Ketamine For Depression? (Page 34)

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've been following this thread for quite some time but haven't posted. I'm happy that caiguise, Mary and Mark are doing well. I pray that you all continue to receive the benefit of Ketamine. I'm a TRD sufferer like you all and am exploring Ketamine as an option having tried a host of antidepressants, ECT and rTMS. I'd like to stay in touch with you all. My e-mail address is {edited for privacy}. Best wishes for a bright depression-free future, Taz.

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Iron, as you can tell I am either passionate about what I am saying or I run off at the mouth a bit. Caiguise is the talented one in here unless MD in Training stops by. Thank you for your kind words and the same back to you. I hate that you or anyone goes through this life not fitting in and feeling good enough. When truthfully we should all want what is rightfully ours and to enjoy those inalienable rights Thomas spoke of in that preamble. I wish you along with anyone that has stumbled down this long road of feelings and I hope you get the opportunity to give ketamine a chance. It was basically prescribed to me as a compounded nasal spray for pain relief yet noticed in a week at the most my depression of many years left me speechless to the point of saying. Wow, is this what the rest of the world feels like most of the time. And all of our lives are very important so do anything you can to investigate what you can regarding some type of treatment protocol that utilizes this. Good luck man, and if there is ever anything any of use can do we are usually here. They say educating yourself makes you over half the way through it. Godspeed man.
take care
mark

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Thank you Mark.

To folks for whom Ketamine has worked, are you happy with the use of intranasal route/tabs/capsules/torches indefinitely until booster treatments are needed? Has anybody done some research on the long term use of Ketamine on the liver/bladder? I'm definitely leaning towards getting Ketamine but wanted to know the full spectrum before signing up for it.

Many thanks in advance for your input.

Regards

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Thank you Iron for your good wishes. I will contact the site to share my email with you. Please do look into the ketamine treatments. This past Monday I received a 4 hour treatment from Dr. Brooks in NYC and again my life was saved and my pain is now tolerable and my mind is at peace again. Came dangerously close to leaving here but Dr. Brooks quick reply to my cry for help gave me the strength not to go through with my plan and wait the two days for the ketamine treatment. It is truly a miracle that I am still here. Last time I tried to take my life I saw a darkness so scary that it had been saving myself. Things had started to get so bad in my personal life that that scary darkness started to look comforting and inviting and much better than staying here and suffering. I know that was pure evil trying to take my soul to eternal hell which there is no co ing back from. For 5 years I have been being abused by my 24 year old daughter physically, mentally and financially. I have tried everything and anything to remove her and also her abusive boyfriend from house. From orders of protection to commitment letter to Adult Protective Services with no results. Finally after being turned down by Legal Aid 3 times I contacted the head of Legal Aid in my county and he is going to help me and she will be served by this Monday. She and the boyfriend have already pretty much destroyed my beautiful home and once she is served I am sure will do much more damage until she is taken out of my home. Only because of the ketamine infusions and all the support I have gotten on here and through facebook groups have I found the strength to fight again and finally get help. My daughter is the one who actually gave me Complex Regional Pain Syndrome or RSD by assaulting me this past January after I was already disabled with MS, Fibromyalgia, PTSD, a brain injury from ECT, with a concussion also from my daughters assault. I'm leaving about 20 other things as to not make this longer than I already have. I consider myself very lucky to have you all here and owe my life also to the people that have gone out of their way to keep me informed and to make me feel cared about. The kindness showed to me is something I will never forget as long as I am on this earth. Much love and blessings to all of you.

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Hi everybody, I have sent a message to the site to share my email address and full name so anybody can contact me on facebook or by email. All that needs to be done for anybody who would like to have more private contact and to write to the site also and ask for my information. Thanks again and wishing everyone a pain free day.

