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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Ruuudy on June 15, 2019, at 0:37:10
Surprised there hasn't been much to any conversation regarding Spravato/esketamine on Babble!
Is it taboo?
I had my 2nd "trip" on it today.
Anyone else trying it?
I'm only my doctor's 2nd patient.
It is certainly quite the experience!
Posted by sigismund on June 15, 2019, at 1:48:27
In reply to Spravato (esketamine), posted by Ruuudy on June 15, 2019, at 0:37:10
>Is it taboo?
No, I don't think so.
I am only familiar with ketamine.
What was it like?
Posted by Roslynn on June 15, 2019, at 12:59:26
In reply to Spravato (esketamine), posted by Ruuudy on June 15, 2019, at 0:37:10
> Surprised there hasn't been much to any conversation regarding Spravato/esketamine on Babble!
>
> Is it taboo?
>
> I had my 2nd "trip" on it today.
> Anyone else trying it?
> I'm only my doctor's 2nd patient.
> It is certainly quite the experience!I'm also surprised there isn't more discussion about it. I'm going to try to convince my dr to try this. Anything you could share would be helpful!!
Roslynn
Posted by Ruuudy on June 15, 2019, at 13:50:46
In reply to Re: Spravato (esketamine), posted by sigismund on June 15, 2019, at 1:48:27
> I am only familiar with ketamine.
>
> What was it like?Very similar experience to all the coke I did back in the heyday.
Nah,,, I wouldn't be able to compare it to that 'cause I've never done an illegal drug in my life (that I know about). I've only experienced intoxication.
But I can say it's a very similar experience to the conscious sedation I was put into for a pre-op procedure about 5 years ago. A feeling of like you are hoovering above your body watching and listening to the doctors & nurses as they work on you.Yesterday was my 2nd treatment.
I still can't say I am feeling any benefit yet - I should state "mental benefit".
I did notice the arthritic pain in my shoulder area was next to gone!What concerns me is that I think I might have started to experience a panic attack midway thru yesterday's treatment. I've only had one other panic attack about a year & a half ago out on the golf course. I sure hope I don't develope a pattern!
The verdict is still out on the Spravato (esketamine) - a derivative of ketamine.
Rudy
Posted by Couleuvre on June 15, 2019, at 16:24:10
In reply to Re: Spravato (esketamine), posted by Ruuudy on June 15, 2019, at 13:50:46
> Very similar experience to all the coke I did back in the heyday.
> Nah,,, I wouldn't be able to compare it to that 'cause I've never done an illegal drug in my life (that I know about). I've only experienced intoxication.
> But I can say it's a very similar experience to the conscious sedation I was put into for a pre-op procedure about 5 years ago. A feeling of like you are hoovering above your body watching and listening to the doctors & nurses as they work on you.
>
> Yesterday was my 2nd treatment.
> I still can't say I am feeling any benefit yet - I should state "mental benefit".
> I did notice the arthritic pain in my shoulder area was next to gone!Ah yes, the "good old days." (You know you've gotten middle-aged when you start finding yourself telling "back in my day" stories! :-) )
I take intranasal esketamine, where you squirt it in your nose from one of those squirt bottles, like some OTC stuff (mostly cough/cold/decongestants, I think).
Are you getting it that way, or do you get the injections? I don't know if you can even get esketamine injections for depression here in Nowheresville (USA). I started taking it before the FDA approved it for depression, and I'm not sure if you could get the intranasal stuff from a regular pharmacy, either, though. It only just occurred to me that I should check with my doctor to find out if maybe I could since it would probably be less expensive. (I get it from a compounding pharmacy.)It's not surprising it was similar to a "conscious sedation" experience, since it's also used for that. It's also considered a good choice for [general] anaesthesia when you don't have the equipment & stuff to monitor patients' breathing, since it doesn't cause a lot of respiratory depression like most anaesthetics.
As for the antidepressant effect...I think it's very good in the short term (my prescription is to take it as needed, up to 3x/week) but when I tried taking it on a regular basis it didn't really seem to help much and made me feel tired a lot. Plus I *really* don't like the way it smells!
I suspect the injection is a more intense experience than taking it intranasally. The way that they said to do it is take one squirt every 5 minutes (or so), five times. It's quite variable, I think that the absorption is not very consistent when you take it this way. Usually I just feel kind of dizzy in a weird way. Occasionally, though, it hardly seems to have much of an effect at all, while other times it's really kind of trippy and causes some feelings of numbness and stuff.
