I Was Paralyzed by Severe Depression. Then Came Ketamine

https://www.nytimes.com/2021/05/30/opinion/ketamine-treatment-depression.html

by WarOnPrivacy • 5 years ago

193 163 5 years ago

I did ketamine IV treatment and was told in the clinic about 1/3 have a good response, 1/3 have a partial response, and 1/3 have no response. Sadly I didn't have a response :( The IV thing is problematic and nasal spray should be more widely available and available at ERs. It's being underused and has a lot of barriers around it as of now.

smabie6• 5 years ago

Maybe try purchasing a gram or two on the street/dark web?

Not ideal, but if it has the potential to change your life for the better, the risk is probably worth it.

cleverpebble2• 5 years ago

ketamine has a lot of potential for abuse, especially for those with severe depression. it is why it is only allowed to be administered in a clinical setting.

bduerst5• 5 years ago

Dark net market products are more scams than not these days. I wouldn't recommend unless there is a referral from someone you trust.

in3d5• 5 years ago

Another option that’s becoming available is lozenges.

How many treatments have you had? Did you go into the “k-hole”? It seems that having the right setting and the state of mind matters. Doctors are still doing a lot of guesswork and stumbling around to find the most effective approach.

cupcake-unicorn2• 5 years ago

The therapeutic treatments aren't meant to go into the "k-hole", they are lower dose in comparison. I did feel woozy, drugged, and mildly dissasociated after the IV and needed a bit of help getting up right after. Something that may have interfered was that I was scheduled for IVs 3 times a week but they were down to 2x per week because it was during the holidays, which kind of sucks. This was done in a hospital setting so it's very clinical and this particular one was right next to the ECT room so it wasn't exactly chill. However I'm used to being in clinical settings and didn't mind it much.

pmoriarty8• 5 years ago

I've heard that Ketamine treatments cost something like between $400 to $1000 per treatment, and insurance often doesn't cover it (as it's off-label use), so it has to come out of pocket for patients.

This seems completely insane, especially as the cost of ketamine itself is supposed to be negligible, and what you're paying for is the therapy.. but the therapists role in the treatment is itself virtually nonexistant.. they just hang out and let the medicine do the work (or, in the case of lozenges that patients take a home all they do is write a prescription).

When you factor in that most people who treat their depression with ketamine have to come back again and again every week or two (possibly for the rest of their life), this is a HUGE money maker for ketamine clinics and I don't see how it wouldn't send any but the richest among us in to the poor house.

I've heard some psychiatrists and psychedlic therapy advocates express concern about this and say they want to find some way of making sure that everyone who needs help gets it, regardless of their financial situation, but I don't know if anything ever came of that. AFAIK ketamine treatment is still not covered by insurance.

All the ketamine clinics springing up like mushrooms after the rain seem like a big money grab, and I can't believe they couldn't make the treatments orders of magnitude cheaper.

pamplemoose• 5 years ago

Ketamine should be a fairly cheap treatment, but there are lots of ways that many involved will try to extract money out of 'doing good'. Check out this take [1] by Slate star codex.

[1] https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescr...

Turing_Machine2• 5 years ago

Scott Alexander (the SSC guy) has recently said some cautiously positive things about Zembrin for depression and social anxiety. It is OTC, and apparently quite safe.

ghotli2• 5 years ago

Would love to see a source on the every other week for their life. That's not at all my understanding of the method of action. Overall though, I agree with the sentiment of the post. I think the answer is it's expensive for no other reason than they can.

after_care2• 5 years ago

Would love to see a source on the every other week for their life.

There is no standard maintenance treatment interval, but maintenance treatments are commonly practiced. I can’t find anyone recommending 26 treatments of ketamine a year for depression.

seattle_spring4• 5 years ago

Fwiw insurance is covering my compounded Ketamine nasal spray 50%. Ends up being $30 for 1.2 grams (100mg/1mL).

AMA, I guess. It was prescribed to me primarily for nerve pain.

pmoriarty8• 5 years ago

Could you go in to detail on the exact symptoms of this nerve pain?

