Ketamine For Depression? (Page 27)

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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Howard,
I wouldn't rule out the glutimate system so quickly. I do not have diagnosed ADD, but I take ritalin in the morning sometimes when depression is at its worst and I cannot focus and cope with all the stimuli. I've found that taking ketamine, while generally reducing anxiety, can make me more sensitive to sounds, and that while it is still being processes in my system I find the excessive stimuli problematic. My mood is improved afterwards, but being around noises (with two active kids it is more a matter of reducing the noise) seems more annoying than usual. I am still trying to figure out if four hours of quiet after taking my dose actually improves how well and how long the dose is effective for treating depression. So this overstimulation may make the initial effects more annoying for anyone with ADD, or any disorder that could be linked to trouble processing too many stimuli at one time, or blocking out some stimuli as a self-defense mechanism. If you can, take a close look at how the process feels at all the stages. Personally, I do Sudoku online. I find that when the ketamine is just kicking in and out I process the puzzles as a gestalt (all at once, rather than in pieces), which suggests I am either able to process more stimuli, or I am unable to reduce the stimuli I need to process. It may require lowering the dosage, or seriously reducing external stimuli for the first hours or day. I really find a distraction free space and ambient sound music (presumably directing my emotional tone and keeping me from seeking patterns) playing to get the most benefit. But, unless there was no effect at all, I would politely suggest continuing to investigate the parameters of how the treatment is applied. I hope your son finds relief, either with this treatment or something else. Best wishes.

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MD,
I don't think you will find any takers here. First, this is a medication that is off-patent, which should make it lower cost as a treatment. For patients this is a good thing. Second, there are large pharmaceutical companies already doing research in this area, either trying to parse out which components provide benefits and which are related to unpleasant side effects, or finding related compounds, or chemicals that interact with glutamate receptors. So there is big money behind this research. Third, the cost of drug trials to get something through the FDA that could be directly marketed as a treatment for depression are phenomenal. Even the smaller, research-focused, pharmaceutical laboratories often need to work with (sell patents or their companies to) big-pharma because they have the resources to get through the FDA trial procedures. You are not going to put together venture capitalists for that amount of money, and for a process that will take many years before it has even a hope of paying out. Fourth, my understanding is that ketamine treats or masks depression, it does not cure it. The underlying condition persists, although you may be able to make changes in your life and behaviours because of the ketamine which have more lasting effects. Fifth, unless you are coming up with a new chemical compound or formulation you can't patent it, and cannot make claims about its use to treat any medical condition.

So instead of telling those on the board that we do not get the point, maybe accept that we see your enthusiasm and would love to see venture capitalists getting together and researching, examining, and marketing an inexpensive and useful variant of ketamine, but you probably need to read up on the process before proceeding further.

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hey, in Los I was looking for any ketamine doctor, but crazy expensive. one session 2000$. maybe the most cheap one is New York infusion therapy.

by the way, why do you think doctor's always use inj. for it? actually,smoking snoozing,drinking, are draining to the internal body. i think inj. is stronger. is it true? and also, how many ml do they use in inj.? too much is dangerous.

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Hello Caiguise,

I wanted you to know that I perhaps could have chosen better words than "grasp this". Regardless, your talents and skills come through loud and clear when you replied to me and I thank you for that. Please understand that as much of an entrepreneur as I am that this is sort of personal with me and my drive is not a financial one. In my old mind the internet has worked wonders for the world because of things such as this. The exchange of ideas and knowledge, I am very grateful for your remarks as well as the fact " you get it." I think this drug has powerful uses that would have saved a friends life I think and has to me unbelievably relieved a lot of issues that for me were hard to get around after 40 years of trying. If you want or should I say have time to talk regarding this you are welcome to email me {edited for privacy}. If not I understand. And thank you for your input. I appreciate it.
m

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I Cannot endorse Ketamine Infusion!
It is not a miracle for TRD by any definition.

My four recent Ketamine Inffusions were 100% ineffective for Depression and left me feeling very sick, dizzy and suffering flashbacks for many weeks.

BEWARE of older MD's setting up shop in 'borrowed offices' and charging you thousands of dollars for less than $1.00 of Ketamine simply b/c they can. They are cashing in on your despair during their 'retirement'.

