Ketamine is a magical drug, I've told this story a hundred times on HN but it cured my depression overnight.
I was given a large hit of it by a doctor after a horrible accident, I went into a K-hole and had a spiritual experience, but even more profound was the effect it had for 4 to 6 months after.
It was like a veil had been lifted from my mind, the simplest pleasures of life made me happy, like smelling fresh coffee or feeling the sun on my skin. I had been living in misery for decades and suddenly I was awake and lucid and happy.
"Depression" is just a label put on a cluster of symptoms to make diagnoses consistent across medical providers. It is definitely not a singular condition with one cause and a consistent treatment across patients. It is likely a multitude of conditions which will respond differently to many treatments.
Some people with a depression diagnosis will be very disappointed with ketamine treatment.
I'm doing silly things for silly reasons, and I've never been this happy and at peace. It let me heal from the moral injury of working in big tech for a decade.
Seconded. For me however, its a monthly treatment for an hour in an office run by an anesthesiologist. The difference is night and day compared to any SSRI, SNRI, or TCA I've ever been on. Exempting the 3-4 hours post treatment, no ill side effects either.
It replaced my lifelong fear (terror?) of death with what I can honestly say is now curiosity. You can experience only so many deaths in your mind before you learn to be comfortable with the idea.
> but even more profound was the effect it had for 4 to 6 months after.
It's important to note that this is an atypically long duration. In clinical studies, the duration of effects is more around 1-2 weeks. It's possible that the overall experience (including surviving an accident and getting a "second lease on life") was the trigger for 4-6 months of improvement, not just the medication you were given once.
That's why, in clinical practice, ketamine is more successfully used in conjunction with typical long-term treatments such as SSRIs and therapy. Some studies used a sequence of 6 treatments spread out over months in an attempt to kickstart the recovery, but it's generally not sustainable as a solo therapy.
The frequency of these kind of posts followed by anecdotes about how it worked for the commenter (who I believe btw) makes me a little uneasy. Somewhere buried in the discussion eventually is a comment from a relevant professional urging caution in interpreting and reacting to these news reports and anecdotes. Now with something as serious as this I would not at all object to such cautions being placed a bit more prominently. This isn’t reckless use of goto being discussed but something much more serious. Anyway, I just wanted to get that off my chest. Perhaps it’s just me, don’t take it as a holier than thou attitude.
As someone who has taken extremely heavy doses of some very, very potent psychedelics (LSD, DMT, ketamine, mescaline and psilocybin), I am inclined to agree with you. I acknowledge that some people experience great benefits from psychedelics, but the current push to label psychedelics as mental health miracle solution doesn't sit right with me.
Make no mistake: these chemicals are not to be trifled with. People with underlying mental health issues - the poeple who would be most interested in using psychedelics - are at heavy risk of exacerbating their illnesses. Even outside of those special cases, I've seen normal people become heavily affected by bad trips. I simply don't think that there is enough scientific literature on the adverse effects of psychedelics. I also do not like the heavy focus on the "spiritual" aspects that these drugs are believed to confer: are you really transcending, or are you just so heavily intoxicated that you believe you are and no longer have the rational capabilities to convince yourself otherwise?
If I can end on just a little anecdote myself, I personally believe that heavy psychedelic use is especially counterproductive to technical/knowledge-based work. I did barely any work during the year that I was experimenting with these drugs. I was so content with my life as it was that I simply didn't feel the urge to exert myself. I was becoming soft, more predisposed to magical thinking. I believed that psychedelics had revealed unto me truths about how society should be run, how life should be and the true nature of mathematics. But I didn't know a damn thing! I just lost the inclination to actually analyse my ideas (or notions, because they barely qualified as ideas), instead being content to just accept them as they were. After a long stretch of abstinence from these drugs, I realised how worthless most of these notions actually were. I also deeply regretted the amount of time I spent taking these notions seriously, as well as the amount of time I had wasted in thinking that I had actually been experiencing any spiritual truths.
Your skepticism is warranted. Psychedelics are a hot topic and journalists have been promoting a lot of one-sided articles that make them sound like miracle cures. In clinical practice, ketamine can be useful as part of a recovery and treatment strategy, but it's not really an effective long-term treatment due to the short duration of effects (1-2 weeks post dosing) and the unsustainable nature of the drug (tolerance builds to the anti-depressant effect with repeated dosing).
