Psycho-Babble Medication Thread 1094405

Shown: posts 1 to 9 of 9. This is the beginning of the thread.

 

Prescribed Ketamine intranasal about a month ago..

Posted by TriedEveryMedication on August 12, 2017, at 15:51:05

a squirt in each nostril every 3 days. I feel intoxicated for about 15 minutes and then the effect is gone.

Seems like it works ok for about a day and a half. Not great, but just ok. But then the remaining day and a half until the next dose is hell. I don't think it would be wise to take this every day.

Anyone tried the intranasal? Does it take time to start working? My impression was it should be longer lasting.

I have a feeling this is going to be another failed trial for me.

 

Re: Prescribed Ketamine intranasal about a month ago.. TriedEveryMedication

Posted by SLS on August 12, 2017, at 16:24:55

In reply to Prescribed Ketamine intranasal about a month ago.., posted by TriedEveryMedication on August 12, 2017, at 15:51:05

> a squirt in each nostril every 3 days. I feel intoxicated for about 15 minutes and then the effect is gone.
>
> Seems like it works ok for about a day and a half. Not great, but just ok. But then the remaining day and a half until the next dose is hell.
>
> I don't think it would be wise to take this every day.


Why not? I think it would be fine to dose every day.


> Anyone tried the intranasal? Does it take time to start working? My impression was it should be longer lasting.
>
> I have a feeling this is going to be another failed trial for me.


I'm sorry that you are having a difficult time getting ketamine to work for you. I have two thoughts.

1. Maybe you are taking too large a dose of ketamine. There is a therapeutic window with ketamine, above which it no longer acts as an antidepressant. The dissociation you experience might indicate that the dose is too high. I may not remember accurately, but I think keeping the dose between 20-50 mg works best. Perhaps you can titrate downward to find the highest dose that does not produce dissociation.

2. Add Lamictal (lamotrigine). It works. I'm not sure what the pharmacology is all about except that, like ketamine, it reduces glutamate neurotransmission. They might complement each other. Each works on a different glutamate receptor.

People who respond well to IN ketamine often have to dose every 5 days. I imagine there is some variability in this.

Perhaps you need to dose every day for awhile and then decrease the frequency if you can. If not, then do what works.

Good luck.


- Scott

 

Re: Prescribed Ketamine intranasal about a month ago..

Posted by TriedEveryMedication on August 12, 2017, at 18:40:02

In reply to Re: Prescribed Ketamine intranasal about a month ago.. TriedEveryMedication, posted by SLS on August 12, 2017, at 16:24:55

> > a squirt in each nostril every 3 days. I feel intoxicated for about 15 minutes and then the effect is gone.
> >
> > Seems like it works ok for about a day and a half. Not great, but just ok. But then the remaining day and a half until the next dose is hell.
> >
> > I don't think it would be wise to take this every day.
>
>
> Why not? I think it would be fine to dose every day.
>
>
> > Anyone tried the intranasal? Does it take time to start working? My impression was it should be longer lasting.
> >
> > I have a feeling this is going to be another failed trial for me.
>
>
> I'm sorry that you are having a difficult time getting ketamine to work for you. I have two thoughts.
>
> 1. Maybe you are taking too large a dose of ketamine. There is a therapeutic window with ketamine, above which it no longer acts as an antidepressant. The dissociation you experience might indicate that the dose is too high. I may not remember accurately, but I think keeping the dose between 20-50 mg works best. Perhaps you can titrate downward to find the highest dose that does not produce dissociation.
>
> 2. Add Lamictal (lamotrigine). It works. I'm not sure what the pharmacology is all about except that, like ketamine, it reduces glutamate neurotransmission. They might complement each other. Each works on a different glutamate receptor.
>
> People who respond well to IN ketamine often have to dose every 5 days. I imagine there is some variability in this.
>
> Perhaps you need to dose every day for awhile and then decrease the frequency if you can. If not, then do what works.
>
> Good luck.
>
>
> - Scott

Hi Scott

Thanks for your reply. The infusions last for an hour or so I have read - so you're getting exposed to the ketamine for an hour plus however long it takes to metabolize it. The intranasal really feels like it is gone after 15 minutes. I was thinking maybe a second dose 30 minutes after the 1st dose (both doses half the strength) would be more of an approximation of the infusion that just the two squirts all at once.

