
Special K, a Hallucinogen, Raises Hopes and Concerns as Treatment for Depression - applecore
http://www.nytimes.com/2014/12/10/business/special-k-a-hallucinogen-raises-hopes-and-concerns-as-a-treatment-for-depression.html
======
joesmo
It's amazing what great lengths some people will go to to stop others who
might feel good from using a substance or performing an activity they are
completely unfamiliar with. In America, at least, this seems to be much more
ingrained in the culture than just about anything else. The really sad part is
that even if this is in pursuit of saving lives, like the therapy mentioned in
the article and many others, most people have absolutely no qualms about
speaking out against it or trying to stop it. It seems, if it were up to the
prevailing mindset in this country, everyone should live in absolute misery
and pain. Drug companies wanting to develop non-generic drugs for profit
reasons is one thing that's at least understandable, but the people who
support such hate of others' potential at an enjoyable (or at least not
horrific in the case of depression) life is just disgusting.

~~~
nhstanley
While it's certainly very true that there are people who just want to ruin
everyone else's fun out of spite, this situation is more complicated because
there really are problems with uncontrolled administration of drugs, even ones
we have studied for other purposes. There a many reasons why people in the
article are stressing the need for trials.

Even if we just stick to ketamine, there are many questions. First, is this
better than the current standard of care? Is it better in the short term, long
term, or both? How much better? Should we discontinue drugs like SSRIs
altogether? Are people dying (committing suicide, in this case) because this
is a fringe treatment and not the standard of care?

Second, while we clearly already use it as an anesthetic, we don't know what
the effects or dangers might be for this kind of use. Is repeated
administration (as seems necessary) a health problem? Are side effects like
hallucinations just temporary, or is the brain altered in some way
permanently? There are drugs that, the longer and more frequently you take
them, the more likely you are to have actual permanent problems (some
antipsychotics, for example).

Doing any kind of controlled study with humans is inherently difficult, and in
some cases impossible (this is why we know so little about nutrition). But not
doing controlled studies and carefully assessing the value of a treatment can
be just as catastrophic as ignoring something that seems to work. And you
can't go with your gut on these things, or we end up with antivaxers and dead
people when we should have just done the study(s) the right way from the
start.

~~~
murbard2
Your argument is basically that it's generally a good idea to make sure a
medical treatment is safe and effective before undertaking it. That's hardly
controversial. What does not follow _at all_ is that Ketamine should be
banned, or that medical researchers should have to jump through D.E.A hoops to
do research.

~~~
refurb
_What does not follow at all is that Ketamine should be banned, or that
medical researchers should have to jump through D.E.A hoops to do research._

Ketamine isn't banned. And it's not all that controlled compared to other
drugs (Schedule III). You'd have a harder time running a trial for morphine
than you would for ketamine.

~~~
murbard2
OK, schedule III isn't so bad, but afaiac, if I can't buy it at Walmart, it's
banned.

------
egypturnash
I have never done ketamine. But a hit of MDMA was kind of instrumental in
lifting me out of twenty years of depression.

~~~
comrh
Which is interesting because of the SSRI I'm on all MDMA did was make me grind
my teeth really bad. I want to try it again but don't want to stop the SSRI to
do so.

~~~
amckenna
You took MDMA while on an SSRI? You really should research a drug's mechanism
of action and how multiple drugs may interact before taking them together.

Im not a medical professional, I just want to give you a quick overview so you
don't repeat that mistake. Do your own research.

\- An SSRI (Selective Serotonin Re-uptake Inhibitor) blocks your brain's re-
uptake of serotonin and effectively increases your brain's levels of
serotonin.[1]

\- MDMA acts as a presynaptic releasing agent of serotonin. Increasing the
amount of serotonin in the synaptic cleft (space between neurons).[2]

\- That means the two of these drugs combined can cause a huge spike in
serotonin and potentially lead to serotonin syndrome (toxicity).

Be safe.

[1]
[https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_i...](https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor)

[2] [https://en.wikipedia.org/wiki/MDMA](https://en.wikipedia.org/wiki/MDMA)

------
jcr
Another place where ketamine has been used "off label" has been in the
treatment of Complex Regional Pain Syndrome (CRPS) formerly called Reflex
Sympathetic Dystrophy (RSD), "causalgia", or Reflex Neurovascular Dystrophy
(RND).

[http://en.wikipedia.org/wiki/Complex_regional_pain_syndrome#...](http://en.wikipedia.org/wiki/Complex_regional_pain_syndrome#Ketamine)

Edit: I'm not sure why this nytimes article is being considered "news" on HN
since topic has been discussed here quite a few times over the last three
years.

