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Dr. Bob is Robert Hsiung, MD,
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Posted by Hugh on February 18, 2016, at 13:54:17
In reply to Ketamine infusions for Depression, posted by TJ_smith on February 17, 2016, at 8:52:23
A number of Babblers have tried ketamine. IV infusion ketamine, ketamine injections, intranasal ketamine. Some have been helped significantly, long-term. Some were just helped temporarily. Some weren't helped at all. Do a search and you'll find some posts about ketamine in the archives.
This slideshow has some interesting information on NMDA antagonists for pain relief. Skip to page 30 and it discusses how ketamine and magnesium work synergistically. The kind of magnesium discussed in the slideshow is IV infusion, but there's a fairly new form of magnesium called magnesium l-threonate that, taken orally, can get more magnesium across the blood-brain barrier than an IV infusion of magnesium.
Here's the slideshow about ketamine and magnesium:
http://www.ndana.org/pdf/NMDAReceptorAntagonistslecture.pdf
An article about magnesium l-threonate:
Posted by SLS on February 18, 2016, at 14:45:34
In reply to Ketamine infusions for Depression, posted by TJ_smith on February 17, 2016, at 8:52:23
The dosage of ketamine is critical - (0.5 mg/kg) over 40 minutes. You can have IV infusions every day, but if the dosage is too low - or too high - it won't work for depression.
With the frequency at which you are being given ketamine treatments, you should respond well, unless your genetics don't allow for this. The majority (66%) of people have the val66val allele for the BDNF (brain-derived neurotrophic factor) gene. These are the full remitters to ketamine. Then, there are those who have val66met. These people are partial responders only. The minority who have the met66met allele are non-responders.
Are you allowed to take any other psychotropic drugs at this time? What about vitamins or food supplements?
Also:
val66val = SSRI responders
val66met; met66met = SNRI or TCA responders
I am wondering if those people with the met66met allele need MAOIs to achieve a robust antidepressant response - or perhaps a combination that would include Lamictal (lamotrigine), lithium, or Abilify (aripiprazole).
- Scott
Posted by Tabitha on February 23, 2016, at 9:14:02
In reply to Ketamine infusions for Depression, posted by TJ_smith on February 17, 2016, at 8:52:23
> Also, if you have any specific questions for me, fire away and I'll do my best to answer.
>Hi TJ! Are you in a clinical trial? I've heard of ketamine for depression but I did not think it was in use yet.
Posted by tj_smith on February 23, 2016, at 10:00:58
In reply to Re: Ketamine infusions for Depression » TJ_smith, posted by Tabitha on February 23, 2016, at 9:14:02
>
It's in use...you can find clinics/Drs that will give it to you off label.
> > Also, if you have any specific questions for me, fire away and I'll do my best to answer.
> >
>
> Hi TJ! Are you in a clinical trial? I've heard of ketamine for depression but I did not think it was in use yet.
>
>
Posted by SLS on February 23, 2016, at 10:28:31
In reply to Re: Ketamine infusions for Depression, posted by tj_smith on February 23, 2016, at 10:00:58
> >
> It's in use...you can find clinics/Drs that will give it to you off label.
>
>
> > > Also, if you have any specific questions for me, fire away and I'll do my best to answer.
> > >
> >
> > Hi TJ! Are you in a clinical trial? I've heard of ketamine for depression but I did not think it was in use yet.I would look at intranasal administration first. It works.
- Scott
Posted by Tabitha on February 23, 2016, at 10:46:41
In reply to Re: Ketamine infusions for Depression, posted by SLS on February 23, 2016, at 10:28:31
Posted by Hugh on February 26, 2016, at 14:04:46
In reply to Ketamine infusions for Depression, posted by TJ_smith on February 17, 2016, at 8:52:23
This NPR story about ketamine was broadcast yesterday.