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Hello there, I posted a thought here the other day because of the belief that I have in the amazing response that " I " have had with Ketamine nasal spray. I believe in it enough to try to get doctors that are willing to consider prescribing it for the cases they deemed it may be helpful. Unfortunately my entrepreneurial spirit got caught in the moment and I sound like a damn preacher begging for money. ( My sincere apologies). Its just that I and perhaps a great deal of folks that have had to deal with depression and not gotten help from the serotonin section, and when I was prescribed this "nasal spray" that is compounded at my pharmacy for "pain control" then something else happened as well. As embarrassed as I am to tell it but it really helped almost stamp out a depression I have had on my back for way longer than I care to admit. I do not and will not ever pretend to know what others are struggling with when it comes to depression for I have gone through or "put myself through" the sadness s*** for so long I hate myself. Honestly I wish for all of us to achieve that peace in this world and be able to walk through it without depression or under the pretense of "I don't fit in". Damn that. Depression is serious stuff and if this drug performs on folks like it has myself then heck yes, I am ready to invest whatever just to get it out to folks that need it. If it helps some that is GREAT. But where I live if you ask about it you are viewed as a drug seeking person. Horse crap. Im not 18 years old and depression is not a game any of us cared to play. Even if what I say does nothing but spread the honest truth about my own help then good. I do not have the knowledge or education of a doctor and that is who should be making these decisions. And I do not like hearing what others are saying about infusions and the "COST" associated with them. My doctor writes me a prescription for the "nasal spray".

It cost me 49.00 for my pharmacists to compound it. These people charging this BIG money to do infusions irritate me to no end. We all need to make a living but come on. Had any of these people charging 2000.00 suffered through depression on their own they would be giving it away to help people. Depression is robbing part of our country some time it seems to me. They do not need to take an inexpensive drug that potentially has the opportunity to help millions of people that fight every day for their life a chance and charge people two thousand for infusions. Wrong. Why can't they just prescribe the nasal spray. Sorry but there is a bit stretch between 49.00 and 2,000.00. And the thought that Americans that need this help are getting put through this. Its just wrong. They may as well be up to crashing electric cars again in California. Human beings ( all of them ) are important and deserve the right to live life in the same manner as folks that are not affected by depression. This is not in any way a "not in my backyard" issue. This is something that could help the well being of this country in the long run perhaps. Please doctors, help these patients with less expensive methods and I promise you will have a patient and friend for LIFE. Isn't that what it's about.? The gentlemen that responded by advising me "its not that easy" ( thank you for the advice" ). This is not something I am so eager to make money from. Just would like to see folks have an opportunity to see if it does for them what it did for my 40 year ongoing problem under there doctors care. And hopefully not have to undergo expensive beyond belief infusions that I see to be more of a racquet than I do seriously considering the mental health of the patients that need to benefit from it. 2000,00 would put me right out of the game to begin with and it does not matter what part of the country I am from. And the best way to describe what it has done multi tasking as a pain control was cure my depression then this is something that need to be explored and certainly not exploited. If that and the stereotypes of this being some kid drug or whatever were viewed differently then we may have something that really could give an "ENORMOUS" amount of individuals that suffer from depression as I have daily. That to me is priceless.

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One last time regarding your reply. Forgive me. And what you said makes every bit of sense. When you see something that you really feel will help someone you want to expedite that any way you can. I appreciate what you told me, and I have learned a great deal from it. Further more I hold it in regard for you are right, this is not some side of the road peach stand. It is of course big money etc. My enthusiasm is brought on by the response I have had to it so its only a small micro causm I am working with. I just hope that the medical folks will help people instead of these enormous charges of 2000.00 for an infusion. The nasal I am prescribed helps enormously for 49 bucks and that is for "pain" with the added bonus of my "life" back for the first time in years. I have read many similar reactions. Would be great if this choice could be made available for doctors who sense a use for this type of treatment in patients who did not respond to the seratonin crowd. I have never thought anyone would choose to be sad, so if this type of treatment can offer folks help with these type of problems I get excited. Thanks for your words of wisdom. Its not as easy as one would want it to be Im sure. Thanks again
md

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hey md I think so. but I have never tried ketamine, so I don't know now. what is your recommendation doctor? i don't know why they are so expensive. in spite of no insurance, these are crazy expensive.

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MD,

I understand why you are upset at the price American patients are being charged for this treatment. I know the quality control is stronger, but ketamine is widely used in veterinary work as an anesthetic. Any drug that is priced suitably for knocking out a horse is not innately expensive. Although I lived in the US for over a decade during grad school, I now live in Canada, where the philosophy and logic of the medical system is different. We probably will never have infusions used here because it is too costly from a physical space and duration of treatment standpoint, as well as using medical professionals' time. I have been prescribed ketamine in two forms, liquid to be taken sublingually (hold under your tongue or against your cheek for 10 min) and a liquid suspension taken with a nasal aspirator (syringe with an attachment that makes it spray out). Currently I am paying $125 Cdn (around $110 US) for 90ml compounded specially, at 50mg ketamine per ml. That is approximately a two month supply. The same suspension is commercially available to pharmacies in small bottles, sold for pain inj's., and would cost approximately $600 for the same amount.