I too was sort of surprised to come back to PB after all these years and not find people talking a lot about this very different sort of new antidepressant. I'm particularly surprised that the FDA actually approved it: usually these days the researchers who are interested in something like this have a very hard time finding any drug companies that are interested in doing all the research to something like this because they don't think it would be profitable. I wonder how they managed it.
Posted by Ruuudy on June 15, 2019, at 17:36:03
In reply to Re: Spravato (esketamine), posted by Couleuvre on June 15, 2019, at 16:24:10
Well, WELCOME BACK Couleuvre!
It's great to have you back and contributing to the discussions!
I like Babble because it seems to attract a "more educated" level of member, such as you - I can tell you're over 18 years old and speak with some intelligence.Yes, it is actually the nasal esketamine that my doctor just started providing - I'm his 2nd patient.
You must have a forward-thinking doctor that has been prescribing you basically the same drug without the "name brand" and probably hundreds of dollars cheaper.Rudy
> I too was sort of surprised to come back to PB after all these years and not find people talking a lot about this very different sort of new antidepressant. I'm particularly surprised that the FDA actually approved it: usually these days the researchers who are interested in something like this have a very hard time finding any drug companies that are interested in doing all the research to something like this because they don't think it would be profitable. I wonder how they managed it.
Posted by Roslynn on June 16, 2019, at 14:36:48
In reply to Re: Spravato (esketamine), posted by Ruuudy on June 15, 2019, at 13:50:46
Yesterday was my 2nd treatment.
> I still can't say I am feeling any benefit yet - I should state "mental benefit".
> I did notice the arthritic pain in my shoulder area was next to gone!
>
> What concerns me is that I think I might have started to experience a panic attack midway thru yesterday's treatment. I've only had one other panic attack about a year & a half ago out on the golf course. I sure hope I don't develope a pattern!
>
> The verdict is still out on the Spravato (esketamine) - a derivative of ketamine.
>
> Rudy
Dear Rudy,May I ask how you got your doctor on board with this?
Is your doctor observing you following administration of the Spravato or are you going to a clinic?does your insurance cover everything?
Thank you so much for any info you can provide; I don't know anyone else receiving Spravato.
Roslynn
Posted by Ruuudy on June 18, 2019, at 6:58:55
In reply to Re: Spravato (esketamine) » Ruuudy, posted by Roslynn on June 16, 2019, at 14:36:48
> Dear Rudy,
>
> May I ask how you got your doctor on board with this?
> Is your doctor observing you following administration of the Spravato or are you going to a clinic?
>
> does your insurance cover everything?
>
> Thank you so much for any info you can provide; I don't know anyone else receiving Spravato.
>
> Roslynn
Hi Roslynn!I'll try responding again - I submitted a reply the other day, but it mysteriousy never appeared!
I have an awesome forward-thinking psychiatrist that stays informed on the latest treatment developements!
I had been discussing the IV Ketamine treatment I had been reading about & researching, when he told me a few months ago to stay tuned in - there was a new drug coming out on the market soon. That was Spravato (esketamine).
He has a very traditional office setting in an older converted house. Very relaxing vibe. He's created a special room with a very comfortable recliner chair, white noise machine, and WiFi to play your tunes.
Both he and his certified staff are there to monitor the treatment.
Very satisified with the setup.
My insurance turned the treatment down, but he did the legwork and got me approved thru the Jansen CarePath Program, which allows me to pay only a small co-pay (suppossed to be $10).
I pay $300 out-of-pocket for each 2-hour office visit - I plan to submit those bills to my insurance company.Hope this helps!
Rudy
Posted by Roslynn on June 18, 2019, at 13:56:13
In reply to Re: Spravato (esketamine) » Roslynn, posted by Ruuudy on June 18, 2019, at 6:58:55
Rudy,
Thank you so much for the info!
So it sounds like your doc has a clinic himself to observe the treatment? He sounds like a great doc.
Please keep me posted, I very much appreciate hearing about your experience.
Roslynn
Posted by pedr on June 18, 2019, at 16:01:34
In reply to Spravato (esketamine), posted by Ruuudy on June 15, 2019, at 0:37:10
Hey Rudy,
thanks for posting about esketamine - the more info for everyone else the better.