Some ketamine treatment providers are running very professional and well-staffed businesses (source: had to do a lot of due diligence on the industry for a potential investment) but some of the others are shockingly under-qualified to be administering high doses of ketamine to patients with little evaluation. The regulatory bodies are slowly catching up to some of these providers and instituting stricter regulations. While there is some therapeutic potential, it needs to be delivered in the context of a long-term treatment strategy rather than just giving someone ketamine over and over again (as some unscrupulous providers will gladly do as long as the patient is willing to pay).
Honestly, I find HN's obsession with "professionals" annoying. For long-tail conditions, the professionals are frequently far less informed than fellow sufferers.
During the beginning of the pandemic, people on HN were telling us that N95 masks do nothing without official fit training. Bro, official fit training is something you can easily sub with a free video from 3M's website. It's this hopeless obsession with "official" and "professional" and shit like that when any reasonably intelligent individual can work through stuff themselves.
The one side effect of regular ketamine use in particular of having it recrystallize in your bladder, ripping it to shreds, is something I wonder if we're going to see more of in the medical literature in the future.
That said it's a pretty interesting wonder drug of sorts for a ton of different things, for example preventing further excitotoxic damage from brain injury
There are many personal anecdotes about how one treatment was a game changer. I don't doubt them, but as the article says, it doesn't work for everyone. I am posting this as a counterweight to all the glowing reports.
My wife has some chronic health conditions (EDS and ME/CFS and depression); I'm sure they are at least partially related. While ramping off of one antidepressant in anticipation of trying something different, her depression came roaring back, so the doctor prescribed ketamine infusions. It didn't help at all.
Part of the problem was the clinic. One of the (correct) refrains about psychedelics is the importance of "set and setting". To the employees, this was just one of eight infusions they were going to do that day and it was all very routine, but for someone who has never experienced psychedelics, an attentive, caring, gentle environment would have helped a lot. Being a woman, it was tremendously anxious for her to go into a closed room with a male nurse she had never met before and give up consciousness and control for half an hour. Having a different nurse every time wasn't great for building trust. There were some other things too, but ultimately the main thing was she experienced no benefit.
I found a single practitioner that did muscle injections instead of an IV so no nurses or anesthesiologists are present. I'm in a cozy room with nice, low lighting, my music, and he leaves the room during the treatment. It feels like going into someone's home. He has a camera to monitor and has come in when I've gotten restless.
Being in a home-like setting isn't for everyone though, so when I guide people to Ketemine treatments I ask them if they are more comfortable in a hospital environment and If so, I recommend the IV clinics.
Psychedelics are illegal not because they create hallucinations but rather because they help break down the hallucinations we have about the world. In the land of the blind, the one eyed man is a hallucinating idiot.
One of my favorite stories about psychedelic experiences is a friend's coworker dosing acid one weekend, coming back in on Monday, saying "I hate it here" and quitting on the spot. They went on to travel and start their own company, and are doing great for themselves.
In my experience, psychedelics really help tear down the justifications we put up for the BS we tolerate in our daily lives and can help you connect with what you really appreciate and want in life. Definitely helped me realize the kind of person I want to be and appreciate the good things in my life. And similarly to the story about the coworker quitting, my tolerance for BS is nil, now, too.
If that were true, we would likely see a greater variety of discourse and testimonies from people who use hallucinogens.
On the contrary, they tend to sound surprisingly similar in terms of world-view to each other. Once you experience hallucinogens yourself, it becomes pretty clear why that might be.
The obvious conclusion is, of course, that hallucinogens unlock an objective, common reality. That's not what the depth and quality of the observations produced suggest, however.
I saw Ketamine remove depression immediately after a single dose in a loved one. Thought it was magic, because it was, a lifetime of depression just evaporated like nothing. But then came the psychosis. Nearly got stabbed in my sleep because a voice told them to do that.
So... let's just say I think there are other explanations, too.
A word of caution: Ketamine treatment is far from standardized. Most of the clinical studies I've read aren't using doses that produce profound psychedelic trips. The more professional clinics seem to have settled on dosing regimens that produce mild impairment, but not the full-blown dissociative trips described in many of these articles.
Meanwhile, there are a lot of questionable ketamine clinic providers popping up all over the country that give much higher doses. Some of them promote the psychedelic angle heavily in their marketing materials, as it has become a major revenue generator from patients who read articles like this one. While a single medium to high dose of ketamine may not produce marked negative effects, some of the high-dose, repeat-dosing regimens used by alternative therapy providers are in the range where I'd begin to be very concerned about lasting damage.
I would strongly caution anyone curious about ketamine treatment to stick to the lower-dose clinics and providers. Avoid anyone trying to sell you on "psychedelic therapy" or who has a reputation on the internet of providing excessively large doses. Also keep in mind that the antidepressant effects are short-lived, so plan to engage with traditional long-term treatment (therapy and/or antidepressants) to create a lasting strategy for yourself when the short-term effects of the ketamine wear off.
