Ketamine For Depression? (Page 2) (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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hey john, thanks for asking - the answer is a resounding yes - 100% - depression GONE - as someone suffering from treatment resistant depression yourself, you can imagine the relief and amazement I'm feeling after a dozen years and dozens of failed medications - it's not that the treatment has made me artificially happy - it simply wiped away the ever present weight that, for no particular reason, was always there and has needlessly caused me so much suffering and sadness - I feel now (one week since the infusion) how I imagine "normal" people usually feel, and that difference is so incredible it's making me giddy - not sure if I'd be able to handle actual happiness now that I have the opportunity to enjoy my life, but I'm willing to risk it :)

Anyway, I was already planning to return to the board to write up the details of everything that's happened (I had the infusion in SD and have since met with Dr. Espinoza at UCLA regarding the possibility of future treatment, if required) and to answer any questions people might have.

Note that I am in no way saying this is the miracle cure-all for anyone with depression nor that I believe I've been cured forever (all those standard caveats are true and remain), just that at this point it's been a resounding success and I am so glad I was able to make it happen. As you know, there's very little reliable, accessible info out there for people who might benefit from this treatment, and message boards like these are pretty much the best resources available - they provided invaluable help in a time and work-intensive process, and I want to give back to make it easier for those seeking treatment to get it

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I find your opinion to be TOTALLY ignorant of the facts and sorry, very insulting as I am so frikken TIRED of hearing from those who do not know the FACT that depression is a MEDICAL ILLNESS!! It is a chemical malfunction of neurotransmitter systems, physical changes in the brain due to depression can be VISUALIZED ON BRAIN SCANS! OK?? This is called SCIENTIFIC FACT!! It's not 'boo hoo, my boyfriend broke up with me and now all I want to do is eat chocolate!'. Psychotherapy CAN be very helpful, but you need to find a good therapist which can take a lot of trial and error effort. Since I am on disability due to my 17 year battle with this serious medical problem, I am limited to therapists through the county, if you do happen to find one that you click with they don't last long cuz the pay is crappy and caseload is ridiculous. The other 'lifestyle' interventions are all well and good, glad you are having success with them. But PLEASE! Learn the facts, do not dismiss my medical problem as something that can be cured with talk, food and sleep. It is a DEVASTATING, potentially deadly, serious brain DISEASE! Be educated and educate others because nothing sucks worse than your own family SHUNNING you because they think you are lazy and enjoy spending the day in bed. You have no IDEA how painful and demoralizing it is for people to be dismissive of your daily, constant suffering.

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I was recently treated with IV Ketamine by Dr. Glen Brooks and had pretty amazing results. I am a physician as well, and due to my depression, I was having trouble getting out of bed to go to work. I'm not sure what the office number is, but he doesn't mind calls on his cell.

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Hi Renee, you may want to try getting into a clinical study being run by Naurex for an experimental drug called GLYX-13. It was developed by a researcher at Northwestern and they have study sites in Evanston and Chicago. It is supposed to have all the positive effects of ketamine but none of the bad (bad "trip" feeling, the "K-hole"). I tried to get into it but was rejected because I am also on klonopin, ambien, and seroquel. Like you I tested off the charts for depression on the Hamilton depression scale. Look for this phase 2 study on the website clinicaltrials.gov and call the contact people. If you are not on the above meds my guess is you will get in. An added bonus; everyone in the study gets the drug; the study intake person told me out of the 16 weeks you could end up getting the actual drug (not a placebo) up to 12 times. So at least you know you're not going to wind up in a placebo-only arm. I highly recommend you try this; ketamine is a tough drug especially if the doctor gives you too much, which happened in my case and I had a horrific experience. Good luck to you.