Also, did you have to nudge-nudge-wink-wink at the doctor to get this prescription or did they actually believe that you had real nerve pain and that ketamine was the best treatment for it?

This is the first time I've heard of ketamine being used for nerve pain. AFAIK it's mostly used as an anesthetic during surgery.

perardi3• 5 years ago

I won’t pretend there isn’t big fat profit in there, but I have to think the cost has more to do with this being an IV infusion. You’re more paying for the medical care, including being under observation.

Apocryphon• 5 years ago

Maybe it’s available via clinical trials?

rsj_hn2• 5 years ago

You can't ask insurance to pay for it unless there is evidence of effectiveness. That requires trials and lots of time, and there is also the issue of heavy regulations and insane costs as soon as the word "treatment" is dropped into the mix. Then there is an extra hurdle for coverage of psychiatric treatments.

Assuming this is a real thing and not anecdata, expect ketamine to be covered in Europe long before it's covered in the U.S. Unfortunately our system is a huge mess and incredibly slow and expensive compared to Europe when it comes to approving new treatments.

ghotli2• 5 years ago

https://www.fda.gov/news-events/press-announcements/fda-appr...

I think it might be further along than your comment suggests. "site:nih.gov esketamine" if you want to peruse what's been done

spaetzleesser2• 5 years ago

That's the sad thing in the US. Everything medical is obscenely expensive. Just wait until psychedelics become accepted for therapy. they will probably also charge thousands for a trip.

neurot• 5 years ago

This is largely a function of Anesthesiologists making a cash grab out of vulnerable populations.

This is the same medical specialty that brought you: Pain pill clinics (opiates) Interventional pain clinics (scams) And now ketamine for rip-off prices.

smabie6• 5 years ago

If someone finds ketamine helpful for depression, I'd just recommend they buy it on the street themselves.

Of course this isn't the best solution (the best solution would be for drugs to be legalized), but if you're strapped for cash and ketamine is having a seriously positive impact on your life, then I think it probably makes sense.

pmoriarty8• 5 years ago

How would you know if you're getting real ketamine?

coef2• 5 years ago

I'm not familiar with ketamine at all, but it just feels unsafe to decide by ourselves. Do psychiatrists have to monitor patients closely and determine the amount and frequency of doses? I wouldn't mind taking medicine for a cold or other common diseases. but could this be a lot risker?

sneak4• 5 years ago

This is also a halfway decent way to become addicted to ketamine, a fate that has befallen many of my close friends, as well as a former partner.

A perfect, near-instantaneous solution to depression button is a compelling button indeed.

Take care.

0x0082• 5 years ago

Since Ketamine is severely addictive, I would not recommend this.

sshumaker• 5 years ago

Check out mindbloom.com. About 150$/treatment, is done virtually (they mail you the medication). Multiple friends have used and have had great results.

pmoriarty8• 5 years ago

Thanks for mentioning that.

Unfortunately, when searching reddit for it the first result was a pretty negative review: [1], though it seems like it was the result of some miscommunication. That was followed by some positive reports, but without much detail.

It was also interesting to learn that there's an r/TherapeuticKetamine

[1] https://www.reddit.com/r/TherapeuticKetamine/comments/hb619w...

bduerst5• 5 years ago

Is there an equivalent for MDMA therapy in treating social anxiety, or is that still too new yet?

sneak4• 5 years ago

Their survey/acquisition funnel is sketchy as hell. They demand your PII before giving you results, after first asking you a bunch of personal questions, and intersperse marketing spam in the steps.

Major turn-off.

cleverpebble2• 5 years ago

Ketamine treatments are meant to be temporary and augmented with proper existing long-term treatments like SSRIs/SNRIs/TCAs/etc. After a few treatments, the long term antidepressants have had time to start working.

vvanpo• 5 years ago

Do you have a source for that? The article seems to contradict this, from what I understand Ketamine is used for cases of treatment-resistant depression, i.e. many kinds of medications have been tried and failed.

in3d5• 5 years ago

I’ve been following this very closely and I’m quite sure you’re wrong.

opheliate3• 5 years ago

Jesus, was not aware ketamine treatment was this expensive. In the UK, a ketamine clinic [0] administers 0.5mg/kg, so 35mg for a 70kg person. At UK street prices, that’s less than £1 per dose. Presumably ketamine clinics pay less than street prices, since they don’t have to deal with the losses associated with illegal drugs.

