Ketamine Could Soon Be Used to Treat Suicidal Ideation

https://www.bloomberg.com/news/features/2019-02-05/ketamine-could-soon-be-used-to-treat-suicidal-ideation

by dankohn1 • 7 years ago

135 119 7 years ago

Side note: I really like the photographic style of this article, particularly the man standing on a brick column as though on a building about to jump off, but perhaps instead standing strong having learned to cope with his negative emotions. The dark motif overall is a nice counterpoint to the ultimately uplifting, persevering tone of the article.

a012• 7 years ago

I guess the photo was shot on wet plate!? The large format lens DoF and the high contrast makes the scene scenery looks dramatic. Very well done.

raihansaputra• 7 years ago

I was intrigued and found out more about the photographer. He was a trained photographer (worked under Annie Leibovitz) and lectured photography in the 90s. Got his medical degree in 2004 and seems like he's coming back to photos. https://www.nationalgeographic.com/contributors/a/photograph... https://www.nationalgeographic.com/magazine/2019/01/max-agui...

bfuller• 7 years ago

IV ketamine is already being used to treat depression. Its about $500 per treatment.

yasp2• 7 years ago

Yes and I believe that nasal administration is either under FDA review or active development.

Edit: For anyone suffering from suicidal ideation, I recommend trying lithium (in close consultation with your doctor).

rhcom2• 7 years ago

Lithium was the only drug that helped me. Two weeks on it and the ideations were gone. Of course it also requires monthly blood tests, and for me being nauseous every morning but the positive effects did stay after I discontinued.

Brometheus• 7 years ago

200 Euro in Germany

WalterSear2• 7 years ago

So is intranasal ketamine.

ketathrowaway17• 7 years ago

I pay $375. And at a different doctor, before I found my current one, I was paying $750.

atomical7• 7 years ago

I pay $375. And at a different doctor, before I found my current one, I was paying $750.

Most of them are charging more than $375. This is not regional pricing. There is no reason why an infusion in Albuquerque should cost half as much as an infusion in Chicago. In another comment you suggested these experts should be respected.

This isn't just my opinion, it's the consensus opinion of ketamine docs across the world.

When doctors are robbing patients that may just be the beginning of impropriety...

brokensegue• 7 years ago

if you read the article you would note that that is true but its use for depression is off-label and without well defined procedures

elorant2• 7 years ago

I thought Ketamine was considered a rape-drug and thus prohibited.

reverend_gonzo• 7 years ago

Not even remotely. You're thinking of GHB.

ceejayoz2• 7 years ago

Which, incidentally, also has perfectly legitimate medical uses - treatment of narcolepsy, anesthesia, etc.

bagacrap2• 7 years ago

It is a common misconception though, perhaps bolstered by anecdotal experiences where the two drugs were confused. Larger doses of K can incapacitate you, so it's not totally off base to think it could be used in that way, but it's certainly not why it's banned by the DEA. It's banned bc of the drug war military-industrial complex.

elorant2• 7 years ago

No, I mean Ketamine.

https://www.womenshealth.gov/a-z-topics/date-rape-drugs

thecatspaw• 7 years ago

Its a disassociative, and at high enough doses can make you loose grip of reality.

It also has a very distinct bitter taste, which would make it quite obvious if someone put it in your drink or similar.

Drugging someone else (wether that be with legal drugs or illegal ones) is allready prohibited, no matter the intent.

xenihn• 7 years ago

The first thing I associate it with outside of recreational human usage is horse tranquilizers.

soroso• 7 years ago

Is the incidence of suicide lower among regular ketamine users?

ketathrowaway17• 7 years ago

There is a gigantic difference in patient outcome between clinical ketamine use and recreational ketamine use. For a variety of reasons: careful dose control, having an actual doctor involved, etc. But the biggest one is the antidepressant effects of ketamine only really happen when it's administered via IV drip over a course of 45 minutes. The most common use of recreational ketamine is inhaling it, the effects come up too fast and go away too fast for the antidepressive effects to occur.

LaikaF4• 7 years ago

Insufflation is the word you're looking for.

