I've posted this in other ketamine news stories before, but I'm offering it as a firsthand testimonial here.
Ketamine was both the best and most depressing depression treatment option I've ever tried.
Within a couple of weeks after having had the initial round of six treatments in two weeks, I was the most functional and productive human being I've _ever_ been - things that used to be impossible or utterly agonizing to complete were as trivial as they "should" be, I was enjoying life, it was great.
After a couple of months of periodic booster treatments, over the course of a week, I felt it completely drain out of me, and no variance or repetition of ketamine treatments has been able to reproduce it since. (We spent months varying dosage levels, frequency, and trying a few OTC things that the doctor had seen synergize ketamine response in people before, to no avail.)
It was...possibly the single worst experience of my life, feeling that slip away, and now having recent crystal-clear memories of how much that fog had been complicating my life.
Ketamine and its analogs are known to have a rapidly developing and profoundly durable (some even say permanent) tolerance, and I find this is often glossed over, especially when studies don't evaluate it over a long enough time period
I think Ketamine itself isn't a real solution but hopefully some of the isolated metabolites will be
This easily explained:
Ketamine seems to repair some kind of cell damage, thereby increasing neural plasticity.
That is a huge asset, but long endured depressions leave many unhealthy neural circuits over the years. These have be unlearned one by one, which takes time.
Ketamine increases freedom of thought and emotion, but you still need a goal and long-term plan to precisely target and unwork all the patterns that circle back to depression.
Luckily the entrypoint away from happiness is discernable and it is bittersweet: giving up, thereby reducing stress. Which is sweet at first, but turns into hell fast.
That reminds me of the short story "Beginner's Luck" By Poi Lass.
It is part of a series examining what happens to people that discover they have a minor super-power.
It was...possibly the single worst experience of my life,
feeling that slip away, and now having recent
crystal-clear memories of how much that fog had been
complicating my life.
I should warn you that the overarching theme of this story aligns almost perfectly with this comment.
My girlfriend receives ketamine treatment for her depression, so I’ve the results first hand. It’s truly astounding. She’s seen more improvement from the ketamine than from a decade of psychotherapy and traditional psychopharmacology.
The only downside is the cost (it’s not covered by insurance) and the potential that there are long term side effects that have yet to be discovered. We pay $375 for a 40-minute infusion. The recommended initial course is six infusions over two weeks. After that a booster or two is usually needed very two to six weeks. (It’s been about every three weeks for my girlfriend.)
- only thing that seemed to work even after TMS and other treatments.
- New pathways (SF and San Mateo locations) is really good.
- more and more treatment places opening up in different cities etc.
- uber assist or drive the patient home (full lucidity afterwards but you don’t want to drive).
- long-term benefits aren’t apparent after the first two treatments. After the third it seemed to last for 2-3 days. After the fourth longer.
- it really seems like a ‘break out of depression’ breakthrough treatment. Though no cure all (talk therapy or a good support system is important too).
- ketamine is used for many purposes (anesthesia, etc.). When given for depression it’s given in much low dosages (presumably without harmful liver or kidney side effects).
- usually the patient listens to music with headphones while the infusion is in progress.
- a nurse monitors BP and heart rate etc., but so far there have been no compications other than a nurse who was bad at putting in an IV (once).
- feel very thankful for it.
- I could see it going mainstream in the near future.
Having no knowledge on the matter, what's the price comparison to just buying ketamine illegally and taking it without a doctor's help?
Depression is like (or possibly is) a form of chronic pain. People suffering from it severely might be willing to do anything for relief. Here's good information that a currently-illegal drug can help but if you want to do it legally you might need to take on a third job just to pay the costs.
It reminds me a bit of the South Park episode[0] where 'concentrated dose of about $180,000 shot directly into the bloodstream' is discovered as the cure to AIDS. Volunteers inform poverty-stricken Africa that all those suffering from AIDS have to do is inject themselves with piles of cash.
