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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on May 31, 2019, at 14:57:29
In reply to Ketamine for depression, posted by rovers95 on May 30, 2019, at 7:59:34
Do you take ketamine every day? If not, why not?
- Scott
Posted by linkadge on May 31, 2019, at 16:50:46
In reply to Ketamine for depression, posted by rovers95 on May 30, 2019, at 7:59:34
People who respond to ketamine may only need to take it every few days to a week or so. For some with, say, bipolar depression, you may only need a short course to get out of depression.
It really depends on your typical duration of depressive phase. You may find that lithium extends the duration of effect.
The research on ketamine as an antidepressant is being written as we speak. It is a bit of no man's land, but the mechanism of antidepressant effect is supposedly unrelated to the euphorigenic properties of the drug.
I've been using cannabis for (possible) bipolar depression (could also be unipolar).
To be honest, its nice to take something that makes you feel better, rather than downing months of medication to wait for some faint to non-existent antidepressant effect.
Linkadge
Posted by SLS on June 1, 2019, at 15:48:08
In reply to Re: Ketamine for depression, posted by linkadge on May 31, 2019, at 16:50:46
> People who respond to ketamine may only need to take it every few days to a week or so. For some with, say, bipolar depression, you may only need a short course to get out of depression.
>
> It really depends on your typical duration of depressive phase. You may find that lithium extends the duration of effect.
>
> The research on ketamine as an antidepressant is being written as we speak. It is a bit of no man's land, but the mechanism of antidepressant effect is supposedly unrelated to the euphorigenic properties of the drug.
>
> I've been using cannabis for (possible) bipolar depression (could also be unipolar).
>
> To be honest, its nice to take something that makes you feel better, rather than downing months of medication to wait for some faint to non-existent antidepressant effect.
>
> LinkadgeRegarding intranasal ketamine, I haven't seen any studies comparing daily dosing with intermittent dosing. What are the disadvantages of daily dosing in terms of clinical outcome? Is there evidence that intermittent dosing is better?
- Scott
Posted by linkadge on June 1, 2019, at 16:11:05
In reply to Re: Ketamine for depression, posted by SLS on June 1, 2019, at 15:48:08
The only real advantages for intermittent dosing (that I can see) would be fewer side effects and the prospect of being in remission between dosing, with no drugs in your system.
I don't know what percentage of patients who respond, need to take it every day.
While ketamine can have a rapid acting, longer lasting effect, does this mean that other patients may not respond to longer periods of daily dosing. I.e. if a patient does not respond immediately, does that mean that they won't respond to chronic daily dosing? Who knows. These are all questions that need to be borne out by research.
My hunch is that there are different mechanisms at play, and that failing one mechanism, a different dosing schedule may allow another mechanism to work.
Linkadge
Posted by Roslynn on June 2, 2019, at 14:34:46
In reply to Ketamine for depression, posted by rovers95 on May 30, 2019, at 7:59:34
Are you taking Spravato?
Posted by rovers95 on June 2, 2019, at 16:32:34
In reply to Re: Ketamine for depression, posted by linkadge on May 31, 2019, at 16:50:46
> People who respond to ketamine may only need to take it every few days to a week or so. For some with, say, bipolar depression, you may only need a short course to get out of depression.
>
> It really depends on your typical duration of depressive phase. You may find that lithium extends the duration of effect.
>
> The research on ketamine as an antidepressant is being written as we speak. It is a bit of no man's land, but the mechanism of antidepressant effect is supposedly unrelated to the euphorigenic properties of the drug.
>
> I've been using cannabis for (possible) bipolar depression (could also be unipolar).
>
> To be honest, its nice to take something that makes you feel better, rather than downing months of medication to wait for some faint to non-existent antidepressant effect.
>
> Linkadge
>
>
>
>
>
>Thanks. For me it would be fantastic if the ketamine could be pull me fully out of my slump, but my gains have only been marginal so far. I'm going to give up drinking (which makes me worse), maybe dose twice weekly for a month and see if it has a more pronounced effect, that lasts longer after.
I'm also not sure re my diagnosis. Had a manic episode induced by sleep deprivation and a light box. That subsided but I've not been well since.
Posted by rovers95 on June 2, 2019, at 16:35:24
In reply to Re: Ketamine for depression, posted by SLS on May 31, 2019, at 14:57:29
> Do you take ketamine every day? If not, why not?
>
>
> - ScottWorries about tolerance and health issues are why I dont take daily. I'm new to it so want to see how I do once a week. I note in the new esketamine spray dosing, they suggest twice a week initially, then revert to once a week.
Posted by rovers95 on June 2, 2019, at 16:36:03
In reply to Re: Ketamine for depression, posted by Roslynn on June 2, 2019, at 14:34:46
> Are you taking Spravato?
No its racemic ketamine I am using.
Posted by Roslynn on June 2, 2019, at 16:58:32
In reply to Re: Ketamine for depression, posted by rovers95 on June 2, 2019, at 16:36:03
> > Are you taking Spravato?
>
> No its racemic ketamine I am using.I must be in a really rural area--my pdoc won't prescribe intranasal generic ketamine.