That's also untrue. IM, and IV are most faster come offs then insufflation or eating it. Though eating ketamine sucks for the amount you need.

What is true about IV is you can control the amount that actually gets taken in much better.

jokowueu8• 7 years ago

I've spoken with a few . Once u start getting high tollerances the anti depressive effects go away permanently .

ketathrowaway17• 7 years ago

You do not build up a tolerance to ketamine if you follow the treatment protocol, which dictates a lower dose (around 100mg, give or take for body weight), and one infusion every 3-6 weeks.

Source: Been having regular infusions every 3-6 months for 3 years, and it still works for me.

I can't say this enough: experience & anecdotes based on recreational ketamine use /do not apply at all/ to clinical use.

mchannon• 7 years ago

A loved one went through a few rounds of Ketamine IV at a recently opened clinic. It was about $400 a treatment, not covered by insurance, but administered by credentialed professionals.

The experience was a bit like a dialysis clinic, where there are a bunch of beds in a room, tatami screens between the beds, and where a huge 2" diameter syringe dosing pump eases a tiny amount of Ket in the line over 15 minutes.

Aside from the expense, it didn't particularly help my loved one's condition. She said it felt more like it just got her high, and not the kind of high you want. Maybe if they used a stronger dose, but those cost more as I recall.

I feel there are at least three treatments one should try before Ketamine, for PTSD/Anxiety/Depression/Suicidal Ideation.

• EMDR. So successful it's amazing that it's not standard fare in counseling and therapy.

• Neurofeedback. The literature is equivocal at best, but the anecdata is very strong.

• LSD. As our nation struggles with medical marijuana still living on schedule I, LSD similarly inhabits schedule I (where the government knows better than your doctor about there being no possible medical benefit). Studies show LSD is over 10x as successful in curing alcoholism as AA.

thatsamonad• 7 years ago

EMDR

I’ve been undergoing EMDR treatment for PTSD and it is quite amazing how well it works. You wouldn’t expect that just watching something move back and forth in front of your face (or having an electric pulse alternate between your hands) in between talking about a traumatic experience would do much, but for me it’s been the most effective thing so far after trying many different kinds of therapy and medication.

I think what a lot of people need when it comes to depression/anxiety/trauma is not simply to feel better in short bursts, but rather to reframe and reprocess thoughts, feelings, and memories in such a way that they become easier to “hold” even if they don’t go away. A lot of our treatments focus on elimination rather than acceptance and reprocessing.

I think of it like short-term dieting vs lifestyle changes. The former may provide a quick fix, but the latter will usually be longer lasting, healthier, and easier to sustain after the initial push.

slfnflctd• 7 years ago

not simply to feel better in short bursts, but rather to reframe and reprocess thoughts, feelings, and memories in such a way that they become easier to “hold” even if they don’t go away

This is absolutely the gist of it. Anything that helps you do something along these lines is worth pursuing. It's about building up scaffolding around a disaster area-- not to cut off access, but to put up a useful, multipurpose firewall.

sibeliuss• 7 years ago

I find it curious that on sufficient doses of MDMA ones eyes can rapidly go back and forth, similar to the EMDR process.

eternalny1• 7 years ago

I have some experience with Ketamine ... the one I can share is when the hospital administered it via IV to put my dislocated shoulder back in place.

It was wild and would certainly NOT be my choice for a sedative in that situation. It hit fast and at first I felt high, doctors faces started to "melt", then a huge black abyss was in front of me and I felt like I was falling head first into it.

I started yelling "no, no!" because it was a very uncomfortable feeling.

Then as I was coming to the entire room was warped, with echoing voices and laughter.

I'll pass on that, not sure how that would help with depression. It would have to be a VERY small dose.

Jhndb• 7 years ago

I don't think they would have given you the same dose if it was to treat depression. By the sounds of your trip, you had way more than the standard dose (even by recreational standards).

jokowueu8• 7 years ago

In a clinic environment they wouldnt be putting ur arm back :) . U would be in a calm environment with nice music and blind folds

Some follow a low dose of around 30-35mg and some go up to 150mg which I found to be life changing

SippinLean• 7 years ago

According to what I can find they were using a dosage of 0.5 mg per kg in this study, but dosages can be as high as 1 to 4.5 mg/kg when used as an anesthetic.