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Renee, I actually don't know much about Catpower but like her name :) I am older than you so am much more of a Kate Bush fan. Anyway good luck with the Naurex trial; all I can tell you is Dr. Best totally overdosed me on ketamine and I am confident the Naurex people won't overdose you on their drug. They have already completed at least one ph 2 trial with good results (you can google this because I don't think it will show up on clinicaltrials.gov). As for good psychiatrists, I see Dr. David McNeil; he has offices in Chicago and Buffalo Grove; his phone number is 847-291-8810. He doesn't know much about ketamine but didn't object to me trying it (kind of wish he had now...) anyway he is a terrific doc and knows about all the other drugs. Hopefully the admins of this site won't delete this post. I think you can ask them to let you contact people privately but I don't know how that works. Again, good luck to you!

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BlueheelerCD, I couldn't agree with you more about the importance of posting about GLYX-13. You are right, it is definitely not a "new" drug, the Northwestern researchers have been working on it for almost 30 years. I was inconsolable when the intake people excluded me from the current phase 2 trial, but I am still hopeful it will be approved and on the market in my lifetime (mid-60s). I used to work in clinical trials and most drugs don't make it past pre-clinical (animal) or phase 1 trials; GLYX-13 sounds like it has a real chance. Don't let your desperation force into finding a crook doctor who will treat you with ketamine after first requiring you to pay for numerous expensive and unnecessary tests, then charge you $700 or more per treatment (which is what I did). All of the legitimate ketamine clinical trials (see clinicaltrials.gov) use only 0.5mg ketamine per kg of body weight; any doctor who uses more in an attempt to "break" your depression is unethical and exposing you to a potential nightmare bad trip. Sorry for repeating myself but I don't want anyone to go through what I did with ketamine. Thanks also BlueheelerCD for the NIMH info.

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@CityGirl The Muscadine Foundation is a Charity based out of Texas working on building up a support system for people needing treatment with Phase 2 clinical trials that do not meet the strict trial criteria and could return to work if treated. Basically they are trying to help people like us. Last I saw they were working on getting 501(c3) status so they could take donations to provide assistance.

More info as it becomes available

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Hi, a quick update on my status. I had been put on nasal ketamine 40 mg every three days. Saw my doc yesterday and reported little or no positive benefits. He changed the regimen to a daily dose. I took a dose last night and about two hours later did feel better. I was able to go out to the the Casino and socialize for the first time in three months. So maybe it is working, I certainly want to catch a break 2013 has been a lost year for me, think I spent most of it in bed!

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@Stillhopeful,

No Naltrexone is Naltrexone hydrochloride
Methadone is Methadone Hydrochloride

Naltrexone is an opioid antagonist used frequently in alcoholics and opioid addiction treatment to block the pleasurable effects of alcohol and opioids. Naltrexone blocks the opioid receptor site, but does not activate it.

Naltrexone in low doses (low dose naltrexone is commonly 4.5mg/day) is sometimes used at the end of Methadone treatment to help reset the brains threshold levels for opioids which are frequently altered by long term abuse.

Methadone and Buprenorphine/Suboxone are similar (to each other) in that they are both opioids and are frequently given to people as a long term replacement for other opioids as they are not as deleterious.

So naltrexone blocks the receptor, Methadone and Buprenorphine/ Suboxone weakly activate it (compared to other opioids)

Now, you mention not responding to opioids. The truth is, and bear with me because this gets a little bit complicated, everyone responds to opioids. HOWEVER, about 27% of people have genetic variations in the gateway system that breaks down the drugs people take and converts them into something our bodies respond to.

There are 4 classifications: Very high metabolizers
High metabolizers
Normal metabolizers
Low/non-metabolizers

Our livers are, amongst other things, factories for a family of enzymes commonly called Human Cytochrome P450 AKA CYP450.

Our genes have the information encoded in them to manufacture these enzymes. However, and I am simplifying here, Some people may have 3 copies, 2 copies, 1 copy or a damaged copy of this information/ blueprint. If you have 3 copies, you would be a Very high metabolizer, 2 copies High metabolizer, 1 copy makes a normal metabolizer, and a damaged copy is a Low/ non-metabolizer.

