
Ketamine: Now by Prescription - phaser
https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescription/
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atomical
My doctor prescribes me sublingual ketamine for use at home. He has been doing
this for 2+ years and his insurance hasn't changed at all (a common refrain of
IV clinics that scam depressed patients).

The issue is that psychiatrists aren't willing to help people by prescribing
off label. They want to blame someone else -- just like this blog entry.

A few other things that make this post suspiciously inaccurate is:

1) Listing IV clinics as a legitimate route of treatment with ketamine. This
isn't the case. Many of the doctors at these clinics suggest patients try to
extend their treatment time in between doses and augment with an oral anti-
depressant to maintain the effect -- often the oral anti-depressant is
prescribed by another doctor.

The author admits that these aren't mental health professionals:

> That meant going to a ketamine clinic that had nurses and anesthesiologists
> for IV access

A doctor doesn't need to be present. There is a clinic in Albuquerque where
nurses moonlight on their lunch breaks, take your credit card, and start the
IV.

2) The author talks a bit about the ROA being important. If it was important
(i.e. only one ROA actually works) it would be the first anti-depressant of
its kind. The author should be more skeptical about this. The author claims
that there are studies where the ROA of intranasal doesn't work, but there are
also plenty of small studies with alternative ROA's that appear to have an
effect.

> Almost all previous studies on ketamine have examined it given IV.

That's because it's easy and one study copies the protocol of other successful
studies. These studies referred to by the author are short in duration and
have a small number of patients. So for all purposes they are equal to studies
that look at other ROAs.