I had the same dose for the same reason, it was very disturbing. Apparently the doctor said it was normal for patients to scream that much.

blobwalker4• 7 years ago

In a situation like that where you're in pain and anxious to start with, and are not prepared for what's going to happen, I can imagine it would be pretty horrible. I was in a comfortable situation and well-prepared when I got my first IV, and there were still a couple of brief, scary moments in the experience. And as someone else said, you probably got a much bigger dose, putting you deep into k-hole territory, if not actually knocking you out. When used for therapy, that kind of dose is usually reserved for those with chronic pain or other conditions, not depression or suicidal ideation.

jokowueu8• 7 years ago

I would like to add MDMA too to that list

fjabre• 7 years ago

Also transcranial magnetic stimulation which is FDA approved for treatment of depression. No drugs involved.

atomical7• 7 years ago

A treatment is either changing brain chemistry with the risk of side effects of some kind or it isn't and there is no potential benefit.

atomical7• 7 years ago

My doctor prescribes ketamine for take home use. Unfortunately infusion clinics are taking advantages of patients by administering the most expensive ROA. Keep in mind that the IV ROA has not been proven more effective or safe than cheaper ROAs.

ozzyman700• 7 years ago

Is this in the US?

ketathrowaway17• 7 years ago

Ketamine's antidepressive effects are by far the most potent when ketamine is administered as an IV drip over a long period of time, like 40ish minutes. If you simply inject it all at once, you will definitely go to la la land, but the duration will be too short.

And if you're talking about starting an IV on yourself... without training, the risks of really bad health issues, including death, are pretty high. Almost no one outside of professional health care has that training. Even if they did, you still need to be monitored by someone else via pulse ox and sometimes blood pressure for safety reasons, and said person monitoring you needs to have the training to know how to help you if something goes wrong. Keep in mind that if ketamine is effective for you, you will end up needing to keep taking it for a long time, typically every 3-6 weeks, or the effects wear off. That frequency multiplies the risks.

In short, I see the ratio of risk to effectiveness for home use ketamine to be emphatically not worth it. Unless you have a partner / friend who has the necessary training.

I know from talking to my doctor that of the $375 I pay, his cost for the ketamine he uses for that one treatment is under 10 bucks. If you've got a medical license, you get access to buy legit pharma drugs very easily. I believe he told me that one vial of Ketamine is something like $20 and there's multiple doses in there.

nickbarnwell5• 7 years ago

Anecdata is also all that supports TMS and Ketamine. There's not been sufficient time for longitudinal studies to be conducted or more efficacious protocols to be developed.

Had your loved one tried ECT prior to ketamine infusion? Though its reputation has been sullied by popular culture, it is bar none the most efficacious treatment we have for treating severe and persistent depression, and its efficacy is well supported by decades of research and outcome tracking.

phren0logy4• 7 years ago

The enthusiasm for ketamine and TMS undoubtedly outstrips the evidence and is driven by financial motivations. But to call it "anecdata" is a bit harsh. The available evidence certainly eclipses some of the other recommendations in the comments (CBD, lsd/psilocybin - before I get angry responses, these look promising but the data just aren't there yet).

Where I totally agree with you is ECT. It is, with a bullet, the best-supported intervention for treatment-resistant depression, and it's not even close. It is an absolute tragedy that it has such an unfairly terrible reputation. Even before anesthesia was a universal element of ECT, it was never as bad as usually portrayed in popular culture.

mruts8• 7 years ago

Ketamine treatments are pretty expensive at a clinic. If you wanted regular Ketamine doses for depression (maybe like 1 a month?), I would just buy some online and insufflate it. Safer than a needle and just as effective.