Posted by brynb on March 3, 2016, at 5:23:30
In reply to Ketamine infusions for Depression, posted by TJ_smith on February 17, 2016, at 8:52:23
hi-
haven't been on here in a while but i use a doc in nyc who administers ketamine for depression (IM). i found it helped temporarily. another doc in nyc administers iv infusions and i got similar (temporary) results. found that it only works temporarily and it can aggravate bipolar symptoms (this seemed to be a general consensus for ketamine), but good luck.
i just wanted to add on that a similar med i've used for years is tramadol (yes, the opiate) which, like ketamine, is an nmda antagonist and works on glutamate (as well as almost all other receptors). though i've had to tweak the dose over the last 3 years, it's been the only consistent AD for me, far better than any SSRI, NRI or any other treatment (and I've tried them all) out there. Most docs balk at it ("it's a pain med!," "it's not a psych med!" "it's addictive!") and the ridiculous list continues, but if you're lucky enough to have a doc on board to treat you with it, give it a go. like ketamine, it hits glutamate, which works for me.
good luck.
-b
Posted by SLS on March 3, 2016, at 8:40:23
In reply to Re: Ketamine infusions for Depression, posted by brynb on March 3, 2016, at 5:23:30
> hi-
Hi.
> i just wanted to add on that a similar med i've used for years is tramadol
How long did it take for tramadol to exert an antidepressant effect?
- Scott
Posted by Edward807 on November 30, 2016, at 10:47:38
In reply to Re: Ketamine infusions for Depression » TJ_smith, posted by SLS on February 18, 2016, at 14:45:34
> The dosage of ketamine is critical - (0.5 mg/kg) over 40 minutes. You can have IV infusions every day, but if the dosage is too low - or too high - it won't work for depression.
>
> With the frequency at which you are being given ketamine treatments, you should respond well, unless your genetics don't allow for this. The majority (66%) of people have the val66val allele for the BDNF (brain-derived neurotrophic factor) gene. These are the full remitters to ketamine. Then, there are those who have val66met. These people are partial responders only. The minority who have the met66met allele are non-responders.
>
> Are you allowed to take any other psychotropic drugs at this time? What about vitamins or food supplements?
>
> Also:
>
> val66val = SSRI responders
>
> val66met; met66met = SNRI or TCA responders
>
> I am wondering if those people with the met66met allele need MAOIs to achieve a robust antidepressant response - or perhaps a combination that would include Lamictal (lamotrigine), lithium, or Abilify (aripiprazole).
>
>
> - ScottHi Scott,
I'm researching ketamine and found your post (I used to be active on this board years ago and just rejoined). How does one determine if they have the val66val allele for BDNF? Is there a particular test you would recommend? I've been reading about the GeneSight Psychotropic test.
Thanks!
Edward
Posted by Edward807 on November 30, 2016, at 12:52:20
In reply to Re: Ketamine infusions for Depression » brynb, posted by SLS on March 3, 2016, at 8:40:23
For anyone interested, there's a Facebook group called Ketamine Infusions for Better Health that is very active and a great resource.
Posted by SLS on November 30, 2016, at 18:13:47
In reply to Re: Ketamine infusions for Depression, posted by Edward807 on November 30, 2016, at 10:47:38
Hi, Edward.
I have no idea if there is a commercially available test for BDNF genotypes. I never looked into it. I don't think there has been a prospective investigation to study the prognosticative value of testing for genotype in advance of ketamine treatment.
- Scott____________________________________________________
> > The dosage of ketamine is critical - (0.5 mg/kg) over 40 minutes. You can have IV infusions every day, but if the dosage is too low - or too high - it won't work for depression.
> >
> > With the frequency at which you are being given ketamine treatments, you should respond well, unless your genetics don't allow for this. The majority (66%) of people have the val66val allele for the BDNF (brain-derived neurotrophic factor) gene. These are the full remitters to ketamine. Then, there are those who have val66met. These people are partial responders only. The minority who have the met66met allele are non-responders.
> >
> > Are you allowed to take any other psychotropic drugs at this time? What about vitamins or food supplements?
