Ketamine For Depression? (Page 33) (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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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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@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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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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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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Almost forgot,
I just read "used up" s post. I am sorry for what you are going through. I wish you much hope in your upcoming years and am as sincere as I can be. Also, I think you should take up writing as you said so many of the things I wanted to. Your talented. I wish all of you well and thanks for everything. Many of you really helped me. Thanks again for that.

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Caiguise:
Sir, I'm just a stupid old man but wanted desperately to say this. During a long life, one can perhaps hear a lot of BS. And then somehow, as if the clouds open up, the turbulence stops and after a lot of debate one person, at one moment stands up and speaks the words of truth basically in 2 of 3 sentences that should put an end to all future debates. Reminds me of a town hall meeting somewhere during the Clinton administration where folks were standing in lines to ask the President a question regarding the drug situation. This sweet african american lady stood up and stated to the whole crowd that we do not have a drug problem in this country; people have serious problems that quite often result in drug abuse. Wow, and that to me said it all. So did you. Take care guys, Keep up the fight.

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@caiguise It is not your sandbox, and you are free to leave whenever you want to. Don't like what I have to say, you are free to do that also. Really doesn't make a hill of beans difference to me.

I am consistent. On one hand I describe my philosophy of psychiatric care, on another I describe the current philosophy of psychiatric care. They are two different things. I can say though that many of the dangerous complainers in this conversation are going to have to seek a 3rd option because they are not going to get medical treatment that they want from either the most common kinds of doctors, or from the model based doctors (such as my upcoming residency group) because the risk does not justify the effort/return. Doctors, outside of sanitariums/ residency clinics do not tend to help people in spite of the patient. I will finish my residency and already have to turn away people who will not fight me to get them well, why am I going to put people who want help out on the street looking for help to help someone like 'used up' or 'md' ?The answer is I am not going to, unless I am one of those residency type doctors. you say "As for your insulting of other people; if you can't play nicely get out of the sandbox. People are looking at this bbs because they (or someone they care about) is suffering. How would you feel if you were depressed, looking for help, and ran into someone who gets his jollies kicking people when they are down? " I say you are full of fecal matter. I don't get my jollies on kicking people down and have never put anyone down on this board. I have pointed out that they are behaving like a drug seeker and that this is why they are not getting help.

You go on being offended by my comments though, when they finally listen to me, someone being honest with them, they will be able to find a doctor to help them, be it with ketamine or some other drug. While they listen to your prattle, they continue to be in pain and suffer. So which one of us is kinder? Me. Which one is nicer? You. Your niceness is helping them to continue suffering though

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Training MD, when I thought about you I was reminded of the Park bench in Boston where Robin Williams delivered a great exchange with Matt Damon in the movie Good Will Hunting. As well as one's motive for even writing in this room. So, hate that you feel how you do but that is your business. I sincerely hope that you are never subjected to serious pain issues that you face every time you open your eyes. It may make you feel different, who knows. Its nice to know that a doctor would just turn his nose up at someone "like" me relying on remarks made online. Wow. But I think that is the norm. You have to protect your license from folks like myself ? I guess it would be best to check out now as oppose to believing in my doctor for help. Times have really changed for I thought I should be truthful with my doctor. "I'm sure you read Oliver Twists" and that sums up the rest of my life. You all take care.

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I have recently been doing IV Infusions and just started the nasal spray. I would have to say the nasal does not even compare to the experience you have with IV. The IV was expensive though at a package of 6 sessions costing $3000! I was told the nasal should be used after IV infusions as a maintenance and then followed up with quarterly infusions.

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Heather,

I'm curious about the difference between IV and nasal spray effects. I've been on an oral suspension and a nasal insufflator (intended to deliver it to the walls of the sinus). Both are effective, but for some reason the nasal route produces fewer immediate perceptual side effects, and a longer period of grogginess. Do you find IV and nasal spray have different initial side effects as well as the nasal seeming less potent (or is it helpful for a shorter time)?

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"Who lives with severe depression for years, cannot rely solely on medical protocols to try off-label drug that is likely to help. "

Who does not takes their foolishness to their own life.

Uruguay has it legally and is next door to Brazil.

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Ketamine antidepressant effects stems from the fact that it is an nmda antagonist. Ketamine is probably the strongest prescription nmda antagonist but there are others if you cannot get your hands on ketamine. Memantine and riluozole for example. But if you are willing to take a risk and go past the approved drug list there are research chemicals that are as potent as ketamine and can be obtained legally for a fraction of ketamine cost. The best example is MXE. MXE is a research chemical, not for human consumption. But... Anyways just sharing the information for those in desperate enough depression to be willing to risk such things.

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