Codeine for example, is not immediately useful to the body as a pain killer. It must first be converted into something else, so we call Codeine a 'Pro-Drug'. Not Pro as on professional, but pro as in before. Codeine is converted into Morphine in the liver by an enzyme called CYP(450) 2D6, another enzyme then breaks down the Morphine and out it goes.

Now, if you do not get analgesia from opioids, such as is the case with myself, you likely have a condition known as GOMD (Genetic Opioid Metabolic Defect).

Why is this important in a discussion about Ketamine for depression?

As it turns out, the vast majority of psychiatric medications use the same liver enzyme pathways as Opioids: CYP2D6, CYP3D4, CYP1A2, etc. If you take a medication that requires it be converted via CYP3D4, and you do not have enough/any CYP3D4 it will not work for you.

In fact, if you have problems with CYP3D4 none of these below will likely work for you: Tricyclic Compounds: Amitriptyline (Elavil), CLOMIPRAMINE (Anafranil), Imipramine (Tofranil), Cyclobenzaprine (Amrix, Flexeril and Fexmid)

SSRIs: Citalopram (Celexa, Cipramil), Norfluoxetine (a metabolite fluoxetine[Prozac], Sertraline (Zoloft, Lustral)

Other Antidepressants: Mirtazapine (Remeron), Venlafaxine (Effexor), Trazodone (Oleptro), Buspirone (Buspar)

The current thought is that Ketamine is processed via CYP2A6, CYP2C19, CYP3A4, CYP2B6, and CYP2C, but human trials I do not think have been run yet.

-----Too Long / Didn't Read Version -----
1) methadone and naltrexone are not the same thing
2) about 1 in 4 to 5 people process medications differently from the normal
3) There are about half a dozen (5 really CYP1A2, CYP2B6, CYP2C19, CYP 2D6, CYP3A4,5,7) paths that psychiatric meds do use.
4) If you do not respond to a medication in one of the Line #3 pathways because you have #2 it is called GOMD (Genetic Opioid Metabolic Defect)
5) There are some drugs, called antagonists, that can mimic the condition in #2 this is called Phenotypical Opioid Metabolic Defect
6) Ketamine uses a different set of paths than most other psychiatric medications.
7) There are at least 8 different possible root causes for depression.
8) The current model for Ketamine use in depression (NMDA or Glutamate Model) covers only 1 of those root causes.
9) Low-Dose Naltrexone covers a different model (inflammation/ immune response)
10) It is possible to have 1 or more root causes manifest as a symptom to another root cause: So if you have NMDA, you might develop inflammation/ immune response as a symptom or vice versa.
11) Treating both the root causes and the symptoms may well be required in refractory cases (cases that resist treatment [like ours])

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This is the way I was introduced to it. First and foremost I have the kindest, most compassionate, and most intelligent doctor I have ever had the pleasure of meeting. His first office visit wasn't cheap but he sat basically toe to toe with me for three hours and about 46 minutes. Taking the time to "understand" and actually "give a damn about what is up with me and my multi piece of crap body. Most doctors I have met are not geniuses at the medications that are out there and the only thing I can say to that is they should never allow their case loads above levels they did not have time to "KNOW" things like that. I think they should know a lot about "everything" that pen prescribes for that is what we are paying for right? Regardless, He has helped me in so many ways by giving a damn about assisting me in working my rear end off. I made my mind up that I would rather eat potted meat and be poor rather than eating a prime rib and be in submission to the Federal Government taking some check so he is assisting me to run my company hurting a helluva lot but getting it done. I must have taken what JFK said too seriously about what you can do for your country rather than the other way around. So you might say My Doctor has helped me to get my life back. That was what I wanted. I am on lots of stuff but tried this ketamine for extreme pain in a nasal compounded spray. 40 ml of it. After using it for terrifying pain that the other meds did not touch I noticed my depression I had all my life really was sort of "gone". My attitude changed from this. Every morning waking up hurting and depressed and HOPELESS to the point of a Colt 45 thought about every day to a productive member of society once again. This Ketamine spray worked unbelievably for me. Allowed me to see the difference I had been making all along it seems. I am sure most of you know that got knocked down in that bed all the time is not out to make things count like I am and that is fine, I just could not take it anymore and would rather hurt and work than lie around and be miserable. Turns out the work helps as I thought it would and the drugs assist me in maintaining that level of interaction. Without that contribution to others what does one really have in life and I mean really ? TV,,,,,no thanks. Good luck and hope that helped.

