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Dr. Bob is Robert Hsiung, MD,
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Posted by rjlockhart37 on January 31, 2013, at 23:40:21
In reply to My Ketamine trial + new pdoc, posted by brynb on January 31, 2013, at 9:48:34
i would love to be in your place right now....ketamenine i've never tried it but i've read alot of about it here on babble...
r
Posted by brynb on February 1, 2013, at 16:05:58
In reply to My Ketamine trial + new pdoc, posted by brynb on January 31, 2013, at 9:48:34
Thanks for all the feedback and positive responses.
My first round two nights ago went well, and I felt ok yesterday morning, but later in the day I felt extremely melancholy and spent a good deal of the afternoon crying and anxious.
I went for my 2nd round of Ketamine shots today; again, they were IM and about 20 minutes apart. They upped the dosage this time (I don't remember what they were, but it's based on weight). Again, I felt good during treatment; weird, but pleasurable--actually euphoric. I was also very tired when I left (like last time), but I'm feeling better now. (And I haven't cried today!)
I think my mood tomorrow will be more telling. I'm going in for my next round of shots this Tuesday, and then my pdoc and I will discuss what to do from that point on.
I read this article today about Ketamine; nothing new, but I thought some people might be interested in it:
Hope everyone's doing well and again, thanks for the support.
-b
Posted by SLS on February 1, 2013, at 16:25:56
In reply to Re: My Ketamine trial-2nd round + article, posted by brynb on February 1, 2013, at 16:05:58
Thanks for the information.
I hope ketamine works magic for you. Although many people do feel better 4 hours after an infusion, it can up to 24 hours. I couldn't guess as to how one responds to injections.
- Scott
Posted by Phillipa on February 1, 2013, at 18:11:05
In reply to Re: My Ketamine trial-2nd round + article » brynb, posted by SLS on February 1, 2013, at 16:25:56
I can't imagine it either. Phillipa
Posted by ChicagoKat on February 2, 2013, at 9:49:28
In reply to Re: My Ketamine trial-2nd round + article, posted by brynb on February 1, 2013, at 16:05:58
Bryn, so glad to hear that things may be slowly getting better. And thanks for the article; I saved it to read after my therapist appt.
Thanks to Hugh I now know of at least one clinic in my area that does Ketamine. I'm kinda waiting to see the results from my very un-scientific after my colonoscopy later this week - they use Ketamine for sedation! Take care my friend.
Kat
Posted by brynb on February 5, 2013, at 18:08:31
In reply to My Ketamine trial + new pdoc, posted by brynb on January 31, 2013, at 9:48:34
I just returned from my third Ketamine treatment. I received 3 IM injections today. During the treatment, I feel great, euphoric and, dare I say, happy.
I'm exhausted right now. It wipes me out. I'll be going in for another round this Friday. So far I've had a total of 7 injections. After Friday, we'll see where I'm at, and then determine how many more treatments are necessary to treat this current depressive episode (which has been plaguing me for a good 2 months) and what will be necessary for maintenance if it's determined that it is indeed the course to stay on.
I'll say this: the fog has lifted. I'm getting out of bed. I'm showering. I'm leaving my apartment for short walks. I still have a very short attention span, little patience and irritability, but for now, that's acceptable considering how bad off I've been.
Here's my current regimen, pdoc approved, which is working:
-2 Ketamine treatments a week (usually 2 injections), going forward tbd
-50-100mg of Tramadol in the morning (for pain and antidepressant effects; it works similarly to and perhaps synergystically with Ketamine)
-15mg of Deplin with breakfast
-20mg of Lexapro before bed
-20mg of Valium for sleep, 10 mg during the day if need be for anxietyIt's not as streamlined as I'd like, but it's working. And it's taking a lot of energy and effort on my part, but it's making a HUGE difference to work with an optimistic pdoc who thinks out of the box and isn't afraid to try and stick with what's working.
