![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 33. Go back in thread:
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
Posted by chumbawumba on January 6, 2017, at 3:49:39
In reply to Re: Ketamine infusions for Depression » chumbawumba, posted by SLS on January 5, 2017, at 9:31:05
Yes I think they don't want people coming out of surgery tripping balls. I had to stop taking flurazapam for 5 days before I could feel the ketamine trippy-ness. Flurazapam has an active metabolite with a half life of up to 200 hours or so.
I know benzos completely negate the psychotomiimetic effects of ketamine. I'm pondering whether they kill the antidepressant effect as well.
For the first 5 days of being fluraxapam free I used my sublingual ketamine regularly and nothing. Then day six I feel it but not much antidepressant effect. Now it's been a few weeks since I took flurazapam and ketamine makes me feel great. Maybe a little too great. I feel a little hypomanic. But I've been depressed for so long I can't be objective about whether this will lead to a Charlie Sheen moment or whether this is just the way normal people feel and the way I used to feel sooooo long ago before I was diagnosed.
Posted by Edward807 on January 6, 2017, at 11:51:50
In reply to Re: Ketamine infusions for Depression, posted by chumbawumba on January 6, 2017, at 3:49:39
> Yes I think they don't want people coming out of surgery tripping balls. I had to stop taking flurazapam for 5 days before I could feel the ketamine trippy-ness. Flurazapam has an active metabolite with a half life of up to 200 hours or so.
>
> I know benzos completely negate the psychotomiimetic effects of ketamine. I'm pondering whether they kill the antidepressant effect as well.
>
> For the first 5 days of being fluraxapam free I used my sublingual ketamine regularly and nothing. Then day six I feel it but not much antidepressant effect. Now it's been a few weeks since I took flurazapam and ketamine makes me feel great. Maybe a little too great. I feel a little hypomanic. But I've been depressed for so long I can't be objective about whether this will lead to a Charlie Sheen moment or whether this is just the way normal people feel and the way I used to feel sooooo long ago before I was diagnosed.I also find ketamine to be a little activating and use Lunesta to help with long term sleep issues. I took 1 mg. lorazapam for a couple days and seemed to fall back into depression. Chumbawumba, could I ask what form and dosage of ketamine are you taking? I'm using 75mg sublingual troches twice a week. I'm also wondering what are the best supplements to take with ketamine for TRD. I take magnesium threonate, curcumin and fish oil and thinking about adding acetyl-L-carnitine.
Posted by chumbawumba on January 7, 2017, at 2:20:31
In reply to Re: Ketamine infusions for Depression, posted by Edward807 on January 6, 2017, at 11:51:50
> > Yes I think they don't want people coming out of surgery tripping balls. I had to stop taking flurazapam for 5 days before I could feel the ketamine trippy-ness. Flurazapam has an active metabolite with a half life of up to 200 hours or so.
> >
> > I know benzos completely negate the psychotomiimetic effects of ketamine. I'm pondering whether they kill the antidepressant effect as well.
> >
> > For the first 5 days of being fluraxapam free I used my sublingual ketamine regularly and nothing. Then day six I feel it but not much antidepressant effect. Now it's been a few weeks since I took flurazapam and ketamine makes me feel great. Maybe a little too great. I feel a little hypomanic. But I've been depressed for so long I can't be objective about whether this will lead to a Charlie Sheen moment or whether this is just the way normal people feel and the way I used to feel sooooo long ago before I was diagnosed.
>
> I also find ketamine to be a little activating and use Lunesta to help with long term sleep issues. I took 1 mg. lorazapam for a couple days and seemed to fall back into depression. Chumbawumba, could I ask what form and dosage of ketamine are you taking? I'm using 75mg sublingual troches twice a week. I'm also wondering what are the best supplements to take with ketamine for TRD. I take magnesium threonate, curcumin and fish oil and thinking about adding acetyl-L-carnitine.
>I'm prescribed 150 mg troches for sublingual use daily. But because of bioavailability (sublingual is 32 plus or minus 17% bioavailable) and rate of delivery issues, I would say the effect is less profound than the nasal spray or a 60 mg intramuscular shot. By spreading the delivery out over the 20 or so minutes it takes for them to dissolve it's a different experience. Supposedly it's better to slow down the rate of delivery because it approximates the infusion "gold standard" treatment rate. And it's hard to say whether it's better in terms of antidepressant response . I actually like the psychedelic-ness of ketamine so the sublingual delivery is a bit of a bummer. And since it's prescribed for daily use I can't really feel any mind altering effects anymore because as I understand it your tolerance for ketamine shoots up very quickly. Which is why you have ketamine addicts doing multiple grams daily and killing their bladders.
