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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Meltingpot on November 12, 2015, at 15:18:27
Hi,
Does anyone know if it is possible to get Ketamine nasal spray without prescription and if so where?
Denise
Posted by SLS on November 12, 2015, at 21:19:20
In reply to Ketamine Nasal Spray, posted by Meltingpot on November 12, 2015, at 15:18:27
> Hi,
>
> Does anyone know if it is possible to get Ketamine nasal spray without prescription and if so where?Sorry. I don't know. My doctor ordered it directly from a compounding pharmacy.
It didn't help me, even at higher dosages. This may be an indicator that I have a reduced rate of BDNF production with a met66met genotype.
Which drugs or drug combinations have you tried recently? I know paroxetine was your miracle drug for awhile. Have you tried duloxetine? Is vortioxetine available? Surely, you must have tried Nardil by now.
In my estimation, Nardil is more serotonergic than Parnate is. Perhaps it is more potent at MAO-A. I also think Nardil does things in addition to MAO inhibition in order for it to produce euphoria. I found it energizing immediately after each dose during the time when I was responsive to it. Who knows? No one studies MAO inhibitors anymore.
- Scott
Posted by Deahoidar on November 14, 2015, at 3:56:17
In reply to Ketamine Nasal Spray, posted by Meltingpot on November 12, 2015, at 15:18:27
> Hi,
>
> Does anyone know if it is possible to get Ketamine nasal spray without prescription and if so where?
>
> DeniseI don't think you're going to find it available without a prescription. Maybe one of the online foreign pharmacies, but that's taking your chances.
My pdoc gladly wrote a Rx for intranasal ketamine. I was able to get. It filled at a compounding pharmacy. ~$70 for a 3 month supply. Much less expensive than the IV infusions I was paying for, and much more pleasant. I could take the dose at home, with some music playing quietly. And just relax into the dose. If I wanted more,, it was right there..
Ketamine ,,along with high level MAOIs and augmentation agents have helped in was that Deep Brain Stimulation completely failed.
Posted by Meltingpot on November 21, 2015, at 4:34:41
In reply to Re: Ketamine Nasal Spray » Meltingpot, posted by SLS on November 12, 2015, at 21:19:20
Hi Scott,
I actually don't want it for me I want the information for an email pal of mine who lives in the States. She has had DBS and it hasn't worked for her so she is thinking of trying either Ketamine nasal spray or Mifepristerone. Unfortunately she can't get her psych to prescribe them for her.
I have tried Ketamine infusions in New York and it was a nice experience but I wouldn't say it cured me of my depression and the seroxat was helping me at the time so hard to know if the Ketamine had the 7 day good affect that it is supposed to for some people.
I'm doing fine on Seroxat thanks and I have the Zyprexa at hand if I ever get really bad so that's good.
I have tried Nardil years ago and although it seemed to help with the anxiety, it made me feel a bit stoned and I didn't particularly like the way I felt it. Although I never gave it longer than six weeks.
I have tried lyrica (like I say in the other thread) and it actually gave me a mood lift when I took it on it's own, didn't notice any difference with it though when I took it with Seroxat. At least I know that it could be something to bear in mind in the future.
How are you feeling? What are you taking at the moment?
Denise
Posted by Meltingpot on November 21, 2015, at 4:37:18
In reply to Re: Ketamine Nasal Spray, posted by Deahoidar on November 14, 2015, at 3:56:17
Hi Deahoidar,
It's not for me it's for a email pal in the States. I don't think she can get her pdoc to prescribe it for her. I think she is in the New York area. Are you in the States? Whereabouts are you.
Do you say, you've had the DBS?
Denise
Posted by SLS on November 21, 2015, at 8:08:51
In reply to Re: Ketamine Nasal Spray SLS, posted by Meltingpot on November 21, 2015, at 4:34:41
Hi Denise.
I am extremely happy that you are doing better on paroxetine. Do you take Lyrica? To what do you attribute your doing better on paroxetine now? I thought it had pooped-out on you.
> How are you feeling? What are you taking at the moment?At the moment, my condition is tolerable as a result of my current treatment. I don't experience a true antidepressant effect, but I do have more mental energy and am not plagued by dangerous thoughts. Without treatment, I tend to remain motionless and without thought. I can't read more than two or three sentences (word-for-word) without comprehension before giving up. I do have some luck with skimming, but it is very fatiguing.