I appear to be the only person around who has been prescribed ketamine as an oral liquid, but from my experience it should be used more. According to the available literature it should be less absorbed than when taken nasally, but I've ended up needing a higher dosage since I was switched to using a nasal aspirator. My experience is that sublingual absorption was as good as nasal (I hold the liquid under my tongue and against my cheeks for 10-15 min, so most is absorbed before hitting the acidic stomach). I had hoped that switching to the nasal aspirator would reduce the dose, and therefore the cost. No such luck. We are still trying to find the right dosage and timing with the nasal aspirator, and I am trying to remain optimistic that we will find something that works sufficiently and in the long term. I hope more U.S. PsyDocs start trying patients on liquid formulations, the lower cost makes the treatment available to more people in need.

Frankly, until more physicians are willing to try prescribing ketamine, the few clinics in the States that offer the treatment can unfortunately charge whatever they like. I think the stumbling block is the association of ketamine with club drugs, and physicians living in fear of being sued. Ketamine is on the World Health Organization's list of core drugs, because as an anesthetic it not only calms the patient, but does not suppress breathing. So it is safer to use in sub-optimal surgical conditions. But that also reduces risk for psychiatric patients, you may be groggy for a bit, but your instinctive breathing remains intact. This medication is probably not a good option as a first, second or even third line of approach (unless someone is actively suicidal, in which case the rapid effect could be a lifesaver). But for those of us who have tried almost every med on the market, in many combinations, for decades, I think the annoying initial side effects are minor compared to getting to feel normal again.

Hopefully as more physicians hear about ketamine being used successfully, without people becoming habituated or addicted, or even hear about colleagues trying it on patients without horrible outcomes, more will come to think of it as an option to try when faced with patients whose depression is not fixed sufficiently (or at all) by the medications with which they are more familiar. The other turning point will probably be when major pharma companies coming out with new meds based on glutamate receptors. They will teach physicians to think of depression and its treatment in ways that make it possible to see ketamine as a scientifically reasonable treatment.

Anyhow, best of luck to you all. I hope you find a treatment that works for you. Until then don't give up hope.

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thank you caiguise for your wisdom filled observations. I appreciate hearing from someone like you for my issues seem similar. I think everything you speak about is spot on for this. IE I have been fortunate to learn a lot from you. So, thanks.
Sincerely
m

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HI guys, this is the original lahelp from the early days of this thread (2012) - saw a post some pages back wondering what I and other older schoolers are up to regarding treatments so wanted to respond - in total, I did six ketamine infusions - infusion #1 in San Diego delivered a 100% response by the next day with depression returning in just under two weeks - no response to infusions #2, 3, 4 & 5 administered in Los Angeles nor to #6 back in SD - thought to check out this thread since I'm now researching psychedelics including ibogaine and psilocybin after giving up on ECT a month ago after 33 treatments across 3 months without a response - clearly, I've yet to find a cure - hope original poster john is still hanging in there too or, better yet, better

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Ketamine? Not likely. At least not for internal use. Topically it is great for joint pain.

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I too, was one of the old school posters from 2012. I find it VERY interesting that lahelp had an initial response to Ketamine and no further responses after that. I had the same experience as well! I was in a Clinical Trial where I had Ketamine infusions but after my positive response in the trial I had a couple infusions and intra-nasal Ket with no positive response! I am very curious as to why that happened and to find another person with the same experience is amazing. Can anyone shed some light on this phenomenon?

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Psychosomatic responses can be powerful. Add to that the hope that treatment would work and one might well see an uptick in mood. How many causes of depression have been accounted for? Ketamine only deals with 1-3 of them.

However ECT has a similar tangential response as Ketamine so it is not surprising that someone who failed a ketamine trail would also fail an ECT trial. Isn't the purpose of the electrical impulses to reset and encourage dendrite regrowth? That is the same effect as one of Ketamine's biggest effects.

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Which reminds me, during almost all of my ect treatments (over two dozen, I'm sure) they added ketamine to the anesthesia chemicals. Made falling asleep feel interesting for a second or two but didn't result in a noticeable response.