PS: Chronic Ketamine use destroys your urinary tract (I know people that wet the bed every night from too much of the stuff). Also, it might cause brain damage, but no one is really sure.

ketathrowaway17• 7 years ago

This is not strictly true. Chronic ketamine ABuse can cause urinary tract problems. The doses and frequency used in a clinical session emphatically do not cause this problem. Ketamine has been in regular use since 1970 for a wide range of medical purposes. It's also been on the WHO Essential Medicines List since 1985.

tl;dr - don't need to worry about urinary tract issues unless you're using the drug (1) recreationally; (2) irresponsibly

senorjazz• 7 years ago

I only know hearsay, but the issue effects those sniffing 2-3+ grams a day, every day for extending periods. The ketamine causes internal scarring of the bladder / urinary tract (not sure which or if either), that scarring stops the organ (maybe wrong word) from expanding and contracting.

So you feel like you need to piss regularly, but only a few drips come out. The damage can get so severe bladder gets removed.

At the lesser end of the damage is agonising stomach cramps, no idea what the cause of this is.

source: spent too long in the uk freeparty rave scene when ketamine was legal and people assumed it was completely safe due to lack of come down. Too many people ended up with severe ketamine addictions and many have to know piss through a bag

SketchySeaBeast3• 7 years ago

I would just buy some online and insufflate it. Safer than a needle and just as effective.

You're advocating buying a black market substance online and then snorting it as the safer option?

jokowueu8• 7 years ago

That's what most do with ketamine to reduce chance of infection . U could also buy a reagent to test it before use .

Only issue I see with intranasal is that bioavailability is only 33%

mruts8• 7 years ago

Are you saying that buying a black market substance and injecting it would be the safer option?

jokowueu8• 7 years ago

The chronic users are on very very high doses . It does happen on users who take low doses but much less compared to others . U need to flush ur system with liqueds according to harm reductions guides

Also egcg seems to completely block it's damaging effects https://www.sciencedirect.com/science/article/pii/S187952261...

trumped• 7 years ago

Is it possible to get some from your local veterinarian?

mruts8• 7 years ago

Absolutely. If you're friends, of course. Or maybe if you have enough money? But at that point, you might as well just go to the clinic.

ZeroFries2• 7 years ago

If you want tighter control, I.M. ketamine using a micron filter is the way to go.

ketathrowaway17• 7 years ago

I would just buy some online and insufflate it. Safer than a needle and just as effective.

Insufflation is only "just as effective" if your goal is to get an intense psychedelic high.

If your goal is a strong antidepressant effect, insufflation is extremely less effective than IV-drip-over-40min. This isn't just my opinion, it's the consensus opinion of ketamine docs across the world.

Insufflation helps you for a few minutes to a few days, IV drip method works for 3-6 weeks.

atomical7• 7 years ago

Ketamine is an off label treatment. Many of the practitioners aren't even psychiatrists. There are nurses, anesthesiologists, and pain specialists that do this as a side gig to make money. Your statement reads like we should put a lot of trust in these people when it's actually the opposite. One of the biggest clinics just hired a CEO to expand their business.

The time that the effect lasts is variable. A patient may need an infusion every week. That's $26,000 a year in some cases.

I actually had a doctor tell me that the infusions last 6 months.

mruts8• 7 years ago

What biological mechanism would make this the case? Are you saying it has to do with bio-availability? Half-life? Onset? Duration?

What about IM? What about rectal administration? How about sublingual? Are there any papers suggesting that IV is somehow quantitatively different from the aforementioned methods?

My personal experience is that IM, IV, and snorted all made me feel better for maybe a period of 2 weeks. I wasn't necessarily doing a "clinical" dose, whatever that means (maybe 25-75mg of IM or IV and 100-250mg snorted), but the anti-depressant effects all seemed comparable.

A drug crossing the blood-brain barrier is a drug crossing the blood-brain barrier. There should be no difference in administration if we are talking about weeks to months later.

ketathrowaway17• 7 years ago

(Pardon the throwaway; I try to keep my medical history private!)

I started monthly ketamine treatment about 3 years ago for treatment resistant depression. It has helped me immensely. It costs me $375 per infusion.

I tried 1-3 drugs from every class of antidepressant (and a few other types) before ketamine and had limited results. Ketamine, however, has been a godsend.