Doesn't ketamine stimulate growth in the same areas of the brain that exercise does, and does therapy prescribe routine daily exercise?
I can imagine there being a great short term benefit to ketamine, as people who are severely depressed can't exercise due to the depression. Has there been any mention switching from ketamine to daily exercise, or doing both?
The effects are so significant that I have gifted small amounts of ketamine to close friends who suffer from depression, so that they may store it long term as an emergency last resort to try in the event of irresistible suicidal ideation. It really is a lifesaver.
> and the potential that there are long term side effects that have yet to be discovered.
Not for medical which is maybe what you are referring to. But long term (recreational) ketamine use (abuse) is well known. Perhaps down to the method of injection (nasal) or the impurities in illicit ketamine, but there is a lot of information on bladder problems, stomach cramps along with heavy addiction
Infusion? Goodness grace, I got belonephobia and got scared shitless there. It doesn't have to be administered intravenous. The article is mainly referring to a nasal spray.
Main upsides of Ketamine for depression vs typical antidepressants (SSRIs, etc)
- Ketamine seems to have a much larger effect size (-~0.99 [1] vs -~0.35 for typical antidepressants [2]) [If anyone spots an error, please let me know]
For context, an SMD of 0.2 is small, >0.5 is medium, and >0.8 is large.[3]
To me this seems to be by far the most important/interesting thing: Ketamine seems to have a much stronger antidepressant effect than our current antidepressants.
- Benefits occur within hours rather than weeks
- Doesn't seem to interfere with sexual function, unlike many antidepressants
Main downsides of Ketamine for depression
- Much more expensive and normally not covered by insurance
- It's less well studied
- You have to go in for additional ketamine infusions to maintain the effects, it seems roughly ~1x a month long term
(The SMD for typical antidepressants seems to range from ~-0.13 to ~-0.35, with Tricyclic antidepressants slightly higher at around -~0.42.[4][5][6])
@HN's chemists - I was under the impression regular ketamine use caused irreversible bladder damage[0] - Is that due to much higher recreational dosage vs medical, or would this be something that couldn't be prescribed long-term?
In the late 90s/early 2000s, I went to a lot of raves and everyone who partied and took club drugs used ecstasy and ketamine regularly, often in combination.
A lot of people that I used to hang out with back then are on a private email list now, where we talk about more boring stuff like our families and jobs and so on, since everyone basically aged out of the scene in our early 30s.
I recently made a post about how my mom had been abusive towards me as a kid.
Almost every single person on the email list responded with a similar story of abuse, sometimes of a horrific nature. And almost everyone talked about dealing with trauma and depression their whole lives — and how the rave scene and the drugs they took probably saved them. Several talked about suicide attempts before getting into raves.
I had known these people for almost 15 years and I had never really talked about this except for the random conversation on ecstasy with one or two of them where they or I as sort of worked out our issues with them at an after party or whatever.
I was pretty surprised at how consistent the story was. I know that’s how I felt about the drugs— that the combination of those two (and lsd to a lesser extent) and the community around the music probably saved my life — even though I took a lot of dumb chances and went well beyond the therapeutic info the hedonistic from time to time.
I went from being a lonely, closed up victim of abuse at home and a decade of bullying at school to being outgoing and popular in that scene - even to the point where I learned to DJ and played gigs in front of crowds of 1000+ people.
It helped me not just in the scene but in my personal life and my career. I learned to recognize some of my learned toxic behaviors that pushed people away from me and how to recognize them in other people. I distanced myself from my family and home town friends who had been treating me terribly, and my career took off — even with no degree — and largely because of connections I made in the scene.
I don’t know where I’m going with this, but it seemed transparently obvious at the time that MDMA, LSD and ketamine were near-miraculous substances and deserving of serious scientific study, and it always seemed perverse that the government was doing everything in its power to prevent people from taking them, while at the same time pushing people to take anti depressants and stimulants that were so much less helpful and enlightening.