Posted by Ruuudy on June 3, 2019, at 2:48:50
In reply to Re: Ketamine for depression » rovers95, posted by Roslynn on June 2, 2019, at 16:58:32
Interesting article about how there studying ways to extend the benefits of ketamine:
https://www.biorxiv.org/content/10.1101/500959v1
Posted by rovers95 on June 3, 2019, at 13:38:27
In reply to Re: Ketamine for depression, posted by Ruuudy on June 3, 2019, at 2:48:50
> Interesting article about how there studying ways to extend the benefits of ketamine:
>
> https://www.biorxiv.org/content/10.1101/500959v1
>
>Wow thanks for this. Essentially means one could take K every 2 weeks based on these findings.
Posted by SLS on June 4, 2019, at 8:50:30
In reply to Re: Ketamine for depression » Ruuudy, posted by rovers95 on June 3, 2019, at 13:38:27
> > Interesting article about how there studying ways to extend the benefits of ketamine:
> >
> > https://www.biorxiv.org/content/10.1101/500959v1
> >
> >
>
> Wow thanks for this. Essentially means one could take K every 2 weeks based on these findings.If you were to learn that taking ketamine every day would produce a lasting remission, would you do it?
Perhaps taking ketamine intermittently works better than taking it every day. I don't know.
- Scott
Posted by Lamdage22 on June 4, 2019, at 10:13:37
In reply to Re: Ketamine for depression, posted by SLS on June 4, 2019, at 8:50:30
Unproven to be safe long term even if used according to the guidelines. There are many things that will temporarily bring relief. But that does not mean its a good idea to do it.
Posted by Ruuudy on June 4, 2019, at 12:22:24
In reply to Re: Ketamine for depression, posted by SLS on June 4, 2019, at 8:50:30
Eating a bowl of "Special K" every morning - part of daily balanced diet!
Rudy
>
> If you were to learn that taking ketamine every day would produce a lasting remission, would you do it?
>
> Perhaps taking ketamine intermittently works better than taking it every day. I don't know.
>
>
> - Scott
Posted by Stargazer2 on June 26, 2019, at 20:14:29
In reply to Re: Ketamine for depression, posted by SLS on June 1, 2019, at 15:48:08
Have any of you gotten IV Ketamine. I would choose that over the nasal administration. I have had 11 treatments with mixed results but would definitely recommend it. My doc is an expert in it.
Posted by Stargazer2 on June 26, 2019, at 20:14:33
In reply to Re: Ketamine for depression, posted by SLS on June 1, 2019, at 15:48:08
Have any of you gotten IV Ketamine. I would choose that over the nasal administration. I have had 11 treatments with mixed results but would definitely recommend it. My doc is an expert in it.
Posted by SLS on June 27, 2019, at 16:29:15
In reply to IV Ketamine, not nasal spray, posted by Stargazer2 on June 26, 2019, at 20:14:33
> Have any of you gotten IV Ketamine. I would choose that over the nasal administration. I have had 11 treatments with mixed results but would definitely recommend it. My doc is an expert in it.
It might make sense to first try intranasal ketamine (not esketamine). Your doctor can prescribe it to be prepared by a compounding pharmacy. It is very cheap and conveniently administered at home. If that doesn't help, you can then move on to I.V. ketamine.
You can find compounding pharmacies here:
http://ecompoundingpharmacy.com/
- Scott
Posted by Ruuudy on June 28, 2019, at 21:09:36
In reply to Re: IV Ketamine, not nasal spray, posted by SLS on June 27, 2019, at 16:29:15
Just had my 6th treatment of "squirts" (Spravato) over a 3-week window.
Wonder if the compounded ketamine would be a similar experience?
Might be something to look into.
Rudy
> Have any of you gotten IV Ketamine. I would choose that over the nasal administration. I have had 11 treatments with mixed results but would definitely recommend it. My doc is an expert in it.
>
> It might make sense to first try intranasal ketamine (not esketamine). Your doctor can prescribe it to be prepared by a compounding pharmacy. It is very cheap and conveniently administered at home. If that doesn't help, you can then move on to I.V. ketamine.
>
> You can find compounding pharmacies here:
>
> http://ecompoundingpharmacy.com/
>
>
> - Scott
Posted by Stargazer2 on June 30, 2019, at 23:41:23
In reply to Re: IV Ketamine, not nasal spray, posted by Ruuudy on June 28, 2019, at 21:09:36
My Ketamine doctor did not feel the nasal spray would have anywhere near the effects of IV K. She explained why and it made sense. Im all for going to the bloodstream directly. I think crossing the blood brain barrier was a big issue.
Posted by Stargazer2 on June 30, 2019, at 23:41:28
In reply to Re: IV Ketamine, not nasal spray, posted by Ruuudy on June 28, 2019, at 21:09:36
My Ketamine doctor did not feel the nasal spray would have anywhere near the effects of IV K. She explained why and it made sense. Im all for going to the bloodstream directly. I think crossing the blood brain barrier was a big issue.
