depression since 2002. I was also recently diagnosed with PTSD. I've tried every single antidepressant on the market. I've also tried Transcranial Magnetic Stimulation, and ECT. Nothing worked. Finally, in May of 2014, I went to see Dr Glen Brooks, who runs the NY Ketamine clinic located in downtown Manhattan. My depression had gotten so bad, and was truly at the end of my rope. After my 3rd infusion, my depression had completely disappeared. I couldn't believe it. Dr Brooks literally saved my life. He's a great Dr and a very caring man. I now receive 1 monthly infusion and have been depression free almost 6 months!

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yes, that is what is so frustrating, it's effective for PTSD, suicidal ideation, depression and anxiety; but the FDA will not approve it and mainstream doctors and clinics will not use it off label, because big pharma is not making money from it. they have to wait for the patented meds to be available.

they could be saving and improving lives now if they really wanted to.

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Yes...Ketamine has been proven to be very successful for PTSD

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google naurex, inc. they expect to have IV "cousin" of ketamine available in 2016 and a pill version in 2017. J and J expects to have a intranasal version in 2017. these will of course be patented and expensive.

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the reason I think the infusions are a rip off are from what I have been told the prices are outrageous. Ketamine from what I understand is not a new drug but one that has been around for a while. My apologies if I seem to overstate the term rip off but when my doctor gives it to me for pain control as a compounded nasal spray and after 5 sprays it wipes out a 40 year serious depression I don't have anything to compare that with. The price of a nasal spray compound at my pharmacy is 49.00. It is tremendous at controlling pain as well as depression. The good thing that I don't understand the risks is that ketamine is a schedule 4 drug. It has no opiates, nor to my "limited" knowledge does not belong to any barbiturate category. The potential for abuse in my eyes perhaps may be in the young folks need to exploit a chemical for the high. It seems every month I run out early however never once have experienced any withdrawal symptoms of any kind. If I offended a treatment that helps you forgive me. I just sense a hi degree of exploitation when it can be put in a nasal compound for 50 bucks versus what I hear Dr's charge for infusions that seem like another way to make a huge buck. Would just like to see some of these negative connotations dissipate when the benefit of something is as much as what I see in it. I had read they are trying to fastback it for nasal approval for depression when I don't understand why that is an issue when it is approved for pain etc. With what you are saying I am assuming itt must be approved for each purpose. If infusions are helping you and affordable then I am glad for you. Certainly did not mean to offend from my lack of education. I wish you well with whatever route you have available if it makes a difference with anyones depression. Depression is tough on everyone. I hope for there relief from that awful condition anyway they can. Sorry.

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@'md'
I am sorry you think infusions are a 'rip off' and that doctors are taking advantage of people. Doctors take a risk any time they prescribe medications that do not have FDA approval for the condition they are prescribing it for, and when that same drug has a large abuse/criminal potential the scrutiny is that much greater. With increased scrutiny comes increased costs and someone has to pay for them. I suspect it will not be until after, if ever, ketamine gets FDA approval for depression that we will see another big price drop. We can hope the nasal Ketamine trials get good results and the protocols get accepted widely as nasal is less expensive, though less effective than IV.

This will be my last posting here, I hope everyone the best. Godspeed!

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Hello All,
Since my Dad got killed when I was 15 I have been depressed and embarrassed about it. My doctor prescribed it to me for pain nasal spray. And good lord it works. And what shocked me is after a week on it a 42 year depression VANISHED. When you never fit it and are not good enough and my dr. gave that to me I was elated, However, when I run out the depression comes back but for that relief of pain and depression even for a short time leaves me so grateful. If I ask to get increased a bit I am turned down. My doctor knows best but being sad for all those years and then unbelievably happy is like I finally found the cure but it is not enough, A bit more spray would work, I think the infusions are a rip off since ketamine is an inexpensive drug, It seems like taking advantage of people seem to be the norm or wanting to control them any way they can., Hell I would get it off the streets to enjoy my life again but they scam too, Why is it when something works they control you with it? I just want to smile sometimes and not feel like I don't fit it all the time. I guess that is asking to much, The nasal compound will help you. In as little as 5 days, Unbelievable. I will just try to be grateful for the days I have enjoyed, thanks

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I know this thread is mainly for discussion of ketamine, but as the discussion has turned to DCTS machines I wanted to chime in. Please understand that this is my personal experience and not that of an expert. Then again, part of the problem with DCTS machines is that there really are no experts.