I had 2 nasal and 2 injections of ketamine several years ago for my chronic pain. After the injections I awoke with the worst hangover ever. I was belligerent, angry, pissed off with everyone and everything and really depressed. I was so, so gutted as I was hoping the ketamine would help with my severe TRD but no luck.
I should highlight I only had it a few times so can't comment on sustained treatment. I was super puzzled and gutted though, about my response to it - has anyone else experienced anger and incredible irritability after ketamine?
Pete
Posted by Ruuudy on June 18, 2019, at 18:15:21
In reply to Re: Spravato (esketamine) » Ruuudy, posted by pedr on June 18, 2019, at 16:01:34
> Hey Rudy,
> thanks for posting about esketamine - the more info for everyone else the better.
>
> I had 2 nasal and 2 injections of ketamine several years ago for my chronic pain. After the injections I awoke with the worst hangover ever. I was belligerent, angry, pissed off with everyone and everything and really depressed. I was so, so gutted as I was hoping the ketamine would help with my severe TRD but no luck.
>
> I should highlight I only had it a few times so can't comment on sustained treatment. I was super puzzled and gutted though, about my response to it - has anyone else experienced anger and incredible irritability after ketamine?
> PeteHowdy Pete,
Those symptoms of anger & irritability have been my most noteable & troublesome mental issues as of the past year. And I'm not gonna say it yet 'cause I've only had 2 treatments with Spravato (esketamine), but I think there might be just a tinge bit less of those temperments. Got quite a bit of stress in my life right now, which I'm sure is contributing to my flare-ups.Were you taking straight ketamine nasal sprays, or are you living somewhere where esketamine has been available?
I was just about to start trying the IV Ketamine, which would have required me to go out of town for treatment, and instead started the Spravato last week.
The main complaint I read about in all the articles is that treatment is "time-consuming" ---
well, I'm not complaining about - it's actually somewhat of a relief to be able to get outta the retail hardware store I run and get some "relaxing" time!
Right now for the month, it's twice a week. Starting next month, it will be once a week. Then after that,,, who knows,,, maybe once a month? Maybe 4 times a year?. We'll see.Feel free to ask me any questions, and I'll update as the treatment progresses.
Rudy
Posted by pedr on June 19, 2019, at 15:05:30
In reply to Re: Spravato (esketamine) » pedr, posted by Ruuudy on June 18, 2019, at 18:15:21
> Howdy Pete,
> Those symptoms of anger & irritability have been my most noteable & troublesome mental issues as of the past year. And I'm not gonna say it yet 'cause I've only had 2 treatments with Spravato (esketamine), but I think there might be just a tinge bit less of those temperments. Got quite a bit of stress in my life right now, which I'm sure is contributing to my flare-ups.I hear ya, all is not OK in my World too unfortunately. That's potentially promising though about the "bit less".
>
> Were you taking straight ketamine nasal sprays, or are you living somewhere where esketamine has been available?It was a pain doctor quack of the highest order in Union Square in the middle of NYC. To be fair, at least he tried different things - even if most of it was quackery.
Ketamine is fair game (and very cheap) outside of Psychiatry.
>
> I was just about to start trying the IV Ketamine, which would have required me to go out of town for treatment, and instead started the Spravato last week.Tough call. IV's supposed to be the more "authentic" delivery route but data's hard to go by.
>
> The main complaint I read about in all the articles is that treatment is "time-consuming" ---
> well, I'm not complaining about - it's actually somewhat of a relief to be able to get outta the retail hardware store I run and get some "relaxing" time!I wish I could get into that mindset w.r.t. missing work. I get super anxious when I have to miss work for my myriad appointments :(
> Right now for the month, it's twice a week. Starting next month, it will be once a week. Then after that,,, who knows,,, maybe once a month? Maybe 4 times a year?. We'll see.
Interesting. Does that vary if you don't respond at all or respond super well?
>
> Feel free to ask me any questions, and I'll update as the treatment progresses.
>
> Rudy
>
Will do. Best of luck Rudy.
Pete
Posted by Couleuvre on July 1, 2019, at 4:14:23
In reply to Re: Spravato (esketamine) » Couleuvre, posted by Ruuudy on June 15, 2019, at 17:36:03
(Sorry I took so long to post. I've had an awful cold. I've been exhausted all the time, with lots of coughing and the like. Bleah. FWIW, aspirin or ibuprofen or another NSAID is pretty good for the sore throat you get with too much coughing. Helps keep it from turning into bronchitis (a "Boston cold").)
