Ketamine For Depression? (Page 32)

It was recommended by the members of a separate thread that one be started that directly relates to ketamine and it's use to treat depression.

If anyone besides myself would like to discuss it's use as a treatment for depression, feel free to post your questions, answers and experiences here.

This thread is an offshoot of a related one that discussed a treatment of Scopolamine for depression.

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REPORT

I could understand how you might think that intranasal ketamine is not faster than IV ketamine. I take that to be your personal belief as you did not provide any citation of authority.

I was merely repeating the scientific findings reporting evidence that:
1. "intravenous ketamine has antidepressant effect within hours" in comparison with evidence that:
2. "intranasal ketamine has antidepressant effects within minutes".

Please see:

Lewis A. Opler, Mark G. A. Opler and Amy F. T. Arnsten. Ameliorating treatment-refractory depression with intranasal ketamine: potential NMDA receptor actions in the pain circuitry representing mental anguish. CNS Spectrums, Cambridge University Press 2015.
(doi: 10.1017/S1092852914000686)

The article cites intranasal ketamine's "ultra rapid" effects and great benefits compared to IV ketamine.

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Md in training. Sir, I do not understand why you find it necessary to keep posting and trying your best to show off your knowledge and education at the expense of "real" people's feelings and those same folk's experiences. I had hoped that you might would just let it go but apparently you just continue. Why?: I think we all agree that you are perhaps well educated and I think that is something to be proud of. Its just that it seems no matter what anyone says you are very quick to talk condescendingly any way you can to that person. I had been learning a great deal of things on this site until you walked in and basically called me and someone else drug addicts and that we exhibiting drug seeking behavior among advising us of our own stupidity and your medical models etc. For one we are all trying to learn about help for depression for most of us have not had the luxury that other s have with other types of antidepressants. From what you have said your only encounter was a clinical trial where they gave you ketamine for same. If you are fighting depression then I must apologize for I am not trying to one up anyone. I would just like it where it used to he where free flowing ideas and thoughts could be transferred. Not a forum to pick fights and show off what one knows or does not know. Its really a shame to see folks not able to obtain any information for after you have had your say people just quit writing in. Haven't you noticed that.? And if you have then you must get off on cutting other's ideas or questions or challenge them at every point along the way. I am glad you know what you do but your constant correcting of folks is not helping. I don't appreciate being called a drug addict for you can't determine that over an online post. Wow. I worked for the FBI for 24 years and they need behavior profilers like that. I am either addicted or dependent on what doctors have given me. I would just hope that you understand that the folks you are talking to here are fighting REAL battles with depression and they do not need an additional comment to spiral them worse. Thank you.

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If I called anyone an addict I deeply apologize. I am not aware of doing so as I have great empathy toward them.

The point of my post was to counter a baseless accusation that my previous post was incorrect, when in fact my post was supported by scientific observations.

I did not see where you addressed the findings I noted. Although quite recent I found them rather interesting in their observation and possible mechanism of action. It grants credence to the experience and observations of many patients. Whether proven and developed over time, or otherwise explained and dismissed, it is an effect worth noting.

As for ketamine, my personal experience is rather extensive but also, by definition, personal and therefore disclosed on a need-to-know basis.

I strongly believe and support discussions of science and fact. Personal experience can inform such discussion but rarely is it authoritative.

As for personal views of others? Until your accusing post I was unaware of them. I will try to be more observant in the future. I wish you success in your studies.

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Deijivan,

The compound I was prescribed is 50mg.ml oral solution. The first time I took it, as I recall, I took 1.5ml, which would be 2mg/kg. The first time I took it was in the doctor's office, in semi-light, and with minimal noise. I find the lack of excess stimulation is helpful when the immediate side-effects kick in. (At home I lay on the sofa with the lights out, and some quiet ambient music) I assume the doctor's office was the location so he would be there if I had an adverse reaction, as well as to reassure me and assess the effectiveness. It took 15-30 min before I noticed anything different, and the side-effects took at least 2 hours to start passing (about 4 hours until I felt normal, the great thing was that it felt normal, not particularly depressed). The side-effects are a nuisance, in that you can't get anything else done, but I've never found them scary or worrisome.