But even though I can't feel it anymore, sleep is still a problem. And every clinic website talks about how you can't use benzos (or Z drugs presumably) or Lamictal while using ketamine. Because Lamictal and benzos are targeting glutamate and GABA, and then ketamine is mucking around with that system as well, benzos end up being a buzzkiller. For reasons that are not completely understood. Especially since it would seem that NMDAR blockade is not the mechanism of the antidepressant response at least in mice.
http://www.nature.com/nature/journal/v533/n7604/full/nature17998.html
I'm kind of flaky when it comes to supplements because my pdoc recommends expensive ones. I did the 23andme genetic testing and then some methylation analysis on the data and my pdoc looks at it and hems and haws and recommended something called Deplin which is about $120 a month and it's considered a medical food so I'd never get insurance to pay for it. It's L-methylfolate technically. It had a funny effect on me though. It made me hypomanic for about 4 days and I thought this is the best stuff ever...as I'm buying weed off some homeless guy in a parking lot. But alas all things must fade. I took it for a while but I couldn't really tell if it made a lasting difference and when I stopped I felt no better or worse. I think it's worth getting a sample pack from your pdoc and trying though because it does something.So now I try to take methyl B-12 sublingual, Magnesium malate, and something called Cerefolin which is another expensive medical food but is basically a bunch of fancy B vitamins along with NAC.
Supposedly a tuberculosis drug of all things, D-cycloserine potentiates the antidepressant effect of ketamine. Figure that one out right? It ain't cheap though. And what pisses me off is the bulk powder is dirt cheap. But put it in a pill and the price goes up 1000% I'd be tempted to try and buy a kilo of it from Alibaba and DIY the capsules.
I tried fish oil in the past never noticed a difference with or without.
Posted by Edward807 on January 8, 2017, at 19:46:29
In reply to Re: Ketamine infusions for Depression, posted by chumbawumba on January 7, 2017, at 2:20:31
> I'm prescribed 150 mg troches for sublingual use daily. But because of bioavailability (sublingual is 32 plus or minus 17% bioavailable) and rate of delivery issues, I would say the effect is less profound than the nasal spray or a 60 mg intramuscular shot. By spreading the delivery out over the 20 or so minutes it takes for them to dissolve it's a different experience. Supposedly it's better to slow down the rate of delivery because it approximates the infusion "gold standard" treatment rate. And it's hard to say whether it's better in terms of antidepressant response . I actually like the psychedelic-ness of ketamine so the sublingual delivery is a bit of a bummer. And since it's prescribed for daily use I can't really feel any mind altering effects anymore because as I understand it your tolerance for ketamine shoots up very quickly. Which is why you have ketamine addicts doing multiple grams daily and killing their bladders.
>
> But even though I can't feel it anymore, sleep is still a problem. And every clinic website talks about how you can't use benzos (or Z drugs presumably) or Lamictal while using ketamine. Because Lamictal and benzos are targeting glutamate and GABA, and then ketamine is mucking around with that system as well, benzos end up being a buzzkiller. For reasons that are not completely understood. Especially since it would seem that NMDAR blockade is not the mechanism of the antidepressant response at least in mice.
> http://www.nature.com/nature/journal/v533/n7604/full/nature17998.html
>
>
> I'm kind of flaky when it comes to supplements because my pdoc recommends expensive ones. I did the 23andme genetic testing and then some methylation analysis on the data and my pdoc looks at it and hems and haws and recommended something called Deplin which is about $120 a month and it's considered a medical food so I'd never get insurance to pay for it. It's L-methylfolate technically. It had a funny effect on me though. It made me hypomanic for about 4 days and I thought this is the best stuff ever...as I'm buying weed off some homeless guy in a parking lot. But alas all things must fade. I took it for a while but I couldn't really tell if it made a lasting difference and when I stopped I felt no better or worse. I think it's worth getting a sample pack from your pdoc and trying though because it does something.
>
> So now I try to take methyl B-12 sublingual, Magnesium malate, and something called Cerefolin which is another expensive medical food but is basically a bunch of fancy B vitamins along with NAC.
>
> Supposedly a tuberculosis drug of all things, D-cycloserine potentiates the antidepressant effect of ketamine. Figure that one out right? It ain't cheap though. And what pisses me off is the bulk powder is dirt cheap. But put it in a pill and the price goes up 1000% I'd be tempted to try and buy a kilo of it from Alibaba and DIY the capsules.
>
> I tried fish oil in the past never noticed a difference with or without.Thanks for the info, you've given me some ideas about how I might improve my regimen.
