
Listening to Ketamine - pmcpinto
https://www.knowablemagazine.org/article/mind/2019/listening-ketamine
======
freedomben
> _Recent approval of a nasal spray promises to expand access, but much
> remains unknown about long-term use and the potential for abuse._

This might surprise everybody, but if it's possible to "abuse" it, somebody
will (turns out some humans will do that). I wish we'd stop restricting access
to things that could help and improve people's lives because we're worried
that somebody might do something with their body that we find morally
objectionable.

~~~
fucking_tragedy
If you're human, you are susceptible to addiction. The prudence prescribers
have towards handing out addictive substances might save _you_ from being the
person who abuses their medicine.

Much like any other potential side-effect, addiction is a risk that must be
heavily weighed and mitigated against. Addiction causes harm, and even death.
It isn't a question of personal morals, it's a question of ethics.

This is the same country that has experienced a decade-long opioid epidemic
because addiction risks of prescription drugs were intentionally covered up,
and in many cases, the drugs themselves were overprescribed.

~~~
slfnflctd
It was a wicked whipsaw. Hordes of new opiate addicts were created, with more
addictive compounds than ever before, at unprecedented levels of
availability-- and then their access was yanked away, with seemingly little
thought to how addicts would react. Curiously, Fentanyl showed up on the black
market in huge amounts around this time... and then users from all walks of
life started dropping like flies.

Narcan is saving a lot of lives (although it does little or nothing for
addiction itself), and kratom looks like a potentially promising way to help
addicts stop/reduce their use of harder stuff (if misguided crusaders don't go
and ban _that_ everywhere), but everything's a tradeoff and nuance is
important. We've got a ton to work on in this area for a long time.

~~~
FireBeyond
> Narcan is saving a lot of lives (although it does little or nothing for
> addiction itself)

Nothing whatsoever, and from a bigger picture hurts.

"Ideal" treatment for opiate overdose? Manage respiratory depression/arrest,
slowly titrate IM (not nasal) Narcan to keep level of consciousness lower, get
to hospital, offer patient treatment options/longer term help.

Blast IN naloxone into someone and they'll almost always AMA (against medical
advice) on scene.

\-- paramedic

~~~
tcj_phx
My girlfriend’s involuntary treatment providers decided to give her a
benzodiazepine addiction, on top of the other non-helpful prescriptions they
thought she needed. Initially the benzos helped her “anxiety”, but the effect
wore off after a month. She ordered heroin from her street pharmacist to get
through benzo withdrawal.

I said... “we’re not going to do this again.” She said it was barely any
heroin at all, that she wasn’t going to get addicted again, and that she just
needed it so she could sleep. Just to show me that it wasn’t much she prepared
a second shot and injected that too. I don’t think she realized that her
tolerance had changed and that benzodiazepines increase the potency of
opiates.

Then she fell forward, said “I meant to do that”, then her face turned blue
and she went non-responsive. I called EMS. They revived her with 2x2mg
naloxone.

After a few minutes the firefighters decided she was okay. The police officers
also decided they didn’t need to intervene. She did very well for about 2
weeks: drinking under control, benzodiazepine withdrawal mostly completed,
etc.

Narcan/naloxone has much broader effects than just kicking out the opiates
from the opioid receptors. The related drug Naltrexone is FDA-approved to help
people get their alcohol use under control. I’m not entirely clear on how the
anti-opiates help with alcohol use, but I think it has to do with fixing the
metabolic problem that is associated with most cases of alcoholism.

You’re correct that narcan isn’t much of a treatment by itself. But naltrexone
is almost the same drug, keeps people sober long enough to get them
stabilized, and partially addresses the long-term emotional pain they’re
actually self-medicating for.

If addicts are helped out of their “cage”, narcan/naloxone and naltrexone are
very useful tools to support them while they recover.

~~~
FireBeyond
Oh, absolutely. That's definitely a challenging situation, and naltrexone is
something to be considered in the longer term help, like you say. It's just
not something we administer in EMS, largely for the same reasons, "treat the
life threats", in her case respiratory depression/arrest.

------
bitforger
Coincidentally, I was talking to my neighbor this afternoon about how much
ketamine has helped his depression. Apparently he loves the stuff, and each
treatment lasts several months.

He did mention, though, that every time you get a dose you basically
hallucinate for an hour. But maybe that's fine, if you're into it.

~~~
finaliteration
For me I guess it would depend on the kind of hallucinations we’re talking
about. If it’s just “reality bending, things seem off” kind of hallucinations
that’s one thing, but full blown warped reality akin to an acid trip is
another. I’d be cool with the former, but I’m terrified of the latter (which
is why I’ve never done any sort of psychedelics).

~~~
blackhatbiodude
high ketamine doses are much more warped than even high lsd doses. You are
unable to move and your consciousness watches a totally different reality.
It's quite scary, but it passes... when you come back though normal stresses
seem to have passed away and you look at problems differently which is why I
think it helps depression. It's like they don't matter so much so don't cause
the same mental stresses.