I think it was a week later (forgive my memory, I am having thyroid problems and write this in a bit of a mental fog) that I had my next appointment. I had felt markedly better through the week, with some worsening in the last few days. While the effect was marked it was not lasting the full week, nor completely alleviating the depression at that dose. The second time I was given either 2 or 2.5ml. At the 2.5ml dose the results were more complete.

After we found that the treatment definitely worked, if was a matter of finding the best dosage and schedule for keeping the depression at bay, without it being too high or frequent (which can stop it working, or reduce effectiveness). If I remember correctly (you could look for an earlier post of mine for more accuracy and detail), my doctor said most of his patients found 2-3ml (so 100-150mg) was an effective dose, although some required a bit more.

I'm glad to hear you know a doctor and are able to try this treatment. I hope it works. From my experience, and what I have heard/read/learned about it from others, you will know within a day whether it works for you or not. If I can offer some advice, start low, be sure your reactions are fine before you consider driving (then wait a bit more), take it in a room with no lights on, in an armchair, or sitting/slouching on the sofa, put on some ambient music, and until you know how you will react (and the side effects may differ each time) have someone to look in on you. How intense, prolonged, or the type of weird effects during the first few hours does not relate to how well the treatment works. So if you find a dose that works and sometimes when you take it there doesn't seem to be as much initial sensory effects do not worry that it will be less effective in reducing/relieving depression, just enjoy having fewer side-effects.

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was given ketamine in the ED. They did 5 small injections in between 5 min intervals. They said I should feel the effects for up to 6 weeks. Is it possible to feel the side effects after.

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MDintraining:
Is there a stronger nmda antagonist available on prescription than ketamine?
If there is I would really like to know. And sure nmda antagonism might not be the only way ketamine affects depression but it is surely the prevailing theory.

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Char,

If you are willing to post, I would love to know to what extent the treatment worked for you. I don't know about the experience of others, but personally, I have never had the side effects appear, except within a few hours of taking my dose.

I knew there was some talk about the real benefit of ketamine therapy being in ER situations, but I think you are the first person I've read of who received it this way. I hope you are doing better than when you went to the ER. I don't know if you have tried antidepressants before. Ketamine tends to be used only in situations where other antidepressants (different classes of them) do not work for you. Do you have a plan in place for getting on an antidepressant in the next few weeks? Reading on this site you might get the impression that antidepressants rarely work, but most people do find an antidepressant that works for them within the first few tries. So hold in there, do not give up hope. Some of the most effective (by the numbers) antidepressants are the oldest and least expensive.

Best wishes.

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@stella,

"I could understand how you might think that intranasal ketamine is not faster than IV ketamine."

IN ketamine will never be faster than IV for the following reason: IN ketamine must pass the mucous membrane and enter the blood stream, where IV Ketamine starts off in the blood stream. IN ketamine then enters the blood stream and begins action.

Therefore IN Ketamine will never be faster acting than IV.

I have looked at journals.cambridge.org/action/9533708&fileId=S1092852914000686 and I know what it says, but since that study has been done metabolic studies have shown that IN and IV share the same metabolic pathways so we know the mechanism of action is the same. As a result again you have one method of insertion that has a mechanical barrier in the mucous membranes and one that has none. it is the equivalent of saying that people eat a sandwich faster if it comes in a plastic package that has to be removed as opposed to being put in their hands.

As to my statement being baseless, No your statement was simply wrong and so I corrected it. It still is wrong, but I see how you misunderstood things.

@Chimpshow,

Several have higher site affinities example: 4-hydroxy-2-quinolones as to the rest There are at least 3 methods of action that Ketamine has demonstrated It acts as an antagonist (as you mention and has been mentioned before), deals with Glia inflammation and has an affect on monamines.