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To all of you there is never no thanks needed for the words that I say. Don't get me wrong I say every one of them from my heart and I mean them. Its just that it saddens me deeply that so many folks are having such ongoing struggles in their lives they get to this point a lot of us ( it seems ) in this room have found their lives. Mary, I wish you well with your daughter and boyfriend. I have 25 years experience in renting my own properties and if you were near I would have fun getting them legally removed. From what I think I have read is that you sound a bit like me. You try to be so kind to people, and then you find out what there real initiatives are. I won't pretend I know what it's like to have children for I don't but from what you say I am sure you have more than your hands full. One thing that might help is this list of assertive rights that I am copy/pasting for you. Maybe they will help you somewhat. They are very true and can provide you with strength when you need it the most. I guess I would not say this but when I hear a friend speaking of taking their life then it concerns me for I know that it is so easy to feel that way. I am basically what you would call an "empath" person at times where I take on folks that I am close to's problems as if they were my own. I don't know why I do it but I do. I really care about people that probably don't even know me. ( Isn't that weird")? I just hate to hear the struggles you are having to work through and believe it or not it makes me realize how thankful I really am for this life that I have not always wanted. I understand about being beaten down both emotionally and financially. I guess the only thing this old hippie could say to you or anyone is believe in yourself. You are worthwhile to anyone. You have something to add to this world. And with you reaching out to try to get help speaks volumes to me that you are trying which I have heard is half of the struggle. I sort of got sick after making 300K a year for a good many years and was too stubborn to accept disability. I kept thinking I would get better. Still, I believed in my abilities enough to know that I would make it. Well, for a few years now I haven't and my wife has carried some of the load. I can't explain the guilt that goes with that. She was use to going on expensive vacations and having what she wanted and now that is not the case. I am very ashamed of that and each day find it harder to force a smile about what has happened. And I have tried so hard with this 22 year relationship. At times I understand what you are thinking about but please don't do it. Your life will change and can do it in a days time sometimes. Just keep trying. Never let anyone manipulate you or make you feel guilty about anything. It will get better I promise.
"IRON" you read right when you read something about kidney or bladder functions being affected because of ketamine. Caiguise is the smartest in here if you want my opinion and I bet they can help you with some of that. Mary, here are those assertive rights and I hope they are of some help.
Mark
Assertive Right #1: I have the right to judge my own behavior, thoughts, and emotions and to take the responsibility for their initiation and consequence. The behavior of others may have an impact upon me, but I determine how I choose to react and/or deal with each situation. I alone have the power to judge and modify my thoughts, feelings, and behavior. Others may influence my decision, but the final choice is mine.

Assertive Right #2: I have the right to offer neither reason nor excuse to justify my behavior. I need not rely upon others to judge whether my actions are proper or correct. Others may state disagreement or disapproval, but I have the option to disregard their preferences or to work out a compromise. I may choose to respect their preferences and consequently modify my behavior. What is important is that it is my choice. Others may try to manipulate my behavior and feelings by demanding to know my reasons and by trying to persuade me that I am wrong, but I know that I am the ultimate judge.

Assertive Right #3: I have the right to judge whether I am responsible for finding solutions to others' problems. I am ultimately responsible for my own psychological well-being and happiness. I may feel concern and compassion and good will for others, but I am neither responsible for nor do I have the ability to create mental stability and happiness for others. My actions may have caused others' problems indirectly; however, it is still their responsibility to come to terms with the problems and to learn to cope on their own. If I fail to recognize this assertive right, others may choose to manipulate my thoughts and feelings by placing the blame for their problems on me.

Assertive Right #4: I have the right to change my mind. As a human being, nothing in my life is necessarily constant or rigid. My interests and needs may well change with the passage of time. The possibility of changing my mind is normal, healthy, and conducive to self growth. Others may try to manipulate my choice by asking that I admit error or by stating that I am irresponsible; it is nevertheless unnecessary for me to justify my decision.

Assertive Right #5: I have the right to say, I don't know.

Assertive Right #6: I have the right to make mistakes and be responsible for them. To make a mistake is part of the human condition. Others may try to manipulate me, having me believe that my errors are unforgivable, that I must make amends for my wrongdoing by engaging in proper behavior. If I allow this, my future behavior will be influenced by my past mistakes, and my decisions will be controlled by the opinions of others.

