Ketamine For Depression? (Page 30)

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

One problem with the larger number of models for depression is that they are still provisional, and the evidence for their role in depression mainly comes from whether treatments that seem to fit those particular explanatory model work. It is promising to see new models, largely because it means new treatments.

When you get down to the details, most types of antidepressants (pharmacologic, physiologic, and psychological/behavioral) have been discovered as side effects in other medicines/methods, followed by attempts to find similar compounds/methods with better profiles and the ability to patent..

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can you please tell me where to find a dr. to prescribe intranasal ketamine for depression?

Please email me at {edited for privacy}

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To Find doctors who prescribe Ketamine for depression go to the Ketamine Advocacy Network. You will find doctors, what treatments they use and other useful information.

As for IN, it is not the ideal delivery method for sustained treatment due to a number of factors already discussed. However, you will find doctors who use it on the aforementioned Ketamine Advocacy Network.

@CAIGUISE
That is how it generally works, if you have a better model or can show a model is not valid, please share. Not certain how the current model system is a problem though and it has over a decade of use in its present form. When enough evidence exists to build a new addition, it will be added. I someone can show that a model is not needed, it will be dropped. It is similar to schizophrenia where the number of models has been expanded to 8 over the past few years as well.

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I am a 61 year old male. Have been depressed since 16 yrs old. I am now in a heavy depression and on meds. I think they are not doing any good. Can you please help me get on a ketamine study?

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MDinTraining

You state: "Not certain how the current model system is a problem though and it has over a decade of use in its present form. When enough evidence exists to build a new addition, it will be added." Could you please expand on this. Which model is 'the current model' which has been in its present form for a decade? The idea that there is a single model, which has new information added to it until there is sufficient counter evidence to trigger a scientific revolution is wonderfully Kuhnian, but in this case I have trouble seeing what would be the hegemonic worldview within this sub-field of science. One of the fascinating things about psychiatry/psychology/neurology is that there are so many models in use, and that how they are used, and even developed, is related to the treatments that appear to work (work in some situations or for some people).

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I mention here that my wife suffers from depression for 25 years and we were thinking of going to the US to try treatment with Ketamine at a clinic in New York. But the financial cost of this is high, because we live in Brazil and the dollar's value has very risen in the last two months. Therefore, we decided to try something else. My wife started yesterday to take 5 mg of Memantine. Next week she plans to increase the dose to 10mg per day. Does anyone here know anything about the treatment of depression with Memantine? We decided to do this because Memantine, as well as Ketamine, is a NMDA glutamate antagonist.

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The current model system means that system which currently exists and breaks down depression into a number of sub diseases based on various models.

So:
Depression:
|
|-First Model: Deficit of Monoamines aka SSRI/ AKA a lot of other things treated commonly with SSRI/SNRIs/MAOI/TriCyclics (last 2 far less commonly)
|-Second Model (of 8): Deficit of Hormones aka Hormonal model. Treated by replacing the appropriate hormone (estrogen/ T3/T4/Testosterone etc)

There are 8 current models that have been created that all are labeled "depression". There are 2 other models I am aware of that may come in and either combine 2 of the above or add a new model to the commonly listed models. So the number can change. When a new model comes into play it can add to the model list, replace another model, or combine 2 or more models.

Some of these models are testable, some are only testable in that you treat the patient as if they had that particular model of depression, and see if it works. If it does, great they likely had that model of depression, if they do not get better, you try a different model (or even sub model)

There is no single model. Rather. there is a system of models which in English would be expressed as a "model system". Each model focuses on a different aspect of neurotransmission and neurological health.

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@Deijivan If you are in Brazil, why not go to Uruguay where Ketamine is legal and is much closer to home.

As for dosages and treatment. Unless I have seen a published protocol, I will not answer

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@HY1V5X, have no problem in buying Ketamine here in Brazil, because my wife is a Medical Psychiatrist and she can buy it. The problem is in relation to intravenous administration. No Medical Clinic or Anesthetist knows what she knows (and we also seek everywhere) agrees to do this kind of experiment with Ketamine. We cannot get support from any hospital, clinic or doctor. We also sought out someone who could do the procedure in Uruguay but did not find anyone!

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MDinTraining

Thank you for explaining your understanding. I assume some of the psycho/social models are among the eight? What I find interesting is how the various models interact, for example the estrogen/serotonin connection. Also how cognitive-behavioral therapy can have physical effects on neurotransmitter balance and modification of stress altering hormone processing..