0: https://www.oxfordhealth.nhs.uk/ketamine-service/faq/

dstick• 5 years ago

Would it be the same quality though?

sneak4• 5 years ago

Thus we see the profits inherent in the protectionist scheme of certain things for sale being by prescription only.

refurb2• 5 years ago

Just like when you buy a sandwich at a restaurant you’re also paying the employees salary, rent for the building, etc, it’s the same for ketamine therapy.

jrowley• 5 years ago

The actual cost of the drug is only part of cost… malpractice insurance, accepting some risk for off label impacts price.

Waterluvian• 5 years ago

Isn't Ketamine an available street drug? Must be so cheap in comparison to $400-$1000.

gallexme• 5 years ago

Even as medicine it's like 10€/g The price comes monitoring of vitals, talking, the room, the bed, stuff for emergency allocated...

thatguy0900• 5 years ago

Funny enough, one of the places I buy phenibut from sends a decent sized package of ketamine for free with every order as a sample. But it's quite a bit of it.

harry8• 5 years ago

In the US you're paying for the clinic's insurance premiums against when you or another customer sues them which is a thing that /will/ happen.

Reforming medical costs means reforming the legal system and that ain't gonna happen. The lawyers make the laws. In the legislature and in the judiciary. I can't think of a politician in the US who has said so since Carter.

loceng• 5 years ago

In Canada you'd assume insurance is lower because you get basically nothing for emotional damages, whereas in US the vast majority awarded is for emotional, however Canada being relatively rich means we get fleeced more and also the arguable excuse due to economies of scale - being 1/10th the population of the US.

If insurance was kept honest, if it was a true free market system where there was an immutable ledger where all insurance companies in real time had to post every action/response they make as to who/what they approve/deny/delay etc, then competitors could come in when they notice how many billions of profits there are each year - meaning that more people or procedures could be covered.

But yes, there are multiple industrial complexes playing together to maintain the status quo.

mynameisash• 5 years ago

When I was first married, we were paying about $350/mo for my wife's antidepressants. With insurance. That made our financial situation extremely difficult.

If what you're saying is accurate -- $400-1000/week or two -- then that certainly is expensive. But it's not like mental health treatment is affordable in the first place. (Well, it's better now than in the mid-2000s, possibly due to my better insurance?)

xkeysc0re• 5 years ago

If you're interested in the history of ketamine (and its subsequent use by the intelligence apparatuses of several nation-states), I cannot recommend this podcast highly enough https://soundcloud.com/inpatientradio/psychotropic-golgotha-...

I think the most intriguing thing I took away from it was that the Esalen Institute was one of the first ketamine clinics - while at the same time hosting backchannel talks between KGB and CIA agents.

perardi3• 5 years ago

It probably goes without saying, but don’t try this at home with ketamine you score off the grey or dark web.

I am generally a fan of the occasional self-prescribed party drug, but if you suffer from severe depressive disorder, you should not do this without proper supervision.

(And no, doing a bump off someone’s mailbox key is not proper supervision. Fun! Not medically wise, though.)

tayo424• 5 years ago

Why? If you test it and have the same dosage it seems to be the same thing? isn't ketamine treatment just taking it and letting the chemical work. Why would your supplier being any different matter?

after_care2• 5 years ago

Self medicating drugs with high abuse potential is very risky. Having tightly controlled doses, intervals between doses, settings for administering the doses can offset much of the abuse and addiction potential.

WarOnPrivacy3• 5 years ago

isn't ketamine treatment just taking it and letting the chemical work.

Generally, no. Self-administering a psychotherapeutic drug, while isolated and without training, can have the lowest likelyhood of a positive outcome.