Assertive Right #7: I have the right to be independent of the good will of others before coping with them. It would be unrealistic for me to expect others to approve of all my actions, regardless of their merit. If I were to assume that I required others' goodwill before being able to cope with them effectively, I would leave myself open to manipulation. It is unlikely that I require the good will and/or cooperation of others in order to survive. A relationship does not require 100% agreement. It is inevitable that others will be hurt or offended by my behavior at times. I am responsible only to myself, and I can deal with periodic disapproval from others.

Assertive Right #8: I have the right to be illogical in making decisions. I sometimes employ logic as a reasoning process to assist me in making judgments. However, logic cannot predict what will happen in every situation. Logic is not much help in dealing with wants, motivations, and feelings. Logic generally deals with black or white, all or none, and yes or no issues. Logic and reasoning don't always work well when dealing with the gray areas of the human condition.

Assertive Right #9: I have the right to say, I don't understand.

Assertive Right #10: I have the right to say, I don't care.

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IRON, One thing to know is I am no medical person whatsoever as if you could not tell from my typing. Secondly, you are the best researcher their is so keep up the good work. What I did want to say to you was that I have never been able to afford the ketamine treatments. The most I have to work with are what my doctor prescribes me in a nasal spray. It does not last long but looking at it all I think that is my way of doing things since there is no way I can afford to pay a doctor some 3000.00 out of pocket for infusions of a drug that has little costs to it. Im not saying that the doctors or the infusions are not worth it. I know they need to make a living too. Its just that the infusions doctors I have spoken with are very kind and knowledgeable however they are so out of my price bracket, it s beyond me even considering at this point. To me I think that having it over the long term or whatever the recommended amount for X amount of months or until you get your stuff back under control to me seems more affordable but that is me. Plus they are giving me this for pain. I am the one that got them to up it a bit for it brought a 40 year depression under control in a week. Go figure. Sometimes it can be upsetting to know that there is a drug or compound that has the qualities "in my eyes" to really help and you have to go through the ends of the earth to find help with it. Finally , I think I have. Good luck to you. Thought this may could be of help to you.

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Ironsheikh,

I have never had ketamine infusions, only a liquid that I take either orally or with an aspirator (to take nasally). Our medical system in Canada makes in-clinic/hospital treatments like infusions inaccessible, so the few people I know of who are prescribed ketamine take it orally (most as capsules made by a compounding pharmacy). The upside is that the cost is far lower, the downside is that most people have to take a dose twice a week, or every three days. I have taken it for over a year (with a gap of a few months) with no unexpected side effects. The only weird thing is that it stopped working once, probably because the pharmacy did not compound it properly. I switched to a more experienced pharmacy and the problem went away.

Regarding long-term risks. I generally avoid taking meds that have not been on the market for a few years, and tried finding out what I could before starting treatment. Ketamine is used medically as a field anesthetic because it does not depress breathing, and for children because it also has a generally calming effect. I think it is still on the World Health Organization list of core medicines (these tend to be long-used, inexpensive meds with few problematic side effects, that are considered the basic necessities for a medical system). It you look on Medscape for articles on ketamine and risk/safety you will probably find what I did, that the information out there is on long term use in addicts, it does not cover lower-dose and less frequent use for medical purposes. From what I remember, there is a small risk of bladder problems (I don't know if this occurs at lower levels, but be aware), but generally the problems occurred in people who were taking large doses more than three times a week. I'm not sure what dose they used as cut-off for 'high levels' but I assume abusers take it for the dissociative effects, so it should be higher than the therapeutic dose. There is apparently a risk that ketamine will reset tolerance to some pain meds. I posted a note about this about two months ago. Basically, if you are on higher then normal doses of pain meds you need to be very careful, as after ketamine treatments you may respond to that higher dose as if you had never developed a tolerance, therefore putting you at risk of overdose.