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Hello Mary G. and all
I read your post regarding Dr. Schneiderman, He must be a very intelligent doctor and willing to think outside the box if he is treating you with things like ketamine. My doctor prescribes me the nasal type that is compounded by my local pharmacy. The thing is, a prescription of 40 ml costs around 49.00 for a nasal sprayer type. When my pain gets to that point that I could just go nuts I do a spray in my nostril and in about 6 minutes it is gone. Bam. The bottle says I can use up to 4 sprays a day but that is too much for me. It has really "SAVED MY LIFE" as in when the nerve pain and damage that I live with gets overwhelming this gives me the opportunity to "think" when things get to throbbing to much. And then, as sort of an added bonus I have realized it "CURED" a forty year old serious depression. Cured! and to me that has given me an upstart to basically a new life. In the better part of 8 months I have went from being in the bed "all" the time, to getting to do what I wanted, TO WORK. So, my life got better all the way around and I owe a great deal to ketamine nasal spray. My wife is happier because I was too stubborn to accept disability when other people need it more than I and the burden was on her up until a month ago. Last 4 months I cleared around 61K and am the Exec VP of a Real Estate Acquisition firm from california. Happiest I have been in years. I think it is sad that ketamine is getting a bad rap from some, mainly the ones that never used it. I got my life back because of it and to honestly go from waking up considering a colt 45 every morning to actually almost being proud of myself is something I am very, very thankful for. Sounds like you have met the right doctor. I am thankful for mine. Good luck with things. Sound as if you are on a good track!!!!

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My doctor, whose practice is part of a university research group has, as far as I know, treated about a dozen depression patients with oral ketamine. I know he used it previously to treat specific types of pain, so he had experience and knew of research from that area. That is where the oral treatment with ketamine research comes in.

I suspect the doctors here are wary of IV infusions because it takes up time and space that is needed for other things, and they don't like the idea of trusting patients with injections in general. As far as I know he had only prescribed it for patients who have tried a wide verity of other options, and who have not found rTMS to work. So it is all patients whose depression is not responding to other treatments. I suspect what we have is somehow different and that is why it does not respond the same way. Really grouping depression as a single condition is like treating fever. Tylenol may bring down the fever, but the underlying cause can be many different things.

The others he treats take it compounded in pills. I've had a vertical sleeve gastrectomy (re-sectioning of the stomach) so there is less surface for absorption and the acidity level is less, so we figured sub-lingual would give a more predictable response. I know he is pleased with the results. At one point he mentioned that the response seemed similar to the tablets at a 25% higher dose (I take a lower dose). I think he also likes that the dosage can be titrated more finely than with tablets that are 25mg or 50mg of ketamine each. He has also been surprised to find out that I am paying far less per month for the oral suspension than the others are paying to have capsules made, and either way it is far, far, more affordable than the IV infusions used in the US. I will try to post next week, if he puts me on the pre-made liquid sold to the hospitals, because it is the same mg/ml as they were compounding for, but should be more consistent quality.

So in reply to your questions, he is treating a dozen people with oral ketamine for depression, at least some of whom have anxiety, with good results on both the depression and anxiety. Yes it is less bioavailable, but the cost for a single IV infusion in the states covers six months of medication for me and that, frankly, makes the treatment viable for a larger group of those who need it. I have had depression off and on since I was in my teens. It is at least partially genetic. I have learned techniques through cognitive behavioral therapy and other psychotherapies that have reduced the severity on some occasions, and can sometimes help me pull out when I can feel myself sliding into that dark pit. But once it gets to a certain point only time and/or medications get me out. I have tried every antidepressant group but the MAOIs, and all the electrical treatments but the implant ones and magnetic seizure therapy. I am on a combination of medications currently, including a mood stabilizer and anxiolytic, as well as an atypical antidepressant. Since I was a teen July has always been the month that sucks, with two exceptions in 20+ years, when I was on rTMS I had only a small downturn, and this summer when I had four blah days in a row and that was it. Oral/sub-lingual ketamine is working well for me.