I bought one of the machines (not a Fisher-Wallace as the results on other machines seemed to show more benefit) after my OHIP insurance stopped covering rTMS. Be careful where you place the electrodes, it really changes not only how it stimulates an area to reduce depression or de-stimulates another area to reduce anxiety. Accept that depression and anxiety probably involve areas that you cannot affect with this mode as well as areas that you might be able to effect. My machine has a cathode and elecrode, each with a pad that you wet down, and a ridiculous set of velcro bands that you use to position the pads on your head. Make sure your family does not have a camera ready. I found that parting my hair front to back and side to side to give better contact on the focal area helped. If you find it does not work, check the info on positioning rather than turning up the stimulation level or using it for longer than recommended. Also, if you are off you can affect other areas of the brain, which you do not want to do. Fight to urge to use it for longer than recommended and accept that you do not need to feel pain for it to work. The level that worked for me only gave a little sting when it was ramping up or down. Regarding the sting, I found it was less of a problem if I used salted water to wet the pads. And if you end up with red patches or scrapes, cuts, whatever do not use the machine for a while. From what I've read it appears that most of the problems involve overuse, or too high a level of stimulation.

Just FYI, I found it helped somewhat for both depression and anxiety, but that I could not use it regularly enough to prevent symptoms coming back. I hope you have better results.

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guessguy9: let me know if you think it's helping you or not. Supposedly it helps with depression, anxiety, and insomnia (and I have all 3), but I'm still not sure if it's really doing anything for me or if it's the other changes I've made (well, diet mostly) that are working. Best of luck to you as you try it! BTW, I see "flashing lights" with my eyes closed when I put it on, and sometimes it stings...but when it stings, I find that if I just reposition it a bit, it stops...or if I just let it be, in a few seconds, it seems more tolerable and I forget all about it. It's an interesting device, an interesting concept...but I would like to hear firsthand what someone else thinks, so please post after a while and give an update.

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Awesome! Thanks so much for the reply. I ended up asking them personally and they said it shouldn't be a problem using the HSA card as an eligible purchase for the stimulator. I went the same route and paid the $50 for the rx which Fisher Wallace reimbursed which was pretty sweet. They also mentioned they will, as of next week, will no longer charge a 10% restocking fee if returned within 60 days which is even more awesome. Though, I really hope that this works and I do not have to send it back. Thanks again!

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guessguy9: If you go on the website, they tell you that you can either get an rx from your own doctor, or you can pay $50 to get one from a doc affiliated with the product. I emailed or called her (I forget which), paid the $50 and she sent me the rx...sent it to my FSA and they accepted it, no questions asked. Then FW had a sale on the sponges that you use in the device,so i bought them and submitted that bill to my FSA (without showing the rx again), and they approved that as well! For once, no headaches with medical bills!

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Hi. I read your post and I am also thinking of giving the Fisher Wallace device a try. I am also a non meat eater for the same reasons you are going on 3 years now. I would say it initially helped boast my energy and mood, but still not enough to keep me afloat of all the stress that has piled up since.

I've also been using SAM-e as a mood boaster because I've tried some other prescription anti depressants in the past and I didnt fair well with the side effects (Im also not a big fan of taking any sort of pills ever since a round of anti biotics 4 years ago has caused systematic problems including severe acid reflux which I now have to have checked annually for cancer prevention).