D-Cycloserine is an interesting drug. I participated in a clinical trial to investigate the effectiveness of using D-Cycloserine to augment cognitive behavioral therapy for social anxiety disorder. This was last year before starting ketamine therapy. There were a few occasions when I was fairly sure that I received the active drug rather than placebo. I got a slight headache and experienced some short term cognitive improvements such as remembering lists and word finding while talking. I wonder if any doctors prescribe it off-label for psychiatric purposes. I like to find some studies to support the argument for using it to augment ketamine. I've also heard of people using agmatine or memantine to potentiate ketamine.
The idea behind curcumin and fish oil (and exercise) is to support levels of BDNF. Maybe one has to take them for weeks or months to notice anything, I don't know.
Posted by chumbawumba on January 9, 2017, at 0:43:33
In reply to Re: Ketamine infusions for Depression, posted by Edward807 on January 8, 2017, at 19:46:29
>
> > I'm prescribed 150 mg troches for sublingual use daily. But because of bioavailability (sublingual is 32 plus or minus 17% bioavailable) and rate of delivery issues, I would say the effect is less profound than the nasal spray or a 60 mg intramuscular shot. By spreading the delivery out over the 20 or so minutes it takes for them to dissolve it's a different experience. Supposedly it's better to slow down the rate of delivery because it approximates the infusion "gold standard" treatment rate. And it's hard to say whether it's better in terms of antidepressant response . I actually like the psychedelic-ness of ketamine so the sublingual delivery is a bit of a bummer. And since it's prescribed for daily use I can't really feel any mind altering effects anymore because as I understand it your tolerance for ketamine shoots up very quickly. Which is why you have ketamine addicts doing multiple grams daily and killing their bladders.
> >
> > But even though I can't feel it anymore, sleep is still a problem. And every clinic website talks about how you can't use benzos (or Z drugs presumably) or Lamictal while using ketamine. Because Lamictal and benzos are targeting glutamate and GABA, and then ketamine is mucking around with that system as well, benzos end up being a buzzkiller. For reasons that are not completely understood. Especially since it would seem that NMDAR blockade is not the mechanism of the antidepressant response at least in mice.
> > http://www.nature.com/nature/journal/v533/n7604/full/nature17998.html
> >
> >
> > I'm kind of flaky when it comes to supplements because my pdoc recommends expensive ones. I did the 23andme genetic testing and then some methylation analysis on the data and my pdoc looks at it and hems and haws and recommended something called Deplin which is about $120 a month and it's considered a medical food so I'd never get insurance to pay for it. It's L-methylfolate technically. It had a funny effect on me though. It made me hypomanic for about 4 days and I thought this is the best stuff ever...as I'm buying weed off some homeless guy in a parking lot. But alas all things must fade. I took it for a while but I couldn't really tell if it made a lasting difference and when I stopped I felt no better or worse. I think it's worth getting a sample pack from your pdoc and trying though because it does something.
> >
> > So now I try to take methyl B-12 sublingual, Magnesium malate, and something called Cerefolin which is another expensive medical food but is basically a bunch of fancy B vitamins along with NAC.
> >
> > Supposedly a tuberculosis drug of all things, D-cycloserine potentiates the antidepressant effect of ketamine. Figure that one out right? It ain't cheap though. And what pisses me off is the bulk powder is dirt cheap. But put it in a pill and the price goes up 1000% I'd be tempted to try and buy a kilo of it from Alibaba and DIY the capsules.
> >
> > I tried fish oil in the past never noticed a difference with or without.
>
> Thanks for the info, you've given me some ideas about how I might improve my regimen.
>
> D-Cycloserine is an interesting drug. I participated in a clinical trial to investigate the effectiveness of using D-Cycloserine to augment cognitive behavioral therapy for social anxiety disorder. This was last year before starting ketamine therapy. There were a few occasions when I was fairly sure that I received the active drug rather than placebo. I got a slight headache and experienced some short term cognitive improvements such as remembering lists and word finding while talking. I wonder if any doctors prescribe it off-label for psychiatric purposes. I like to find some studies to support the argument for using it to augment ketamine. I've also heard of people using agmatine or memantine to potentiate ketamine.
>
> The idea behind curcumin and fish oil (and exercise) is to support levels of BDNF. Maybe one has to take them for weeks or months to notice anything, I don't know.Do you know how many miilgrams were given in the cycloserine trial? BEst price in the US is about $10 per 250 mg capsule. But I haven't reviewed the literature as far as using it for ketamine augmentation. I'm sure my pdoc would prescribe it. If there is evidence to support it's use.