I haven’t used drugs in nearly a decade and don’t intend to, but I’m glad that researchers are starting to take them seriously.
I recognize this kind of story. I also suffered pretty horrendous abuse from both parents growing up. I partly credit weed for self-treatment of extreme social anxiety, and being able to get out into the world and function, if only poorly. I also took LSD and MDMA, but not nearly as much. I'll certainly credit LSD with ... other things, but that's another story.
If you're an American, every time you read a new article on Ketamine for depression your thought should be "Jeese, healthcare is screwed up". Pharma companies don't benefit from getting Ketamine approved (since it's no longer patent protected), so no one is putting it through FDA for depression. As a result insurance will never cover it (under the current model).
The reason this treatment isn't mainstream isn't because "the research is still out" (though that may still be). It's because there are no financial interests to get it over the hoops into the highly convoluted state that enables affordable medical care.
The very article you're commenting on directly contradicts what you're saying. Big pharma is actively running studies and trying to get this fast tracked for treatment in the US and Europe.
Granted the article is somewhat poor reporting because the title should read "esketamine" not ketamine.
> Pharma companies don't benefit from getting Ketamine approved (since it's no longer patent protected), so no one is putting it through FDA for depression.
This is incorrect.
There are ongoing phase 3 clinical trials for nasally applied esketamine that will lead to FDA approval if succesfully reviewed. These trials are conducted worldwide and are very encouraging. The specific application seems to be patentable. First results should be available around 2019ish or 2020.
Just as a different perspective ketamine is (and was) pretty common in my circle and the idea that it works as anti depressant slowly faded.
It never really worked for me as that, at least not more than lsd or so would. And some friends claim that it has way less effect on them today even thought it seemed have to worked before.
It may is the abuse (probably higher amount on some occasions) it may are long term effects.
But it surely is not the magic cure some make it out to be.
My psychiatrist was mentioning this to me a few months ago. The data he’s seen mirrors the study referenced here.
This could be a breakthrough for individuals in the midst of major depressions, which are often very hard to treat, considering how long it can take for other anti-depressants to start to work.
Ketamine is an anesthetic. Has anyone compared it to e.g. ibuprofen for this use case? Ibuprofen works very well for me when experiencing depressive symptoms. I'm down to about 2h max per depressive episode (logged at 10-30 depressing thoughts per minute, compared to none after). Mechanism intuitively "feels" inflammatory and looking at my logs seems related to exhaustion due to over-productivity, lack of rest, etc.
Mechanistically, there is a large difference between ibuprofen and ketamine. Ibuprofen does not work on the NMDA receptor, as ketamine does. NMDA activity modulation is associated with psychological phenomena:
"""NMDA receptor antagonists can mimic these problems; they sometimes induce "psychotomimetic" side effects, symptoms resembling psychosis. Such side effects caused by NMDA receptor inhibitors include hallucinations, paranoid delusions, confusion, difficulty concentrating, agitation, alterations in mood, nightmares, catatonia,;ataxia, anesthesia, and learning and memory deficits.""" (From Wikipedia)
Ibuprofen hits the COX enzymes, for which no psychological effects are noted.
Edit: of course I'm not discounting your own observations, just regurgitating some textbook knowledge.
There could be some connection, since physical and mental pain activate similar brain regions. I can see how pain killers may help to some degree with emotional pain. (Not a doctor)
Paracetamol, metamizol, acetil acid, diclofenac and ibuprophen all fall into the same category (I have chronic headaches) but I really doubt any of them are good for depression. For stress I take small amount of frontin (xanaxish thing) and it acts all differently (for me at least) from the rest.
Ketamine isn't a pain reliever. It's a dissociative hallucinogen. It works by disconnecting you from sensory input and putting you in something like a lucid dream.
I've heard that ketamine usage long term can affect your microbiome [0], which seems to play a much greater role in depression that previously thought [1]. Has anyone had similar experiences?