Currently:
Parnate 80 mg/day
desipramine 250 mg/day
Lamictal 300 mg/day
lithium 300 mg/day
Abilify 10 mg/day
prazosin 30 mg/day
- Scott
Posted by Deahoidar on November 22, 2015, at 0:09:28
In reply to Re: Ketamine Nasal Spray Deahoidar, posted by Meltingpot on November 21, 2015, at 4:37:18
Hi Denise,
I'm in the States but on the other coast. And yes, I've had DBS but it was not effective. I think I may already be in touch with your pal in the States. Would you happen to be across the pond? DBS has a way of bringing people together. If the Ketamine is for CK, I think I've already sent some info. They may know me as Jim.
My experience with Ketamine was initially disappointing. I tried IV infusions for as long as I could afford it, then tried nasal. I got frustrated and stopped. My pdoc helped me to try it again with a different approach. It took some time but it soon became evident it was helping.
I don't know if it will "cure" me, as I've had too many episodes of too great severity and duration. But it seems to be helping me to climb out of this dark hole.
All the best to you and your friend.
CB
Posted by Deahoidar on November 22, 2015, at 0:18:22
In reply to Re: Ketamine Nasal Spray SLS » Meltingpot, posted by SLS on November 21, 2015, at 8:08:51
> At the moment, my condition is tolerable as a result of my current treatment. I don't experience a true antidepressant effect, but I do have more mental energy and am not plagued by dangerous thoughts. Without treatment, I tend to remain motionless and without thought. I can't read more than two or three sentences (word-for-word) without comprehension before giving up. I do have some luck with skimming, but it is very fatiguing.
>
> Currently:
>
> Parnate 80 mg/day
> desipramine 250 mg/day
> Lamictal 300 mg/day
> lithium 300 mg/day
> Abilify 10 mg/day
> prazosin 30 mg/day
>
>
> - ScottHello Scott,
I don't mean to divert the thread but wanted to say Hi! as a fellow high-dose Parnate (and augmentation) patient. I have tried quite a few treatments over time and Parnate has been the one that holds up the best for me. I'm currently taking 140mg/day with methylphenidate 100mg/day and lithium 900mg/day along with a handful of others. I strongly relate to the existence you described. It's not fun, I know. Hang in there. With eachother's sharing and support, we can endure.
Call me Jim
Posted by SLS on November 22, 2015, at 6:45:47
In reply to Re: Ketamine Nasal Spray SLS » SLS, posted by Deahoidar on November 22, 2015, at 0:18:22
Hi Jim.
Nice to meet you.
I took intranasal ketamine for two weeks. There was not even a hint of improvement. I even tried taking the amount necessary to produce a very mild dissociative state. A good response to ketamine should take no longer than a week, and can take less than 48 hours.
I am probably met66met for BDNF. People with this uncommon genotype do very poorly with ketamine. People with the more common val66val variant do the best. Perhaps you are heterozygous - val66met, the genotype that produces a partial response.
http://bipolarnews.org/?p=2318
By the way, lithium is supposed to extend the response to ketamine.
The idea occurred to me to combine ketamine with memantine. They work on different areas of the NMDA receptor. You might want to look into it. I found this:
http://www.ncbi.nlm.nih.gov/pubmed/18197514
Unfortunately, no abstract is included. My concern would be the production of a synergistic effect to produce a dissociative state.
If you take too much ketamine all at once, it doesn't work. This would be a problem with I.V., but not likely with intranasal administration.
- Scott
Posted by Deahoidar on November 22, 2015, at 19:31:34
In reply to Re: Ketamine Nasal Spray SLS » Deahoidar, posted by SLS on November 22, 2015, at 6:45:47
Scott,
I'm with you on this. The IV Ketamine infusions weren't helpful for me, and the intranasal didn't produce results immediately. But then again, I wasn't using it to address imminent suicidality.
I stuck with it for over a month before I could see some benefits. Actually it was people around me who noticed the benefits.
I was taking it at noticeable doses while I reclined and meditated in a relaxing atmosphere with pleasant sights, sounds and smells. The goal was to help improve the severe anhedonia. I also use it during experiences that should be pleasurable, like good meals, a massage, etc. and that's where I have found it is proving most helpful. It's not an overnight or overwhelming change but change it is.