Hope my fellow babblers are faring well.
-b
Posted by Phillipa on February 5, 2013, at 21:08:31
In reply to Ketamine: it's working, posted by brynb on February 5, 2013, at 18:08:31
Bryn so glad you feel so much better. So the lexapro stays? I am betting you are asleep now. So you did get out to walk? Congrats Phillipa
Posted by Emme_V2 on February 5, 2013, at 22:20:13
In reply to Ketamine: it's working, posted by brynb on February 5, 2013, at 18:08:31
Excellent! I hope this is the start of a lot of wellness for you. Glad the new pdoc is really working with you.
Posted by jrbecker76 on February 5, 2013, at 23:24:16
In reply to Ketamine: it's working, posted by brynb on February 5, 2013, at 18:08:31
> I just returned from my third Ketamine treatment. I received 3 IM injections today. During the treatment, I feel great, euphoric and, dare I say, happy.
>
> I'm exhausted right now. It wipes me out. I'll be going in for another round this Friday. So far I've had a total of 7 injections. After Friday, we'll see where I'm at, and then determine how many more treatments are necessary to treat this current depressive episode (which has been plaguing me for a good 2 months) and what will be necessary for maintenance if it's determined that it is indeed the course to stay on.
>
> I'll say this: the fog has lifted. I'm getting out of bed. I'm showering. I'm leaving my apartment for short walks. I still have a very short attention span, little patience and irritability, but for now, that's acceptable considering how bad off I've been.
>
> Here's my current regimen, pdoc approved, which is working:
>
> -2 Ketamine treatments a week (usually 2 injections), going forward tbd
> -50-100mg of Tramadol in the morning (for pain and antidepressant effects; it works similarly to and perhaps synergystically with Ketamine)
> -15mg of Deplin with breakfast
> -20mg of Lexapro before bed
> -20mg of Valium for sleep, 10 mg during the day if need be for anxiety
>
> It's not as streamlined as I'd like, but it's working. And it's taking a lot of energy and effort on my part, but it's making a HUGE difference to work with an optimistic pdoc who thinks out of the box and isn't afraid to try and stick with what's working.
>
> Hope my fellow babblers are faring well.
>
> -bGlad to hear it's working. We're all cheering for you.
What meds did this new doc add in, if anything, besides the ketamine? I know you mentioned the Deplin but wondering if he prescribed the Ultram.
Are you finding that the irritability and attention span is worse since the treatment began or just the same as before? I recall reading in a report on bipolar depression case studies using ketamine treatment that irritability and cognitive dysfunction were reported side effects.
How long would you say the side effects that you might be feeling (including the sleepiness/exhaustion) are lasting after each injection?
Keep us updated!
JB
Posted by brynb on February 6, 2013, at 0:32:20
In reply to Re: Ketamine: it's working » brynb, posted by Phillipa on February 5, 2013, at 21:08:31
> Bryn so glad you feel so much better. So the lexapro stays? I am betting you are asleep now. So you did get out to walk? Congrats Phillipa
Thanks, Phillipa. Yes, Lexapro's in for now. I was asleep but now I'm wide awake. Side effect perhaps? As long as it doesn't become a pattern, I can deal...
-b
Posted by brynb on February 6, 2013, at 0:35:00
In reply to Re: Ketamine: it's working » brynb, posted by Emme_V2 on February 5, 2013, at 22:20:13
> Excellent! I hope this is the start of a lot of wellness for you. Glad the new pdoc is really working with you.
Thanks, Emme.
I vaguely remember you being on minocycline (I think). If so, are you continuing to use it and is it helping?
Hope you're well.
-b
Posted by brynb on February 6, 2013, at 0:57:59
In reply to Re: Ketamine: it's working, posted by jrbecker76 on February 5, 2013, at 23:24:16
> Glad to hear it's working. We're all cheering for you.
Thank you!