> >
> > Also:
> >
> > val66val = SSRI responders
> >
> > val66met; met66met = SNRI or TCA responders
> >
> > I am wondering if those people with the met66met allele need MAOIs to achieve a robust antidepressant response - or perhaps a combination that would include Lamictal (lamotrigine), lithium, or Abilify (aripiprazole).
> >
> >
> > - Scott
>
> Hi Scott,
>
> I'm researching ketamine and found your post (I used to be active on this board years ago and just rejoined). How does one determine if they have the val66val allele for BDNF? Is there a particular test you would recommend? I've been reading about the GeneSight Psychotropic test.
>
> Thanks!
> Edward
>
Posted by Edward807 on November 30, 2016, at 18:47:34
In reply to Re: Ketamine infusions for Depression » Edward807, posted by SLS on November 30, 2016, at 18:13:47
> Hi, Edward.
>
> I have no idea if there is a commercially available test for BDNF genotypes. I never looked into it. I don't think there has been a prospective investigation to study the prognosticative value of testing for genotype in advance of ketamine treatment.
>
>
> - ScottScott thanks for the response. Since a course of ketamine infusions cost thousands, something like that would be very helpful. I'm also considering the cytochrome P450 test to see if it might shed some light on my treatment resistant depression.
Edward.
____________________________________________________
Posted by SLS on November 30, 2016, at 20:13:18
In reply to Re: Ketamine infusions for Depression » SLS, posted by Edward807 on November 30, 2016, at 18:47:34
> > Hi, Edward.
> >
> > I have no idea if there is a commercially available test for BDNF genotypes. I never looked into it. I don't think there has been a prospective investigation to study the prognosticative value of testing for genotype in advance of ketamine treatment.
> >
> >
> > - Scott
>
> Scott thanks for the response. Since a course of ketamine infusions cost thousands, something like that would be very helpful. I'm also considering the cytochrome P450 test to see if it might shed some light on my treatment resistant depression.
>
> Edward.
> ____________________________________________________
I'm sorry that you have such a frustrating and painful condition.For me, it made sense to try the intranasal administration of ketamine first. It brings many people to full remission. However, there are people who don't respond to intranasal ketamine who do respond to IV ketamine.
- Scott
Posted by Edward807 on December 1, 2016, at 11:59:41
In reply to Re: Ketamine infusions for Depression » Edward807, posted by SLS on November 30, 2016, at 20:13:18
____________________________________________________
> I'm sorry that you have such a frustrating and painful condition.
>
> For me, it made sense to try the intranasal administration of ketamine first. It brings many people to full remission. However, there are people who don't respond to intranasal ketamine who do respond to IV ketamine.
>
> - ScottGood point.The hard part may be finding a doctor who will prescribe it but I'm desperate enough to keep looking. One clinic I've talked with in San Antonio prescribes oral lozenges for maintenance treatment after doing the infusions. They claim the lozenges work better that the intranasal. Have you continued using the intranasal ketamine?
Edward
Posted by SLS on December 1, 2016, at 20:40:02
In reply to Re: Ketamine infusions for Depression » SLS, posted by Edward807 on December 1, 2016, at 11:59:41
Hi, Edward.
I was unaware that ketamine was being distributed as a lozenge. Is it used sublingually?
Intranasal ketamine didn't help me at all. It didn't make things better or worse.
- Scott____________________________________________________
> > I'm sorry that you have such a frustrating and painful condition.
> >
> > For me, it made sense to try the intranasal administration of ketamine first. It brings many people to full remission. However, there are people who don't respond to intranasal ketamine who do respond to IV ketamine.
> >
> > - Scott
> Good point.The hard part may be finding a doctor who will prescribe it but I'm desperate enough to keep looking. One clinic I've talked with in San Antonio prescribes oral lozenges for maintenance treatment after doing the infusions. They claim the lozenges work better that the intranasal. Have you continued using the intranasal ketamine?
