Ketamine For Depression? (Page 31) (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.

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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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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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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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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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Howard,

I looked at your earlier posts. What you are doing for your son is downright heroic. Is the government helping in any way, even if giving him disability status so he can be claimed as a dependant? Have your doctors found a way to help with the anxiety component? Buspar/Buspirone seems to be a common choice because its side effects seem relatively benign. But a traditional benzodiazepine, such as klonopin/clonazepam or lorazepam might help with the anxiety and because it can be noticeable when it starts working and wears off, your son might be more willing to take it.

Have they tried methylphenidate/ritalin for the depression? It used to be used that way in the 1960s and 70s. It doesn't seem to reduce the anxiolytic effects of clonazepam (at least for me), but it again has a noticeable period of effect, and can be a mood elevator. I have taken it periodically when depressed, and my mood was worse in the morning. It got me functioning until noon, by which time I was able to cope a bit more. There are some theories that depression is part of the autism spectrum, basically that it is a reaction to excessive stimuli in certain situations. Ritalin seems to help my husband cope with excess stimuli, so it may be worth asking your doctor about trying it out.

I really hope that you find some answers soon. It would be great for your son, but also seriously reduce the stresses in your own life. Getting to be an irresponsible adult once in a while can be quite fun. Or so I understand. Got to get back to my kids.

Let me know if the nitrous oxide helps. Best wishes,
Cai

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Kris

You can google "pain management specialist". There are some in the southwest; San Diego and La Jolla. This may be edited, but please post if you are successful or not. Also feel free to contact me at {edited for privacy}.

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Kris,
I'm curious, have you ever tried Buprenorphine? I've been battling severe chronic major depression for the past 30 plus years(the past 10 have been the worst). I've tried over 25 different antidepressants, ECT and TMS, but the response I've gotten from Buprenorphine is the best so far.

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Hi,
I'm very interested to see how things are progressing with the nasal Ketamine treatment.
I live in South Carolina and have no easy way to get to any doctors in that area to seek treatment.
I've been on the usual Paxil, Zoloft, Lexipro type medications with some help with depression and anxiety. Unfortunately, these drugs have so many dangers associated with them (most of all Serotonin Toxicity/poisoning) of which I've been hospitalized twice. These antidepressives are dangerous if mixed with just about any other medication and doctors have no understanding of these risks.

My question is, what brand name, if any, does the inhaler go by? My pain management doctor and psychiatrist both would like to know more. Are they just Ketamine inhalers? What brand name and dosage are you on? We need to get the word out to the East Coast where we are still in the stone age of prescribing Advil for broken bones and Tramadol with Cymbalta for chronic pain (these sent me to the ER where they assumed flu due to my 104+ degree fever and muscle tremors.)

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"Any idea of dosage in the inhaler?"

It depends on ideal body weight your doctor will need to decide what protocol he wants to use and go with that. That information can typically be found by going to clinicaltrials.gov searching for ketamine, finding a ketamine study then contacting that study for their protocols.

I am not trying to be round about, but the reason for the current clinical trials of IN Ketamine is in fact to determine dosage per ideal kg of body weight. It will also show certain other factors that affect dosing.

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The doctor who suggested god punishes sinners with depression should lose his or her license. I am glad you did not buy into that.

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I wanted to message a member directly but I think it's edited out..
Thank u! For responding. I have tried suboxone with minimal results.

I just have a feeling this will work for me. I called the compound pharm. In Illinois and they won't even tell me who prescribes it!#!!

I just want to know who prescribes the nasal.ketamine in illinois....it's unbelievable that this is so top secret :(

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Formatting paragraphs are your friend.

Doctors charge 350 for a ketamine infusion that costs 50 dollars for the Ketamine because they also have to:
-Pay a nurse to watch you,
-Prep for an audit because Ketamine has not been approved yet
-Pay the rent/ utilities/ advertising / overhead in general
-Pay for the disposable supplies like IV Bags
-Pay malpractice insurance
-Pay for numerous other miscellaneous expenses
-Pay off that practice loan
-Pay off their college loan
-Actually make a profit.

Think about this before you go off on a rant: If Ketamine worked for everyone and you could sell it at a 700% markup that was pure profit with no oversight, why would any doctor not prescribe it?

If it is as you describe, then why not go find a doctor who does not prescribe it and go into business with them and make a fortune selling IV infusions at 'only' $300 a pop?

Medical supplies are only part of the issue. Like driving a car. In the US it is estimated the cost of operating a car is ~58c per mile. Even when gas was $4.00 a gallon, that only equates to 16c per mile if you got 25mpg. Where do the other costs come from? Depreciation, maintenance, insurance, time etc. Same thing with a doctors office.

Otherwise take the $4200 that 12 iv transfusions would cost and fly first class to Uruguay where drugs are legal w/o a scrip and do it cheaper then spend the rest on a vacation. Or sponsor a medical student through school...