> What meds did this new doc add in, if anything, besides the ketamine? I know you mentioned the Deplin but wondering if he prescribed the Ultram.
Ketamine, Valium and Deplin (along with Vitamin D and the suggestion to cut out gluten--a bit hard for me as I'm a vegetarian and a picky eater).
My internist originally prescribed me Ultram last spring for leg pain (which seems to be somatic) and at the time it helped me out of a funk, too. Since then, I've used it as a prn and not very often, but I'm finding it's helping with the depression again.> Are you finding that the irritability and attention span is worse since the treatment began or just the same as before? I recall reading in a report on bipolar depression case studies using ketamine treatment that irritability and cognitive dysfunction were reported side effects.
Very interesting, actually. My irritability and reduced attention span have always seemed separate from my depression. They were initially bad, but I have a feeling that the Ketamine isn't helping in this area either (I feel irritable right after the treatment) and my cognitive dysfunction hasn't improved. Ultram makes me a bit "up" and energetic/chatty, which I like as it's better than my baseline of being down, but I realize is hypomanic. This observation kind of cements my feeling that I have bipolar 2 rather than MDD.
I plan to address this at my next appointment; however, mood stabilizers are out (they make the depression worse and make me flat), as well as AP's, which make me a zombie, too sluggish, and generally worse off. Perhaps I could do Ultram every other day, and at this point, I will never exceed 50mg, the smallest dose.
> How long would you say the side effects that you might be feeling (including the sleepiness/exhaustion) are lasting after each injection?
Well, it's almost 2 am in the morning now and I'm wide awake, so probably not that long :/.
> Keep us updated!
>
> JB
>
I will! Thanks, JB. Hope you're well.-b
Posted by Emme_V2 on February 6, 2013, at 5:54:31
In reply to Re: Ketamine: it's working » Emme_V2, posted by brynb on February 6, 2013, at 0:35:00
> > Excellent! I hope this is the start of a lot of wellness for you. Glad the new pdoc is really working with you.
>
> Thanks, Emme.
>
> I vaguely remember you being on minocycline (I think). If so, are you continuing to use it and is it helping?
>
> Hope you're well.
>
> -b
Hi Bryn,Yes, that's right. The minocycline does seem to be very helpful. Thanks!
emme
Posted by alchemy on February 6, 2013, at 14:55:35
In reply to Re: Ketamine: it's working » brynb, posted by Emme_V2 on February 6, 2013, at 5:54:31
Are infusions more likely to have a more effective response than injections? I know they are suppose to over the nose sprays.
Also, is the agitation and lethargy after the treatment common?
Posted by brynb on February 6, 2013, at 15:22:13
In reply to Re: Ketamine: injections vs infusions, posted by alchemy on February 6, 2013, at 14:55:35
> Are infusions more likely to have a more effective response than injections? I know they are suppose to over the nose sprays.
> Also, is the agitation and lethargy after the treatment common?Hi Alchemy,
My pdoc said that infusions and injections are equally as successful, and that the injections may be even better (he thinks they're better controlled). Both are stronger than the nose sprays.
I'm not sure if agitation is necessarily common, but jrbecker, a poster on this thread, read that it is a likely side effect of ketamine in patients with bipolar. The assistant who monitors me during the treatment told me fatigue afterwards was pretty common.
I don't feel as great today as I had been feeling, but I think I need to remind myself that everyone, even non-depressives, have dips in mood and energy. I just get really nervous as I worry that it's a sign that I'm slipping into the abyss again. As much and as long as I've suffered, I've become more fearful of depressive episodes occurring.
Hope you're doing well. I read you're trying minocycline. Good luck!