Does anyone know what the therapeutic ranges are at different clinics? I'm currently in IV infusion clinic where they start at 0.5 mg/kg, and increase by 0.1 per session. They are trying to target having a light psychedelic experience during the infusion, as they've found that gives the desired antidepressant effects later on, but not so much so as to be really far out, or to be frightening, totally out of body, or loss of consciousness at all.
I'm told the max therapeutic dose they administer is somewhere between 1-2mg/kg, and I believe anesthetic effects come on somewhere in between 2-4mg/kg? Anesthesia doses are administered much faster, so I'm sure that it's not a direct comparison.
This would be far more helpful if you included the dose ranges you allude to, how many you think are required to cause damage, and threw in a few citations.
They should not be lumping ketamine in with all the other psychedelics which act on the serotonin 2A receptor. I’m hesitant to say ketamine is a psychedelic at all.
Regardless, I find .25 mg of Klonopin can get rid of my depression as well, they’ve known for a long time that depression has a strong linked glutamate excitation in certain parts of the brain.
Amongst psychedelic therapists it’s pretty normal to include Ketamine under the rubric of psychedelics these days, even though receptor purists might still object. Same is true of MDMA. From a subjective experience there’s no doubt that it’s different, but at psychedelic dose ranges most psychonauts will characterize it is a psychedelic experience, and ketamine can produce experiences every bit as weird and life altering as the tryptamines.
One interesting line of research on thinking about new ways to characterize this that they all can be characterized as re-opening critical periods of development. Gul Dolen at Johns Hopkins is spearheading this, and this interview with her is worth a listen.
Ketamine therapy has made a significant improvement to my quality of life but it’s a shame it’s not FDA approved for depression / anxiety and thus not available on insurance. The cost is a barrier for people who could benefit from it.
I am hoping that MAPS ( https://www.maps.org ) will one day undertake clinical trials for ketamine, although this seems to not be on their radar right now.
I've wondered: what are the chances that big pharma will attempt to suppress these medicines that compete with their patentable products, like seems to be the case with the majority of drugs caught up in "the war on drugs"?
My opinion? They’ll start marketing and selling it as well.
Just like a hundred years ago people believed putting cocaine into everything was great, we’ll do the same.
These drugs may work for some, but we don’t know the effects at scale. Who knows maybe in a 100 years we will think damn they were really doing that? Meanwhile we’ll all be hitting some new drug that someone found out about from some ancient civilization. Then we will find out why they are ancient.
Braxia (a canadian company) recently acquired KetaMD to expand their US footprint with their ketamine clinics. I believe something between shrooms and K is the future for depression.
Has anyone had bad experience taking this drug as a treatment for depression? I’m on my third SSRI and am quite desperate to find something to improve my “quality of mind”.
Plenty, see erowid.org. It’s vital to note that the therapy used in combination with these medicines appears to be a key component in all trials I’ve read into—simply taking mushrooms themselves, for example, doesn’t guarantee any positive outcome.
Anecdotally, many people report self-guided use of psychedelics to have been transformative for their own mental health, but it’s equally important to not blind yourself to the very real risks posed in doing so. I don’t say this to discourage you, but rather encourage you to really dive into the topic and learn as much factual information as you can, particularly before undertaking any treatment.
Is this the "science" rag that just decided to censor any research that paints any "groups" in a bad light[1]? Yeah, nature.com is compromised, we need sources with more integrity.
[+] [-] ad404b8a372f2b9|3 years ago|reply
I was given a large hit of it by a doctor after a horrible accident, I went into a K-hole and had a spiritual experience, but even more profound was the effect it had for 4 to 6 months after.
It was like a veil had been lifted from my mind, the simplest pleasures of life made me happy, like smelling fresh coffee or feeling the sun on my skin. I had been living in misery for decades and suddenly I was awake and lucid and happy.
[+] [-] colechristensen|3 years ago|reply
"Depression" is just a label put on a cluster of symptoms to make diagnoses consistent across medical providers. It is definitely not a singular condition with one cause and a consistent treatment across patients. It is likely a multitude of conditions which will respond differently to many treatments.
Some people with a depression diagnosis will be very disappointed with ketamine treatment.
[+] [-] mathgladiator|3 years ago|reply
I'm doing silly things for silly reasons, and I've never been this happy and at peace. It let me heal from the moral injury of working in big tech for a decade.