I'm not yet a believer in the genetic/metabolic testing for major depression. Perhaps in time but I've yet to see really convincing evidence. Guess that's just the skeptic in me.
The article you mentioned appears to be a report of a single patient case study from some years ago. Is there anything more recent or more objective available? Thanks.
Posted by SLS on November 22, 2015, at 21:15:30
In reply to Re: Ketamine Nasal Spray SLS, posted by Deahoidar on November 22, 2015, at 19:31:34
> The article you mentioned appears to be a report of a single patient case study from some years ago. Is there anything more recent or more objective available? Thanks.
I couldn't find anything, sorry.
- Scott
Posted by Meltingpot on November 24, 2015, at 12:05:03
In reply to Re: Ketamine Nasal Spray SLS » Meltingpot, posted by SLS on November 21, 2015, at 8:08:51
Hi Scott,
The Seroxat never actually pooped out on me, just didn't work as well as the first two years. Having said that (and I know I keep harping on about it) it's never worked like it did in my 20s and early 30s. Then it felt like a cure and in some ways it was as I was able to come off it and was ok for three years.
I guess ultimately I want a cure, maybe that sounds greedy, I want to take something, do something, it work and then I want to be able to stop it just like with antibiotics.
I know that you have been on some of the drugs you are on now for years. I can understand why you are taking the desipramine and parnate but not the Abilify, lamictal and the lithium. What does each one do for you on it's own or do they all act in synergy.
It's hard to imagine you not being able to take anything in as you respond so well to so many messages on here. Are you able to work as you seem so clever?
Denise
Posted by Meltingpot on November 24, 2015, at 12:26:17
In reply to Re: Ketamine Nasal Spray Deahoidar, posted by Deahoidar on November 22, 2015, at 0:09:28
Hi CB,
Yes, I think it is CK. I also think I got her location wrong. She is actually in Washington, not New York.
I will mention you to her.
Did the DBS cause any negative affects?
Denise
Posted by Deahoidar on November 25, 2015, at 2:02:15
In reply to Re: Ketamine Nasal Spray Deahoidar, posted by Meltingpot on November 24, 2015, at 12:26:17
> Hi CB,
>
> Yes, I think it is CK. I also think I got her location wrong. She is actually in Washington, not New York.
>
> I will mention you to her.
>
> Did the DBS cause any negative affects?
>
> DeniseWashington DC is correct, with trips to NY for programming.
DBS was not beneficial for me. I did experience negative effects but not nearly as devastating as some of the participants. If you haven't seen it, there is a well-research and quite objective recent article, "Perils of Deep Brain Stimulation for Depression". I have come to accept that DBS "broke" something in my brain that may never come back. I count my blessings it wasn't worse, though I truly wish I was one of the lucky few.
Posted by Meltingpot on November 26, 2015, at 11:36:06
In reply to Re: Ketamine Nasal Spray Deahoidar, posted by Deahoidar on November 25, 2015, at 2:02:15
Hi,
Yes, I have read the article. I was quite shocked as when Mayberg first did the trial on about 6 or 8 people (I can't remember) the results seemed to be quite miraculous and from what I had read the risks were mainly physical, stroke or infection. Didn't mention anything about behavioural problems. Sounds quite horrific now. Can I ask you what negative symptoms you experienced?
I read another article from Mayberg saying that 3D scanning showed that in responders they found that there was involvement of 3 specific areas of the brain. There wasn't this involvement with non-responders. Not sure if that is significant or not. Did they do 3D scans on you?
I'm so sorry to hear that it didn't work for you, must have been devastating.
Denise
Posted by Deahoidar on November 29, 2015, at 22:40:27
In reply to Re: Ketamine Nasal Spray SLS » Deahoidar, posted by SLS on November 22, 2015, at 21:15:30
> > The article you mentioned appears to be a report of a single patient case study from some years ago. Is there anything more recent or more objective available? Thanks.
>
> I couldn't find anything, sorry.
>
>
> - ScottScott,
I was interested by the potential of Memantine, so I searched a bit and came across this article in the American Journal of Psychiatry."A Double-Blind, Placebo-Controlled Study of Memantine in the Treatment of Major Depression" http://dx.doi.org/10.1176/appi.ajp.163.1.153
METHOD: In a double-blind, placebo-controlled study, 32 subjects with major depression were randomly assigned to receive memantine (520 mg/day) (N=16) or placebo (N=16) for 8 weeks. Primary efficacy was assessed by performance on the Montgomery-Åsberg Depression Rating Scale (MADRS).