Having an experienced guide or trained therapist present - someone to provide appropriate nudges/direction/counseling or sometimes just for company - this is where we often see experiences with huge, lasting benefits.

perardi3• 5 years ago

Have you…done ketamine?

Ketamine can be intense. I would not like to take a clinical dose of K, while in a depressed state, sans supervision.

mjfl2• 5 years ago

I got ketamine for a wisdom tooth removal. I definitely had a psychedelic experience, with the nurses around me seemingly moving back and forth in time, but to be honest I'm not sure how something like that is supposed to effect my longterm mental health. It's just not that big a deal. I'm personally skeptical of this.

smt88• 5 years ago

This is an anecdote from someone who is not depressed (as far as you've stated). It means nothing about ketamine's effectiveness.

tartoran• 5 years ago

Your experience is completely different. You were not depressed, were you? What did you expect it’d for you then?

pmoriarty8• 5 years ago

"I'm not sure how something like that is supposed to effect my longterm mental health."

No one knows. It's one of the biggest and most interesting open questions regarding psychedelics: how and why do they work?

What there is a lot of evidence for is that they seem to help a lot of people with very severe depression. The people involved in such studies tend to be ones that have had severe depression for a very long time and have tried many different treatments without success, some including trying electro-convulsive therapy (ECT.. or what used to be known as electroshock therapy), and some of which had had multiple suicide attempts... and psychedelics have helped a significant number of such people -- not everyone, but many.

Another big open question is why it helps some people but not others.

mjfl2• 5 years ago

The placebo effect has similar outcomes

https://www.newscientist.com/article/2269908-benefits-of-mic...

astrange• 5 years ago

Ketamine mostly likely doesn't help depression because of being a psychadelic, but rather it's a coincidence that it's a psychadelic. This is much like SSRIs, which also seem to only work as antidepressants as a side effect, not because of messing with serotonin.

spaetzleesser2• 5 years ago

When I take mushrooms I don't have deep experiences. But I usually feel better for weeks after. I think it highly depends on the person but there are enough people describing the benefits they are getting. So it should be taken seriously.

lovemenot• 5 years ago

It might be just a matter of terminology, but this comment has me confused.

Could you please give a counter-example of what has actually triggered a deep experience for you. Was it an even more potent psychedelic? Or do you just not consider this kind of experience deep? Or perhaps your dosage was very low?

For anybody who is reading naively, don't assume that you won't have a deep experience. Of course ymmv, but the consensus seems to be very different from my parent. Be advised not to take it lightly.

seattle_spring4• 5 years ago

I suffer from chronic pain, and marijuana makes my pain significantly worse.

That means that cannabis does not work for my pain, but it means nothing with regard to its effectiveness for others. The same is true of your experience with Ketamine.

marikio• 5 years ago

If you're interested in the intersection of startups/tech x psychedelics would love to chat: marik@tabularasa.ventures

mindwok3• 5 years ago

The recent wave of psychedelics being used to treat mental illnesses has been really interesting. I'm somewhat skeptical of the effects so I'm keen to see what long term research has to say, but I've read a few experiences like this about various psychedelics and it gives me enormous amounts of hope that there might be some answer to what seems like a problem we've been banging our heads against for the last few decades without any good answer.

Even if a small percentage of people have experiences like the author, I think that easily makes it worth pursuing this avenue.

sibeliuss• 5 years ago

I'm somewhat skeptical of the effects

Can you elaborate?

mindwok3• 5 years ago

Sure! I just think the field is immature and dominated by anecdotal evidence, and especially only short term evidence. Plus I think there's some survivorship bias, people who don't have live changing experiences on these drugs rarely post about it and even when they do I doubt it'd end up in the New York Times.

I'm just trying to temper my expectations.

serf• 5 years ago

I'm paralyzed, the result of a traumatic spinal cord injury.

I offer no advice on how to write this kind of stuff, but i'd like to bring up the point that my situation , as someone who is paralyzed, is totally different than the situation of someone who is clinically depressed.