My question for you is, when you used your HSA to pay for the fisher wallace device, did you have a prescription to purchase it? I have an HSA as well, and I am worried with all the stipulations for things not covered, if i would have a problem purchasing this without an Rx and being charged an extra 20% because of this.

Any information would be helpful. Thanks!

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Dear Rick....The only positive reception I have received from the many Infusion Clinics/Dr's I have contacted was from a truly compassionate MD (Eastern USA) who was kind enough to speak to me via phone.

He said after you crunch the numbers there is a % difference in positive response between females & males, length of depression and age.

Generally speaking for prediction purposes only.... in his experience "the ideal patient is age 25 & female".

He goes on to say that it's only a statistic and that there are many, many exceptions in his own practice. His success rate is about 70%. This Doctor does not want to give misleading hope to desperate people.

Many of his pts travel to his clinic and incur great expence in doing so. I appreciate his candor. The positive outcome of 70 % is disappointing (some clinics claimed 90% success???), but it's understandable as depression does cause brain damage over time and brain plasticity does lessen w/ age.

I still going to try Ketamine Infusion. Would be blessed to live nearby this Dr in the East. My West USA contacts from Ketamine Advocacy have all been very negative (as in "not taking new pts", no call back in 2 weeks, "Our clinic is not open yet", etc;).

CATCH 22...If Ketamine works for me I'll move, of course, but job is here....... No paycheck = No Ketamine.But first have to try it....

RICK...I am so happy you are doing well w/ Ketamine. Did you respond w/ first Infusion? Don't know if it is proper to ask or mention Dr's names here but I do wonder who you go to and how long the treatments releive your depression before you go in for another?

Please share more about your success. I am failing and don't know how much longer I can hang on. My body pains are nothing compared to the pain of depression which is incapcitating.

All the Best to you Rick....mayday

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Here is what I know about the protocol they use. Patients start at approximately 1mg/kg of weight. You take it in a room in the office, in a lazy-boy chair, with a bit of water. The lights are dim and they suggest you listen to quiet ambient music. I get bored easily and like to know more, so I had ambient music on my tablet and was playing sudoku. I found it very strange that the first effect I noticed was that my sudoku skill and speed increased for a short period as I started perceiving the puzzle as a gestalt. The doctor came in after half an hour and just talked to me for a little bit, I think he was checking for odd reactions and ability to focus/communicate. He did the same thing after the hour mark. They expected me to wait 1.5-2 hours before going home, and you were expected to bring someone with you to get yourself home.

The dose schedule was twice a week, so I took the next dose at home, then the following time I was in the office and we repeated the procedure at either 1.3 or 1.5 mg/kg. From what I understand the protocol after that point differs by patient. Many find complete remission of symptoms at that dose and frequency, but he said it was common for patients to find that after about a month they needed it bumped up slightly, but then not to need changed afterwards. He said there were also patients who took higher dosages. I kept track of how I felt each day, so I started being aware of how many days it was before things started wearing off, and what were the early signs. I found that at the beginning of my menstrual cycle I was fine with 3 or occasionally 4 days between doses, but at the end of the cycle it was 2 days. We ended up with me simply taking 3ml every second day, which is 2mg/kg. He says I don't need to, but I hold it under my tongue and against my cheeks for 10 min before swallowing.

From what I've discerned, the only difference with the oral tablets is that you can only take dosages that are in 25 or 50mg increments.

I understand your point about bioavailability varying by patient, and the need for blood level diagnostics, but it works well to judge by the effects. If you are honest with your doctor, you should be able to find the lowest possible dose that provides good results. Some people may need a dosage that is higher or lower than others, not because it gives the same blood level, but because a different blood level is therapeutically required. I've been on other antidepressants, in combination, where the dosage was lower than the therapeutic dose, but it worked. So blood levels, I think, are more useful for diagnostics if you are getting too high a dose to be safe.