Posted by Edward807 on January 9, 2017, at 9:22:11
In reply to Re: Ketamine infusions for Depression, posted by chumbawumba on January 9, 2017, at 0:43:33
> >
> > > I'm prescribed 150 mg troches for sublingual use daily. But because of bioavailability (sublingual is 32 plus or minus 17% bioavailable) and rate of delivery issues, I would say the effect is less profound than the nasal spray or a 60 mg intramuscular shot. By spreading the delivery out over the 20 or so minutes it takes for them to dissolve it's a different experience. Supposedly it's better to slow down the rate of delivery because it approximates the infusion "gold standard" treatment rate. And it's hard to say whether it's better in terms of antidepressant response . I actually like the psychedelic-ness of ketamine so the sublingual delivery is a bit of a bummer. And since it's prescribed for daily use I can't really feel any mind altering effects anymore because as I understand it your tolerance for ketamine shoots up very quickly. Which is why you have ketamine addicts doing multiple grams daily and killing their bladders.
> > >
> > > But even though I can't feel it anymore, sleep is still a problem. And every clinic website talks about how you can't use benzos (or Z drugs presumably) or Lamictal while using ketamine. Because Lamictal and benzos are targeting glutamate and GABA, and then ketamine is mucking around with that system as well, benzos end up being a buzzkiller. For reasons that are not completely understood. Especially since it would seem that NMDAR blockade is not the mechanism of the antidepressant response at least in mice.
> > > http://www.nature.com/nature/journal/v533/n7604/full/nature17998.html
> > >
> > >
> > > I'm kind of flaky when it comes to supplements because my pdoc recommends expensive ones. I did the 23andme genetic testing and then some methylation analysis on the data and my pdoc looks at it and hems and haws and recommended something called Deplin which is about $120 a month and it's considered a medical food so I'd never get insurance to pay for it. It's L-methylfolate technically. It had a funny effect on me though. It made me hypomanic for about 4 days and I thought this is the best stuff ever...as I'm buying weed off some homeless guy in a parking lot. But alas all things must fade. I took it for a while but I couldn't really tell if it made a lasting difference and when I stopped I felt no better or worse. I think it's worth getting a sample pack from your pdoc and trying though because it does something.
> > >
> > > So now I try to take methyl B-12 sublingual, Magnesium malate, and something called Cerefolin which is another expensive medical food but is basically a bunch of fancy B vitamins along with NAC.
> > >
> > > Supposedly a tuberculosis drug of all things, D-cycloserine potentiates the antidepressant effect of ketamine. Figure that one out right? It ain't cheap though. And what pisses me off is the bulk powder is dirt cheap. But put it in a pill and the price goes up 1000% I'd be tempted to try and buy a kilo of it from Alibaba and DIY the capsules.
> > >
> > > I tried fish oil in the past never noticed a difference with or without.
> >
> > Thanks for the info, you've given me some ideas about how I might improve my regimen.
> >
> > D-Cycloserine is an interesting drug. I participated in a clinical trial to investigate the effectiveness of using D-Cycloserine to augment cognitive behavioral therapy for social anxiety disorder. This was last year before starting ketamine therapy. There were a few occasions when I was fairly sure that I received the active drug rather than placebo. I got a slight headache and experienced some short term cognitive improvements such as remembering lists and word finding while talking. I wonder if any doctors prescribe it off-label for psychiatric purposes. I like to find some studies to support the argument for using it to augment ketamine. I've also heard of people using agmatine or memantine to potentiate ketamine.
> >
> > The idea behind curcumin and fish oil (and exercise) is to support levels of BDNF. Maybe one has to take them for weeks or months to notice anything, I don't know.
>
> Do you know how many miilgrams were given in the cycloserine trial? BEst price in the US is about $10 per 250 mg capsule. But I haven't reviewed the literature as far as using it for ketamine augmentation. I'm sure my pdoc would prescribe it. If there is evidence to support it's use.50 mg. Link to study: https://clinicaltrials.gov/ct2/show/NCT02066792
I haven't been able to find a US source for cycloserine.
Posted by chumbawumba on January 10, 2017, at 15:00:31
In reply to Re: Ketamine infusions for Depression, posted by Edward807 on January 9, 2017, at 9:22:11
>
> 50 mg. Link to study: https://clinicaltrials.gov/ct2/show/NCT02066792
> I haven't been able to find a US source for cycloserine.
>huh, that's interesting. Pretty small dose. I see they have used doses of up to 1000 mg/day in treating depression.
Damn, it's expensive though $50 for five 250 mg capsules? Cough...bulllshit...cough. Even a Canadian pharmacy is still maybe half that.
The only cheap source is buying the bulk powder through Alibaba. And I was just reading a post over on Reddit from an online reseller of nootropics that every sample he has sourced through Alibaba has been contaminated or not what it was declared to be. Four different sources and 100% fail. Too bad because the bulk powder is about a dollar a gram.
This is the end of the thread.
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