~~~
TheSpiceIsLife
Is the psychedelic dose _necessary_ for treatment of depression?

~~~
mathieuh
Probably not, as far as I have read it is ketamine metabolites that have anti-
depressant properties, not the experience itself, which only lasts about 40-60
minutes

------
tmp192489
I've done ketamine recreationally and haven't been that impressed. Not sure if
it's the dosage or my personal reaction to the drug, but it's like a very
temporary (30 min max) feeling that is similar to being drunk.

There are better highs IMO.

------
neom
Folks say really really positive things about Ketamine. I wouldn't say I'm an
inexperienced psychonaut, yet ketamine scares me. Two close friends told me
they have problems "abusing" ketamine. If anyone is able to help shed some
light what abusing ket looks like, I'd appreciate it.

------
no_identd
Pah. The Ketamine Fast Track approval feels a bit like a bad joke. See Scott
Alexander's recent blog post here:

[https://slatestarcodex.com/2019/03/11/ketamine-now-by-
prescr...](https://slatestarcodex.com/2019/03/11/ketamine-now-by-
prescription/)

Really wish they'd have gone for Arketamine. To quote in part from above:

"Another possibility is that everyone made a huge mistake in using left-handed
ketamine, and it’s right-handed ketamine that holds the magic. Most previous
research was done on a racemic mixture (an equal mix of left-handed and right-
handed molecules), and at least one study suggests it was the right-handed
ketamine that was driving the results. Pharma decided to pursue left-handed
ketamine because it was known to have a stronger effect on NMDA receptors, but
– surprise! – ketamine probably doesn’t work through NMDA after all. So
there’s a chance that this is just the wrong kind of ketamine – though usually
I expect big pharma to be smarter than that, and I would be surprised if this
turned out to be it. I don’t know if anybody has a right-handed ketamine
patent yet."

I don't think that quite covers it, tho. Personally, I suspect Esketamine, as
the part of racemic Ketamine that causes hallucinations exhibits an
'antidepressant' effect similar to the one weakly associated with
psychedelics, i.e. more by granting new high level psychological insight than
via some low level neurological effect - whereas I'd speculate Arketamine
causes the documented 'magic' and RAPID next-day antidepressive effect of
racemic Ketamine.

Which makes me suspect we'd probably do well doing the same thing done with
some other stereoisomeric medications such as for example in the case of
Adderall, which has a ratio of Dexamphetamine to Levo Amphetamine of 3:1(viz.,
75% Dex, 25% Levo):

Figure out the optimal ratio of the two stereoisomers (to each other) for
depression treatment.

------
atomical
> Zarate and others are still thrilled to see big pharma investing in
> ketamine, after decades of stalled efforts to find new psychiatric drugs.
> “As esketamine hits the market, venture capitalists will come up with better
> versions and move the field forward,” Zarate says.

My doctor prescribes me sublingual ketamine for use at home. What we have now
is good enough.

We need doctors like mine that have the courage to prescribe off label.

------
skilled
I can't be the only one thinking that solving 'drug problems' with drugs is
not the way to go?

Meditation and yoga offer plenty of support for managing stress and in fact
depression. But most people want a quick antidote, something that 'burns' the
edge off and not fixes it for good.

~~~
adyavanapalli
Ketamine is usually prescribed to people with "treatment"-resistant severe
depression, and these "treatments" include other types of medication,
exercise, and meditation. That aside, often, severely depressed people can't
do even the basic things like showering, going to work, or making dinner.
Ketamine treatment offers a severely depressed person to bootstrap themselves
into a state where they _can_ start doing things that will allow themselves to
support themselves.

~~~
ridgeguy
Well said, thank you.

Few seem to understand how debilitating treatment-resistant depression can be.
Source: wife's cousin, who when s(he)'s ok, is super smart, capable, and lives
a good life. When s(he)'s in the depression hole, s(he)'s nearly comatose.
Ketamine has helped greatly in his/her case.

~~~
JshWright
Unrelated: Wouldn't "they" have worked fine as a pronoun there (and been less
distracting)?

~~~
ridgeguy
Yeah, it would have.

It's just that the ghost of my 5th grade English teacher would have emerged
from the mists to point out that "they" is plural, whereas I was referring to
an individual. Can't win.

~~~
TheSpiceIsLife
Your 5th grade teacher, nor dictionaries, ought be considered authoritative
sources of word meanings.

Words mean what people who use them intend them to mean.

But if you want something more authoritative than random-internet-comment,
definition three from dictionary.com has you covered:

[https://www.dictionary.com/browse/they](https://www.dictionary.com/browse/they)

 _they

pronoun, possessive their or theirs, objective them.

1 nominative plural of he, she, and it.

2 people in general: They say he's rich.

3 (used with a singular indefinite pronoun or singular noun antecedent in
place of the definite masculine he or the definite feminine she ): Whoever is
of voting age, whether they are interested in politics or not, should vote. A
person may apply only if they are over 21. They have been an actor since
childhood._