RESULTS: The linear mixed models for total MADRS scores showed no treatment effect.
CONCLUSIONS: In an 8-week trial, the low-to-moderate-affinity NMDA antagonist memantine in doses of 520 mg/day was not effective in the treatment of major depressive disorder.While not conclusive proof, it dampens my hopes for Memantine. Perhaps further study is warranted. Who knows.
Posted by Deahoidar on November 29, 2015, at 23:09:08
In reply to Re: Ketamine Nasal Spray Deahoidar, posted by Meltingpot on November 26, 2015, at 11:36:06
Like you, I was wowed when I saw the slickly edited YouTube videos and reports of Mayberg's successes with DBS for severe refractory depression. I was deep in the worst depressive episode (#8 I think) I'd experienced. Nothing had worked so I volunteered. Only much later did I learn what I wished I'd known earlier.
Because it was a double blind clinical trial, a lot was not disclosed but I'm pretty sure they did not perform functional MRI scans. Just basic MRI.
My surgery went well enough but it soon was clear that I was not receiving stimulation. My mood had (incredibly) worsened and I was on 24 hr suicide watch. Still, they wouldn't break protocol to provide me with any of my antidepressant meds. After the sham stimulation period, I tried to be hopeful but instead, I found my thinking became foggy and distant. I lost all interest. It was anhedonia like I'd never had. I couldn't even remember what it was like to want to do something. I would just sob. And it only got worse as they adjust the settings. I became an empty shell. I felt totally detached from life and things and people around me. I was just an observer. I couldn't experience it.
Things have improved since I got the DBS removed. But progress has been very very slow and some aspects haven't improved at all.
It was interesting to read in a recent article that Dr. Mayberg, Dr. Riva-Posse, et al have acknowledged that testing DBS contact points during the operation, with the patient AWAKE, is essential to confirming the appropriate site for stimulation. This is exactly the opposite of how the clinical trials were conducted. No wonder they failed. It also lends support to the possibility that the placebo effect could play a significant role in the "successes". Some experts have contended as much, and DBS researchers do not deny it.
I wish I'd known all this beforehand. It would have saved me years of grief and suffering.
Posted by SLS on November 30, 2015, at 7:12:29
In reply to Re: Ketamine Nasal Spray SLS (Memantine study) » SLS, posted by Deahoidar on November 29, 2015, at 22:40:27
> > > The article you mentioned appears to be a report of a single patient case study from some years ago. Is there anything more recent or more objective available? Thanks.
> >
> > I couldn't find anything, sorry.
> >
> >
> > - Scott
>
> Scott,
> I was interested by the potential of Memantine, so I searched a bit and came across this article in the American Journal of Psychiatry.
>
> "A Double-Blind, Placebo-Controlled Study of Memantine in the Treatment of Major Depression" http://dx.doi.org/10.1176/appi.ajp.163.1.153
>
> METHOD: In a double-blind, placebo-controlled study, 32 subjects with major depression were randomly assigned to receive memantine (520 mg/day) (N=16) or placebo (N=16) for 8 weeks. Primary efficacy was assessed by performance on the Montgomery-Åsberg Depression Rating Scale (MADRS).
> RESULTS: The linear mixed models for total MADRS scores showed no treatment effect.
> CONCLUSIONS: In an 8-week trial, the low-to-moderate-affinity NMDA antagonist memantine in doses of 520 mg/day was not effective in the treatment of major depressive disorder.
>
> While not conclusive proof, it dampens my hopes for Memantine. Perhaps further study is warranted. Who knows.I agree with the results and interpretation of the study. However, I know of no reason why mementine could not be used as an augmenter of drugs like Wellbutrin or Lamictal.
- Scott
Posted by SLS on November 30, 2015, at 7:15:29
In reply to Re: Ketamine Nasal Spray Deahoidar » Meltingpot, posted by Deahoidar on November 29, 2015, at 23:09:08
> Like you, I was wowed when I saw the slickly edited YouTube videos and reports of Mayberg's successes with DBS for severe refractory depression. I was deep in the worst depressive episode (#8 I think) I'd experienced. Nothing had worked so I volunteered. Only much later did I learn what I wished I'd known earlier.