We don't really have more access to rTMS in this part of Canada (I heard rumours one of the prairie provinces was planning to cover it), but I live near Toronto where CAMH (Centres for Addiction and Mental Health) is headquartered. A friend was one of the earliest rTMS patients and at her suggestion I looked at the CAMH and university med school sites for a study needing volunteers. Outside studies it is available only through MindCare, a for-profit chain that charges over $250 per treatment. So effectively it is not available unless you have a very high income or have gone through the initial round of treatments on a study and are one of the luckly people who only need a touch-up once a month.

As to ECT and rTMS, I agree that in the research ECT is still the gold standard. I have resorted to ECT once, and it worked. This did not make it impossible to get in the study. I received 6 ECT treatments (the doctor said that was the minimum for it to have a lasting effect), I felt fine after the first one, and after the second, and after that I have no memory for the next few months. ECT has a higher cure rate than anything else out there (although I look forward to the research on MST) but most people I know would never go through the treatment because there is not only a risk of memory loss, there is a risk of personality change. To me, myself, me sense of self is part of that personality and I am not suicidal, even if that death of personality might cure my body of depression for a time.

I don't see ECT going anywhere, because when someone is an active suicide risk it is the only thing that produces a quick response. Frankly, I think the biggest challenges to its hegemony as the gold standard are magnetic seizure therapy for efficacy and ketamine, because it can be given in the emergency room to people who are actively suicidal and there is a significant chance that it will reduce/remove the problem. Or in emerg terms, it will stabilize their condition sufficiently for them to be moved out of emerg and into the regular system.

FYI- I am currently in limbo as to whether I will be taking the nasal or oral ketamine in the future. Surprisingly the compounded liquid costs about 1/4 to 1/6 the cost for the pre-made liquid. I left the office today expecting to start on nasal, then got the sticker shock and am currently sorting things out with a different compounding pharmacy from the one I have previously used. For those who have not read further down this chain, I've been on oral/sublingual ketamine for over six months with very good results, but the last bottle from the compounding pharmacy seems to lack potency. The new pharmacy and my doctor are sorting things out, but my mood is plummeting and I really am not sure if they are compounding it for oral or nasal use. I am really looking forward to hearing from them, so I can take the dose I should have taken this morning, and hopefully by the end of the weekend switch to a batch that lasts more than a day and a half, and does not give me headaches.

Anyhow, best wishes to you all, and if you need different info about the protocol, let me know.

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@MaydayMaydayMayday

I think you misunderstood me. I never meant to suggest that you were addicted. What I am saying is that Naltrexone is used to treat addiction at full strength, and typically doctors will only prescribe medications they are familiar with. Since addiction doctors are very familiar with Naltrexone they are much more likely to prescribe it because they know it has no addiction potential and it is used to treat addiction.

I personally order many of my medications from overseas and know people that travel overseas to get their medications, but there are a LOT of scammers out there and you are not the only one who reads these replies. Even though I get many of my medications from overseas, I do have prescriptions for all of them.

When you order prescription medication w/o a prescription you take a large risk. That you are willing to assume that risk on yourself is your choice, I can not, and will not ever suggest to someone in a public forum that they should do so however. I will always suggest that patients work with their doctors and follow the laws of the land.

My goals are twofold representing Muscadine:
1) Educate patients and doctors about causes and treatments of refractory conditions, current research because we believe that the educated patient working with an educated doctor is the best possible combination AND
2) When we get 501c3 status to actually fund patients treatments so that they can return to healthy productive lives we will do that by matching them with a doctor who is willing to follow the protocols and maintain treatments.

If you go back and read what I actually said you will find your negative response is highly unwarranted. No one has attacked you, I think we have all been supportive and have tried to give you constructive advice as to how to find a doctor that will treat you and how to legally obtain the medication you may need.

There is a spanish proverb that reads "Take what you want, God said to man, and pay for it."

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I do not take nor am I prescribed ANY meds other than once per week Fosamax for osteoporosis. I do not have any addiction, recreational drug or alcohol issues and never have!

DAILY Ice packs & rarely an occasional asprin are my only vices.