My doctor is very forward-thinking, yes. I think if you've got TRD and have tried all the ordinary stuff, you need someone like that if you're to have any hope of getting better. I'm seeing him at an outpatient clinic at an academic medical centre; the way it works is the attending physicians supervise a certain number of residents (the young docs who just finished med school; residency is a different number of years in different specialties, I think for psychiatry it's 3). The residents mostly just make decisions on their own, although I'm pretty sure they're supposed to at least check with the attending before making a change. But the attending actually sits in on my appointments for the last 10-15 minutes or so and makes suggestions and stuff. My impression is that he does this because: (1) he knows that the residents would be helpless to do anything for me, and (2) he considers me more "interesting" because of my lengthy and elaborate history and unusual list of meds. He's pretty cool, and if he doesn't sincerely care about me, he does a really good job of faking it. <g>
I've had a lot of lousy docs who are totally closed-minded about trying anything remotely different from the standard stuff, and since I don't live in a big city or anything, I feel *really* lucky to have found someone who really knows what he's doing and all that.
So how is the Spravato administered - how is it dosed (what's the concentration? it should say on the bottle), and how often do you take it?
The big trouble with IN administration is that the absorption is kind of unpredictable compared to other routes. I'm sorta wondering why they decided to go with it, because I think esketamine could be administered by several routes that would be more convenient for the patient than having to go to a clinic to get IV injections and more consistently absorbed than IN, so that you could generally expect that if dose X works well for a certain patient while minimising side effects, then you can have that patient keep taking dose X and assume that it will keep working and there won't be any big changes in side effects.
So...anybody have any idea how expensive Spravato is?
Posted by pedr on July 1, 2019, at 7:17:02
In reply to Re: Spravato (esketamine) » Ruuudy, posted by Couleuvre on July 1, 2019, at 4:14:23
> I've had a lot of lousy docs who are totally closed-minded about trying anything remotely different from the standard stuff, and since I don't live in a big city or anything, I feel *really* lucky to have found someone who really knows what he's doing and all that.
Same here. Unwilling to remotely step outside the rules. I'm highly, highly atypical and they just won't act accordingly. Extremely frustrating and, well, life-destroying really.
>
> The big trouble with IN administration is that the absorption is kind of unpredictable compared to other routes. I'm sorta wondering why they decided to go with it, because I think esketamine could be administered by several routes that would be more convenient for the patient than having to go to a clinic to get IV injections and more consistently absorbed than IN, so that you could generally expect that if dose X works well for a certain patient while minimising side effects, then you can have that patient keep taking dose X and assume that it will keep working and there won't be any big changes in side effects.Yeah - what happens when you have a cold for example? surely that thicker layer of mucus inside your nose affects absorption. I don't get it either.
>
> So...anybody have any idea how expensive Spravato is?From https://www.statnews.com/pharmalot/2019/03/22/antidepressants-cost-effective-johnson-and-johnson/ : "...which set a list price of $590 to $885 per treatment session, depending on dosing and number of sessions, which can vary by patient. The initial month of therapy can cost from $4,720 to $6,785
I.e. a mega bucketload.
Is it helping at all for your depression? You mentioned it helps very short term which is nice but the main point of it is to help in the days after dosing of course.
Thanks for your update.
Pete
Posted by Ruuudy on July 2, 2019, at 15:25:47
In reply to Re: Spravato (esketamine) » Couleuvre, posted by pedr on July 1, 2019, at 7:17:02
Well peeps,
I had my 7th Spravato treatment yesterday.
Gotten to be pretty "routine", meaning I walk in, blow my nose, squirt, and wait 5-10 minutes to start to feel it kick in.
Yesterday, I seemed to get a bit more drainage in the back of my throat, and it seemed to take an extra few minutes to start getting some effect. I explained that I thought there was more than usual drainage in my throat, but she said that was ok - it would just take a little longer for the medicine to get to its destination. And it did make it, and it put me in that conscious sedated mode just as strongly as all the previous treatments.I will tell you this, at about the 30 minute mark, it really opens the doors of your mind to be accepting to some internal introspection. Believe it or not, despite my sense of humor, I do tend to hoard negative emotions for too long.
During this 30-60 minute window, I feel I can really let it out.