Paralysis might be a nifty way to explain the 'inability to act' in non-clinical situation, but 1) it's confusing when talking within medical contexts and 2) it equivocates experiences between those that fall under the adjective -- I don't know anything about clinical depression, and I have my doubts that this experience taught the author anything about clinical paralysis.

I have spoken to blind friends with similar attitude towards headlines that say things like "Doctors blinded by surprise lack of supplies.". It's not an uncommon sentiment.

Generic adjectives exist to describe this general inability to fulfill needed tasks or ability criterion -- yes, I know that popular use of the words allows this context, but in the interest of those that might read this stuff, understand that it's confusing and in some worst cases potentially insulting.

derefr• 5 years ago

To be clear, https://en.wikipedia.org/wiki/Akinetic_mutism is a thing — without enough dopamine in your motor cortex, you're "paralyzed" in the sense that there's nothing you (or anyone else) can do to force your body to respond — sometimes even going as far as your body no longer having autonomous reflex responses to reflex-inducing stimuli, similar to someone who's been rendered unconscious.

I'm not a neurologist, but I imagine there's a spectrum there, where other less-severe neurological problem-states (like depression) can get you part of the way to akinetic mutism, and thus you may be fully "paralyzed" in the above sense some of the time, or partially "paralyzed" all of the time.

refurb2• 5 years ago

Agreed. A friend who almost died before getting a liver transplant was talking to his neighbor who had just moved in. His neighbor said he was a “California transplant”. Very insensitive.

pkAbstract• 5 years ago

As the neighbor just moved in, I'm guessing they were unaware of your friend's liver transplant. If this was indeed the case, I find your friend's situation difficult to sympathize with. .

If you did the slightest bit of digging, I think you'd find that 99% of people mean no offense, and would be deeply apologetic if their "transgression" were brought to their attention.

If you're sensitive enough, you'll find yourself offended all the time.

numlock86• 5 years ago

Although I probably insult everyone that has been electrocuted before, I think that's pretty shocking.

vidarh• 5 years ago

The word transplant came to Old English from Latin via Old French, so it predates transplant operations by many centuries. As such, unless the neighbour was doing it on purpose it's an unreasonable thing to get upset over. Words have multiple meanings.

dukeyukey• 5 years ago

I honestly can't tell if you're being sarcastic or not.

trainsplanes• 5 years ago

Not trying to be rude, but as with most things, there are scales within the ranges of blindness and paralysis.

A lot of people assume blindness means absolutely no sight whatsoever, which isn't true, because quite a large number of legally blind people have eyes that detect some degree of light. Temporary blinding from illness/injury exists. Flashing a bright light into someone's eyes, rendering them momentarily unable to see, is also a very valid and very old usage of "blind" in the English language. Being metaphorically dazzled by something and temporarily unable to respond ties in with the latter meaning and goes way back in its usage.

Paralysis has a similar scale. Many people assume total lack of movement, and "only" having one's lower body unable to move doesn't even immediately register as paralysis in the mental image a lot of people have. People with severe mental illnesses like depression and some forms of schizophrenia are rendered unable to move (it's not a desire to stay still). People can also be temporarily paralyzed through poison or mental shock (as in they literally, physically cannot move out of fear).

Words have range. Context makes their meaning precise. I really hate to bring this word in here, but denying someone with a mental illness the right to use a word is because it's not "real" enough compared to another person's struggle is "gatekeeping". Suggesting words they use to describe their illness is "insulting" is harmful to them.

lnenad4• 5 years ago

I completely agree. I think the lack of real, immediate issues (war, famine, terrorism, poverty) in the western world right now is leaving a lot of people with extra time and mental capacity on their hands to try to dig up issues where there aren't any. Everyone can take offense over anything they read, it doesn't mean it's grounded in anything or it makes sense. On the other hand there are people hovering the internets waiting for such a person, to jump to the opportunity and virtue signal how said person is seriously endangered and everyone should adjust to them.

skinkestek2• 5 years ago

I offer no advice on how to write this kind of stuff, but i'd like to bring up the point that my situation , as someone who is paralyzed, is totally different than the situation of someone who is clinically depressed.

Thanks for writing this in such a non judgemental way.