Hope this helps. If you do find more information, please post a quick note. I hope you find a treatment that works well for you.

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Dear Rain,

I have read your message over 20 times already and still can't find the right words in my mind to thank you. Just the fact that you took the time to write all the encouragement to me overwhelms me beyond words. You have helped me a great deal. I have written several emails to the site and do not see them anywhere so I pray you receive this. I have also given them permission to share my real full name and email address. People who want that information just need to write into the site and ask, and they will receive my information. You're an amazing person as are the rest of the people in this group who have literally been saving my life. My infusions seem to last 5 or 6 days and then I am right back where I was. God has sent me an angel who will be giving me another infusion tomorrow morning. Although the physical and mental pain is out of control, you have brought me much needed comfort and hope. You are forever in my prayers and I know God will Bless all who have reached out and literally touched my heart. Mary

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Dear Mary,

I'm super happy that you are doing well. Im also very happy and impressed by your positive attitude and belief in God.

I'm planning to undergo ketamine treatment with Dr. Brooks most probably starting next week based on your strong recommendation about him. Who knows, we might bump into each other.

If not, I'd be game for seeing you somewhere if the feeling is mutual (hopefully) :) knock on wood.

Many blessings and prayers for all especially Mary,
Iron

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I don't know how old this thread is or, if anybody will even see my questions, much less answer them. But, I'm going to throw them out there anyway and, see what happens. I have been reading up a lot on scopolamine for depression which led me to reading a lot on ketamine for it as well. Both sound very promising. A while back I googled treatment resistant major depression disorder and that's what led me to scopolamine which, I was already a bit familiar with because scopolamine is in the same family as belladonna and hyoscyamine which I usually take for colon spasms. (although I haven't been to the doctor in some time now)
Anyway, for a long time now, I have been really wanting, or NEEDING to try something different because over the course of my life, I have tried just about everything else there is from A to Z and STILL haven't landed on the right medication or, combination of medications.
To get to my question (finally ??) I am really sick and tired of being sick and tired and, I am looking for a new psychiatrist.
My question is, how do you tell the psychiatrist that you want to try this medication, particularly ketamine, without sounding like you're "drug seeking" or, asking for the scopolamine that is still in clinical trials for the treatment of depression?
A lot of doctors, I'm sure, would not be ready to just write a script for something that's still being researched, for some person that walks in and says they would like to try it.
Do I look for a particular psychiatrist? Does Medicaid pay for scopolamine or ketamine? Where would I go to get the medicine, just any pharmacy or, a compound pharmacy? Or, do they give it to you at the doctors office? How is the ketamine taken, is it in pill form?
Okay, I think that's all my questions. I really hope somebody answers but, lol I really don't expect it. Haha oh well. I'm still going to ask cuz, I didn't find a million places that were discussing this topic.
Thank you in advance to anyone that actually reads this and provides some useful information.

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Nihilissa,

The issue of finding the right doctor is a major issue. Even with common antidepressants, whenever I moved or changed insurance and had to get a new psychiatrist there was a good chance that she/he would look at what I was taking and want to switch me to one of the meds he/she was more familiar with. And ketamine's mechanism of action does not fit well with how some doctors think about depression, as well as the issue of generally associating it with drugs of abuse. I'm not sure how to approach a doctor, but I think I would phrase it in terms of their feelings about 'evidence-based' medicine, rather than theory-driven. Ketamine is sort of like ECT in that it was found to work, then studied to figure out why (admittedly even the first anti-depressants were discovered this way, because they improved mood in people taking them for TB). The neuropsychiatrist who tried me on ketamine is an amazing researcher, and was able to explain some of the initial side effects in terms of which regions of the brain were doing what, but even then the explanation is incomplete. Personally, I suspect part of the way ketamine benefits me is partially the benefits on PFC neurons that have been stressed for too long, but also that it starts and stops an inflammatory cycle, and I used to have high inflammation markers (for years).