Interesting about the therapeutic window. I will talk to my doctor about this.

lamictal is a big no-no for me. I end up in very serious awful rages on the stuff. I don't know why, but for me, it is dangerous to take it.

 

Re: Prescribed Ketamine intranasal about a month ago..

Posted by linkadge on August 12, 2017, at 18:44:28

In reply to Re: Prescribed Ketamine intranasal about a month ago.., posted by TriedEveryMedication on August 12, 2017, at 18:40:02

What other meds are you taking?

I wonder if other meds could block the effect?

Linkadge

 

Re: Prescribed Ketamine intranasal about a month ago.. TriedEveryMedication

Posted by SLS on August 12, 2017, at 20:13:20

In reply to Re: Prescribed Ketamine intranasal about a month ago.., posted by TriedEveryMedication on August 12, 2017, at 18:40:02

Have you ever tried NAC (N-acetylcysteine)? You might consider adding that to ketamine instead of lamotrigine. NAC has antiglutamatergic properties in addition to its antioxidant (via glutathione) and anti-inflammatory properties.

Regarding ketamine having a therapeutic window when treating depression, you might be able to find some articles written by John Krystal. I saw a video of him giving a lecture about ketamine in which he emphasized this point.


- Scott

 

Re: Prescribed Ketamine intranasal about a month ago..

Posted by pedr on August 21, 2017, at 16:41:04

In reply to Prescribed Ketamine intranasal about a month ago.., posted by TriedEveryMedication on August 12, 2017, at 15:51:05


> Anyone tried the intranasal?

Yes, once and the IV. Like you're finding, neither helped. I remember just feeling really 'drunk' and in a terrible, terrible mood/mindset. I was devastated as I had high hopes for Ketamine.

 

Re: Prescribed Ketamine intranasal about a month ago.. pedr

Posted by linkadge on August 23, 2017, at 17:14:44

In reply to Re: Prescribed Ketamine intranasal about a month ago.., posted by pedr on August 21, 2017, at 16:41:04

I noticed you mentioned you have atypical depression.

I wonder if ketamine is more effective for typical than atypical depression?

Linkadge

 

Re: Prescribed Ketamine intranasal about a month ago..

Posted by chumbawumba on September 21, 2017, at 3:11:57

In reply to Prescribed Ketamine intranasal about a month ago.., posted by TriedEveryMedication on August 12, 2017, at 15:51:05

I was prescribed 150 mg sublingual troches for daily use. The response to ketamine seems highly idiosyncratic. You may need to be on a higher daily dose.

But I think after taking it for a year or so that it's had a somewhat curative effect. I don't take it anymore because I take a benzo and benzos pretty much negate ketamine's benefit. At least that's what most of the infusion clinics are saying. Same with Lamictal.

 

Re: Prescribed Ketamine intranasal about a month ago..

Posted by SLS on September 21, 2017, at 7:48:26

In reply to Re: Prescribed Ketamine intranasal about a month ago.., posted by chumbawumba on September 21, 2017, at 3:11:57

> I was prescribed 150 mg sublingual troches for daily use. The response to ketamine seems highly idiosyncratic. You may need to be on a higher daily dose.
>
> But I think after taking it for a year or so that it's had a somewhat curative effect. I don't take it anymore because I take a benzo and benzos pretty much negate ketamine's benefit. At least that's what most of the infusion clinics are saying. Same with Lamictal.

A friend of mine *requires* Lamictal to obtain a full response to intranasal ketamine.

Isn't a 150 mg dose of ketamine substantially higher than what is currently recommended for sublingual administration? You can take too much ketamine such that it has no therapeutic effect for depression or anxiety. That's why the I.V. recommendation is so exacting. John H. Krystal at Yale explains this.


- Scott


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