[+] [-] rincebrain|8 years ago|reply
Ketamine was both the best and most depressing depression treatment option I've ever tried. Within a couple of weeks after having had the initial round of six treatments in two weeks, I was the most functional and productive human being I've _ever_ been - things that used to be impossible or utterly agonizing to complete were as trivial as they "should" be, I was enjoying life, it was great.
After a couple of months of periodic booster treatments, over the course of a week, I felt it completely drain out of me, and no variance or repetition of ketamine treatments has been able to reproduce it since. (We spent months varying dosage levels, frequency, and trying a few OTC things that the doctor had seen synergize ketamine response in people before, to no avail.)
It was...possibly the single worst experience of my life, feeling that slip away, and now having recent crystal-clear memories of how much that fog had been complicating my life.
[+] [-] nylonstrung|8 years ago|reply
I think Ketamine itself isn't a real solution but hopefully some of the isolated metabolites will be
[+] [-] mabbo|8 years ago|reply
[+] [-] _bdog|8 years ago|reply
That is a huge asset, but long endured depressions leave many unhealthy neural circuits over the years. These have be unlearned one by one, which takes time.
Ketamine increases freedom of thought and emotion, but you still need a goal and long-term plan to precisely target and unwork all the patterns that circle back to depression.
Luckily the entrypoint away from happiness is discernable and it is bittersweet: giving up, thereby reducing stress. Which is sweet at first, but turns into hell fast.
[+] [-] Sukotto|8 years ago|reply
It is part of a series examining what happens to people that discover they have a minor super-power.
I should warn you that the overarching theme of this story aligns almost perfectly with this comment.http://web.archive.org/web/20061112225415/http://www.subreal...
[+] [-] NeutronStar|8 years ago|reply
[+] [-] pw|8 years ago|reply
The only downside is the cost (it’s not covered by insurance) and the potential that there are long term side effects that have yet to be discovered. We pay $375 for a 40-minute infusion. The recommended initial course is six infusions over two weeks. After that a booster or two is usually needed very two to six weeks. (It’s been about every three weeks for my girlfriend.)
[+] [-] tmsh|8 years ago|reply
Some other tidbits of information:
- only thing that seemed to work even after TMS and other treatments.
- New pathways (SF and San Mateo locations) is really good.
- more and more treatment places opening up in different cities etc.
- uber assist or drive the patient home (full lucidity afterwards but you don’t want to drive).
- long-term benefits aren’t apparent after the first two treatments. After the third it seemed to last for 2-3 days. After the fourth longer.
- it really seems like a ‘break out of depression’ breakthrough treatment. Though no cure all (talk therapy or a good support system is important too).
- ketamine is used for many purposes (anesthesia, etc.). When given for depression it’s given in much low dosages (presumably without harmful liver or kidney side effects).
- usually the patient listens to music with headphones while the infusion is in progress.
- a nurse monitors BP and heart rate etc., but so far there have been no compications other than a nurse who was bad at putting in an IV (once).
- feel very thankful for it.
- I could see it going mainstream in the near future.
[+] [-] mabbo|8 years ago|reply
Having no knowledge on the matter, what's the price comparison to just buying ketamine illegally and taking it without a doctor's help?
Depression is like (or possibly is) a form of chronic pain. People suffering from it severely might be willing to do anything for relief. Here's good information that a currently-illegal drug can help but if you want to do it legally you might need to take on a third job just to pay the costs.
It reminds me a bit of the South Park episode[0] where 'concentrated dose of about $180,000 shot directly into the bloodstream' is discovered as the cure to AIDS. Volunteers inform poverty-stricken Africa that all those suffering from AIDS have to do is inject themselves with piles of cash.
[0]https://en.wikipedia.org/wiki/Tonsil_Trouble
[+] [-] proverbialbunny|8 years ago|reply
I can imagine there being a great short term benefit to ketamine, as people who are severely depressed can't exercise due to the depression. Has there been any mention switching from ketamine to daily exercise, or doing both?
