Ketamine For Depression? (Page 34) (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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Chimpshow, his explanation of other drugs with the same action of Ketamine was very interesting. Thank you!

Caiguise, thanks for the tip about compounding pharmacies for production of Ketamine orally or nasally. If you know the exact dose for this type of administration, please let me know. In this case, my wife (which is doctor) can issue a recipe for compounding pharmacy.

Stella, thanks for the information!

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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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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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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 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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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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Hello Caiguise, I wish that there was a way that I could perhaps find a copy of what you are speaking of their? If time permits you. And to add "something about Mary" is to say of course you are worth a great deal to many more folks than you know. Families sometimes have this way of showing you a video of there hi points in life acknowledging your low points with the same type of pain that reminds us of a bully in school. Life can be quite hard enough without ones insistent upon clouding the water. Its never quite clear anymore.

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Thanks you for the messages. I have very good news to share. I don't have Lyme!!! The doctor wanted to put me on the medicine that would make me sicker anyway but I said no. I called Dr. Glen Brooks, who I have to admit I absolutely love him. I explained my parents would no longer help me because they paid the $850.00 for the Lyme doctor and blame Dr, Brooks which is ridiculous but another reason why I need treatments so bad. Dr. Brooks is going to work with me on the cost and I'm going to sell my engagement ring to pay myself which breaks my heart but it would be no good to me dead. I was a little upset to read that you go so quickly from feeling fine to feeling depressed. Would you have any information on how that can be fixed. Maybe if I could get a prescription for the Nasal Spray and just use it like a booster. Right now is the worst I've ever felt. I'm consumed with the idea of stuffing up the tailpipes in the car but k owing I'm going to get help and have you guys to talk to is helping a great deal. I'm just scared now that the depression will come back and I won't have the money for a booster. I pray all of us can get well and stay well for good.

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I didn't intend to frighten by warning that the ketamine (oral or intranasal) can wear off quickly, it is just that when your doctor is trying to find a dosage and schedule that works it is likely that this may happen and I think it is important to know that it is normal. Once you know what is happening, you realize this is something that can probably be fixed by a proper schedule. But my experience is that when it wears off it is distressing because rather than sliding into depression over the course of weeks it happens in a day (once it was 4 hours). I think my doctor generally had patients take their dose twice a week, or every three days (depending on need and the persons ability to follow the pattern). For many months my protocol was 3 ml every second day, and it prevented the roller coaster. But I think he prefers every three days to allow the cells to rest, and for almost everyone this works well.

I'm going to post a synopsis of the ketamine protocol my doctor uses, hopefully it will be of some use.

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@Caiguise: thank you so much again for all the information and the time you took to that. I went to my regular pain doctor yesterday and he convinced my mother to continue with the ketamine treatments. Dr. Brooks is actually coming into the office on July 4th to give me my 3rd infusion, and then will have two more Monday and Tuesday. Problem is Dr. Brooks is taking time off until the 14th and I can't get back until the 17th. I asked Dr. Brooks if he would give me the nasal spray but he said he doesn't use that anymore but would give me the capsules. I was a little unsure of them until I read your message and feel much better now about using them. Thank you so much for that and the warning about the opioids. I didn't have a problem last time but my doctor has increased my dosage of pain medication since my last infusion so I will be sure to take less on the days I use the ketamine. That actually is fantastic news to here as I was on a morphine pump 20 years ago when I first got sick and it destroyed my tolerance. That made it very hard to find a doctor to treat me because they were nervous prescribing for high tolerant patients. If the ketamine resets my tolerance, it will make my life so much easier not having to take high dosages. You've been a great support to me caiguise and probably saved me from taking my life because I knew there was at least one person out there who cared about me. Thank you doesn't seem sufficient for what you've done for me but know you will be in my prayers forever. Will post again to let you know how the treatments go.

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