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Sorry to hear that some people have found only the initial infusion effective, or that efficacy tapered off quickly.

I've never tried the infusions. I have taken an oral suspension, either sublingually, or with a nasal aspirator. But I've been taking it 2-3 times a week since January, and the only times efficacy has trailed off have been because the compounding pharmacy had some sort of problem, or we were trying to figure out the appropriate dosage and schedule.

So far 3ml (so 150mg) liquid taken orally (hold under tongue and against cheeks for 20-30 min, then swallow) every second day has had the best effects. Higher doses don't seem to last longer for me. We went up to 200mg with a nasal aspirator every second day and it was less effective (basically the brain did not have time to recover so did not respond as well to the dose). It worked better taking the same dosage every three days (at least it worked well for 2 days). I am hoping to convince my doctor to switch back to the 150mg (3ml) orally every second day. It is a lower effective dose (in theory oral ROA provides less ketamine absorbed in a useful form), but it was not high enough to reduce dose effectiveness when taken that frequently, and frankly, I hate this rebound to apathy by the third day. So almost 1 year of continuing effectiveness.

So I'm sorry that some of you found the medication did not continue to be beneficial, but for those of you who found some benefit, it may be worth convincing your physician to modify the dose, frequency, or route of administration. Placebo effect can play a role, but if your depression is very treatment resistant were you feeling optimistic and expecting it to work? Personally, I was hoping, but was depressed enough that optimistic was simply out of my emotional range.

Best wishes to you all. Hold in there.

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caiguise

Do you have a doctor in the US or are you in another country?

Howard

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Howard,

While I lived in the U.S. for over a decade, I currently live in Canada. While there has been some mention of ketamine in the press, I don't think there are many psychiatrists here who are prescribing it (they are waiting for the early adopters to show that there is both benefit to the patient, and little risk to the physician). My impression is that the status of ketamine as a controlled/scheduled drug is similar in both countries, but that our medical and legal systems have significant differences. Health insurance in general is run province by province, but everyone is covered (when you move back there is a three month waiting period). Prescription drug benefits, unless you are a senior, are not covered, so most people either pay out of pocket, or have supplemental insurance through their employer. Ketamine is not covered by our policy, but some mental health medications were covered by our insurance in the U.S. and not here. I think physicians here are not as obsessed about legal suits, in part because when something goes wrong (assuming there was no serious negligence) juries are not put in a position where declaring the doctor was acting in good faith means leaving a family without resources to treat the patient. We also, I think, still have a good samaritan law.

Because the motivations and resource restrictions are different, the tendency is to promote treatments that reduce use of physicians time, and hospital/clinic resources. So rTMS will have a tough time being approved for coverage under OHIP (Ontario Health Insurance Program) because it is a hospital or clinic based treatment that requires somewhat expensive equipment. Ketamine infusions would have a similar problem. It is probably more of a stumbling block that if it is done in hospital or clinic it should be covered by OHIP rather than your own insurance (as in the case of antidepressants).

I've been lucky to live in a big city with many teaching hospitals and specialists. My regular psychiatrist would never have started me on ketamine, but is willing to continue overseeing the process. The neuropsychiatrist who prescribed it is highly specialized, and my impression is that he only sees patients who have already tried multiple types of antidepressants, mood stabilizers, ECT, and other treatments. He is very knowledgable about which areas of the brain do what, and how medications influence not only mood and anxiety, but other aspects of behaviour and personality. And, frankly, he is more interested in novel approaches than most psychiatrists I have met (my regular psychiatrist is still amazing). The neuropsychiatrist is presumably salaried, so for him the benefit to trying out a promising approach is both the possibility of helping people who have not otherwise found relief, and the geeky joy of learning something new and helping improve the body of existing knowledge.

In any case I am extremely lucky. I hope he published his experiences with oral ketamine. It is cost effective, and for those of us who find it works, it is well worth the annoying initial weirdness for the ability to enjoy a normal life.

Best wishes.

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lahelp, I'm also an earlier poster to this thread.

Look into Ayahuasca. This has helped me the most. I've tried Ibogaine which led me to pursue Ayahuasca. I've posted my experience with both psychedelics in a separate thread on this site.

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caiguise

Thanks for the info. If you are interested, I explained what we have done/tried for our son in posts 512 and 514.

Another item of interest, I just saw in Science Daily that Washington University of Medicine in St. Louis, in a pilot study, found that nitrous oxide,or laughing gas, is effective in treating mood disorders, The finding were published online in the journal Biological psychiatry Dec. 9.

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