
Ketamine Could Soon Be Used to Treat Suicidal Ideation - dankohn1
https://www.bloomberg.com/news/features/2019-02-05/ketamine-could-soon-be-used-to-treat-suicidal-ideation
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mchannon
A loved one went through a few rounds of Ketamine IV at a recently opened
clinic. It was about $400 a treatment, not covered by insurance, but
administered by credentialed professionals.

The experience was a bit like a dialysis clinic, where there are a bunch of
beds in a room, tatami screens between the beds, and where a huge 2" diameter
syringe dosing pump eases a tiny amount of Ket in the line over 15 minutes.

Aside from the expense, it didn't particularly help my loved one's condition.
She said it felt more like it just got her high, and not the kind of high you
want. Maybe if they used a stronger dose, but those cost more as I recall.

I feel there are at least three treatments one should try before Ketamine, for
PTSD/Anxiety/Depression/Suicidal Ideation.

• EMDR. So successful it's amazing that it's not standard fare in counseling
and therapy.

• Neurofeedback. The literature is equivocal at best, but the anecdata is very
strong.

• LSD. As our nation struggles with medical marijuana still living on schedule
I, LSD similarly inhabits schedule I (where the government knows better than
your doctor about there being no possible medical benefit). Studies show LSD
is over 10x as successful in curing alcoholism as AA.

~~~
eternalny1
I have some experience with Ketamine ... the one I can share is when the
hospital administered it via IV to put my dislocated shoulder back in place.

It was wild and would certainly NOT be my choice for a sedative in that
situation. It hit fast and at first I felt high, doctors faces started to
"melt", then a huge black abyss was in front of me and I felt like I was
falling head first into it.

I started yelling "no, no!" because it was a very uncomfortable feeling.

Then as I was coming to the entire room was warped, with echoing voices and
laughter.

I'll pass on that, not sure how that would help with depression. It would have
to be a VERY small dose.

~~~
SippinLean
According to what I can find they were using a dosage of 0.5 mg per kg in this
study, but dosages can be as high as 1 to 4.5 mg/kg when used as an
anesthetic.

I had the same dose for the same reason, it was very disturbing. Apparently
the doctor said it was normal for patients to scream that much.

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RankingMember
Side note: I really like the photographic style of this article, particularly
the man standing on a brick column as though on a building about to jump off,
but perhaps instead standing strong having learned to cope with his negative
emotions. The dark motif overall is a nice counterpoint to the ultimately
uplifting, persevering tone of the article.

~~~
a012
I guess the photo was shot on wet plate!? The large format lens DoF and the
high contrast makes the scene scenery looks dramatic. Very well done.

~~~
raihansaputra
I was intrigued and found out more about the photographer. He was a trained
photographer (worked under Annie Leibovitz) and lectured photography in the
90s. Got his medical degree in 2004 and seems like he's coming back to photos.
[https://www.nationalgeographic.com/contributors/a/photograph...](https://www.nationalgeographic.com/contributors/a/photographer-
max-aguilera-hellweg/)
[https://www.nationalgeographic.com/magazine/2019/01/max-
agui...](https://www.nationalgeographic.com/magazine/2019/01/max-aguilera-
hellweg-left-photography-medicine-could-he-do-it-again/)

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faissaloo
I'm very much concerned that rather than traditional psychotherapy where a
person has to confront the issues and trauma of their life we're moving
towards the idea that if you drug someone enough they won't commit suicide. I
should also point out that the anecdote given makes reference to Prozac, a
prescription drug which some users have claimed has caused their suicidal
ideation.

~~~
gnulinux
Sorry, but this bizarre. Psychotherapy is just one tool in the toolbox against
treating mental illnesses. If there is evidence this drug helps treating
mental illnesses, what's the reason not to use it? This is not some
alternative medicine that is offered instead of or in addition to scientific
practice. This is part of the usual treatment that involves psychotherapy, if
it's useful. There is nothing inherently bad with drugs; you don't hesitate to
use drugs when your liver chemistry breaks, why hesitate it when your brain
chemistry breaks?

~~~
faissaloo
You don't use a nuke if you only need to kill one guy. I'm not against it
being used but we need to be careful, we don't want another opiod crisis.

~~~
gnulinux
I think opioids are in a very special spot. There are very few drugs that are
as intensely addictive and as harmful as opioids and are used in medical
profession. In particular, ketamine is nowhere near as addictive or harmful as
opioids. Your point is valid, we should be careful, but we should also
recognize the special status of opioids.

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mruts
Ketamine treatments are pretty expensive at a clinic. If you wanted regular
Ketamine doses for depression (maybe like 1 a month?), I would just buy some
online and insufflate it. Safer than a needle and just as effective.

PS: Chronic Ketamine use destroys your urinary tract (I know people that wet
the bed every night from too much of the stuff). Also, it might cause brain
damage, but no one is really sure.

~~~
SketchySeaBeast
> I would just buy some online and insufflate it. Safer than a needle and just
> as effective.