And I'm one of those persons that is hesitant towards psychotherapy, especially for someone that is not primed and ready for it.With that being said, I need to take advantage of this opportunity to explore the vast contents of my mind.
To add funny to my post here, while I was waiting for the medicine to take hold, I was cleaning up data on my cell phone. When the office secretary popped in to check on on me, I held my cell phone to my head as it was displaying a message, "Click to free up 593mg of cache memory". Her response - "If only it were that easy!".
I'm kinda viewing these Spravato treatments as, hopefully, a healing process.
I hope that my neurons and chemistry are reaping some benefit!Rudy
Posted by pedr on July 5, 2019, at 10:53:37
In reply to Re: Spravato (esketamine), posted by Ruuudy on July 2, 2019, at 15:25:47
Thanks for the update Rudy. How is it faring when you're not under its immediate effects e.g. in between doses? Has it lifted your mood overall?
BTW I saw this https://www.psychologytoday.com/us/blog/evolutionary-psychiatry/201907/esketamine-depression-new-fda-approval-new-controversy which was a good read, esp. about discontinuation :
"JAMA Psychiatry also released a paper earlier this month that looked at longer-term treatment with esketamine. This study took 297 patients whose depression responded to esketamine + antidepressant and enrolled them in a randomized discontinuation phase after 16 weeks of treatment. Half continued with esketamine + antidepressant, the other half a placebo nasal spray and antidepressant, and were followed for about two years. Here the differences got quite significant: Continuing esketamine decreased risk of relapse of depression by 50-70% compared to placebo. Half of the relapses occurred in the first four weeks after stopping esketamine."
Pete
Posted by pedr on July 5, 2019, at 10:53:42
In reply to Re: Spravato (esketamine), posted by Ruuudy on July 2, 2019, at 15:25:47
Thanks for the update Rudy. How is it faring when you're not under its immediate effects e.g. in between doses? Has it lifted your mood overall?
BTW I saw this https://www.psychologytoday.com/us/blog/evolutionary-psychiatry/201907/esketamine-depression-new-fda-approval-new-controversy which was a good read, esp. about discontinuation :
"JAMA Psychiatry also released a paper earlier this month that looked at longer-term treatment with esketamine. This study took 297 patients whose depression responded to esketamine + antidepressant and enrolled them in a randomized discontinuation phase after 16 weeks of treatment. Half continued with esketamine + antidepressant, the other half a placebo nasal spray and antidepressant, and were followed for about two years. Here the differences got quite significant: Continuing esketamine decreased risk of relapse of depression by 50-70% compared to placebo. Half of the relapses occurred in the first four weeks after stopping esketamine."
Pete
Posted by Ruuudy on July 5, 2019, at 17:49:02
In reply to Re: Spravato (esketamine) » Ruuudy, posted by pedr on July 5, 2019, at 10:53:37
> Thanks for the update Rudy. How is it faring when you're not under its immediate effects e.g. in between doses? Has it lifted your mood overall?
When I first walk out of the office following the 2 hour visit, I feel like I just got out of surgery. The next morning, I'm not jumping with bundles of joy & energy, but I can say I probably have a slight lift in mood.
I still have not taken my stimulant (dextroamphetamine), nor my benzo (clonazapam) since beggining Spravato treatment.I had my 8th treatment yesterday and will go a full week between treatments this time.
I am also scheduled to bump up to 84mg next Friday to start the "once a week" treatments.>
> BTW I saw this https://www.psychologytoday.com/us/blog/evolutionary-psychiatry/201907/esketamine-depression-new-fda-approval-new-controversy which was a good read, esp. about discontinuation :
>
> "JAMA Psychiatry also released a paper earlier this month that looked at longer-term treatment with esketamine. This study took 297 patients whose depression responded to esketamine + antidepressant and enrolled them in a randomized discontinuation phase after 16 weeks of treatment. Half continued with esketamine + antidepressant, the other half a placebo nasal spray and antidepressant, and were followed for about two years. Here the differences got quite significant: Continuing esketamine decreased risk of relapse of depression by 50-70% compared to placebo. Half of the relapses occurred in the first four weeks after stopping esketamine."
>
> PeteThanks for the link. Gonna read right now.
As long as I believe there's a cumlative effect with a possibility of additional improvement, I don't mind going in for treatments.I will let you'all know how the longer time between treatments goes. Thanks!
Rudy
This is the end of the thread.
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