It would be wonderful if most physicians considered the theories that underlie their prescribing decisions. If you find one, you are extremely lucky. The current push for 'evidence based medicine' promotes decision making without consideration of theory. Ultimately most use a subset of available pharmaceuticals; those with which they are most comfortable.

In any case, it would be great to hear your insights on how you have been told ketamine works. My psychiatrist/neurologist has ways of explaining it, but the effects in creating a controlled start and stop of inflammation seems like another possible reason for its benefit (at least for some).

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To Caiguise: You said this in a post and you are right
It would be wonderful if most physicians considered the theories that underlie their prescribing decisions. If you find one, you are extremely lucky. The current push for 'evidence based medicine' promotes decision making without consideration of theory. Ultimately most use a subset of available pharmaceuticals; those with which they are most comfortable.
You are so right. What I can't understand is why do doctors do what "they" are comfortable with when there is help with something that works for "me". Which makes me wonder how much they ever consider their patients

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I assume some of the psycho/social models are among the eight?

1 commonly called the Psychology or emotional model. In psychiatry, medicine/ biology is the key and so Psychology is the redheaded stepchild.

Ketamine has at least 3 (likely 4) methods of action. NMDA antagonism (blocks glutamate), Inflammation (reduces glia cell inflammation and so assists in glutamate removal), & Monoamines (neurotransmitters). There is evidence that ketamine also reverses depotentiation in certain brain structures, however this is not presently considered an area of primary depression, rather secondary

As for the link between estrogen and serotonin, to my understanding there is no primary link. Instead hormones (endocrines in general in fact) work along the HPA axis so it is at least tied to the inflammation model.

This is one of those places things get wonky. So physiologically there are 2 major overarching models of depression. Inflammation and Monoamines. If you have too little of certain monoamines like serotonin or nor-epinephrin you will be depressed or if your 5HT genes are wonky and not accepting the monoamines then depression... maybe turns out mice with no serotonin receptors are not depressed so ... well lets say studies are ongoing. Inflammation is the other elephant in the room when cells become inflamed, a number of bad things happen, including depression.

What the models tell us is that the pathway is related to depression. Think of it as a multi-car accident on a busy highway. You are at exit 12 trying to get to exit 3 all you see in front of you is stopped cars. Is the problem at exit 7? Exit 2? All you know immediately is that where you are traffic is not moving. Each model in the current model system covers at least one exit, treatments frequently cover 1 exit, and help out at others. To extend the analogy, traffic is like inflammation, it will improve if more lanes are added, more exits are added, cars get smaller.

As a side project, I am working on an infographic showing each model and how/where each treatment affects things. I suspect with all my free time, it will never be complete, or if it is it will be immediately outdated.

As to MF's comment, Doctors are constantly bombarded with novel drugs and treatments. Usually for whatever has just been approved. It is very difficult for a Psychiatrist to keep up with the broad field of Psychiatry and effort is frequently not consumate with results. Insurance dictates frequently just how much time a doctor has with a patient, frequently between 15m and 40m. Plus there is documentation, so lets say a doctor has 30 minutes per patient 15 face to face, 15 notes and such. In an 8 hour day that is 16 patients, 80 patients a week, 320 patients a month how many conditions do you think manifest? How many patients are identical (hint: none). Doctors are human, many put in far more hours than 40, just with patients. Research is often poorly understood or contradictory. So what does a doctor do who is not highly specialized? Optimize time to help as many people as well as can be. Engineers frequently claim the last 10% takes 90% of the time. In Psychology, 70 % of people are helped by the standard treatments, so you focus on those standards, when they do not work you seek out help/research/treatments that may work, but lines have to be drawn somewhere. Most patients are not candidates for clinical trials and most doctors are not research practitioners.