[+] [-] dundercoder|3 years ago|reply
[+] [-] whiskyagogo|3 years ago|reply
[+] [-] FollowingTheDao|3 years ago|reply
Ketamine has been known to trigger hypomania and mania in patients.
https://pubmed.ncbi.nlm.nih.gov/33587793/
10 mg of Prozac will do the same thing to me, but that’s just my genetics.
[+] [-] PragmaticPulp|3 years ago|reply
It's important to note that this is an atypically long duration. In clinical studies, the duration of effects is more around 1-2 weeks. It's possible that the overall experience (including surviving an accident and getting a "second lease on life") was the trigger for 4-6 months of improvement, not just the medication you were given once.
That's why, in clinical practice, ketamine is more successfully used in conjunction with typical long-term treatments such as SSRIs and therapy. Some studies used a sequence of 6 treatments spread out over months in an attempt to kickstart the recovery, but it's generally not sustainable as a solo therapy.
[+] [-] bhedgeoser|3 years ago|reply
[+] [-] fassssst|3 years ago|reply
[+] [-] Overtonwindow|3 years ago|reply
[+] [-] jahnu|3 years ago|reply
[+] [-] akuro|3 years ago|reply
Make no mistake: these chemicals are not to be trifled with. People with underlying mental health issues - the poeple who would be most interested in using psychedelics - are at heavy risk of exacerbating their illnesses. Even outside of those special cases, I've seen normal people become heavily affected by bad trips. I simply don't think that there is enough scientific literature on the adverse effects of psychedelics. I also do not like the heavy focus on the "spiritual" aspects that these drugs are believed to confer: are you really transcending, or are you just so heavily intoxicated that you believe you are and no longer have the rational capabilities to convince yourself otherwise?
If I can end on just a little anecdote myself, I personally believe that heavy psychedelic use is especially counterproductive to technical/knowledge-based work. I did barely any work during the year that I was experimenting with these drugs. I was so content with my life as it was that I simply didn't feel the urge to exert myself. I was becoming soft, more predisposed to magical thinking. I believed that psychedelics had revealed unto me truths about how society should be run, how life should be and the true nature of mathematics. But I didn't know a damn thing! I just lost the inclination to actually analyse my ideas (or notions, because they barely qualified as ideas), instead being content to just accept them as they were. After a long stretch of abstinence from these drugs, I realised how worthless most of these notions actually were. I also deeply regretted the amount of time I spent taking these notions seriously, as well as the amount of time I had wasted in thinking that I had actually been experiencing any spiritual truths.
[+] [-] PragmaticPulp|3 years ago|reply
Some ketamine treatment providers are running very professional and well-staffed businesses (source: had to do a lot of due diligence on the industry for a potential investment) but some of the others are shockingly under-qualified to be administering high doses of ketamine to patients with little evaluation. The regulatory bodies are slowly catching up to some of these providers and instituting stricter regulations. While there is some therapeutic potential, it needs to be delivered in the context of a long-term treatment strategy rather than just giving someone ketamine over and over again (as some unscrupulous providers will gladly do as long as the patient is willing to pay).
[+] [-] willhinsa|3 years ago|reply
Caution is useful, but it’s not always an unalloyed good.
Chemotherapy isn’t healthy or safe, but the thing it’s used to stop is even worse.
[+] [-] renewiltord|3 years ago|reply
During the beginning of the pandemic, people on HN were telling us that N95 masks do nothing without official fit training. Bro, official fit training is something you can easily sub with a free video from 3M's website. It's this hopeless obsession with "official" and "professional" and shit like that when any reasonably intelligent individual can work through stuff themselves.
[+] [-] jamal-kumar|3 years ago|reply
That said it's a pretty interesting wonder drug of sorts for a ton of different things, for example preventing further excitotoxic damage from brain injury
[+] [-] tasty_freeze|3 years ago|reply
My wife has some chronic health conditions (EDS and ME/CFS and depression); I'm sure they are at least partially related. While ramping off of one antidepressant in anticipation of trying something different, her depression came roaring back, so the doctor prescribed ketamine infusions. It didn't help at all.
Part of the problem was the clinic. One of the (correct) refrains about psychedelics is the importance of "set and setting". To the employees, this was just one of eight infusions they were going to do that day and it was all very routine, but for someone who has never experienced psychedelics, an attentive, caring, gentle environment would have helped a lot. Being a woman, it was tremendously anxious for her to go into a closed room with a male nurse she had never met before and give up consciousness and control for half an hour. Having a different nurse every time wasn't great for building trust. There were some other things too, but ultimately the main thing was she experienced no benefit.
[+] [-] bradly|3 years ago|reply
Being in a home-like setting isn't for everyone though, so when I guide people to Ketemine treatments I ask them if they are more comfortable in a hospital environment and If so, I recommend the IV clinics.