Any physician can prescribe ketamine, so if you have a good relationship with your GP, maybe try talking to him/her first. I suspect a younger doctor is more likely to be flexible because they will have been trained to think in terms of evidence-based medicine rather than theory driven (as if any of it is really theory-free).

Here is a ridiculously long list of things you might want to do: I think if you show your doctor that you are making an informed suggestion (be way more informed than necessary of both the benefits and risks), that you can provide her/him all the information necessary (sources written by physicians with academic/research affiliations) to know the parameters, that you want to start at a low dose (which will probably not be fully effective, but will tell you clearly if it will work or not. This is not just being reasonable, but helps reduce any concern they have about drug seeking, or a desire to feel high.) which is not likely to cause hallucinations, are willing to try it in the office (chair in a low-light room. This shows you want to do this as a medical treatment, as well as providing the doctor the change to see for him/herself whether it works), will sign a waiver (reducing fear of lawyers), only want enough for a single trial (you could even arrange to have it made up and kept by the doctor for the trial), and have a pressing need (so that waiting a few weeks for a traditional antidepressant to work is a problem), and that if it does not work you are willing to try something more traditional (showing that you see this as trying a different category of anti-depressant/mood-stabilizer/adjunctive therapy). You probably do not want to broach the topic, but if the doctor has concerns about safety you might want to look up safety info, including that it is used as a field anesthetic, and on children because it does not depress respiration. I think the main risk is in people who are on high doses of narcotics for pain; that it resets your body to a naive state and continuing to take a high dose of the other med can therefore be dangerous. It is a medicine that has been around for decades, and is used in veterinary medicine, and I believe it is on the World Health Organization list of core medicines (usually a good sign that it is not too expensive, does not have major side effects, and is useful, although it is on the list as an anesthetic).

Reading the posts here, you will note that in the US there are a few doctors doing infusion treatments, which are expensive, done in the clinic, and seem to have the most complete and lasting effects. I don't know if you are in a position to go to one of those known people and pay the cost. I had moved back to Canada before trying this therapy. Here the financial logic is different, anything in-hospital or in-clinic is a drain on resources. I was given it orally; the neuropsychiatrist had treated other patients and used tablets made up by a compounding pharmacy. This is less expensive and, if it works, can be used at home. I take an oral liquid because stomach surgery left me with a low-acid stomach which might not metabolize the coating. I've also tried taking the liquid with a nasal aspirator (squirt up the nose into the sinus cavity), which in theory increases bioavailability and reduces the required dose. I did not find a difference, which is probably because my low-acid stomach also doesn't metabolize the ketamine into un-useful components as quickly as normal, but I understand that his current protocol includes this method. I suspect the lower-dose and more predictable level that is bioavailable is the major issue. I would suggest talking to your doctor about tablets because it is less expensive, does not require equipment, you can have a small number made up, and frankly because anything with liquid or powder might feel more drug-abuse-ish to them. I have a long post from earlier this summer which sets out the protocol that was used for me. My regular psychiatrist now oversees this. Really, if your doctor sees you take it in the office, he/she will see very dramatically if it works of not. If you take it and are not sure if it worked, it didn't. When I first tried it, within an hour I could make eye contact without it being painful.

I've probably overwhelmed you with advice. Before you look into ketamine further, the first thing I would ask you is, why do you want to try ketamine treatment now? You said you've tried lots of different meds in the past. Did any of them work, and if so in what ways? If you are willing to talk about it, I will check back on the board every few days for the next week.