[https://news.ycombinator.com/item?id=4043198](https://news.ycombinator.com/item?id=4043198)

[https://news.ycombinator.com/item?id=4615602](https://news.ycombinator.com/item?id=4615602)

[https://news.ycombinator.com/item?id=5116706](https://news.ycombinator.com/item?id=5116706)

[https://news.ycombinator.com/item?id=5758647](https://news.ycombinator.com/item?id=5758647)

[https://news.ycombinator.com/item?id=7522343](https://news.ycombinator.com/item?id=7522343)

~~~
justinpaulson
Still Called RSD by many :) I am upvoting and commenting to spread awareness
about CRPS. It is one of the most terrible disorders that a human can ever
endure and it is insane that the use of ketamine has not been accepted as a
non-expiremental treatment for it. My wife just finished a two day ketamine
booster yesterday, and without the use of ketamine she would not be able to
walk or even open and close her hands. Nothing else has ever helped her CRPS
and ketamine has improved her quality of life in immeasurable ways. Yet we
still have to pay for every single dollar of every single treatment out of
pocket. So glad we are forced to pay for insurance that won't even acknowledge
thousands of dollars a year of medical spending for necessary treatments.

~~~
refurb
Have you tried appealing to your insurance company about coverage?

Insurance companies won't cover most drugs when used "off label". However, the
doctor is allowed to appeal by providing peer-reviewed article supporting the
use.

It's a hell of a lot of paper work, but most of the folks at insurance
companies (I work with them a lot) are pretty reasonable people. Their default
is to deny, but if you can build a strong enough case they will often cover
it.

It's not like ketamine is all that expensive. Hell, I've seen people get
covered for "off-label" use of oncology drugs that are $100K+/yr.

~~~
justinpaulson
Yes, multiple times to multiple companies. It is not about the cost of the
drug itself, it is the cost of administration. This isn't just a bottle of
ketamine pills, it is an IV infusion in a hospital setting.

~~~
refurb
Sorry to hear that! Are you appealing or is your doctor? Just curious.

~~~
justinpaulson
Both

------
Mvandenbergh
Alternative headline: "Ketamine, a commonly used anaesthetic drug long on the
WHO's list of essential medicines, raises hopes and concerns as treatment for
depression"

But that headline would be way too long.

~~~
warfangle
Not only that, it's not a hallucinogen. It's a /dissociative/ anesthetic.
About the only other thing commonly used that has similar effects is
dextromethorphan hydrobromide - the primary ingredient in over the counter
cough syrup.

~~~
antihero
It's a dissociative hallucinogen.

[http://en.m.wikipedia.org/wiki/Hallucinogen](http://en.m.wikipedia.org/wiki/Hallucinogen)

------
chimeracoder
Just goes to show that the difference between medical use and recreational use
is really in the set, setting, dosage, and means of ingestion!

Ketamine is already very commonly used medically, because it is relatively
safe (compared to other similar dissociative anesthetics) and has a very short
half-life, making it a good choice for certain procedures.

Unlike many anesthetics, ketamine does not suppress breathing much. Combined
with the fact that it is a bronchodilator, it can be used in many situations
for which other anesthetics would be risky or inappropriate.

If you've had a colonoscopy[0], there's a good chance you've already had
ketamine, just not in the same doses that you would have taken at a club!

[0] Which, if you're over the age of 50, you should do! Colon cancer is very
treatable if it's caught early.

~~~
blacksmith_tb
I had noticeable psychosis courtesy of ketamine in the ICU after being run
over by a truck. Likely having a broken pelvis etc. didn't contribute to a
positive trip, of course, but I would be very reluctant to take it again (not
that anyone asked at the time - or that I could have answered sensibly). But
like most psychoactives, dosage is key...

~~~
refurb
The WHO lists ketamine as a "essential medication" since it is an ideal
anesthetic for countries with limited resources. It's quite safe (doesn't
depress breathing) and effective.

However, as you noticed, _many_ folks who are treated with ketamine find the
experience very unpleasant. Unless there is a good reason for using it as an
anesthetic, doctors typically go with other drugs.

------
girvo
They're also looking into using buprenorphine (which I take daily as suboxone
as treatment for my previous addiction) for depression. Anecdotally, it's
pushed my horrendous depression into remission entirely since I began on it.

[http://www.psychiatrictimes.com/major-depressive-
disorder/qa...](http://www.psychiatrictimes.com/major-depressive-disorder/qa-
buprenorphine-treatment-resistant-depression)

------
WhitneyLand
One thing I don't see in the comments is direct testimony (standard caveats
apply).

Anecdotally, I can tell you this works. And it's not just incremental
improvement, it's a night and day difference.

I wouldn't normally comment on this but it seems unethical not to when so much
is at stake.

------
stronglikedan
I've always heard that Special K is a dissociative, not a hallucinogen. This
has been confirmed with my experience with it as well. It's the only drug I've
every tried where I can float above myself and look down on my body, but I've
never seen anything that really wasn't there, no matter how much I've taken.