>
> Edward
Posted by Edward807 on December 2, 2016, at 21:22:12
In reply to Re: Ketamine infusions for Depression » Edward807, posted by SLS on December 1, 2016, at 20:40:02
> Hi, Edward.
>
> I was unaware that ketamine was being distributed as a lozenge. Is it used sublingually?
>
> Intranasal ketamine didn't help me at all. It didn't make things better or worse.
>Yes the ketamine lozenges (aka troches) are used sublinqually.
be well, Edward
____________________________________________________
Posted by SLS on December 3, 2016, at 6:55:57
In reply to Re: Ketamine infusions for Depression » SLS, posted by Edward807 on December 2, 2016, at 21:22:12
Hi, Edward.
Perhaps there advantages to using sublingual lozenges. Would you know?
I think intranasal administration allows for ketamine to bypass the blood-brain barrier and reach its target sites more directly. Sublingual doesn't do this.
If you can get enough ketamine in the brain to produce a mild dissociative state, then it is probsbly getting to where it needs to go.
- Scott
Posted by Edward807 on December 3, 2016, at 16:03:55
In reply to Re: Ketamine infusions for Depression » Edward807, posted by SLS on December 3, 2016, at 6:55:57
> Hi, Edward.
>
> Perhaps there advantages to using sublingual lozenges. Would you know?
>
> I think intranasal administration allows for ketamine to bypass the blood-brain barrier and reach its target sites more directly. Sublingual doesn't do this.
>
> If you can get enough ketamine in the brain to produce a mild dissociative state, then it is probsbly getting to where it needs to go.
>Hi Scott,
I agree, it would seem that intranasal administration would be more effective. Perhaps the lozenges they are using contain a larger dose of ketamine or the rate of absorption makes a difference.
Janssen Pharmaceuticals has several intranasal esketamine trials going on that I'm looking into.
Edward
Posted by DetroitPistons04 on December 21, 2016, at 11:41:35
In reply to Ketamine infusions for Depression, posted by TJ_smith on February 17, 2016, at 8:52:23
Things have been so bad for so long that I'm willing to do just about anything right now. I haven't brought up ECT to my doc yet, but I will if things don't get better.
I looked into ketamine infusion and it's $600 per treatment and they say it typically takes 6 treatments to help with depression. Of course, I can't afford that, but if it was really that much of a miracle cure I might find some creative way to finance it.
I did start Rexulti yesterday and I've seen reports that it works very fast, so I'm keeping my fingers crossed.
Posted by chumbawumba on January 4, 2017, at 2:32:27
In reply to Re: Ketamine infusions for Depression » TJ_smith, posted by SLS on February 18, 2016, at 14:45:34
> The dosage of ketamine is critical - (0.5 mg/kg) over 40 minutes. You can have IV infusions every day, but if the dosage is too low - or too high - it won't work for depression.
>Why do so many docs use intranaasal ketamine or intramuscular shots? One could deliver the correct dosage but timing smooth delivery over 40 minutes would be impossible. Is the rate critical, the dosage critical or both?
Posted by SLS on January 4, 2017, at 6:39:31
In reply to Re: Ketamine infusions for Depression, posted by chumbawumba on January 4, 2017, at 2:32:27
> > The dosage of ketamine is critical - (0.5 mg/kg) over 40 minutes. You can have IV infusions every day, but if the dosage is too low - or too high - it won't work for depression.
> >
>
> Why do so many docs use intranaasal ketamine or intramuscular shots? One could deliver the correct dosage but timing smooth delivery over 40 minutes would be impossible. Is the rate critical, the dosage critical or both?It is critical. Taking too much ketamine ruins the effect. Intranasal ketamine can be regulated by changing and titrating the dosage. However, there are people who do not respond to intranasal who do go on to respond to infusions.