I take the oral dosage every second day, which sounds very frequent compared to the infusion cases. But I can afford to pay for this out of pocket, which I could not otherwise. I agree with the other comments that there are few/no studies on oral treatment for depression. I kept a detailed daily log for my doctor for the first few months so he had feedback, probably because I was his first sublingual route patent, and also because I am the sort of person who actually is willing to log all the details for the sake of promoting medical research. The drug has been around for decades and no corporation has an interest in paying for a big double-blind placebo controlled study. I think he may be trying a few patients on the nasal route, and may want me to volunteer. I will, not because I think oral does not work, but because it could be more predictable and...well he needs someone who can give feedback. I have two kids, and with a family history of depression I have a strong desire to promote finding good treatments for all the different conditions that manifest under the category of 'depression'.

I hope this helps.

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caiguise

Thanks for the info. If you are interested, I explained what we have done/tried for our son in posts 512 and 514.

Another item of interest, I just saw in Science Daily that Washington University of Medicine in St. Louis, in a pilot study, found that nitrous oxide,or laughing gas, is effective in treating mood disorders, The finding were published online in the journal Biological psychiatry Dec. 9.

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I'm not sure how the system works in Australia, and most of the people on this board are in the USA. Ketamine is not commonly used in Canada (where I live), but the neuropsychiatrist who put me on it seems to mainly prescribe it compounded in pills/capsules. I take it as a liquid because of stomach complications. You may want to simply talk to the physician who was doing the inj. treatment successfully and ask about having a pharmacy compound it as a pill, or liquid (if you can find a place that carries the nasal sprayer attachment for a syringe). The proportion of the drug that is bioavailable is much lower with the oral route, a bit higher with nasal. For me there did not seem to be much difference. My doctor sends the prescription to a compounding pharmacy. I've worked with two of these places and highly suggest finding one that deals only with compounding, and which has a good reputation among doctors.

I hope you are able to find a way to make this work for her. It sounds as if she has been through a lot over the past two years, and I hope ketamine continues to work for her and you are able to find a route of administration that works well.

Best wishes.

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Hello
For a doctor in training you are perfect
No empathy or insight
I have 6 post graduate qualifications in medicine
The psych team treating her totally believe her and me
She was totally non functioning has actually been suffering for almost 4 years now
60% of depression (varies on what literature you read)
Is not treatable with current medications
I hope you become an a surgeon and do not deal with payments as you are rude and implausible
Australia has very very strict laws on medications and is much stricter than USA
God pity your patients
Thank you to the other reply
I thought this was a forum to help one another no judge on a few words someone has typed
The world does not need more money grubbing doctors who are "smart" but have zero EQ like you!

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MDinTraining,

If you are planning to use a utilitarian model to justify treatment you might want to consider that if it was a simple matter of applying an algorithm there would be little need for physicians. Statistical truths are just probabilities, they don't apply in all cases, and people with treatment resistant depression are already statistical outliers.

Your comments also seem not to fit your earlier statements about different disease models. One benefit of going to a different doctor is that the model that informs their prescribing behaviour may be different (consciously or subconsciously). If your current doctor does not believe in the new electromagnetic treatments, simply because they don't fit with their way of understanding depression, I don't think you will have much luck convincing them to try. Despite all the talk about 'evidence based' medicine and it not being based on theories, people have to form theories, or at least beliefs, groupings, or a way of understanding the world. Nobody crosses the road thinking through the physics of it each time; we learn to make assumptions from previous experience or how we were taught to think.

