Misc How dangerous is Amitriptyline?

[snmfmy]

We are talking about Spravato nasal spray, right?

No, we're talking about ketamine and it's affect on neuroplasticity as the basis for nasal spray.

However, doctors are not limited to only prescribing spravato nasal spray. Doctors can prescribe medication off label. They do it all the time, at least in the US.

Where are you located?

"Results: SC Ketamine was administered to unipolar and bipolar patients a single or multiple doses, weekly or twice-weekly, a dose-titration approach was made in major studies, dose ranged from 0.1 to 0.5 mg/Kg of racemic ketamine and 0.5–1 mg/Kg of esketamine. Across all studies, SC ketamine showed a rapid and robust antidepressant effect, with response/ remission rates from 50 to 100% following both single or multiple doses, with transitory side effects."

Subcutaneous Ketamine in Depression: A Systematic Review

Background: Ketamine has been shown to produce a rapid and robust antidepressant effect. Though numerous routes of administration have been studied, subcutaneous (SC) has proven to be a convenient and cost-effective route making its use particularly relevant ...

www.ncbi.nlm.nih.gov

 

[ChemicallyEnhanced]

I've been on 100mg Amitriptyline for a decade. It doesn’t work as antidepressant at all. It's off the label sleeping aid and I take it together with 20mg Zolpidem and 6mg Bromazepam. Just then I can have 4-5 hours of sleep (if I am lucky). Wanted to tapper it down but my Neurologist (who originally prescribed this poison) is strongly against it. Why?

In overdose? Very, as it is very cardiotoxic (in overdose). Otherwise, pretty safe.
I'd imagine it has a nasty discontinuation syndrome, most anti-depressants do*, but that would be mitigated by doing a slow taper like you suggested.
Were you wanting to JUST come off the Amitriptyline or were you thinking about switching to another anti-depressant?


*I was mistakenly taken off my anti-depressant (Sertraline, an SSRI, not Amitriptyline) while in hospital once and didn't notice because I'm on like 18 meds so didn't notice the pills not being there...until I started having panic attacks and was formulating a plan to kill myself...fortunately, a nurse came to me before I did anything and said "You were accidentally taken off your Sertraline 6 day ago. Here's your dose for today. How are you? I'm so sorry, that never should have happened.
That was being taken off of it cold turkey, though.

 

[Parabolan]

I was on it for a few years when I was a teenager.
The problem with it is that you basically can't take almost anything else while you're in it. It has bad interaction with a lot of recreational drugs. Doctors switched me to SSRIs afterwards "I believe it was either Paxil or Zoloft I can't remember.

 

[Man67]

In overdose? Very, as it is very cardiotoxic (in overdose). Otherwise, pretty safe.
I'd imagine it has a nasty discontinuation syndrome, most anti-depressants do*, but that would be mitigated by doing a slow taper like you suggested.
Were you wanting to JUST come off the Amitriptyline or were you thinking about switching to another anti-depressant?


*I was mistakenly taken off my anti-depressant (Sertraline, an SSRI, not Amitriptyline) while in hospital once and didn't notice because I'm on like 18 meds so didn't notice the pills not being there...until I started having panic attacks and was formulating a plan to kill myself...fortunately, a nurse came to me before I did anything and said "You were accidentally taken off your Sertraline 6 day ago. Here's your dose for today. How are you? I'm so sorry, that never should have happened.
That was being taken off of it cold turkey, though.

My Dr. got me started on Sertraline as well (50mg at the moment). Still waiting for any effects.

 

[Man67]

No, we're talking about ketamine and it's affect on neuroplasticity as the basis for nasal spray.

However, doctors are not limited to only prescribing spravato nasal spray. Doctors can prescribe medication off label. They do it all the time, at least in the US.

Where are you located?

"Results: SC Ketamine was administered to unipolar and bipolar patients a single or multiple doses, weekly or twice-weekly, a dose-titration approach was made in major studies, dose ranged from 0.1 to 0.5 mg/Kg of racemic ketamine and 0.5–1 mg/Kg of esketamine. Across all studies, SC ketamine showed a rapid and robust antidepressant effect, with response/ remission rates from 50 to 100% following both single or multiple doses, with transitory side effects."