You're advocating buying a black market substance online and then snorting it
as the safer option?

~~~
mruts
Are you saying that buying a black market substance and injecting it would be
the safer option?

~~~
SketchySeaBeast
No, I'd suggest using a clinic.

~~~
mruts
If you read my comment. I'm suggesting that you don't inject ketamine and
instead you should snort it. I'm not suggesting that snorting black market
ketamine is safer than a clinic.

Though, ketamine is pretty damn safe, and it's rarely adulterated on the black
market. In powder form, it forms crystals so it's hard to fake.

A priori, you can always say that something regulated is more safe than
something not. But if you're a savvy consumer, you can significantly mitigate
or eliminate that risk.

~~~
SketchySeaBeast
So in this case this has nothing to do with treating suicidal ideation and
instead strictly for recreational consumption?

~~~
mruts
I'm not sure what point you are trying to make. I didn't say anything about
doing it for recreational consumption.

I'm suggesting that if you can't afford a Ketamine clinic: a) Ketamine is
generally unadulterated on the black market b) if it is adulterated you can
often tell c) unless a professional is administering it, you probably want to
snort it and finally d) snorting Ketamine should have roughly the same effects
(anti-depressant or otherwise) as injecting it.

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ketathrowaway
(Pardon the throwaway; I try to keep my medical history private!)

I started monthly ketamine treatment about 3 years ago for treatment resistant
depression. It has helped me immensely. It costs me $375 per infusion.

I tried 1-3 drugs from every class of antidepressant (and a few other types)
before ketamine and had limited results. Ketamine, however, has been a
godsend.

If anyone has any questions about the treatment, the drug, its effects on me,
or anything else, feel free to ask.

~~~
nabnob
Is the dose administered during these sessions high enough to cause
hallucinogenic effects?

Could you describe what your depressive symptoms were like before/after
treatment?

How many sessions did it take before you saw improvement?

Also, any personal insight on why it was so effective for you? Do you think it
helped you view circumstances in your life in a different way (the way other
hallucinogens like LSD might)?

~~~
ketathrowaway
> Is the dose administered during these sessions high enough to cause
> hallucinogenic effects?

Yes. It isn't effective unless you get well into a hallucinogenic state. The
antidepressant effect seems to be maximized by setting the dose such that you
are fairly "out there", but not so far out there that you get scared, or pass
out. (Ketamine is used all the time as anesthesia for surgery, and they give
you a much larger dose than is used in depression treatment, because past a
certain dose, you just immediately zonk out 100%. Good ketamine therapy for
depression is achieved by feathering the dose between the two extremes of zero
effect and passing out.)

Hallucination means a lot of different things, but with ketamine it's pretty
specific. It's not the kind of hallucination where you're looking around the
room you're in and see things that don't exist. With ketamine you basically
disconnect from the world you're in at the moment and go somewhere else
entirely, in your own head. You will often not ingest input from your eyes,
even if they're open. What goes on inside someone's head at this point varies
wildly, I could tell you what it's like for me but not sure how much interest
there is in that. I will say though that music has a profound impact on what
goes on in my head during an infusion, and is a fun way of customizing the
ketamine experience. I particularly love using my AirPods for this, because
there are no wires and especially under ketamine, it feels like the sound is
coming from inside your head, as opposed to feeling like you're wearing
headphones.

> Could you describe what your depressive symptoms were like before/after
> treatment?

My depression manifest itself in extreme anhedonia, and after my 3rd infusion,
I played, and enjoyed playing, a video game again, for the first time in over
a year. Also, at that point in my life (3 years ago) I was going through a lot
of difficult personal life problems, and dealing with those problems went from
"completely insurmountable" before, to "this is shitty but I can figure it
out" after.

In other words, it helped me deal with my life and enjoy things again, but it
didn't turn me into someone who will never experience sadness again. It
doesn't mean you'll never have a bad day again, but it does mean you'll be
able to handle those bad days a lot better.

> How many sessions did it take before you saw improvement?

The way my doctor recommended starting ketamine treatment was to have 6 doses
over the course of 2 weeks (m/w/f, m/w/f), and then after that "as needed",
which for me turned out to be every 4 weeks. It was after the 3rd dose in my
initial course of 6 that I noticed a significant effect.

> Also, any personal insight on why it was so effective for you? Do you think
> it helped you view circumstances in your life in a different way (the way
> other hallucinogens like LSD might)?

I can answer this in two parts.

First, one reason it is effective for me is because I don't take any other
drugs that conflict with ketamine. Regular benzodiazepine use, or opiate use,
or lamictal (this list is not exhaustive) significantly impact the
effectiveness of the treatment. Lamictal completely kills the effectiveness. I
had just started on lamictal treatment a month prior to discovering ketamine
treatment, and had to come off it for 10 days before starting. Same with
benzos.

Second, and this is just my personal theory about my own experience, I think
one thing ketamine does that helps me is to get my mind out of ruts. The
experience of ego death, or near ego death, that I get with ketamine feels
like a complete reset for the problems my brain was relentlessly focusing on
before. Afterwards, I still care about those problems, but obsessing over the
negative parts of my life abates significantly. I would say that before, my
focus on the negative vs positive was quite lopsided to the negative, to the
point that I rarely noticed / felt the positives. Whereas now, the two are
much more balanced. I still lean a bit towards the negative, but just a bit.

One more personal anecdote: Before ketamine, I was dating a lot, but almost
out of desperation because of how extremely lonely I felt, rather than because
I was being thoughtful/intentional/patient about finding a great partner. The
ladies I dated picked up on this quite easily, and it lead to a lot of
negative outcomes. And each negative outcome felt like the world ending, which
made things worse. A few months after starting ketamine I tried dating again,
and it went so much better. I wasn't as desperate, and I took the time to
figure out who I was and what I really wanted, and what I offered. It still
took a while before I found the right partner for me, about one year after
starting ketamine treatments, but we're happily married!