A major question is, would someone want to commit the rest of their life to going for infusions every few days to a week rather than sniff a liquid for a few seconds every 1-5 days? Try intranasal first, then go for infusions if necessary. That would be my answer to the question.
http://bipolarnews.org/index.php?s=intranasal+ketamine
- Scott
Posted by Edward807 on January 4, 2017, at 10:08:03
In reply to Re: Ketamine infusions for Depression » chumbawumba, posted by SLS on January 4, 2017, at 6:39:31
> > > The dosage of ketamine is critical - (0.5 mg/kg) over 40 minutes. You can have IV infusions every day, but if the dosage is too low - or too high - it won't work for depression.
> > >
> >
> > Why do so many docs use intranaasal ketamine or intramuscular shots? One could deliver the correct dosage but timing smooth delivery over 40 minutes would be impossible. Is the rate critical, the dosage critical or both?
>
> It is critical. Taking too much ketamine ruins the effect. Intranasal ketamine can be regulated by changing and titrating the dosage. However, there are people who do not respond to intranasal who do go on to respond to infusions.
>
> A major question is, would someone want to commit the rest of their life to going for infusions every few days to a week rather than sniff a liquid for a few seconds every 1-5 days? Try intranasal first, then go for infusions if necessary. That would be my answer to the question.
>
> http://bipolarnews.org/index.php?s=intranasal+ketamine
>
>
> - ScottI've had five infusions and am taking sublinqual ketamine (troches) for maintenance. The dosages for the infusion varied, it's not one size fits all. Both produce an almost immediate antidepressant effect. It remains to be seen if it is sustainable. The infusions produced a self reflective inner experience that's hard to describe. Journaling my impressions and working with a therapist was indispensable.
Posted by chumbawumba on January 4, 2017, at 22:05:43
In reply to Re: Ketamine infusions for Depression » chumbawumba, posted by SLS on January 4, 2017, at 6:39:31
> > > The dosage of ketamine is critical - (0.5 mg/kg) over 40 minutes. You can have IV infusions every day, but if the dosage is too low - or too high - it won't work for depression.
> > >
> >
> > Why do so many docs use intranaasal ketamine or intramuscular shots? One could deliver the correct dosage but timing smooth delivery over 40 minutes would be impossible. Is the rate critical, the dosage critical or both?
>
> It is critical. Taking too much ketamine ruins the effect. Intranasal ketamine can be regulated by changing and titrating the dosage. However, there are people who do not respond to intranasal who do go on to respond to infusions.
>
> A major question is, would someone want to commit the rest of their life to going for infusions every few days to a week rather than sniff a liquid for a few seconds every 1-5 days? Try intranasal first, then go for infusions if necessary. That would be my answer to the question.
>
> http://bipolarnews.org/index.php?s=intranasal+ketamine
>
>
> - ScottThank you for that link, I had not seen that.
Perhaps you would care to opine on the concurrent use of benzodiazepines with ketamine. All the clinics are saying you can't use them with ketamine. They are total buzz killers. Lamictal as well.
I have found both of these to be true myself. I cannot experience the ketamine bliss state or the antidepressant afterglow if I am taking benzos or Lamictal. No problem with the Lamictal. I take Lithium now and that works better anyway.
Problem is ketamine stimulates the hell out of me and I can't sleep without taking 60 mg of flurazepam. I am thinking of asking my pdoc to change from flurazepam, which is long acting by virtue of it's active metabolite. To a high dose of a short acting benzo like Halcion. That way when I wake up the benzo willl be more or less out of my system and I can take the ketamine and have a nice day.
A link for you, perhaps you've seen it maybe others haven't. Over ten years since publication. Seems like ancient history for the subject at hand.
http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4637.2006.00208_8.x/abstract
Posted by SLS on January 5, 2017, at 9:31:05
In reply to Re: Ketamine infusions for Depression, posted by chumbawumba on January 4, 2017, at 22:05:43
Ketamine, when used as a anesthetic, is often combined with midazolam, which is a benzodiazepine. Side effects of the combination include dizziness, drowsiness, confusion, and difficulty concentrating according to www.drugs.com.
Also,
http://pediatrics.aappublications.org/content/99/3/427
- Scott
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