-b
Posted by Phillipa on February 6, 2013, at 20:52:43
In reply to Re: Ketamine: injections vs infusions » alchemy, posted by brynb on February 6, 2013, at 15:22:13
Bryn how are you this evening. As you wrote a dip this afternoon? Phillipa
Posted by brynb on February 7, 2013, at 6:50:29
In reply to Re: Ketamine: injections vs infusions » brynb, posted by Phillipa on February 6, 2013, at 20:52:43
> Bryn how are you this evening. As you wrote a dip this afternoon? Phillipa
Thanks for asking, Phillipa. I bounced back and felt better later on. I get nervous if I have a dip in mood as I fear I'm going into a depressive episode again. I think I need to remind myself to live in the moment...
-b
Posted by Phillipa on February 7, 2013, at 20:46:24
In reply to Re: Ketamine: injections vs infusions » Phillipa, posted by brynb on February 7, 2013, at 6:50:29
Bryn more today IM's? Phillipa
Posted by brynb on February 8, 2013, at 5:30:39
In reply to Re: Ketamine: injections vs infusions » brynb, posted by Phillipa on February 7, 2013, at 20:46:24
> Bryn more today IM's? Phillipa
p, yes. followed my the usual fatigue. otherwise, it went well. thanks for asking :).
b
Posted by brynb on February 8, 2013, at 5:43:30
In reply to My Ketamine trial + new pdoc, posted by brynb on January 31, 2013, at 9:48:34
I went for another IM (3 shots) of Ketamine yesterday. Again, it went well. So far, the only side effect I feel immediately is fatigue afterwards. It's really helped my mood. (It lifted me out of a bad depressive episode.)
I still suffer from irritability and cognitive difficulties, but the pdoc told me last night that Ketamine should help irritability, as they've had great success with it in bipolar patients as well as in those with MDD. Hopefully that symptom will resolve, but we'll reevaluate each time.
The plan is to get 2 more rounds of treatment next week, then 1 Ketamine treatment a week for the following 2 weeks, followed by 1 treatment a month thereafter as maintenance.
I've got my fingers and toes crossed. So far, so good,
I'm happy to answer any questions if you're interested in knowing more.
Hope you're all faring well.
-b
Current regimen:
-Ketamine IM injections
-Lexapro 20mg
-Tramadol 50 mg
-Valium 30 mg (20 @ night, 10 during the day)
-Deplin 15mg
Posted by jrbecker76 on February 8, 2013, at 14:52:14
In reply to Moving Forward with Ketamine, posted by brynb on February 8, 2013, at 5:43:30
B-
I'm surprised they plan on stepping you down to a ketamine injection just 1x a month as an eventual maintenance schedule. Is this part of a protocol that they've formulated with their experience with past patients? I assumed they'd at least wait for you to stabilize more on a week to week basis before making that determination. From what I've read, most patients receiving maintenance treatment on a weekly to biweekly schedule. Curious what there experience is with maintenance dosing.
Also, what is the dosage per injection?
I was also wondering about your experience with the benzodiazepines. You mentioned issues with anergia and being reclusive. For me, the benzos made these issues worse. But I found that Valium and Klonopin were bigger offenders when it came to this than Ativan was. Not sure if you have any experience with it but just wanted to throw it out there.
JB
Posted by brynb on February 8, 2013, at 15:10:26
In reply to Re: Moving Forward with Ketamine » brynb, posted by jrbecker76 on February 8, 2013, at 14:52:14
> B-
>
> I'm surprised they plan on stepping you down to a ketamine injection just 1x a month as an eventual maintenance schedule. Is this part of a protocol that they've formulated with their experience with past patients? I assumed they'd at least wait for you to stabilize more on a week to week basis before making that determination. From what I've read, most patients receiving maintenance treatment on a weekly to biweekly schedule. Curious what there experience is with maintenance dosing.
>
> Also, what is the dosage per injection?
>
> I was also wondering about your experience with the benzodiazepines. You mentioned issues with anergia and being reclusive. For me, the benzos made these issues worse. But I found that Valium and Klonopin were bigger offenders when it came to this than Ativan was. Not sure if you have any experience with it but just wanted to throw it out there.