[+] [-] jokoon|3 years ago|reply
if doctors are unable to find ways to make a drug work and predict it, then it's pointless.
A 4 days vacation every month will have better results, and it's something most therapists and psychiatrist also say, that lifestyle matters.
If a drug cannot do better than lifestyle change, then the drug doesn't work.
[+] [-] kornhole|3 years ago|reply
[+] [-] heavyset_go|3 years ago|reply
In my experience, psychedelics really help tear down the justifications we put up for the BS we tolerate in our daily lives and can help you connect with what you really appreciate and want in life. Definitely helped me realize the kind of person I want to be and appreciate the good things in my life. And similarly to the story about the coworker quitting, my tolerance for BS is nil, now, too.
[+] [-] Bakary|3 years ago|reply
On the contrary, they tend to sound surprisingly similar in terms of world-view to each other. Once you experience hallucinogens yourself, it becomes pretty clear why that might be.
The obvious conclusion is, of course, that hallucinogens unlock an objective, common reality. That's not what the depth and quality of the observations produced suggest, however.
[+] [-] Natsu|3 years ago|reply
So... let's just say I think there are other explanations, too.
[+] [-] PragmaticPulp|3 years ago|reply
Meanwhile, there are a lot of questionable ketamine clinic providers popping up all over the country that give much higher doses. Some of them promote the psychedelic angle heavily in their marketing materials, as it has become a major revenue generator from patients who read articles like this one. While a single medium to high dose of ketamine may not produce marked negative effects, some of the high-dose, repeat-dosing regimens used by alternative therapy providers are in the range where I'd begin to be very concerned about lasting damage.
I would strongly caution anyone curious about ketamine treatment to stick to the lower-dose clinics and providers. Avoid anyone trying to sell you on "psychedelic therapy" or who has a reputation on the internet of providing excessively large doses. Also keep in mind that the antidepressant effects are short-lived, so plan to engage with traditional long-term treatment (therapy and/or antidepressants) to create a lasting strategy for yourself when the short-term effects of the ketamine wear off.
[+] [-] cypherpunks01|3 years ago|reply
I'm told the max therapeutic dose they administer is somewhere between 1-2mg/kg, and I believe anesthetic effects come on somewhere in between 2-4mg/kg? Anesthesia doses are administered much faster, so I'm sure that it's not a direct comparison.
[+] [-] nwienert|3 years ago|reply
[+] [-] FollowingTheDao|3 years ago|reply
Regardless, I find .25 mg of Klonopin can get rid of my depression as well, they’ve known for a long time that depression has a strong linked glutamate excitation in certain parts of the brain.
[+] [-] krrrh|3 years ago|reply
One interesting line of research on thinking about new ways to characterize this that they all can be characterized as re-opening critical periods of development. Gul Dolen at Johns Hopkins is spearheading this, and this interview with her is worth a listen.
https://www.iheart.com/podcast/1119-psychoactive-84544756/ep...
[+] [-] heavyset_go|3 years ago|reply
I'd argue that the term "psychedelic dissociative" accurately captures what ketamine can be.
[+] [-] mathgladiator|3 years ago|reply
For me, whatever I experienced was definitely something. https://www.adama-platform.com/2022/07/02/the-path-of-the-mo...
[+] [-] dabinat|3 years ago|reply
I am hoping that MAPS ( https://www.maps.org ) will one day undertake clinical trials for ketamine, although this seems to not be on their radar right now.
[+] [-] loceng|3 years ago|reply
[+] [-] moomoo11|3 years ago|reply
Just like a hundred years ago people believed putting cocaine into everything was great, we’ll do the same.
These drugs may work for some, but we don’t know the effects at scale. Who knows maybe in a 100 years we will think damn they were really doing that? Meanwhile we’ll all be hitting some new drug that someone found out about from some ancient civilization. Then we will find out why they are ancient.
[+] [-] fourstar|3 years ago|reply
[+] [-] hestefisk|3 years ago|reply
[+] [-] liamwire|3 years ago|reply
Anecdotally, many people report self-guided use of psychedelics to have been transformative for their own mental health, but it’s equally important to not blind yourself to the very real risks posed in doing so. I don’t say this to discourage you, but rather encourage you to really dive into the topic and learn as much factual information as you can, particularly before undertaking any treatment.
[+] [-] unknown|3 years ago|reply
[deleted]
[+] [-] responsible|3 years ago|reply
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[+] [-] the_doctah|3 years ago|reply
[1]https://archive.ph/xvuBk