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Thank you for the lesson in paragraph creation. My rants are that doctors such as perhaps yourself get so regulated by DEA that do not have the education or knowledge that you possess when it comes to treating your patients however every one of you bend over to Drug Enforcement Badges telling you limits on treating your patients. Since it appears I am in the dark about business then perhaps the public should just go to the DEA for healthcare and treatment since they regulate most physicians anyway.

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You may want to chart the type and extent of response to each of those meds. Antidepressants can work in different ways. If you track partial responses and non-responses it might help you and your doctor figure out how your depression is related to production/uptake/use of serotonin and/or dopamine and/or norepinephrine and/or the glutamate system.

Best wishes. I hope you quickly find a treatment that works, and remember that they are still coming up with new treatments. Do not give up.

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I really understand what you are saying about putting a bullet in his head but don't do it. And don't put one in your own either.. I can really relate to what you are saying for sometimes they need to stop and think that "we" did not ask for this type of life. You try your best and when it comes down to it the DEA is telling doctors what they can and cannot do. I thought that doctors took an oath to help people. To me they practice more of "covering their ass" as oppose to covering the well being of their patients. Its not that I am knocking doctors for when they have allowed themselves to be controlled by the DEA, insurance companies or whoever they are blaming it on this week they are allowing patients like a lot of us to slip through cracks except the cracks that they are allowing you in are potentially life threatening. Why has the time went by that we cannot sit down with out doctors and talk to them and learn from them the way we can deal with what is ahead of us. Life is hard enough without having to deal with a doctor that is controlled by a government agency telling them what to do. I have a friend that went to AA for 14 years and stayed sober yet the doctors in this area shy away from prescribing the man anything that would really help his pain. Instead they throw stuff like gabopentin or whatever at them and pray it will suffice. Well 9 out of 10 times it does not. Part of the reason that we seek out a doctor is for their knowledge of an illness and the right way to control or help the patient live their lives. And before you go pointing guns remember that the people you are dealing with find it quite easy to make predetermined judgement calls about your health instead of doing the right thing and "taking the time" needed to understand what you are going through. It makes you wonder if all these doctors are sitting their cocked and ready to find anything they can "not" to help you. Lets say you smoked a joint or ate some dog crap because you were told that would stop it from hurting. Then, most of these doctors have already been told by the long arm of drug enforcement that they are watching their prescription writings so instead of getting the help you need the doctor still takes your money yet is more worried about keeping theDEA happy than their patients is unbelievable. Perhaps if some of these drug enforcers that push physicians around had a great deal of pain themselves and had to go through it then they may understand.

Same with nurses (some of them) compassion and understanding do not exist in their vocabulary and they actually exhibit signs of jealousy that a certain patient is being prescribed narcotics. The whole medical community at times seem to have the idea that " ahhh,,, your not in that much pain" . Jesus, where does it end. I wish I had a t shirt that said HELLO, dope addicts have pain just like folks that aren't!!!!! If anyone thinks that folks in pain are just overreacting and trying to find drugs then they have not ever been in pain in their lives. Don't they understand that none of us choose this crap?????? I don't know about others but I would rather be shot myself than have to live in this pain filled life but before I do that I would have to exhaust every channel I could in finding a doctor that honest gave a damn about your well being. And then be prepared for their childish pill counts, U/A's or any other "control" measures they can find for they feel we are selling our meds I guess. when I read your post it saddened me for I know in a way how you feel. All I can say is start calling different doctors until you find one that will actually shut their mouth and "LISTEN" to you about your health. Your the important issue here and doctors have just stepped aside and allowed government agencies scrutinize their judgement. I wish there was a way to speak with you re this but I do not know how to offer address on here to talk. Just please don't pick up those guns for when you do someone normally gets shot. You don't need that on top of the rest of this crap. Im nothing but an old man and tired as it seems you are of being told how we are feeling when they do NOT really know. Everyone is NOT alike but they are important as you are and their feelings as well. Hang in their and hopefully some help will be in your future soon if you start driving at it hard. And understand that these metaphors are as screwed as they come. When an animal is in unbearable pain they at least put him out of his misery if they can't fix them. Why do they have to treat us so different. And why do doctors allow the DEA to tell them how to treat their own patients. War on drugs my rear end. Our CIA has been the largest H for Vietnam and Coke Distributors for S America that have ever played the game and they do so to fund their covert ops around the world. Not caring that their products spills right out on to the streets of the United States and harms our citizens and then thrown them in jail for using them. Oliver North had a lot more he could have stated about Barry Seals C-123 loaded down with coke that came right to the US streets but since they are involved in their cloak of National Security it gives them the right to sell their drugs, screw up lives and them jail people for using them. The same way I could never understand if marijuana were so illegal why did the govt always allow the sale of rolling papers and bongs etc. Double standards for everything and I wish there would be enough of us that have just had enough.

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