If anyone has any questions about the treatment, the drug, its effects on me, or anything else, feel free to ask.

nabnob2• 7 years ago

Is the dose administered during these sessions high enough to cause hallucinogenic effects?

Could you describe what your depressive symptoms were like before/after treatment?

How many sessions did it take before you saw improvement?

Also, any personal insight on why it was so effective for you? Do you think it helped you view circumstances in your life in a different way (the way other hallucinogens like LSD might)?

ketathrowaway17• 7 years ago

Is the dose administered during these sessions high enough to cause hallucinogenic effects?

Yes. It isn't effective unless you get well into a hallucinogenic state. The antidepressant effect seems to be maximized by setting the dose such that you are fairly "out there", but not so far out there that you get scared, or pass out. (Ketamine is used all the time as anesthesia for surgery, and they give you a much larger dose than is used in depression treatment, because past a certain dose, you just immediately zonk out 100%. Good ketamine therapy for depression is achieved by feathering the dose between the two extremes of zero effect and passing out.)

Hallucination means a lot of different things, but with ketamine it's pretty specific. It's not the kind of hallucination where you're looking around the room you're in and see things that don't exist. With ketamine you basically disconnect from the world you're in at the moment and go somewhere else entirely, in your own head. You will often not ingest input from your eyes, even if they're open. What goes on inside someone's head at this point varies wildly, I could tell you what it's like for me but not sure how much interest there is in that. I will say though that music has a profound impact on what goes on in my head during an infusion, and is a fun way of customizing the ketamine experience. I particularly love using my AirPods for this, because there are no wires and especially under ketamine, it feels like the sound is coming from inside your head, as opposed to feeling like you're wearing headphones.

Could you describe what your depressive symptoms were like before/after treatment?

My depression manifest itself in extreme anhedonia, and after my 3rd infusion, I played, and enjoyed playing, a video game again, for the first time in over a year. Also, at that point in my life (3 years ago) I was going through a lot of difficult personal life problems, and dealing with those problems went from "completely insurmountable" before, to "this is shitty but I can figure it out" after.

In other words, it helped me deal with my life and enjoy things again, but it didn't turn me into someone who will never experience sadness again. It doesn't mean you'll never have a bad day again, but it does mean you'll be able to handle those bad days a lot better.

How many sessions did it take before you saw improvement?

The way my doctor recommended starting ketamine treatment was to have 6 doses over the course of 2 weeks (m/w/f, m/w/f), and then after that "as needed", which for me turned out to be every 4 weeks. It was after the 3rd dose in my initial course of 6 that I noticed a significant effect.

Also, any personal insight on why it was so effective for you? Do you think it helped you view circumstances in your life in a different way (the way other hallucinogens like LSD might)?

I can answer this in two parts.

First, one reason it is effective for me is because I don't take any other drugs that conflict with ketamine. Regular benzodiazepine use, or opiate use, or lamictal (this list is not exhaustive) significantly impact the effectiveness of the treatment. Lamictal completely kills the effectiveness. I had just started on lamictal treatment a month prior to discovering ketamine treatment, and had to come off it for 10 days before starting. Same with benzos.

Second, and this is just my personal theory about my own experience, I think one thing ketamine does that helps me is to get my mind out of ruts. The experience of ego death, or near ego death, that I get with ketamine feels like a complete reset for the problems my brain was relentlessly focusing on before. Afterwards, I still care about those problems, but obsessing over the negative parts of my life abates significantly. I would say that before, my focus on the negative vs positive was quite lopsided to the negative, to the point that I rarely noticed / felt the positives. Whereas now, the two are much more balanced. I still lean a bit towards the negative, but just a bit.

One more personal anecdote: Before ketamine, I was dating a lot, but almost out of desperation because of how extremely lonely I felt, rather than because I was being thoughtful/intentional/patient about finding a great partner. The ladies I dated picked up on this quite easily, and it lead to a lot of negative outcomes. And each negative outcome felt like the world ending, which made things worse. A few months after starting ketamine I tried dating again, and it went so much better. I wasn't as desperate, and I took the time to figure out who I was and what I really wanted, and what I offered. It still took a while before I found the right partner for me, about one year after starting ketamine treatments, but we're happily married!

jokowueu8• 7 years ago

This is J&J's S-ketamime NOT racemic ketamin

Racmic is better

ketathrowaway17• 7 years ago

This has been my experience too. None of the ketamine-based drugs have been as effective as regular ketamine. That said, drug companies will not seek to get regular ketamine FDA approved because they can't patent it. So this is the only way they will go through the process of FDA approval. I hope it leads to regular ketamine being FDA approved for treating depression because only then will it be covered by insurance.

