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Re: Ketamine infusions for Depression

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.
> >
> >
> >
> > 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 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.




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