Subcutaneous Ketamine in Depression: A Systematic Review

Background: Ketamine has been shown to produce a rapid and robust antidepressant effect. Though numerous routes of administration have been studied, subcutaneous (SC) has proven to be a convenient and cost-effective route making its use particularly relevant ...

www.ncbi.nlm.nih.gov

There is nothing like that being approved in Australia. Only the overpriced nasal spray.

 

[snmfmy]

There is nothing like that being approved in Australia. Only the overpriced nasal spray.

Actually, the study regarding subcutaneous ketamine injection was done in Australia and there is a clinic in Sydney that actually gives it to patients. (literally a 30 second search on Google)

Sydney TMS, Neuromodulation & Novel Medication Clinic - Black Dog Institute | Better Mental Health

Specialists in neuromodulation treatments for those with a mental health condition who have tried other treatments without success.

www.blackdoginstitute.org.au

"This trial used a generic form of ketamine, which is currently listed by the Therapeutic Goods Administration (TGA) for use in anaesthesia and sedation, meaning that it is low cost and relatively easy to access. "

Since generic ketamine is already approved by your TGA for use in anesthesia sedation, all the doctors said is we'll just give it as an injection instead of an infusion.

No need to go get new approval from the TGA.

 

[snmfmy]

There is nothing like that being approved in Australia. Only the overpriced nasal spray.

You may have to get accepted into another clinical trial that they're going to be conducting, but the other article I read pointed to the link that I pasted.

 

[ChemicallyEnhanced]

My Dr. got me started on Sertraline as well (50mg at the moment). Still waiting for any effects.

How long have you been on it? It can take 6 weeks (my doctor actually said 2 months) to feel the full benefits.

 

[Man67]

How long have you been on it? It can take 6 weeks (my doctor actually said 2 months) to feel the full benefits.

Just 3 weeks. I hope it will work soon because I am also "formulating a plan" especially early in the morning when I just wake up.

 

[Man67]

Actually, the study regarding subcutaneous ketamine injection was done in Australia and there is a clinic in Sydney that actually gives it to patients. (literally a 30 second search on Google)

Sydney TMS, Neuromodulation & Novel Medication Clinic - Black Dog Institute | Better Mental Health

Specialists in neuromodulation treatments for those with a mental health condition who have tried other treatments without success.

www.blackdoginstitute.org.au

"This trial used a generic form of ketamine, which is currently listed by the Therapeutic Goods Administration (TGA) for use in anaesthesia and sedation, meaning that it is low cost and relatively easy to access. "

Since generic ketamine is already approved by your TGA for use in anesthesia sedation, all the doctors said is we'll just give it as an injection instead of an infusion.

No need to go get new approval from the TGA.

I don't live in Sydney and trial is only available to a selected group of people. Most likely locals.

 

[LucidSDreamr]

The end game of the ketamine therapy is morphological changes in NMDA and other receptors that disrupt the physical neural pathways and associated negative engrams that have precipitated and been reinforced by the severely depressed mind state.

Ketamine produces a profound and long-lasting neuroplasticity after infusion or consumption. This can allow morphological changes that can act as prophylaxis against future depressive states.

Rapid neuroplasticity changes and response to intravenous ketamine: a randomized controlled trial in treatment-resistant depression - Translational Psychiatry

Intravenous ketamine is posited to rapidly reverse depression by rapidly enhancing neuroplasticity. In human patients, we quantified gray matter microstructural changes on a rapid (24-h) timescale within key regions where neuroplasticity enhancements post-ketamine have been implicated in animal...

www.nature.com

So they want to actually rewire the brain of treatment resistant depressed patients with ketamine co-administered (Not at the same time) pharmacological and cognitive therapy treatments.

Thanks I’ll read the study.

I have doubts that such limited treatments can cause permanent changes.

For a ketamine addict I would think definitely you can cause long lasting changes but that is heavy use, daily for years.

I used it heavy daily for 5 years and I noticed zero cognitive or mental changes. It did wreck my bladder as expected though.