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As to MD's reply to Caiguise that MD in training replied to. Thank you MD in training for your input. However, I am prescribed nasal ketamine, for pain yet unbelievably it really helped my depression that has lasted 40 years since my Dad got killed. I have been taking it two years and I run out of it after 2 weeks and he acts as if he does not want to up the script. He does not accept insurance so it is all out of pocket. Drug panels repeatedly with erroneous results and yet I still have to pay them. What hurts me the most is that I thought I could talk to this doctor but after one wrong panel for something I have NEVER taken I have to drive 2.5 hours for random pill counts, more evaluations and he never discusses my NEEDS anymore. Its all about some diagnostic issues that I could care less about. He does not spend more than 5 mins with me now. I am not getting nothing but an education about U/A's. I have been on high doses of methadone 20 years because it is the only one that helps without making me slur my friggin words. I had never taken ketamine until he prescribed it two years ago. It is great however after about a week without it the depression starts to return. These U/A's are humiliating, expensive, and it is all too much. I wanted a Dr. that cared about me and my issues that he gets paid "cash" to care. Not to give me an education on some darn U/A. Especially when they are wrong. If you are a Dr in training I hope that you never treat people like this. I thank you for all you have said. I apologize for about having enough of all of it. Don't know where to turn and am trying my best to make a decision as to living life in pain constantly, depressed constantly (yet when I find something that works they won't give me enough.) And not able to take care of my own family. And all this money just to keep from hurting. I was too proud to take disability for I kept thinking I would get better. What does it take to get someone to hear you and maybe increase a pain/depression drug that WORKS? I had hoped that more of ketamine might allow me to take less of the opiates that I won't to come off of.

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Hello,

My 16 yr old has had severe depression and anxiety, suicidal for 2 years with inpatient treatments, tried 15 medications with severe side effects and no improvement. Subcutaneous Ketamine twice a week 40mg works but she has a needle phobia. She has returned to school for the first time in 2 years which is brilliant. Do you know how I can get nasal ketamine? We live in Australia. The cost of subcutaneous inj. is $150 each, which is not covered by public health and is becoming prohibitive. Thank you

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Well, I passed my return to work drug panel (hair). I was fired 2 days after returning to work for not being 100% capable of performing my duties. I'm in a right to work state so I have no way to fight it. I'm healthier than 99.9% of the other workers. Most are morbidly obese chain smokers with horrible attitudes. I am a go-getter, never say no, the most experienced troubleshooter at a Michelin tire manufacturing plant. But. I have a "bad back".

That is a death sentence in any job, much less a skilled labor position with 2 college degrees. I'm unemployed, bankrupt, and the only thing that helps is painkillers (Drs wont prescribe for degenerative disc disorder and multiple fused discs with an ineffective stimulator implant). I get 800mg ibuprofen! Yayyy. That sure helps. It helps if I take em with Johnnie Walker.

Ketamine in very small doses makes my situation night and day. Two 25 mg IM doses a week and the pain is tolerable. The PTSD and depression manageable. A doc in Charleston does Ketamine treatment at thousands of dollars a month. So he lives a fine lifestyle treating the rich with a dirt cheap med. The poor and lower middle class suffer. Forget that. I am self treating for now. Thank you to this "war on drugs" for making me a criminal just treating my illnesses. I have never broken a law in my 43 years.

There is a cure, but it is cheap and has an expired patent. Therefore they keep it from us and give us new poisons that make our conditions worse and sometimes kill us. Oh, but Pfizer gets richer. Drug reps deserve to die of horrible diseases. Big pharma bigwigs deserve a million times worse. Last post from me. I'm spending my spare time on the 400 yard range honing my skills. Adios.

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I'm not sure how the system works in Australia, and most of the people on this board are in the USA. Ketamine is not commonly used in Canada (where I live), but the neuropsychiatrist who put me on it seems to mainly prescribe it compounded in pills/capsules. I take it as a liquid because of stomach complications. You may want to simply talk to the physician who was doing the inj. treatment successfully and ask about having a pharmacy compound it as a pill, or liquid (if you can find a place that carries the nasal sprayer attachment for a syringe). The proportion of the drug that is bioavailable is much lower with the oral route, a bit higher with nasal. For me there did not seem to be much difference. My doctor sends the prescription to a compounding pharmacy. I've worked with two of these places and highly suggest finding one that deals only with compounding, and which has a good reputation among doctors.

I hope you are able to find a way to make this work for her. It sounds as if she has been through a lot over the past two years, and I hope ketamine continues to work for her and you are able to find a route of administration that works well.

Best wishes.

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@Used Up: You say "There is a cure, but it is cheap and has an expired patent."

What is this cure? Ketamine is not a cure it is a treatment, an ongoing treatment for some, a booster for others but it is most certainly not a cure.

As to being in a right to work state and being fired for not being able to 100% do your job when others are less able to, you are wrong. You can still sue, so long as you can prove them wrong.

@MD Sorry but what you say is simply statistically improbable and quite frankly probably at the root of why you cannot get a doctor to listen to you. You come across as a polyabuser or drug seeking individual and doctors are trained to avoid such people. Nota Bene: I am not saying you are a poly abuser or drug seeking, simply that you present yourself as such in your comments.