@rain,

It is nice you worked for the FBI all those years. Could you please cite, using your FBI training possibly, where I said or even implied that you were a drug addict? I do recall saying that several people were acting in manners that doctors would see them as drug seeking. I pointed it out, as I have already stated repeatedly, so that they can change their behavior to match what a doctor expects and so be able to get treatment as opposed to working against their best interests and continuing to behave like a drug seeker. I respond to these forums the way I do because people put out so much false information. For example IN ketamine acting faster than IV (see above). I also try and give people real and valuable information on ketamine and its effects and methods of operation.

Feel free of course to be upset at me, That is fine, you should however get my gender at least correct, and note that I have both been a recipient and a trial statistician for ketamine/an analogue.

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Although the biomechanics make sense, you might consider that IV ketamine (infusion) is far more dilute than intranasal ketamine. As the mucous membrane is the only barrier to entering the blood stream, the effects could be noticeable more quickly with intranasal than IV (infusion) because the amount of active compound is higher at first with the intranasal. If ketamine is given directly as an injection, however, the ketamine would not only pass into the bloodstream more quickly, but the dose passing into the bloodstream would hit all at once.

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@caiguise If the entire dose were to be delivered at one time as a single block across the mucous membrane, however, it is not.

There are other problems though as well. For example, it is not believed that the efficacy of Ketamine is mental state specific. In other words, ketamine need not be delivered at levels that cause dissociation to be effective. What is required is for enough ketamine to be in the nerve cells to block enough NMDA sites for things to change. So long as the dosage is over that for a sustained length of time, the ketamine is effective.

I suspect that people have different expectations for IV and IN ketamine. IN Ketamine burns on induction, that enough is going to change ones mood. IV ketamine has some time for the ketamine itself to move down the IV tube, though that time is quite small. Having taken IV and IN medications, and having worked with both IV and IN Ketamine I can tell you that regardless of getting 50mg of Ketamine via IV or 50mg via IN you get neither immediately. In the case of IN ketamine, 50mg would be delivered in 8 nose puffs over the course of an hour, 50mg of Ketamine would be delivered via IV over the course of 45 minutes. And at the end you will get 50mg in your blood via IV, you will only get 15-30mg via IN because of the differences in bioavailability.

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I live in Rockland county New York and am looking for a pain doctor to prescibe Ketamine nosal spray for my Complex Regional Pain sydome. I had treatments last week two 4 hour ketamine infusions that worked but was charge $350.00 as a break causse he usualy charges $550. then he sent me to a crooked doctor who said I have lyme on top of the CRPS MS fibromyalagia, chronic fatigue syndrome, degenerative disk disease, my spine is narrowing and I have sciolios siatica, listethisis and a nerve disease. my depression level is beyond resonpable. i feel like Im dying and my pain doctor moved to tx without setting me up with someone before he left. I cant can find a doctor where my insurance covers ketamine if you have CRPS because it was made for that perticular illmess becauise it works. I just cant find a doctor with the courage to stand up for me and treat me the correct way.

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I appreciate how personal experience can seem authoritative but to discount the scientific observations in a journal-published article seems rather unwarranted and disrespectful. When a scientific journal article reports Intranasal ketamine administration appears to product fewer dissociative side effects and an"ultra-rapid" relief within minutes (relief not merely a drug-induced "high"), and then goes on to relate the clinical observations and suggest theories that allow this "ultra-rapid improvement in mood." If one disagrees with scientific findings, they should use science to counter it.
Regarding one's personal experience as to whether an intranasal application "burns" or not may vary with the individual and depend, in no small part, upon the compounding pharmacy. Certainly, dissolving ketamine at maximal concentrations is simply distilled water is likely to be unpleasant to many patients.
A good pharmacist can prepare IN doses with different buffering solutions until a preferred formulation is found. Patients may also wish to explore different ketamine concentrations until they find one they prefer.
As some have previously posted, it appears that doctors prefer the IV ketamine treatments. How much of this preference is due to the greater profit generated by the IV treatments is unknown but seems likely.