But a handful of infusions at barely threshold doses can cause these changes? Maybe it’s answered in the study you posted I’ll read when I have time.

 

[snmfmy]

Thanks I’ll read the study.

I have doubts that such limited treatments can cause permanent changes.

For a ketamine addict I would think definitely you can cause long lasting changes but that is heavy use, daily for years.

I used it heavy daily for 5 years and I noticed zero cognitive or mental changes. It did wreck my bladder as expected though.

But a handful of infusions at barely threshold doses can cause these changes? Maybe it’s answered in the study you posted I’ll read when I have time.

My answer to that is low dose naltrexone (LDN) does things that high dose naltrexone doesn't.

Sometimes dose response. Curves are u-shaped and sometimes they are a bottom left corner ordinated asymptotic hyperbola (Obviously truncated because doses start somewhere and they don't go to infinity)

 

[ChemicallyEnhanced]

Just 3 weeks. I hope it will work soon because I am also "formulating a plan" especially early in the morning when I just wake up.

That's concerning! Were you also making plans BEFORE the Amitriptyline taper? If not, I'd go back up to your original dose immediately and also call your doctor.

 

[LucidSDreamr]

I literally can’t take more than 5 mg of amitriptyline every other day or else I’ll get nasty stomach pain. It causes the worst constipation at lowest mg doses of any drug I’ve ever tried

 

[Man67]

That's concerning! Were you also making plans BEFORE the Amitriptyline taper? If not, I'd go back up to your original dose immediately and also call your doctor.

It wasn't Amitriptyline as l still take the same dose. It was Bromazepam tapering from 6mg to 4.5mg. The same thing happened to me last year when l tried to switch from Bromazepam to Lorazepam . It can't be a coincidence.

 

[ChemicallyEnhanced]

It wasn't Amitriptyline as l still take the same dose. It was Bromazepam tapering from 6mg to 4.5mg. The same thing happened to me last year when l tried to switch from Bromazepam to Lorazepam . It can't be a coincidence.

Do you live in an area where you can be detoxed as a hospital inpatient?

 

[Man67]

Do you live in an area where you can be detoxed as a hospital inpatient?

I can't even see my Dr. without an appointment (usually 7-10 days wait). No chance of detox for such a small doses. Only for heavy drug addicts. Privately? I can't afford it. I was perfectly fine before tapering and that was the only way to get some sleep. I am getting back to 6mg Bromazepam and don't see a point for suffering in vain. It was my new Dr's idea and obviously a mistake.

 

[ChemicallyEnhanced]

I can't even see my Dr. without an appointment (usually 7-10 days wait). No chance of detox for such a small doses. Only for heavy drug addicts. Privately? I can't afford it. I was perfectly fine before tapering and that was the only way to get some sleep. I am getting back to 6mg Bromazepam and don't see a point for suffering in vain. It was my new Dr's idea and obviously a mistake.

7-10 days?! Damn, that's crazy. I feel like if you have to wait that long whenever you're sick, by the time you actually see them you'll either be better or dead :/

Staying on the 6mg Bromazepam definitely sounds like the right idea.

 

[Juicewrldfan]

I heard about that. Unfortunately it's not subsidised by Medicare in Australia. Monthly treatment (2 times per week) is between $5000-6000. I don't have that money and basically only rich people can afford it.

What about psilocybin. I’ve done both and psilocybin by far helped me more and I did the full ketamine treatment IV at that. Psilocybin was far more effective. I didn’t have any symptoms for 6 months but I find the it much better than my 9k ketamine treatment and you have to take enough for a trip to get the benefits

 

[Man67]

What about psilocybin. I’ve done both and psilocybin by far helped me more and I did the full ketamine treatment IV at that. Psilocybin was far more effective. I didn’t have any symptoms for 6 months but I find the it much better than my 9k ketamine treatment and you have to take enough for a trip to get the benefits

Thanks for the tip. Apparently it will be available in Australia from 1/7/24. Prescription only by Psychiatrist. Unfortunately it's not subsidised by the Government and average price is around $25.000 per treatment.