[+] [-] sneak|8 years ago|reply
[+] [-] senorjazz|8 years ago|reply
Not for medical which is maybe what you are referring to. But long term (recreational) ketamine use (abuse) is well known. Perhaps down to the method of injection (nasal) or the impurities in illicit ketamine, but there is a lot of information on bladder problems, stomach cramps along with heavy addiction
[+] [-] andrewingram|8 years ago|reply
[+] [-] unknown|8 years ago|reply
[deleted]
[+] [-] Fnoord|8 years ago|reply
[+] [-] unknown|8 years ago|reply
[deleted]
[+] [-] anythingnonidin|8 years ago|reply
- Ketamine seems to have a much larger effect size (-~0.99 [1] vs -~0.35 for typical antidepressants [2]) [If anyone spots an error, please let me know]
For context, an SMD of 0.2 is small, >0.5 is medium, and >0.8 is large.[3]
To me this seems to be by far the most important/interesting thing: Ketamine seems to have a much stronger antidepressant effect than our current antidepressants.
- Benefits occur within hours rather than weeks
- Doesn't seem to interfere with sexual function, unlike many antidepressants
Main downsides of Ketamine for depression
- Much more expensive and normally not covered by insurance
- It's less well studied
- You have to go in for additional ketamine infusions to maintain the effects, it seems roughly ~1x a month long term
(The SMD for typical antidepressants seems to range from ~-0.13 to ~-0.35, with Tricyclic antidepressants slightly higher at around -~0.42.[4][5][6])
[1]: https://www.ncbi.nlm.nih.gov/pubmed/25038867
[2]: https://onlinelibrary.wiley.com/doi/pdf/10.1002/wps.20112
[3]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730804/
[4]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903535/
[5]: http://www.annfammed.org/content/3/5/449.full
[6]: http://www.cochrane.org/CD011735/MUSKEL_selective-serotonin-...
[+] [-] ry_ry|8 years ago|reply
[0] http://www.bbc.co.uk/newsbeat/article/29811499/k-bladder-the...
[+] [-] empath75|8 years ago|reply
A lot of people that I used to hang out with back then are on a private email list now, where we talk about more boring stuff like our families and jobs and so on, since everyone basically aged out of the scene in our early 30s.
I recently made a post about how my mom had been abusive towards me as a kid.
Almost every single person on the email list responded with a similar story of abuse, sometimes of a horrific nature. And almost everyone talked about dealing with trauma and depression their whole lives — and how the rave scene and the drugs they took probably saved them. Several talked about suicide attempts before getting into raves.
I had known these people for almost 15 years and I had never really talked about this except for the random conversation on ecstasy with one or two of them where they or I as sort of worked out our issues with them at an after party or whatever.
I was pretty surprised at how consistent the story was. I know that’s how I felt about the drugs— that the combination of those two (and lsd to a lesser extent) and the community around the music probably saved my life — even though I took a lot of dumb chances and went well beyond the therapeutic info the hedonistic from time to time.
I went from being a lonely, closed up victim of abuse at home and a decade of bullying at school to being outgoing and popular in that scene - even to the point where I learned to DJ and played gigs in front of crowds of 1000+ people.
It helped me not just in the scene but in my personal life and my career. I learned to recognize some of my learned toxic behaviors that pushed people away from me and how to recognize them in other people. I distanced myself from my family and home town friends who had been treating me terribly, and my career took off — even with no degree — and largely because of connections I made in the scene.
I don’t know where I’m going with this, but it seemed transparently obvious at the time that MDMA, LSD and ketamine were near-miraculous substances and deserving of serious scientific study, and it always seemed perverse that the government was doing everything in its power to prevent people from taking them, while at the same time pushing people to take anti depressants and stimulants that were so much less helpful and enlightening.
I haven’t used drugs in nearly a decade and don’t intend to, but I’m glad that researchers are starting to take them seriously.