>
> JBHi JB-
I'm not really sure, but I think their protocol has been once the patient is stabilized via Ketamine, maintenance is once or twice a month or every 3 weeks. I'll speak to my doctor more about this next week (I'm going in again on Tuesday). I've reacted positively fairly quickly. It seems I have a high tolerance for it, too. Dosages are based on weight, but at my session yesterday, I had an initial 30 mg, then a 2nd round of 30 mg, and lastly, a 10 mg injection for a total of 70 mg IM. I titrated up to this dose over the past 2 weeks. I'll let you know what they decide to do in terms of number of injections, etc. going forward.
It's costly. At $250 a treatment, it's been $500 a week, but I will say that the pdoc is there to talk to me and answer questions and I'm not charged separately for his time. He doesn't rush me and he listens. My family is paying for it; without them I don't know where I'd be.
As far as anergia, I'm pretty tolerant to benzos, and found Valium to be the best for me; I get a lot of muscular aches and pains and it helps with that, too. The Ketamine treatments render me exhausted afterwards. I'm still having difficulty with cognitive functions and irritability, but I was told to give that time, so I'll reassess in the upcoming weeks. Actually, I wonder if Lexapro is contributing to these symptoms, too. I don't doubt it.
Hope you're doing well,
b
Posted by Starsly on February 8, 2013, at 15:18:37
In reply to Ketamine: it's working, posted by brynb on February 5, 2013, at 18:08:31
Hi Bryn, I'm very glad it's working for you. It's very hard for it not to work especially at first. I'm just hoping that it's able to work for you long term.
I have been on Ketamine for a while & you must be responding if you feel better for more than a few hours after the injections. Sometimes ketamine tolerance does happen so you may need it more often(in my case, I still got about 2 years where it was pretty effective), but I really hope that it doesn't happen for you.
Posted by brynb on February 8, 2013, at 16:54:51
In reply to Re: Ketamine: it's working, posted by Starsly on February 8, 2013, at 15:18:37
> Hi Bryn, I'm very glad it's working for you. It's very hard for it not to work especially at first. I'm just hoping that it's able to work for you long term.
>
> I have been on Ketamine for a while & you must be responding if you feel better for more than a few hours after the injections. Sometimes ketamine tolerance does happen so you may need it more often(in my case, I still got about 2 years where it was pretty effective), but I really hope that it doesn't happen for you.Hi Starsly,
thanks! I sure hope it doesn't wear off or that I build a tolerance to it.Do you still do Ketamine treatments? are they injections, or do you use the nasal spray? if you use the nasal spray, do you find it effective?
thanks,
b
Posted by Starsly on February 8, 2013, at 22:52:22
In reply to Re: Ketamine: it's working » Starsly, posted by brynb on February 8, 2013, at 16:54:51
Hi, the name is actually meant to be Starskly but I may as well get used to it.
I have used Ketamine for 2-3 years. I still do it & when I first started I used either the spray or the syrup I don't remember. It never completely treated the depression, but it kept me from getting in too bad of shape.
I did infusions after having started the spray, as part of a study, these were very effective but only while I was hooked up to the IV. They used so much of a dose that could cause some people to lose their mind temporarily, but I was kinda prepared.
Anyways, 2-3 years the depression is still bad & it gets worse slowly, but the Ketamine is what is essentially keeping me alive. The problem has been that the tolerance has slowly crept up & it's not enough to treat it anymore. Outwardly, I look pretty good so most people don't even get the depression thing. The doctor I'm going to says Im the highest dose of I think 30+ patients on it, so I may be an exception.
I would imagine it would work well for you maybe as maintenance between infusions. But if you don't need it just keep doing the shots/infusions. I don't want to scare ya! I'm happy that your doing well, but even if it does wear off you should get at least 2 or 3 years out of it because I usually require way more of a drug than the average person.
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