The International Pharmacy I placed my order w/ for LDN is well known and a 'real pharmacy' whose name you would recognize. Unfortunately they emailed me that they are out of stock now & unsure when /if they will carry LDN in the future. So that is a dead end for me.

I had a Dr's appt today and mentioned LDN and my Dr said he'd never heard of using LDN for depression. Suggested excersize & Aleve for shoulder/arm pain.

BTW...I would never order random unbranded meds from an unknown source...much less take any additional med along w/ Rx'd meds w/o asking my MD. As I stated in my post I gave up on ALL anti-depressant meds well over 2 years ago after MORE THAN 40 YEARS of obediantly trying them under various MD's care b/c they NEVER, EVER WORKED!

THEY DID CAUSE MANY undesirable S/E's however!

The days of me enriching Dr's & big Pharma "just b/c" are OVER!

In my post I was open and honest re/ my depression only to have you guys respond as if I am a criminal. Am I missing something here? Why assume one who is suffering TRD is also irresponsible and careless???

Many mature, responsible law abiding sufferers are very tired of being lumped into the same category as those who chronically abuse drugs & alcohol, drive under the influence; commit domestic violence etc.......Makes it difficult for all to receive help & meds they need.

Thirty years from now if you are still suffering agonizing pain made so much worse by the ravages of age I pray you are better received.

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First YAY! #484 made it out of moderation ...

Next:
Cai,
Next time you see your doctor could you ask him if there is currently a protocol they are following? I would love to add it to the other protocols we have on file.

I know that oral ketamine for children exists as a syrup, any compounding pharmacy should be able to get access to it. That would allow your doctor to fine tune things more.

As far as really fine tuning things that becomes very difficult with oral ketamine because it takes a bunch of blood tests to know just how bioavailable it is in a particular patient and how fast hey absorb it. One of the big benefits of nasal is that the bioavailability is well known, not because of FDA backed tests but because of battlefield and military testing since nasal ketamine has been used in our military since Vietnam.

It is interesting that in Canada you have better access to rTMS than we do here in the States. Most places to get into an rTMS or iTMS trial you have to have already failed ECT. ECT is still considered the gold standard treatment, despite the side effects though SNRIs and SSRIs are going to replace it in the next few years I expect.

One of the things Muscadine is really trying to push is the understanding of the different forms of depression and their symptoms/ causes. If we can get doctors away from the one size fits all responses we think we can help a lot more people get back to leading full and productive lives. So I think you for mentioning it.

It bears repeating that there are at LEAST 8 different major causes of depression we know about today, and different treatments work differently on each of the 8 different models. Even the models are very large though in most cases.

Example the Nutrition model. The nutrition model rally covers 3 different sub forms of depression but since most are treatable by Deplin (A Medical food) they get lumped together.

Or Hormonal. Yes one of the models is simply generically labeled Hormonal, but which Hormone. In men for example low testosterone can cause all of the symptoms of major depression, Low Thyroid can affect anyone and can mimic depression. Women can suffer from depression because of low estrogen. A pituitary tumor can cause depression by creating an adenoma (a hormone secreting tumor) or someone could have an adrenal tumor that would cause depression and anxiety. Yet, they all are listed as "Hormonal" and there are 8 of these models.

What we have to balance as patients and advocates is what is covered by insurance, what can be tested for, what is the over all cost, and what is available for treatment. Take into account al the patient variables and it can seem overwhelming.

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My doctor, whose practice is part of a university research group has, as far as I know, treated about a dozen depression patients with oral ketamine. I know he used it previously to treat specific types of pain, so he had experience and knew of research from that area. That is where the oral treatment with ketamine research comes in.

I suspect the doctors here are wary of IV infusions because it takes up time and space that is needed for other things, and they don't like the idea of trusting patients with injections in general. As far as I know he had only prescribed it for patients who have tried a wide verity of other options, and who have not found rTMS to work. So it is all patients whose depression is not responding to other treatments. I suspect what we have is somehow different and that is why it does not respond the same way. Really grouping depression as a single condition is like treating fever. Tylenol may bring down the fever, but the underlying cause can be many different things.

