Ketamine For Depression? (Page 22) (Top voted first)

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

I am not familiar with the muscadine foundation. As in grapes?

REPLY

Was this helpful? 0

@CityGirl
Do you have a link to the study, or even better possibly a copy of the protocol?

REPLY

Was this helpful? 0

I do have a copy. Is there a way to share it here?

REPLY

Was this helpful? 0

@CityGirl You could scan it to something like Google Drive or DropBox then share it.

REPLY

Was this helpful? 0

GLXY-13 study protocol

docs.google.com/file/d/VUVLSwU2s/edit

Let me know if that works.

REPLY

Was this helpful? 0

@CityGirl, Perfect thanks!

REPLY

Was this helpful? 0

I finally started reading that protocol last night. It does use an IV delivery mechanism. My Pysc doc is good with it but suggests I consider the St.Louis 5 day study first since I would get the study drug for certain. I am waiting to hear if the last spot in St, Louis has been filled.

REPLY

Was this helpful? 0

John
Thanks for sharing you experience with IV Ket, I'm on AntiDep for long time, and there is no improvement. any recommendation to go from here

REPLY

Was this helpful? 0

@Keller, it seems everyone on this forum is desperate to find way to cure our Depression, I m on SSRI but no good result,
can you give us some summery what others options we have at this time,
Thanks

REPLY

Was this helpful? 0

@sue How is this going to save lives? If someone is here it is because they are already looking at ketamine as a treatment option. Spamming links doesn't add anything to the conversation. Further, the information presented is out of date/ incorrect with regards to cost, treatment numbers and efficacy. Lastly it treats (or rather does not even examine) the underlying differences at all. It presents a single possible mechanism as the origin in a fluff piece designed to promote a particular treatment.

REPLY

Was this helpful? 0

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

REPLY

Was this helpful? 1

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

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

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

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

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

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

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

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

REPLY

Was this helpful? 0

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

REPLY

Was this helpful? 0

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

REPLY

Was this helpful? 0

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

REPLY

Was this helpful? 0

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

REPLY

Was this helpful? 0

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

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

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

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

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

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

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

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

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

REPLY

Was this helpful? 0

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

REPLY

Was this helpful? 0

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

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

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

REPLY

Was this helpful? 0

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

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