[+] [-] psyc|8 years ago|reply
[+] [-] ada1981|8 years ago|reply
[+] [-] TTPrograms|8 years ago|reply
The reason this treatment isn't mainstream isn't because "the research is still out" (though that may still be). It's because there are no financial interests to get it over the hoops into the highly convoluted state that enables affordable medical care.
[+] [-] Brybry|8 years ago|reply
The very article you're commenting on directly contradicts what you're saying. Big pharma is actively running studies and trying to get this fast tracked for treatment in the US and Europe.
Granted the article is somewhat poor reporting because the title should read "esketamine" not ketamine.
[+] [-] tibuma|8 years ago|reply
This is incorrect.
There are ongoing phase 3 clinical trials for nasally applied esketamine that will lead to FDA approval if succesfully reviewed. These trials are conducted worldwide and are very encouraging. The specific application seems to be patentable. First results should be available around 2019ish or 2020.
You can find the trials here:
https://clinicaltrials.gov/ct2/results?term=esketamine+depre...
And one of the patent applications here:
https://patents.google.com/patent/US20130236573A1
[+] [-] herbst|8 years ago|reply
It never really worked for me as that, at least not more than lsd or so would. And some friends claim that it has way less effect on them today even thought it seemed have to worked before.
It may is the abuse (probably higher amount on some occasions) it may are long term effects.
But it surely is not the magic cure some make it out to be.
[+] [-] filmgirlcw|8 years ago|reply
This could be a breakthrough for individuals in the midst of major depressions, which are often very hard to treat, considering how long it can take for other anti-depressants to start to work.
[+] [-] themodelplumber|8 years ago|reply
[+] [-] isoprophlex|8 years ago|reply
"""NMDA receptor antagonists can mimic these problems; they sometimes induce "psychotomimetic" side effects, symptoms resembling psychosis. Such side effects caused by NMDA receptor inhibitors include hallucinations, paranoid delusions, confusion, difficulty concentrating, agitation, alterations in mood, nightmares, catatonia,;ataxia, anesthesia, and learning and memory deficits.""" (From Wikipedia)
Ibuprofen hits the COX enzymes, for which no psychological effects are noted.
Edit: of course I'm not discounting your own observations, just regurgitating some textbook knowledge.
[+] [-] spiralx|8 years ago|reply
https://www.smithsonianmag.com/smart-news/painkillers-might-...
[+] [-] AstralStorm|8 years ago|reply
The real question is, how long do the effects last and what are the side effects.
[+] [-] amelius|8 years ago|reply
https://www.nhs.uk/news/medication/ibuprofen-linked-testoste...
[+] [-] kvgr|8 years ago|reply
[+] [-] ada1981|8 years ago|reply
Congrats on the self study and experimentation and on finding an over the counter solution.
Have you tried any non-ordinary states of concioisness work, like Holotropic Breathwork?
[+] [-] xab9|8 years ago|reply
[+] [-] nylonstrung|8 years ago|reply
Ibuprofen actually does work, believe it or not.
[+] [-] psyc|8 years ago|reply
[+] [-] starpilot|8 years ago|reply
[+] [-] herbst|8 years ago|reply
[+] [-] starpilot|8 years ago|reply
[+] [-] quantumwoke|8 years ago|reply
[0] https://www.thestar.com.my/lifestyle/health/2011/03/20/ketam...
[1] https://www.sciencedirect.com/science/article/pii/S016622361...
[+] [-] starpilot|8 years ago|reply
Can anyone comment on how long it might take for it to hit the market, from this stage?
[+] [-] odammit|8 years ago|reply
[+] [-] man2525|8 years ago|reply
[+] [-] ElijahLynn|8 years ago|reply
https://www.goodreads.com/book/show/721609.Spark
[+] [-] DrScump|8 years ago|reply
[+] [-] unknown|8 years ago|reply
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[+] [-] unknown|8 years ago|reply
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[+] [-] ninjakeyboard|8 years ago|reply
[+] [-] coderdude|8 years ago|reply
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[+] [-] polmoya|8 years ago|reply
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