The others he treats take it compounded in pills. I've had a vertical sleeve gastrectomy (re-sectioning of the stomach) so there is less surface for absorption and the acidity level is less, so we figured sub-lingual would give a more predictable response. I know he is pleased with the results. At one point he mentioned that the response seemed similar to the tablets at a 25% higher dose (I take a lower dose). I think he also likes that the dosage can be titrated more finely than with tablets that are 25mg or 50mg of ketamine each. He has also been surprised to find out that I am paying far less per month for the oral suspension than the others are paying to have capsules made, and either way it is far, far, more affordable than the IV infusions used in the US. I will try to post next week, if he puts me on the pre-made liquid sold to the hospitals, because it is the same mg/ml as they were compounding for, but should be more consistent quality.

So in reply to your questions, he is treating a dozen people with oral ketamine for depression, at least some of whom have anxiety, with good results on both the depression and anxiety. Yes it is less bioavailable, but the cost for a single IV infusion in the states covers six months of medication for me and that, frankly, makes the treatment viable for a larger group of those who need it. I have had depression off and on since I was in my teens. It is at least partially genetic. I have learned techniques through cognitive behavioral therapy and other psychotherapies that have reduced the severity on some occasions, and can sometimes help me pull out when I can feel myself sliding into that dark pit. But once it gets to a certain point only time and/or medications get me out. I have tried every antidepressant group but the MAOIs, and all the electrical treatments but the implant ones and magnetic seizure therapy. I am on a combination of medications currently, including a mood stabilizer and anxiolytic, as well as an atypical antidepressant. Since I was a teen July has always been the month that sucks, with two exceptions in 20+ years, when I was on rTMS I had only a small downturn, and this summer when I had four blah days in a row and that was it. Oral/sub-lingual ketamine is working well for me.

I take the oral dosage every second day, which sounds very frequent compared to the infusion cases. But I can afford to pay for this out of pocket, which I could not otherwise. I agree with the other comments that there are few/no studies on oral treatment for depression. I kept a detailed daily log for my doctor for the first few months so he had feedback, probably because I was his first sublingual route patent, and also because I am the sort of person who actually is willing to log all the details for the sake of promoting medical research. The drug has been around for decades and no corporation has an interest in paying for a big double-blind placebo controlled study. I think he may be trying a few patients on the nasal route, and may want me to volunteer. I will, not because I think oral does not work, but because it could be more predictable and...well he needs someone who can give feedback. I have two kids, and with a family history of depression I have a strong desire to promote finding good treatments for all the different conditions that manifest under the category of 'depression'.

I hope this helps.

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I have a much larger reply coming that is in moderation. I swear it bases moderation based on length some times.

oral Ketamine is not used in clinical situations for 2 really good reasons:

1) There are few clinical trials that have used it (if any) so there is little support on the evidence side that it works. Note I am not saying it doesn't just that the supporting evidence is missing.

2) The Bioavailability problem. The bioavailability of oral ketamine is very wide across the population and so does not allow the fine tuning of the dosage. Of the 4 methods of ingesting Ketamine, (IV, IM, Nasal, Oral) Oral is the most variable and least bioavailable. Nasal is what is going to be used in emergency room situations and likely IV for clinical situations until GLYX-13 or another analog makes it through trials.

So doctors have to prescribe more ketamine for the same effect and there is less evidence of the usefulness and that is why you see it much less frequently.

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maydaymaydaymayday,

I don't know who told you that ketamine is less likely to work with age but they are absolutely incorrect. There is a well documented study of ketamine being used in a hospice environment where depression was obviously peaking. The effects of the ketamine were the same 70-75% that they have been in almost every other study.
I would be happy to provide you more info and some well experienced guidance. I only thank G-d for the huge difference ketamine has made in my life after 29 years.

Rick

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