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Stella said: "As some have previously posted, it appears that doctors prefer the IV ketamine treatments. How much of this preference is due to the greater profit generated by the IV treatments is unknown but seems likely."

Or the fact that there has been 0 research on the long term effects of IN Ketamine in depression. I repeat 0.

No clinical trials, no published articles nothing. So when the DEA comes knocking, I know I was to be able to point to published evidence that says this is how you treat refractory depression according to the medical journals. Not "Well I thought it was a good idea and it seems to have worked for the patients I have seen."

Why people want to assume all doctors are greedy rather than looking at the arguments that have already been expressed, I do not know.

As for Mary... It has nothing to do with bravery if you have CRPS then you need to see a pain specialist. If you want Ketamine for depression, do not go see a pain specialist, go see one of the 20 or so Psychiatrists that treat depression with Ketamine, but expect to pay 300-1000 per infusion because that is what is being charged. If you are fortunate enough to have an insurance plan that covers experimental treatments, then you are lucky. The vast majority will not cover things that have not yet passed a stage 3 trial, which BTW Ketamine has not yet passed a stage 3 trial.

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That is very true. I went to see Dr. Glen Brooks who originally charges $550 but gave us a break for $350.00. He only did two infusions because he said he thinks I have Lyme also and sent me to a Dr. Daniel Brooks who charged $850.00 to tell me I did have Lyme without blood tests. My primary care researched this Dr. Brooks and found him to be a scam artist. Waiting for the results to see whaTs what. The infusion lasted 6 days until someone upset me pretty bad. It probably would of lasted longer if that had not happened. Also found out that my insurance doesn't cover ketamine nasal spray and the on it does thatS in the same family is profosol. Hope I spelled that right. It just kills me that there's a medicine that made me stop thinking about killing myself and I can't afford it. My parents were helping until they found out we were conned.

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Mary, I don't think you were conned. MD in training and Caiguise seem to be the smartest guys to ask what is up. As for being conned there is nice doctor in Oregon that does infusions and they are sort of expensive. He told me that after an infusion the IN Nasal Ketamine would work better. I think you are on to something for when you said it was the first time in a long while you did not want to kill yourself and you can't afford it. I understand what you are saying but you are worth more than anything so try your best not to think that way. The nasal spray I am given for pain compounded costs me around 50.00 out of pocket and to me its worth every penny of it. I am not educated like MD in training and Caiguise are but I will try to say please work on getting your nasal spray somehow, and perhaps it will work on you the way it does me. It gives me a different way of looking at things instead of thinking about the things that can hurt us in life. Your worth so much more than that. Right? Yes.

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I actually know Dr. Brooks, though I am not associated with his practice. He is not a scam artist. There are a few Ketamine doctors who are simply in it for the money, but He is not one of them. Ketamine is a late term treatment for him, He prescribes Oral Ketamine for long term patients, though a few get IN still. Our patients report to us that IN Ketamine costs less than $100 a month here in our state, and that is shipped to them.

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Sorry made a big mistake I need to correct. It was not Dr. Glenn Brooks that scammed us but the Lyme Doctor he sent us too Dr. Daniel Cameron. I apologize for the mistake.

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FYI, I have no personal experience with IV ketamine (infusions) because, although there is more published information on their use, I do not know of anyone using this form of treatment in Canada. There are few planed studies of ketamine treatment for depression in general because it is already on the market, and has been for decades, so there is no funding for studies.

I have, however, been treated with ketamine compounded as a liquid(suspension), and for many months was taking it with a nasal aspirator. I had fewer initial side effects that way, but the necessary dosage wasn't different for me, and I found the efficacy more erratic. I suspect using a neti pot (snot pot) to remove excess mucous might have made the results a bit more predictable. In theory taking it nasally should reduce necessary dose by up to 50%, but most of my stomach is gone and the remainder does not produce much acid to break ketamine down. I am back to taking the liquid orally, and I find this method works well.