So while I would agree that risk-aversion is one important factor causing doctors not to try patients on ketamine, I would also argue that many physicians simply are not willing (or unable) to challenge their own belief systems enough to include some of the more novel treatments. I have friends who are psychiatrists of various flavours, and many of them believed absolutely that rTMS could not work because they could not fit it into a neurotransmitter model. Ketamine challenges the models that are still used by many physicians, and this means the burden of proof they require to believe it works is significantly higher than for drugs that fit into there conceptual schema.

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?

And to everyone reading this, hold in there. Eventually you will find something that works. If it is ketamine, that's great. It may not be available, it may not be a good choice for you, and it may not work for you. If not, there are other options and new treatments in the pipeline. Just hang in there.

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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.

I am fully in favor of the use of ketamine to treat depression, regardless of whether the person tried or not tried other treatment methods. If there is a chance, regardless of the risks, it should be attempted! Nothing can be worse than living with Depression!

Unfortunately, the cost of treatment with Ketamine off label is still high. Some people can access to this treatment, but many people can not use it, simply because they have no money for it or because they don't live in the USA.

I believe in Ketamine, but as I live in Brazil, I still don't have access to treatment off label. While the things don't change, decided to try the Memantine, which is a drug that is used for the treatment of Alzheimer's disease. My wife is already in the second week of treatment with Memantine off label and the results are encouraging!

So I suggest to those who can not continue or try the treatment of off label Ketamine, attempt to somehow experience the Memantine. Start with 5 mg per day (half a tablet) for one week. Then increase 5 mg per week until they mood stabilization and a gradual decrease of the Depression happens. It works! And the cost is much smaller than off-label treatment with Ketamine.

Moreover, it is easier to find a doctor willing to try the Memantine, because it is a drug approved by the FDA and easy to find at any drugstore. So you get rid of a**holes doctors who think you are not the right type of patient to experience Ketamine!

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Deijivan,

Have you talked to a compounding pharmacy? If you can get a prescription, and they are able to order it in solid form, it can be made into capsules or a liquid suspension. I was most recently on the oral suspension, but have also taken it as a nasal spray (squirt up the nose into the sinus cavity). As far as I know, my doctor is the only one in this part of Canada who has experience with ketamine, and I believe all his patients (admittedly not that many) are on oral forms. Aside from myself, I think everybody is either on capsules, or nasal aspirators. If this information is useful, but you need more details, feel free to ask.

Best wishes

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Mary, here is a synopsis of the protocol my doctor uses:

Regarding availability and prescribing:Compounded oral capsules of ketamine can be obtained from any compounding pharmacy. The prescription they usually start out with is "Ketamine 25 mg compoundedcapsules, 4 capsules po qhs, q 3 days, or as directed under supervision. M: 50 caps". In Ontario 50 capsules will cost about $70-120, and "Ketamine 50mg/ml nasal suspension" costs about $150 for 90 ml, an oral suspension is slightly cheaper.

The ketamine is only given every 3 days and is only in the system for a few hours after each dose. The one thing to watch out for is opioid medications as ketamine can reset the tolerance to opiods, so people who are on high doses because they have developed tolerance run the risk of their opioid dose being dangerously high. If you are on a higher than initial dose of an opioid make certain to talk to your doctor about this, and you may not be a suitable candidate for ketamine therapy.