The best way to get treatment is to find a psychiatrist who currently prescribes ketamine and work through their process.

You are very unlikely to convince a doctor who does not use ketamine to start using it. If you had been a patient of theirs for years and they were familiar with your condition and were willing to take a risk, then maybe. Some doctors are willing to do maintenance treatments after another doctor has set you up and done the initial dosing, but you will need to have your complete medical records transferred over to them.

I see so many people who are convinced that ketamine is a cure or the cure for them because they read something somewhere. Ketamine is a near last treatment presently. It is a treatment for the ER (1 time not repeatedly) or if you have failed 3 or more other models. It is not a first line treatment it is experimental.

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Hello
For a doctor in training you are perfect
No empathy or insight
I have 6 post graduate qualifications in medicine
The psych team treating her totally believe her and me
She was totally non functioning has actually been suffering for almost 4 years now
60% of depression (varies on what literature you read)
Is not treatable with current medications
I hope you become an a surgeon and do not deal with payments as you are rude and implausible
Australia has very very strict laws on medications and is much stricter than USA
God pity your patients
Thank you to the other reply
I thought this was a forum to help one another no judge on a few words someone has typed
The world does not need more money grubbing doctors who are "smart" but have zero EQ like you!

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@kate So answering someone else's question offends you? I am not sorry. Do you commonly get offended when someone answers a question that does not involve you in any way? You might want to get off the internet because people answer other people's questions all the time directly and they do not involve you either.

No one here is my patient, I came here to talk about many of the questions I see frequently involving Ketamine for the treatment of depression.

I, in fact, have participated, as a patient, in a ketamine analog trial, I have participated in a ketamine trial as a data analysis tech. Want an honest answer that I can give, I will. Want your hand held, I am not your parent.

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You know the laws in my state as well as being a "dr in training". Well I'm an astronaut in training. So I know more than you. Also I'm ex special forces and future CEO of Goldman Sachs. Now that that's settled, having been fired and told to my face that it was that they can't have someone with a bad back on crew because I'm too high of a liability. I brought this to several lawyers, the workers relations board, the sate's AG, all said the same thing. Only Race, religion, gender, and age protect me from being fired or not hired in a "right to work state". Some told me it also means "right to fire state". I appreciate the unsolicited legal advice from a "MD in training ". However,
I broke my back when I was 9 and told by an MD that "kids don't get bad backs, it's a pulled muscle. Give him so Tylenol. "I have never stopped hurting since. My left leg stopped growing so I have a thin, twisted leg. I hide it so I can get jobs because if I don't, I don't get hired, no matter the job. All around me ran away from me.

My dad kicked me out on the street because I wouldn't "pick myself up and get back to work and school". I lived on the street in my '81 Civic. Never got support for my loss. No one cared because they only care about themselves. Parents, bosses, owners, investors, and "MD's in training". I've been reading your posts. They are what I call "public masturbation". I've lived it. Not been a tech in a study. Not a clerk in a trial. I've lived it. I've been treated by people of your level. You really just shotgun treatment, using the drug that gives the best rewards for each script written. I've been on EVERY antidepressant, EST, hypnotherapy, acupuncture, and poisoned numerous times.
Experienced multiple seizures from drug interactions. Oopsie. Not our fault.

Everyone told me I was the one responsible for getting two drugs SPECIFICALLY warned not to be prescribed together. Dr, pharmacist, insurance company, none have liability. I must read the tiny foldout warning paper that folds out to 2' x 3' with nothing but legal and medical language. In 4 point font. Oh, the pharmacy didn't provide that? Oopsie. Not their fault. I should have requested it. You don't even belong in a surgical suite. You shouldn't be allowed within a mile of any medical facility. You, young man, belong in a ditch with a hand trowel (a shovel would be dangerous for you and those around you).

You speak big words regarding pharmaceuticals, but one word is never used, "care". Care for those suffering. You have zero interest in the care of humans. Go back to your lab and create another designer drug, stay away from a forum based on supporting each other as they navigate through hell. I was put on Ketamine for a short period. Wow. No side effects, hopeful, and engaged in self improvement.
As soon as the doctor got that feedback I was taken off Ketamine treatment and prescribed Lexapro. The drug that gave me seizures. To hell with all "drs". You WANT us sick and suffering. If we get better your profit disappears. NEGLIGENCE. I hope I survive long enough to sue you into homelessness. Live my life. Watch the love of your life get murdered. Then come back here with your arrogance.

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