Psycho-Babble Medication Thread 1105863

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Ketamine treatment for TRD while on an MAOI safe?

Posted by dbser on August 22, 2019, at 14:00:31

I am on an MAOI, and have tried every treatment FDA approved plus for my treatment-resistant MDD. I am thinking of trying Ketamine, but not only am I on an MAOI (Parnate/Trancyl-I don't know how to spell it), I also have DBS (which was effective for some time, but no longer). I am in the process of pursuing an appointment with a local psychiatrist with knowledge of ketamine treatment, but I'd like to know now if taking an MAOI contraindicates the treatment. Thanks.

 

Re: Ketamine treatment for TRD while on an MAOI safe?

Posted by linkadge on August 22, 2019, at 14:56:36

In reply to Ketamine treatment for TRD while on an MAOI safe?, posted by dbser on August 22, 2019, at 14:00:31

I haven't done any research but I would say yes that there is (or could be) a contraindication. The issue is that ketamine has some serotonin reuptake inhibition (as well as dopamine) which could cause serotonin syndrome. I'm not sure if the serotonin action of ketamine is large enough to interact, but it could, in theory.

Don't quote me on this, but I'll look around to see if I can find any other info.

Linkadge

 

Re: Ketamine treatment for TRD while on an MAOI safe?

Posted by linkadge on August 22, 2019, at 15:05:29

In reply to Ketamine treatment for TRD while on an MAOI safe?, posted by dbser on August 22, 2019, at 14:00:31

Hey,

So, I did a little PubMed searching. I couldn't find any case reports of problems with ketamine + MAOI. However, there probably isn't a lot of clinical experience with the combination since, up to recently, ketamine wasn't considered an antidepressant and so was likely avoided in patients on MAOIs.

I did find a few case reports of the combination being used without incident:

Possibly Safe:

https://www.ncbi.nlm.nih.gov/pubmed/26302763
https://www.ncbi.nlm.nih.gov/pubmed/2271195
https://www.ncbi.nlm.nih.gov/pubmed/6849728

Ketamine Inhibition of Serotonin Transporter

https://www.ncbi.nlm.nih.gov/pubmed/6460944


This being said, it does still inhibit serotonin reuptake and so any concurrent use should be done under supervision AND likely starting at a low dose.

Linkadge

 

Re: Ketamine treatment for TRD while on an MAOI safe?

Posted by Stargazer2 on August 25, 2019, at 18:49:34

In reply to Re: Ketamine treatment for TRD while on an MAOI safe?, posted by linkadge on August 22, 2019, at 15:05:29

I recently received Ketamine while taking Nardil, a MAO.
Although initially I was told By an anesthesiologist I needed to come off of Nardil, the doctor who actually administered the Ketamine said I did not have to come off of it. So they had a difference of opinions.
Dr Lori Calabrese ion East Windsor, CT is an expert in K administration and she told me being in Nardil was fine.

 

Re: Ketamine treatment for TRD while on an MAOI safe? dbser

Posted by pedr on September 24, 2019, at 14:02:27

In reply to Ketamine treatment for TRD while on an MAOI safe?, posted by dbser on August 22, 2019, at 14:00:31

> I am on an MAOI, and have tried every treatment FDA approved plus for my treatment-resistant MDD. I am thinking of trying Ketamine, but not only am I on an MAOI (Parnate/Trancyl-I don't know how to spell it), I also have DBS (which was effective for some time, but no longer). I am in the process of pursuing an appointment with a local psychiatrist with knowledge of ketamine treatment, but I'd like to know now if taking an MAOI contraindicates the treatment. Thanks.

Hey dbser,

this really piqued my interest because I'm about to commence Esketamine treatment and the docs are worried because I'm on a large AD cocktail and take Oxycodone for chronic pain. It's the Oxy they're worried about due to increased CNS depression. Anyway, the REALLY weird thing is that these super-high caliber Mt. Sinai psychiatrists have required my GP to write a letter saying that Oxy+Ketamine is OK. WTF? My GP was as astounded and confused as I was.

Secondly, you write "I also have DBS (which was effective for some time, but no longer)." - what happened to DBS? How long was it effective for?

I'd love to know as the Esketamine is a means-to-an-end for me to get VNS/DBS.

Any info on DBS would be hugely appreciated.
Cheers,
Pete


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