I really didn't care much about such imprecise language but I too am starting to wonder if something needs to be done - and where.

This and similar wordings are what my teachers would refer to as a literary tool (not sure of the correct English translation but it should suffice.)

But it seems a lot of people doesn't understand (and some won't understand) this. This holds true for both writers and readers.

Recently someone said something about a certain well known country being apartheid, so I pointed them to the encyclopedia (not Wikipedia) that describes apartheid. It didn't work. Journalists had said apartheid so apartheid it was. Was it apartheid? Only in the same sense where the bank "robs" someone by not adjusting interest rates in a timely manner: as a way to spice up language.

hutzlibu• 5 years ago

It is important to not forget, that natural language do not work like programming languages. They are not clear and precisely defined. Context matters a lot. And allmost no 2 people define one given word exactly the same.

So I do have my trigger words, too, where I try for people to use them in the right way, but it is pretty much an uphill battle and in my experience usually not worth the time fighting it. Just accepting that words have different meanings for different persons ... and most importantly - go out of discussions, when it is not about the topic anymore, but people fighting over the meaning of words.

TulliusCicero4• 5 years ago

I really didn't care much about such imprecise language

But it's not imprecise, it's just metaphorical.

Someone saying they're in hot water does not literally mean they're currently standing in a cookpot or hot tub.

coldtea2• 5 years ago

I don't think anything is needed. People just like to fuss over language too much, when its clear (from the context) what was meant.

trashcan_• 5 years ago

I can really get behind your first bullet. Taking clearly defined medical terminology and exporting to strange contexts just sound like nonsense to anyone that uses those terms with any regularity. Like every time someone uses the term antisocial to refer to someone who doesn't get out much I can't help but wince.

TulliusCicero4• 5 years ago

People using "paralyzed" or "blinded" in a more metaphorical or abstract sense is very common, and has been for some time: paralyzed by indecision, blinded by love (or lust), etc.

This argument that we may only use words literally feels very Drax-like: "Nothing goes over my head. My reflexes are too fast, I would catch it."

chalupa-man• 5 years ago

Metaphorical meanings for medical issues are some of the most common metaphors in most languages, and I would be surprised if you aren't using them yourself. Rejecting it seems frankly as bizarre as rejecting metaphor entirely. Are you wincing when you read Shakespeare, Plato, Dante, Dostoevsky, etc, who all use this regularly? You're never been shocked or dumbstruck, never find anything lame or sickening? Never describe anything as crippling, mad, callous, stupid, idiotic, crazy, never get drowned in work?

The metaphorical use of paralysis even predates its modern precise medical usage, having meant more broadly enfeebled before relatively recently taking on its specific motor function related meaning--so that would be the medical field assigning a new clear definition to a term with a 2300+ year metaphorical history.

Anyway, please sign my petition denouncing libraries everywhere for putting all these joke books in the humour section. It is a real hassle for melancholics trying to balance out their bile. Then we're getting onto this Jesus fella for all this fancy double-talk about eye debris, I've had specks in my eye before and cornea scratches are a legitimate problem.

nxpnsv• 5 years ago

A thought provoking point that will make me think more about how I use language. "I suffered from severe depression. Then came ketamine" would also have done the job.

lnenad4• 5 years ago

It really shouldn't. Words that have a defined meaning and that are used properly shouldn't be banned from use.

coldtea2• 5 years ago

Where does that stop? Should we "walk on eggshells" for everything we say, lest a well known metaphor is not understood immediately by someone, or someone (perhaps even in another country, speaking another language, with different social moral norms) gets offended?

colonwqbang• 5 years ago

These words have both a literal/medical and a metaphorical meaning.