Just to give you a disclaimer and context. I had been taking ketamine orally, two to three times a week for over a year. I had tried antidepressants from every category except MAOIs (which I consider more risky than ECT). I've even tried ECT once. It worked beautifully on the depression, but I still don't remember a month or two afterwards. FYI, responding to ECT is one thing that apparently is associated with responding to ketamine. I've been told that people whose depression comes and goes are also more likely to respond. I have also tried rTMS, which works beautifully if done a certain way. A month ago I was able to restart that treatment, stopping the ketamine as it kicked in. I don't have a tendency to addiction, and found no desire to continue taking ketamine. I am currently waiting to find out if they are going to do maintenance therapy (hopefully once a week rTMS touch-ups). For me, it is the only thing in 25 years that produced a full year without any depression (the ketamine treatment was effective, but I had a batch that we think was mis-compounded. It also has a short effectiveness period in me, sometimes only 2 full days.) If the doctor decides to stop rTMS until I get depressed again my plan is to proceed from the clinic to an ice-cream shop until I can stop crying, then wait until the symptoms start coming back and go back on ketamine. I really would like some predictability in my life, especially the ability to make plans for things more than three months in the future, knowing that the depression won't knock everything down again.

Hold in there. There are options. Ketamine may be one of them, but even if it isn't, there are others.

Best Wishes,
Cai

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Nihilism: I wrote to the administrators saying anybody who asks for my contact may have it. I will write to them again and add your name specifically. I have not heard from anyone in this very special group for quite sometime. Many were suicidal. I can't bear to finish that thought. I will help you as much as I'm able. Hang in there and I beg of you not to loose hope. There's been too much loss on this site already. I will keep you in my prayers until I hear from you. May

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Dear Iron:

Thank you for your kind message. I'm extremely worried about everybody. I sent a letter to administration telling them to share my email and information with you. You just need to write a letter and ask them for it. Praying you ok, Mary xo

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Mary,

Sorry I haven't been on the board for many weeks. I started rTMS treatment a month ago, and due to car issues have been spending about five hours a day on transit alone. The good news is that the treatment worked wonderfully and I don't feel depressed or particularly anxious. Now I am waiting to see if they will do maintenance therapy (hopefully once a week) or decide to follow the usual protocol of waiting until the depression recurs (it is sort of like having someone help you up after you fall down stairs; you really appreciate the hand up, but after so many times, you wish they would just stop the person/depression from pushing you down the stairs in the first place). I've made arrangements with my regular psychiatrist, and if they won't do maintenance I will start taking the ketamine once symptoms start to recur. The thyroid issue is still up in the air, with a possibility that one of my parathyroid glands is over-active (strangely this would be good news as it is quite fixable).

Last I heard you were working out a treatment schedule. Tablets or nasal to keep you going between infusions? How is it working? Do you find it is helping certain symptoms more than others, or some for a longer period than others? Have you noticed any patterns relating to how long or how completely the treatments work?

Best Wishes,
Cai

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Hi, yes I have been struggling with severe major depressive disorder and chronic and severe anxiety as well as severe social anxiety. I am a mess around people so I simply never leave my house. I too have tried a zillion different medicines from every category of antidepressants and mood stabilizers and antipsychotics, etc... They even wanted to to try me on MAOIS but I refused.( For reasons I'm sure I don't need to explain. I'm sure you know.) That was how I came to learn of ketamine for depression in the first place. I googled "treatments or medications for treatment resistant depression" and that's where I learned that scopolamine and ketamine both have been effective and, since I have tried just about everything from A -Z (a few things I tried more than once even) I am at the end of my rope, I have been living with this depression most of my life and have YET to find ANY relief at all. At this point I'm desperate. I'm tired of living and it's time to try something different because I'm not going to take MAOIS. I just think those are more scary to put in my body than ketamine which I'm familiar with and, understand whatever possible risks involved. And, I recently found out ketamine, as well as scopolamine, is in the same family as belladonna which, I KNOW I can take because I have taken a couple of medicines that are in the same family of medicine, as well as pure belladonna. I too have stomach problems. Hyoscyamine is in the same family of scopolamine, and belladonna, I take those for colon spasms. So, I already know how my body reacts to that type of medication. I have never had any problems with it so, I'm thinking I shouldn't have any problems with other meds in that category. But of course I would be more than willing to take it in the doctors office or, even stay in the hospital a few days if necessary. I have Medicaid because I'm on disability so, cost is not a worry for me. Unless it's not covered since its technically still in clinical trials for depression treatment. I'm familiar with ECT but, I don't want to try that. However, I don't know what is RTMS?