Mary, I hope you don't have Lyme disease. Illnesses that make you sluggish complicate the picture and it can be hard to tell which symptoms are depression and which are not. I'm in a similar boat right now, as my thyroid is on the fritz (we are still assuming it is just thyroid levels that need adjusting). All I can suggest is what I am trying to do, see if you can explain what is different about the way you feel now, compared to previous episodes of depression. Do you feel cruddy all day, or better in the morning, when previously the depression was worst in the mornings? Eating patterns? Apathy? I'm finding that I generally have no energy to do things, but when the ketamine wears off it is also apathy in that I don't care if I accomplish nothing. So the depression part, for me, seems to include apathy and the hypothyroid seems to include more exhaustion. Sorry I'm not on the ball, but if you have been treated with ketamine and it made a difference then highlighting that change to the doctor should be good evidence. Is there any reason why ketamine would improve symptoms of Lyme disease? Have you tried explaining that if it is Lyme disease and depression then even a partial improvement helps you keep treading water (or other analogy) until the Lyme disease issue is resolved?

Mary, I hope your doctors are able to find an answer, and soon. In the mean time, have you considered reading up on depression symptoms and making a list of your own pattern this time, and what you remember of how it differed in the past? I'm not getting on-line too often right now, but I'll try to look for your posts. Best wishes, and hang in there.

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Thank you for your kind words caiguise. I see a pain doctor but he is away and not back until July 1st. My psychiatrist has been sending patients for ketamine research trials and said he doesnt know enough to prescribe it to me IN. still no results from the Lyme test which was a week ago today. My depression and anxiety is at an all time high. Im in a rather bad situation as I have to stay with my parents who have come out and showed me that they dont love and trust me but just love and trust my brother. I know that has nothing to do with ketamine but the heartache it has caused me has me thinking constantly of leaving hear. My parents also payed for the two ketamine infusions and promised we would go back no matter what and then discussed it with their golden child and told me they are not going to help me now. I am on disability and there is no way I can afford the treatments without their help. I felt good for six days after the two four hour infusions and had I not found out mother lied to me I am sure it would of lasted longer. those six days where the best I have felt in my entire life. I would literally do anything to get this medicine again and feel like a normal human being. I make jewelry as a hobby but have lost interest in everything. Im so tired and drained Im going to sleep at 8:00PM every night. also as an escape. Its just so hard for me to get through my head that there is a medicine out there that made me feel like a normal human being and it is just out of my reach. My family is punishing me for having a nervous meltdown 3 years ago when my psychiatrist cut me off my abilify instead of weaning me off. I was put on Lituda and did very poorly and ended up in the hospital and loosing most of my family and still being punished for that by my parents. I thank you so much for responding to me. I know Im a good person and shouldnt let the opinion of sick people matter so much but when its your own family the mental pain is unbearable and the physical pain I cant even describe but I know your in the same boat if you have thyroid disease. I will pray for all us who suffer from these horrible life altering diseases.

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Mary,

So you do beadwork/jewelry making too! I find it relaxing to create things, and it is really disturbing when my apathy level goes up so high that I just drop doing these things. The neuropsychiatrist here who prescribed ketamine for me is moving away from prescribing it. As far as I can tell it is a matter of workload, and that he feels it is well enough established for the regular psychiatrists and GPs to handle the treatment. If you email me at {edited for privacy} I can send you three documents he prepared for other physicians. It includes a detailed description of the protocol he uses, which is for oral tablets. A good compounding pharmacy should be able to make up the tablets.

I understand what you are saying about wanting to feel ok again. While ketamine can work spectacularly well, I find that when it wears off it is rapid and shifting within a day (once it was four hours) from fine to depressed is a real punch in the stomach. Hopefully the written protocol can help your doctor feel more comfortable with the possibility of trying you on ketamine.

Have you tried some of the older antidepressants? Tricyclics? Or mirtazepine? Another possibility is looking into rTMS therapy. It is the treatment that works best for me, as well as ketamine, but continuous for a week at least and with no side effects. There may be trials in your area, or if you are on government health care check if it is covered.

In the meantime, hold in there. I'm glad you still know you are a worthwhile person, no matter how your family makes you feel.

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