Paralysed - inability to act

Blind - unaware of what's going on

The metaphorical meaning was probably intended.

beaunative• 5 years ago

On the contrary, I think paralyzed is quite an accurate depiction of the effect of severe depression. Most people still don't consider mental conditions on par with physical conditions, but that's simply not true, those severe mental conditions' are the result of neurological damage in the brain. In that sense, the person is paralyzed just as you are as problems with his neurological system limited his movement. Spinal cord is also an important part of our neurological system, it's essentially the southbridge of our body, but wouldn't it be funny if we call southbridge damage resulted inability paralyzed, but CPU damage resulted inability not? I get your point where you think spinal cord injury is more physical, but those mental conditions can be just as physical.

manjana• 5 years ago

Immobilized seems more fit.

agumonkey• 5 years ago

Please pardon the author, you might never know what severe depression does to a brain. Having been on both sides of the spectrum (mental and physical disability, albeit small), I can say it may not be abusive usage of the word.

In any case good luck, may research progress (and there was some recently) and find solutions.

acituan3• 5 years ago

Devil is in the details, the fact that the author remembers their state of mind is odd. Because currently most of the clinics co-administer a benzodiazepine (midazolam) with ketamine, which actually is used for its amnesiac effects.

Also, although assumed to be transformational, there are now indicators that ketamine’s anti-depressive effects might be tied to the opioid system of the brain, rather than the psychedelic, altered-state experiences, which most patients don't remember anyway.

Finally, the article peculiarly omits if they have been in ongoing ketamine therapy since that time frame. Phrasing neither denies or confirms this;

In May 2021, 15 years after dropping out of high school, five years after beginning ketamine treatment, I graduated from college.

Don't get me wrong, I'm happy that they have found a treatment that works, and it might as well be rational to use this therapy to ratchet out of a deep disease state. But we also need a balanced account of the durability of the effects, its downstream consequences and therefore a better idea of its mechanism of action. Without such an account, uppers like amphetamines and cocaine would also be considered to "treat" depression, except for terribly short durations and with unsustainable side-effects. To what degree ketamine is different, we are yet to find out.

in3d5• 5 years ago

Huh? Most clinics definitely do not co-administer benzodiazepines.

What’s your reference to patients not remembering their experiences?

What’s your reference to ketamine being tied to the opioid system? Never heard that. In fact there is a lot of research that shows it works differently.

Honestly, your comment seems totally misinformed. It’s like you’re just confusing ketamine with some other drug.

acituan3• 5 years ago

Most clinics definitely do not co-administer benzodiazepines.

You're welcome to call and conduct your own survey, I have no way to document mine for you.

Clinics don't tend to detail their procedures at this level online but I found a random internet one for you: https://www.universityhealthsystem.com/~/media/files/clinica.... You should check page 8, item b "Prior to administration of the first bolus, patients will receive midazolam 1 mg IV push."

What’s your reference to patients not remembering their experiences?

That's what versed (midazolam) specifically does. It is used in other outpatient procedures like endoscopies too.

What’s your reference to ketamine being tied to the opioid system? Never heard that.

Literally the first Google result for "ketamine opioid" is https://med.stanford.edu/news/all-news/2018/08/ketamines-ant.... There is tons of other primary research too.

Honestly, your comment seems totally misinformed.

Sorry to hear you feel that way but I know what I am talking about. I wish you researched a bit more on your own before writing your comment.

elevenoh3• 5 years ago

Ketamine allows me to view my reactions to every/all stimuli without a default/reactionary emotional impulse.

It's incredible for identifying & working on your emotional 'triggers'.

Aside: many folks aren't aware ketamine is fairly non-recreational (e.g. zero euphoria)

rmac• 5 years ago

Non-recreational? :)

opheliate3• 5 years ago

Other than E, ketamine is the most popular party drug at my university. Saying it’s non-recreational just seems flat out wrong.

elevenoh3• 5 years ago

Have you done Ketamine? It's the least recreational drug I've done.

Dma54rhs• 5 years ago

What the heck is this dangerous misinformation? It's a great choice of recreational drug in the rave scene since the dawn of times.

elevenoh3• 5 years ago

Ketamine is less recreational than most antidepressants, benzos etc. IMO.

So label it what you will. But try it & see for yourself.

giantandroids• 5 years ago

I'm paralyzed, by the paywall.

dmingod666• 5 years ago

Incognito

andai• 5 years ago

My browser's Reader View got me through.

ptr2voidStar• 5 years ago

I thought Ketamine was a street (illegal) drug - and people on here are talking about it being available OTC - am I missing something here?