~~~
ketathrowaway
One more thing I'd like to add, my mother has a very similar kind of
depression as I do, and ketamine was not effective for her at all. She was on
a fairly high, regular dose of opiate medication, and also she's in her mid
50s. Doc said that it doesn't work as well sometimes, for older people. But we
couldn't say for sure if it was her age or the opiates, and getting her off
the opiates wasn't an option for her unfortunately.

~~~
rocgf
Thank you for your comment. I can't really relate, but it does sound very
interesting and potentially useful to many others.

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starpilot
FYI - Kaiser Permanente is running some ketamine in clinics in California. If
your insurance is Kaiser, this might be a low-cost option.

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throwawayWGBiFc
I've never used ketamine, but I did take hallucinogenic doses of
dextromethorphan (DXM, a dissociative hallucinogen, the same class of drugs as
ketamine) a few times in college. I have mild depression, and for several days
to a week after each DXM trip, I felt very energized and creative, with all of
my depressive symptoms gone. I'm not surprised that ketamine helps depression
in some people. I sometimes consider microdosing DXM for depression and also
general productivity.

Of course, don't take any medical advice from anonymous online posts.

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bfuller
IV ketamine is already being used to treat depression. Its about $500 per
treatment.

~~~
yasp
Yes and I believe that nasal administration is either under FDA review or
active development.

Edit: For anyone suffering from suicidal ideation, I recommend trying lithium
(in close consultation with your doctor).

~~~
rhcom2
Lithium was the only drug that helped me. Two weeks on it and the ideations
were gone. Of course it also requires monthly blood tests, and for me being
nauseous every morning but the positive effects did stay after I discontinued.

~~~
yasp
At least in my case, I didn't need to continue with the monthly blood work
once my optimum level was found. Also I fortunately never experienced the
nausea you mention but did experience tremors occasionally at the beginning,
when trying to find the right level. Too high and they would begin to
manifest.

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soroso
Is the incidence of suicide lower among regular ketamine users?

~~~
ketathrowaway
There is a gigantic difference in patient outcome between clinical ketamine
use and recreational ketamine use. For a variety of reasons: careful dose
control, having an actual doctor involved, etc. But the biggest one is the
antidepressant effects of ketamine only really happen when it's administered
via IV drip over a course of 45 minutes. The most common use of recreational
ketamine is inhaling it, the effects come up too fast and go away too fast for
the antidepressive effects to occur.

~~~
LaikaF
Insufflation is the word you're looking for.

That's also untrue. IM, and IV are most faster come offs then insufflation or
eating it. Though eating ketamine sucks for the amount you need.

What is true about IV is you can control the amount that actually gets taken
in much better.

~~~
ketathrowaway
> What is true about IV is you can control the amount that actually gets taken
> in much better.

I agree 100% with this. Furthermore, being able to carefully control the dose
and duration is paramount in getting the effects to last as long as possible.

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jokowueu
This is J&J's S-ketamime NOT racemic ketamin

Racmic is better

~~~
WalterSear
The literature points to R-ketamine, on it's own, appearing to have stronger
antidepressant effect, with less of the disassociative effects.

AFAICT, it's not patentable, so nobody would pay for the trials.

~~~
jokowueu
This is very true . R-ketamine holds most of the benefit but some of the
metabolites of s-ketamine also do contribute to the positive effects .

Regarding patents . It is possible to patent an ROA method just like what j&j
did with s-ket

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elorant
I thought Ketamine was considered a rape-drug and thus prohibited.

~~~
reverend_gonzo
Not even remotely. You're thinking of GHB.

~~~
ceejayoz
Which, incidentally, also has perfectly legitimate medical uses - treatment of
narcolepsy, anesthesia, etc.

~~~
bagacrap
As do cocaine, MDMA, shrooms, ...

Science might be finally gaining the upper hand in the drug war against
political forces which won the public opinion battle back in the 70s. It's
much harder to convince the public drugs r bad if 95% of the "hard" drugs have
medical uses.