The doctor usually starts with a low dosage and adjusts up (if there are signs that it is working) until either it is efficacious at reducing depression or you find the initial side effects are not acceptable. He usually starts patients at 100 mg (4 capsules or 2 ml) for the first dose. Then increase by 1 capsule at each subsequent dose, with the doses 3 days apart. I took the first two doses in the doctors office, but it appears he now does not require that now that there is more experience with the procedure. You should be at home, in a quiet space and dim the lights. In case you find your balance off for the first few hours, use the washroom beforehand. I like ambient music. With tablets or an oral liquid you take your dose and lie down, or recline while it takes effect and for 2-3 hours until the acute effects wear off. Do not drive for at minimum 6-8 hours afterwards. I think they recommend taking it at bedtime now, which reduces the wasted time. The acute effects at low doses are minimal. I found I was processing things as Gestalts (from 15-20 min after dose my Sudoku speed goes up), found binocular vision strange, and was not ignoring sounds of things father from me. I also found that my speech had a slight delay, but felt as if it was coming out before my brain told it to do so. At medium doses there may be some visual hallucinations, disorientation, dizzyness. I found that my mind liked examining objects by mentally rotating them, and I was only aware of my body if I thought about it. Closing my eyes I would have vivid, mainly abstract, dreams, not scary, fascinating really. At higher doses there can be a dissociative state (not noticing your body or feeling a sense of unreality) for about half an hour, and hallucinations. Again strange, but I didn't find it scary. Note that the dose that causes the dissociative state is not linked to how effective it is for you. The acute effects may differ each time and how 'strong' the acute effects are is not a sign of how well it works for depression.

If it works, you will definitely know. If the treatment works, even at the low dose you should notice a marked reduction in depression and anxiety either immediately after the weirdness wears off, or at least by the following day. So you should know after the first dose if this treatment will work for you. If it does then your doctor will want to find the right dose to keep the depression at bay. If it does not work, I really am sorry, and hope one of the other treatments help, but trying a higher dose is not likely to help. (if this is the case, I strongly suggest looking into rTMS therapy)

My doctor says that the effects tend to start wearing off after 2-3 days, and are gone in a week. So the doctor will titrate the dose to figure out how little you need to get good effects that last at least 3 days. His patients take it either every three days or on two days of the week, generally. A stronger dose than necessary can actually be less effective.

My doctor has generally found most people who do respond to this treatment find therapeutic effects in the 175-250 mg range, with a few needing up to 300 mg. Personally, I'm at the 150mg dose, and a higher dose does not seem to make it last longer, in fact it seemed to make it less effective. Sometimes patients find they need the dose adjusted up by 25-50mg after a month, but after that there should not be need for increasing dosages. My doctor has patients who have been on ketamine for over a year with continuing efficacy.

The known adverse side effects have generally been found in people taking far higher amounts (10x) and more frequently. There can be bladder inflammation, persistent psychosis, or corneal edema. Be aware, but note that these problems are infrequent and generally associated with abuse of the drug.

Note that this information is for oral tablets, or oral liquid. My doctor also has patients who use a liquid suspension and and nasal aspirator (mist up the nose), which in theory reduces the required dose by up to half. The theory did not apply to me, however.

Treatment-resistant depression is distressing, but there are a wide variety of treatments out there, and if you hold on there should be something that works. I've had at least one bout of depression every year (except one year when I was on rTMS, which I get to start again in August, hurrah!!!) for the past 26 years. I've learned to really appreciate the time when my mood is normal, and I'm so glad I kept stubbornly continuing to keep going.

Best wishes to all of you.

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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
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I will go to the states to take ketamine treatment for depression. Ketamine is probably a great pill for depression, as ...

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## What is Cispin? ## Cispin is a common misspelling for the antidepressant called Zispin SolTab. Active Ingredient: Mir...

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My friend was prescribed Haldol for depression. My friend suffers from being addicted to Perocets, and because he was go...

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My Son went to the Dr. for anxiety and depression, pristiq created more problems for him, panic attacks, insomnia, loss ...

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Has anyone started taking Rexulti, if so how is it going so far. I just started 1 mg today and will phase out abilify? #...

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After being on every imaginable antidepressant over the past twenty-five years and undergoing ect, I have found that Rit...

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This thread is to discuss Ibogaine as a means to treat Depression and Pain Management, including, but not limited to, an...

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DOES ANYONE KNOW A MD WHO PRESCRIBES SUBOXONE FOR DEPRESSION IT HELPS ME TREMENDOUSLY ## HAVE YOU FOUND A DOC TAT WILL W...

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is colozapam for anxiety and depression ? ## The pill in description is Clonazepam; which is a benzodiazepine derivative...

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anyone with experience using riluzole for treatment resistant depression ## Hello, Pance! How are you? I've not take...

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