6nf• 5 years ago

It's used as animal anaesthetic but I don't think it's generally available OTC?

bduerst5• 5 years ago

Ketamine is a schedule III drug in the U.S., meaning it's not as controlled as heroine and ritalin, but still not available OTC. It's treated the same as really strong codeine or anabolic steroids.

sneak4• 5 years ago

It's a common pharmaceutical, manufactured and distributed like many others.

Schedule 3 in the USA, so less controlled than, say, Adderall (Schedule 2).

calt• 5 years ago

I actually got more interested in pranayama and breathing techniques after some experiences with N2O, nitrous oxide.

It helped me quite a lot at one point, and I have a theory that some of its dissociative effects are a similar mechanism as ketamine.

I would really love to do some more research on the link between the 3, but I feel incredibly out of my depth.

txtsd• 5 years ago

I have tried all medicines that traditional psychiatry has to offer, and none of them have worked for me. Should I aim for Ketamine next, or Psilocybin?

in3d5• 5 years ago

I’m not a doctor but here is a decent summary: https://www.psychologytoday.com/us/blog/the-lucid-mind/20210...

say_it_as_it_is2• 5 years ago

Psilocybin needs to be taken with therapy treatment unless you're highly skilled with self-therapy. It opens pathways for change, but you still have to do the work to change your thought patterns. The work is started during the trip but follows during integration therapy.

hiram112• 5 years ago

MAOIs when all else fails.

aidenn03• 5 years ago

All the research I've read shows MAOIs as being extremely effective, but has so many interaction effects as to make it very likely to cause problems. Like no sauerkraut if you are on MAOIs.

pmoriarty8• 5 years ago

There's no clear, one-size-fits-all answer to this.

The antidepressant effects of ketamine seem to be more short-lived (though not in everyone... for some there is a long-lasting effect).

Psilocybin therapy seems to have a more long-lasting effect, and some people only need one to three treatments to never need it again, vs ketamine for which many people need many (perhaps indefinite) treatments.

Then there are legal issues to consider. In the US, at least, ketamine can be used legally as off-label treatment for depression. As far as I know that's not the case for psilocybin yet, though you could get legal psilocybin therapy if you're part of a research study.

It's also possible to get psychedelic therapy from an underground therapist.. or maybe you're in a country where it's legal.

I'd suggest finding out as much as you can about both ketamine and psilocybin use in treating depression. There have been a lot of studies done on both, and a lot of good information about this.

say_it_as_it_is2• 5 years ago

If ketamine treatment is the best thing available to you today, it's better than nothing, but is more business-aligned than patient-aligned and representative of the problem with U.S. healthcare in that it profits by treating illness rather than attempts to cure it. Ketamine treatment involves a series of front-loaded sessions (6) and periodic sessions, and costs thousands of dollars. This is a dream come true for business as it gets desperate, committed customers for an indefinite period of time.

On the other hand, psilocybin-assisted therapy involves two sessions three weeks apart and a series of regular therapy sessions leading up to and following trips. Psilocybin + therapy offers the potential of cognitive changes lasting far longer than those available from ketamine.

Aside from these two, MDMA-assisted therapy is having phenomenal gains for treating PTSD, and ibogaine for treating addiction (psilocybin can cure certain addictions, too).

jokoon• 5 years ago

Well many people experience depression at some point, but "severe depression" doesn't affect a lot of patients.

Also, this comes off with a lot of survivor bias, all I can read is "ketamine made me superman".

It's important to remember that modern anti-depressants regulate serotonin and act on the same receptors than psilocybin and other psychedelics that are told to treat depression.

I would rather trust a medical doctor and science than follow an internet trend that encourage the use of drugs. I'm suspecting some have things to gain from drug trafficking, and so they spread information about those substance being better than listening to a doctor. Sorry but I prefer listening to my skepticism.

I Was Paralyzed by Severe Depression. Then Came Ketamine

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