~~~
jtmcmc
". It's the only drug I've every tried where I can float above myself and look
down on my body" would certainly be a hallucination.

Ketamine is both a dissociative (it makes you feel disconnected from your
body) and a hallucinogen (it can cause visual patterns or images to appear
that are not parsimonious with what you would normally see).

It becomes far more hallucinogenic (or psychedelic preferentially) when you
"khole".

~~~
stronglikedan
Cool. Thanks for the clarification. Whatever it is, it sure is "special". (in
a good way)

------
crystaln
If anyone is interested in the sordid history of the prescription and
prohibition drug dichotomy, I highly recommend "This is Your Country on
Drugs."

The book details how the drug war came to be as a political and economic tool
to expand government power and create pharmaceutical monopolies, not primarily
for consumer safety.

~~~
innguest
Thanks for the recommendation.

------
Raphmedia
My mother has had Ketamine injections for fibromyalgia. It wasn't successful
in managing her pains.

I have done Ketamine once, and all I felt was... drunk. As opposed to
psilocybin which changed my worldview heavily and taught me a lot about
myself.

~~~
Sanddancer
Everyone reacts different to medications, that's why there are so many of
them, and why it's sometimes a problem for people with chronic problems to
find the right one. I'm on my third anti-anxiety med, and I think I've finally
found the right one, after the prior one made my depression worse and sapped
what little motivation I had. There's no magic bullet in pharmaceuticals,
that's one of the reasons there is constant research into the subject. More
availability means a greater chance to find the drug that works.

~~~
Raphmedia
Yes!

Don't get me wrong, I'm very happy that health professional are taking a look
at drugs that are taboo. There is a wealth of potential in a lot of those
substance!

------
aantix
On a side note, why does the following always get disclosed as a downside?

>Besides the psychoticlike effects, ketamine can raise blood pressure and
heart rate.

Doesn't exercise or even caffeine do the same? Is it even worth mentioning
this side effect unless it's for an abnormally long period?

~~~
nerfhammer
If you already have problems with either of those you would want to know about
them being possible side effects

------
flippyhead
Funny, this is new but there is this article from 2010:
[http://www.nytimes.com/2010/08/10/health/10depress.html?_r=0](http://www.nytimes.com/2010/08/10/health/10depress.html?_r=0)

------
oddshocks
Could have sworn Ketamine was classified as a dissociative. Maybe I was wrong.

~~~
bashinator
You're not wrong - it's a terrible clickbait headline.

------
KyleSanderson
[http://www.bbc.co.uk/newsbeat/29811499](http://www.bbc.co.uk/newsbeat/29811499)
[http://www.bbc.co.uk/newsbeat/25186316](http://www.bbc.co.uk/newsbeat/25186316)

Exercise extreme caution, the article doesn't even seem to acknowledge the
seriousness of this at all...

~~~
lomidrevo
The ketamine depression therapy operates with doses of no more than 100mg,
taken once or twice a month.

Ketamine abusers typically consume well upwards of a gram, or a couple, daily.

This is a similar situation as the difference between having two glasses of
wine on Sundays, and downing a fifth of hard liquor every day.

Edit: FYA: "Matt developed K bladder after taking as much as 15g of the drug a
day."

Yeah...if anything, it's testament to the relative safety of the drug, if
taking 150x the therapeutic dose daily did not cause the individual to drop
dead right away!

~~~
PublicEnemy111
No drug user starts out by saying, "I'm going to get addicted to this." It
creeps up on you. 100mg works for a week, then you need 125mg to maintain the
effects, then 175mg, and so on. There was a post on reddit about a heroin
addicts experience with the drug. It was eery to hear how it becomes part of
your life so easily.

I think Ketamine has great potential, but the risk of abuse far outweighs the
benefits.

~~~
cloudwalking
Heroin is very addictive, Ketamine is not.

~~~
tesq
Tolerance builds quickly and a strong mental addiction develops quickly.
Having to take a shit ton constantly means you're pissing brown within a few
months and cessation means withdrawals (nothing even close to heroin, but
still there).

Source: my friend with a ketamine addiction.

~~~
lawlesstwo
Self control goes a long way. Particularly for something that's not physically
addictive.

~~~
tesq
That it does, but you cannot dismiss the addictive qualities of ketamine with
such a statement, because it is an addictive drug. What part of tolerance
build up and withdrawals makes you think it isn't physically addictive? Both
are physical documented phenomena.