The one thing though is that I am on pain medicine and, I'm on a lot. I take 210mgs of methadone every day to treat chronic pain. I think maybe it would actually be a good thing though to lower my tolerance because, I don't hardly get much pain relief from it anymore and, this great big dose is causing me upset stomach and nausea and sometimes vomiting. It may be helpful if I can take a smaller dose. I have also read about ketamine as a treatment for fibromyalgia and, that is a contributing factor in my pain issues. So, if I can get the added benefit of it treating that as well, that would be another bonus. To be honest, I don't really WANT to try it without having the doctor watch how i react to it. That way, if I do have a bad reaction, he will be right there to help me and make sure I'm okay. I'm always nervous when I take something new. Especially something that will alter the way I think. I have had adverse reactions before and, I happened to be in public and, I almost landed myself in jail a couple times and, there were even a couple times that, it was a mystery how I even survived. A little off the subject but, I once had an adverse reaction and went to the e.r. but I was so out of it, I didn't know what I was doing. What did they do at the hospital? Gave me a huge mega dose inj. of the very SAME medicine I was reacting to, then kicked me out of the hospital cuz "I was acting strange" so I called my mom to come get me and I was outside waiting for her and it was midnight and the security guard told me if I didn't leave the property "NOW!" he would have me out in jail. Next thing I knew I woke up in a trashy pick up truck in the middle of nowhere and some fat old man was sitting in the driver's seat pleasuring himself. I should have sued the HELL out of that hospital!! So anyway, THAT is why I always prefer to be watched by a medical professional when I try something new.

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Nihilisa,

I agree about the MAOIs. Death by cheese is a ridiculous risk, and almost every other medication says do not take with MAOIs.

As far as insurance goes, you may find a problem in that ketamine has been around for a long time, and is a generic drug. The catch is that nobody can patent it, and therefore nobody will pay to get it approved as a treatment for depression. There are apparently similar compounds coming through the pipeline. I do not know the status of its use in treatment of pain.

I know this thread is about ketamine, but I'll answer your question about rTMS anyhow. Basically it is a treatment where they use a coiled electromagnet to create a very focused microcurrent at a specific point, (or points) in the prefrontal cortex. From what I understand, a high frequency wave potentiates/stimulates, and lower frequency de-potentiates/de-stimulates. I think it is basically getting your brain to a more normal equilibrium (like a set-point, or homeostasis). What works for me is sequential, bilateral treatment, where they stimulate the left side (associated with depression) and de-stimulate the right (associated with anxiety). I managed to get into a study a few years ago and after the first week I had gone from severely depressed to my main worry whether I was in the sham group, because I felt normal (which was wonderful) and what would happen if I found out this was a placebo reaction? Anyhow, it turned out to be a real treatment, and for me it produced fantastic results on depression, anxiety, and sleep, with no side effects. There may be studies in your area, and if not, you might want to check if medicaid covers the treatment. I know they were in the process of giving it a billing code a few years ago.

I understand that you have experience with medications similar to ketamine, but what I was suggesting was finding out from published research studies about this particular drug, because knowing this may make it easier to talk to your physician. Especially if your own experience is with medications that the doctor is not likely to have prescribed before, you will probably be better off working from what he/she is familiar with, and the style of information that they consider professional.

You've probably read the other postings in this thread. I don't know much about the pain medication issue, aside from the danger, but it sounds like something you should look into both to prevent problems, and because it might play an important role in justifying treatment, or how the doctor proceeded.

You sound like a real survivor, someone who has been through a lot and has a real core of strength. Please let me know if you find a doctor, and whether she/he decides to treat or not, I think it would be useful for us to know how it played out. I hope you also take a look at rTMS, either under Medicaid, or through a research study. It seems to be helping a significant chunk of people who have very treatment resistant depression.