> Because it was a double blind clinical trial, a lot was not disclosed but I'm pretty sure they did not perform functional MRI scans. Just basic MRI.
> My surgery went well enough but it soon was clear that I was not receiving stimulation. My mood had (incredibly) worsened and I was on 24 hr suicide watch. Still, they wouldn't break protocol to provide me with any of my antidepressant meds. After the sham stimulation period, I tried to be hopeful but instead, I found my thinking became foggy and distant. I lost all interest. It was anhedonia like I'd never had. I couldn't even remember what it was like to want to do something. I would just sob. And it only got worse as they adjust the settings. I became an empty shell. I felt totally detached from life and things and people around me. I was just an observer. I couldn't experience it.
> Things have improved since I got the DBS removed. But progress has been very very slow and some aspects haven't improved at all.
> It was interesting to read in a recent article that Dr. Mayberg, Dr. Riva-Posse, et al have acknowledged that testing DBS contact points during the operation, with the patient AWAKE, is essential to confirming the appropriate site for stimulation. This is exactly the opposite of how the clinical trials were conducted. No wonder they failed. It also lends support to the possibility that the placebo effect could play a significant role in the "successes". Some experts have contended as much, and DBS researchers do not deny it.
> I wish I'd known all this beforehand. It would have saved me years of grief and suffering.I'm sorry for your lost time and protracted pain.
- Scott
Posted by Deahoidar on November 30, 2015, at 16:08:49
In reply to Re: Ketamine Nasal Spray SLS (Memantine study) » Deahoidar, posted by SLS on November 30, 2015, at 7:12:29
That may be quite possible. I would defer to others on that usage as it is beyond my knowledge and my current Rx regimen. Thanks!
Posted by Meltingpot on December 1, 2015, at 10:07:30
In reply to Re: Ketamine Nasal Spray Deahoidar » Meltingpot, posted by Deahoidar on November 29, 2015, at 23:09:08
Hi,
It sounds like you went through hell and back and now (from what CK tells me) you can't even participate in another trial where the implant is given whilst you are conscious to see what your "sweet spot" might be.
I hope you are a lot better now than you were.
I don't understand though why you say "It also lends support to the possibility that the placebo effect could play a significant role in the "successes".
Denise
Posted by Deahoidar on December 3, 2015, at 0:10:21
In reply to Re: Ketamine Nasal Spray Deahoidar, posted by Meltingpot on December 1, 2015, at 10:07:30
> I don't understand though why you say "It also lends support to the possibility that the placebo effect could play a significant role in the "successes".
>I'm no expert on advanced statistical analysis or the various theories regarding the power of placebo. So, my understanding and comments are derived from scientific journal publications and statements by professional DBS researchers.
It has been shown that placebo surgery will seem to be more effective than a placebo pill. i.e. the magnitude of the placebo response varies according to its supposed potency. (It's easy to imagine how DBS as a "treatment of last resort" could foster considerable placebo response)
There are also placebo-enhancing effects that may be associated with treatment. e.g., the effect of informed-consent procedures, the effect of medical and nursing care, and even the patient-doctor relationship -- these can all contribute to a patient's perception of clinical benefit.
A good randomized controlled trial seeks to ensure that these factors and effects are similarly distributed. That's one of the reasons why multiple study sites are incorporated.
Literature on placebo effect has repeatedly reported prominent placebo effects are found in 3 neurological disorders: pain, depression, and Parkinson's disease. Antidepressant drug trials have revealed that 35% of patients receiving placebo show improvement. Some authors suggest the overall effect is even higher.
As for DBS as treatment for depression, an editorial in the Journal of Neurosurgery observed that open-label studies of DBS "cannot be regarded as evidence of efficacy. A 29% improvement rate at 1 year is modest and may be consistent with a placebo response."
The American Academy of Neurology (AAN) reported on the significant failures of 2 large scale clinical trials for DBS, with a prominent researcher saying "The bottom line is that we can't separate out active treatment from placebo... it's bad news for DBS." It was also reported that the placebo response in one clinical trial was approx. 25%. That's not a lot, but it wasn't significantly different from the actual treatment. They couldn't tell them apart. Some believe the failure of these clinical trials may mean the end for this DBS technology.
So that's my understanding. Despite tremendous treatment-resistance, some patients are still able to produce significant placebo response. If they improve, that's great! But before a treatment is marketed as effective, it has to be proven.
This is the end of the thread.
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