Posted by SLS on July 2, 2019, at 11:53:36
In reply to Re: IV Ketamine, not nasal spray, posted by Stargazer2 on June 30, 2019, at 23:41:28
> My Ketamine doctor did not feel the nasal spray would have anywhere near the effects of IV K. She explained why and it made sense. Im all for going to the bloodstream directly. I think crossing the blood brain barrier was a big issue.
Actually, intranasal administration circumvents the BBB. Intravenous still requires that ketamine cross the BBB. In general, I think I.V. ketammine is more effective. However, since many people respond to intranasal ketamine robustly, it seems like it is worth trying first. I don't know what advantages there are to using intranasal esketamine compared to ketamine. All I know is that ketamine is dirt-cheap and can be administered at home.
- Scott
Posted by Stargazer2 on July 5, 2019, at 0:06:31
In reply to Re: IV Ketamine, not nasal spray » Stargazer2, posted by SLS on July 2, 2019, at 11:53:36
How would Ketamine be administered at home. Who would prescribe it for anyone unless you can get it somehow directly and even still how would you administer it?
My doc is a member of a National Assn of Ketamine researchers/providers that meet regularly to discuss their findings, practices, outcomes and guidelines of Ketamine administration. She sends out newsletters to her patients and everything I read did not support the use of intranasal K for intractable depression.
That is just what I have heard from her and read in the news letters. She is a brilliant psychiatrist and also does not advise for Ketamine to be given in clinics run by anesthesiologists. I initially was supposed to be treated by an Anesth. and she made me come off Nardil before she could treat me. Then she decided not to treat me because of my history. She referred me to Dr Lori Calabrese in West Hartford, CT and was informed by her that I DID not need to come off Nardil. Wow. The anesth was wrong about that. I know Dr C is an expert based on her background, education and membership in the Ketamine National Assn, who are the leading researchers and practitioners who are currently utilizing it in their repertoire of depression treatments. I have total faith in her honestly and integrity in administering Ketamine not solely for the purpose of financial gain as many clinics are being criticized for.
Posted by Ruuudy on July 5, 2019, at 0:38:25
In reply to Re: IV Ketamine, not nasal spray, posted by Stargazer2 on July 5, 2019, at 0:06:31
Awesome! You've got a highly intelligent, compassionate doctor!
I get those email newsletters from Dr. Calabrese.
Very good reading!Do you use Facebook?
There are two excellent ketamine discussion groups that I belong to that provide excellent dialog.Rudy
> My doc is a member of a National Assn of Ketamine researchers/providers that meet regularly to discuss their findings, practices, outcomes and guidelines of Ketamine administration. She sends out newsletters to her patients and everything I read did not support the use of intranasal K for intractable depression.
> That is just what I have heard from her and read in the news letters. She is a brilliant psychiatrist - Dr Lori Calabrese. I know Dr C is an expert based on her background, education and membership in the Ketamine National Assn, who are the leading researchers and practitioners who are currently utilizing it in their repertoire of depression treatments. I have total faith in her honestly and integrity in administering Ketamine not solely for the purpose of financial gain as many clinics are being criticized for.
Posted by SLS on July 6, 2019, at 22:47:58
In reply to Re: IV Ketamine, not nasal spray, posted by Stargazer2 on July 5, 2019, at 0:06:31
> How would Ketamine be administered at home. Who would prescribe it for anyone unless you can get it somehow directly and even still how would you administer it?
A doctor can prescribe ketamine as a solution to be prepared by a compounding pharmacy and delivered in a nasal spray container.
Scientific studies evaluating the efficacy of intranasal ketamine in the treatment of depression are inconsistent. Some report success. Others report failure. I recall seeing somewhere that some people who fail to respond to intranasal go on to respond to I.V. I would be interested to know if anyone claims to be certain that intranasal ketamine is useless. Dosage is very important, and it must be finessed. A dose that is too high doesnt work according to John Krystal. Perhaps this is why the results with I.V. are more consistent than those with intranasal. The amount of ketamine reaching the brain using I.V. is presumably controlled better.
I know someone who responds to monotherapy intranasal ketamine who had not done well with any other antidepressants. After her third day of ketamine treatment, she described her response as being robust, and even used the word "remission" shortly thereafter. She no longer uses such optimistic words, but she is significantly better than she was. However, she is inconsistent in the timing of her doses. I tried intranasal ketamine a number of years ago using daily dosing. It had no effect. In retrospect, I think I should have tried a different pharmacy. I think most people dose intranasal ketamine once every 5 days.
Have you heard anything about hydroxynorketamine (HNK)? It is a metabolite of ketamine that can be given orally. It is not supposed to have psychotomimetic or dissociative side effects.
- Scott
Posted by SLS on July 9, 2019, at 9:47:37
In reply to Re: IV Ketamine, not nasal spray, posted by SLS on July 6, 2019, at 22:47:58
> Have you heard anything about hydroxynorketamine (HNK)? It is a metabolite of ketamine that can be given orally. It is not supposed to have psychotomimetic or dissociative side effects.
After poking around a little, I am left with the impression that HNK is not as effective as ketamine, even though it raises BDNF levels, increases mTOR signaling, and promotes neuroplasticity in rats. I would still like to see well-controlled human trials. I don't think there are any.
- Scott
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