WalterSear2• 7 years ago

The literature points to R-ketamine, on it's own, appearing to have stronger antidepressant effect, with less of the disassociative effects.

AFAICT, it's not patentable, so nobody would pay for the trials.

jokowueu8• 7 years ago

This is very true . R-ketamine holds most of the benefit but some of the metabolites of s-ketamine also do contribute to the positive effects .

Regarding patents . It is possible to patent an ROA method just like what j&j did with s-ket

starpilot• 7 years ago

FYI - Kaiser Permanente is running some ketamine in clinics in California. If your insurance is Kaiser, this might be a low-cost option.

faissaloo3• 7 years ago

I'm very much concerned that rather than traditional psychotherapy where a person has to confront the issues and trauma of their life we're moving towards the idea that if you drug someone enough they won't commit suicide. I should also point out that the anecdote given makes reference to Prozac, a prescription drug which some users have claimed has caused their suicidal ideation.

ZeroFries2• 7 years ago

A drug that actually works is far preferable. Talk therapy is expensive, hard work, tough to scale, and it's difficult to find a qualified therapist who is right for you.

gnulinux3• 7 years ago

Sorry, but this bizarre. Psychotherapy is just one tool in the toolbox against treating mental illnesses. If there is evidence this drug helps treating mental illnesses, what's the reason not to use it? This is not some alternative medicine that is offered instead of or in addition to scientific practice. This is part of the usual treatment that involves psychotherapy, if it's useful. There is nothing inherently bad with drugs; you don't hesitate to use drugs when your liver chemistry breaks, why hesitate it when your brain chemistry breaks?

nickbarnwell5• 7 years ago

The problem is that the effect sizes for most anti-depressants is quite small and the role of pharmaceutical companies in advancing their use has been quite a bit larger. The difference between psychotherapy and medication and psychotherapy alone is small.

I would also point out that dialysis, chemotherapy, etc are also quite expensive, time consuming, and difficult to scale. We still consider them valid, life-saving treatments.

faissaloo3• 7 years ago

You don't use a nuke if you only need to kill one guy. I'm not against it being used but we need to be careful, we don't want another opiod crisis.

cc-d4• 7 years ago

I'm very much concerned that rather than traditional psychotherapy

Why on earth would you be concerned about a tool which allows clinically depressed individuals to see immediate, significant improvement in their condition with relatively few side effects? You should also not group ketamine therapy with prozac, they are completely different drugs with completely different mechanisms of action, grouping them under a broad "antidepressant!" umbrella is borderline negligent.

Psychotherapy is often a long, drawn out process which doesn't necessarily always guarantee results. Not to mention the large amount of variance between individual therapists.

Psychotherapy is useful as an adjunct to psychiatric drugs, and vice versa. They are both useful tools when fighting mental illness, and are even more efficacious when combined. Drawing a line between the two for ideological reasons, instead of purely evidence-based results, is a mistake.

faissaloo3• 7 years ago

Because I feel it may encourage existing harmful behaviours that are causing the ideation to persist and end up fueling a cycle of dependancy.

throwawayWGBiFc• 7 years ago

I've never used ketamine, but I did take hallucinogenic doses of dextromethorphan (DXM, a dissociative hallucinogen, the same class of drugs as ketamine) a few times in college. I have mild depression, and for several days to a week after each DXM trip, I felt very energized and creative, with all of my depressive symptoms gone. I'm not surprised that ketamine helps depression in some people. I sometimes consider microdosing DXM for depression and also general productivity.

Of course, don't take any medical advice from anonymous online posts.

Ketamine Could Soon Be Used to Treat Suicidal Ideation

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