Best Wishes,
Cai

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Dear caiguise:

I can't express the happiness I felt when I saw your name. I thought I lost this whole group. It's taken me 3 days to answer cause I start crying out of gratitude that your ok. I've share my info with you and anyone that wants it. Have some private things to share. My Rockland County Doctor is getting so frustrated with my Complex Regional Pain Syndrome/RSD that he is trying to get rid of me. He was writing me 10mg when he knew, although he says he thought I showed him neurontin, that I was on 900mg of capsules already. He said let your NYC doctor write them for you then. Which is so unfair because I don't pay my NYC doctor and it's just not right and also makes things very difficult as far as I can't just say I'd like to come in once a week until I feel good. I have to wait until the pain gets unbearable and I am full on suicidal. He is prescribing me 50mg troches that are still to weak and make me sick and I can't get in contact with him to get me Zofran. I stopped disassociating with the ketamine and don't know why. The doctor tried 3 times the time before last and nothing but I did still get 8 days of normalcy out of it. A week ago yesterday we tried again two times but he gave me 300mg and after the second one it was too much. Also discovered if a woman goes for an infusion and has PMS the ketamine doesn't work right away and will make you feel more out of your mind than before the infusion. When the PMS is over then I felt the infusions and I am now on my 9th day for the first time still feeling ok and still able to deal with the burning pain. The thing that kills me is I only got CRPS/RSD in January and it could still be reversed and nobodies doing anything as far as that goes to reverse it. I contacted a Dr. Robert Schwartzman who I found out retired but he was kind enough to recommend a doctor in Philadelphia PA at the Drexal University. Sorry I know I'm saying that wrong and can't think of the doctor name right now. But I will update you and let you know. I thank God your treatments are working and I hear you, believe me I hear you. Tired of getting kicked down the stairs myself. Love, Mary

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Mary,

So frustrating to have doctors play hot potato with you. I'm going through something similar, through thankfully not with the depression-related stuff. I wanted to make sure you know that the dissociation effect of ketamine is not related to how well it works for depression. My neuropsychiatrist warned me about this, because it is tempting to worry if the initial effects are mild that it is not working. I have had a wide variety of intensities of reaction to the same dose, but when I charted my mood, I found that he was right. So don't worry about not disassociating, this may be a very good thing. If you are finding that the dosage does not feel strong enough, the only thing I can think of that might alter things is how quickly the medication is broken down by stomach acids. Do you melt it under your tongue and against your cheek? Do you find any difference if you have eaten recently?

I found your comments about PMS really interesting. After the Thalidomide scare around 1960 Canada and the US (and I assume many other countries) made an effort to ensure possibly pregnant people would not be included in drug studies. I've read some of the arguments justifying this, some are that women are effectively the same as men and therefore it doesn't matter if they are not included, others argue that women's hormones just complicate the situation and mess up the studies. So for decades the drug evaluation process has basically avoided diagnosing the effects on 'possibly pregnable persons' (a term used in a Supreme Court case to explain how excluding women from job categories is not sexual discrimination). I think this has skewed the types of antidepressants out there. I believe women tend to get depression in combination with anxiety more than men, but these are treated as separate medical conditions.

I found that ketamine's effectiveness is shorter just before my period. I don't know your age, but if you are even in your late 30s, you might want to look at hormone issues as another way to help deal with pain and depression. I've tried hormone/birth control pills, and found they were not what I needed. I ended up with a hormone-releasing IUD (lasts 5 years and releases a much smaller dose that affects only a small area of the body), plus estrogen/progesterone patches. It has made a tremendous difference (as well as no longer being anemic) in reducing the mood swings.

Let me know how things are going. And forgive me if it takes a few days to respond. I'm reducing thyroid meds and hoping it won't return me to a spacy, slow, forgetful creature.

Best Wishes,
Cai

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Dear Caiguise,

I am also in Canada (Ontario) and have been desperately looking for information on where to go to try the ketamine infusions. I've contacted a few clinics in Southern Ontario but they strictly use it for pain relief. I'm wondering if we could chat about this. Is there a doctor in particular you might be able to recommend?

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