Is this what they refer to with the description 'dissociative'? I've always found this confusing because psychology refers to another phenomenon with the same name, dissociation as it happens with traumas. Ketamine & other dissociatives dissociate you from the physical world but not completely so, only when reaching dissociative anesthea or a hole it is complete. They also inhibit physical response to anxiety and panic, their anxiolytic efficacy goes beyond just that but it's a relevant factor. For me they are of similar efficacy like benzodiazepines but without the sedation and when snorted the effects come within seconds.
Is this what they refer to with the description 'dissociative'? I've always found this confusing because psychology refers to another phenomenon with the same name, dissociation as it happens with traumas. Ketamine & other dissociatives dissociate you from the physical world but not completely so, only when reaching dissociative anesthea or a hole it is complete. They also inhibit physical response to anxiety and panic, their anxiolytic efficacy goes beyond just that but it's a relevant factor. For me they are of similar efficacy like benzodiazepines but without the sedation and when snorted the effects come within seconds.
dissociation is more a term used to refer to a psychological effect, disconnecting your brain from reality, but yes the NMDA antagonism dissociates input from your spinal cord, particularly pain, from reaching your brain. It's why ketamine is used as a 'field anaesthetic' in combat settings. Rapid acting and doesn't cause respiratory depression in the same way other traditional anaesthetics do.
I find it interesting that dissociatives at least on lower recreational dosages don't actually dissociate myself, they don't induce dissociation like in trauma but rather disable my ability to feel negative emotions, anger, pain, anxiety etc and induce kind of a carefree, euphoric and a bit empathogenic state.
Yeah it's remarkable that ketamine doesn't require monitoring of vital signs but I've seen the requirement of exactly this listed for Sprava, for as little as 50-74mg. They're stupid.
Does anyone here have any first hand experience with using a clinical Ketamine infusion regimen for help with long term sobriety and depression and anxiety that comes along with it ?
Thanks for getting this conversation going! It’s really interesting to hear different anecdotal accounts of people adopting different regimes and approaches with ketamine. Below, I’ve shared my experience and have included a brief summary of the current literature on the use of ketamine for treatment of opioid use disorder (i.e. sustained opioid cessation - that was my goal) and as an adjunct to rapid detoxification. I’ve focussed on including literature that addresses opioid cessation and management of rapid detoxification, and haven’t covered it’s value in treating and managing depression and anxiety. Hopefully it helps!
We’ve done two treatments to support the rapid detoxification and explore stages of sustained opioid cessation (this was my goal at the time), using ketamine administered intramuscularly (IM) at dosages ranging from 0.8mg/kg - 2mg/kg. Here, I’ve shared details of Treatment 2.
Treatment 2 was used as an adjunct to rapid detoxification from oral methadone (30mg) and concurrent IV heroin use (approx. 0.8g/day). This treatment included two daily IM administrations (07h00 and at 16h00) on each consecutive day over a total five day period. For each IM administration, the dose was increased by 0.1mg/kg. On each day, the second administration included an assisted-psychotherapy session (approx. one hour). A COWS score was obtained daily. Following this five-day regime, I continued ketamine-assisted psychotherapy sessions once-monthly (with IM administrations) for a period of six-months.
Following Treatment 2, I remained abstinent from opioids for 1.5 years. It should be noted that at 12 months, I moved to a new country to take up a new position. Personally, during the first 5 five days, I found the physical pain reduced relative to previous detoxes. In addition, there was a rapid and overall improvement in my mood and mental well-being. This was reflected in the COWS scores.
Did it help? Yes, it did, both as an adjunct to rapid detoxification and for longer-term management of opioid abstinence. However, I strongly believe that ketamine is not a panacea - a “silver-bullet” - but rather only one tool in the toolbox of skills and support I needed. In my opinion, the psychotherapeutic support was essential to me achieving set-goals. I was fortunate enough to work with an amazing team.
I echo this. Yes, the ketamine provided support but it strongly believe that the assisted-psychotherapy and intense introspection I did was essential to not only managing the rapid detoxification but also sustaining my abstinence from opioids.
This is fantastic to hear! And, your anecdotal report is consistent with findings from other countries and contexts. In particular, Krupitsky et al. (2007).
What the science says about ketamine for sustained opioid cessation and rapid detoxification?
There could be more recent work published (for example, the clinical trials led by Elias Dakwar), but in the systematic review by Jones et al. (2018), the authors highlight studies that looked into the use of ketamine in the treatment of opioid use disorder (OUD) and as an adjunct to opioid detoxification. A more recent systematic review and meta-analysis was published by Walsh et al. (2022), but referred to the same studies as Jones et al. (2018).
In Krupitsky et al. (2002), the authors conducted a randomized controlled trial of 70 heroin-dependent participants in which they compared the efficacy of higher dose ketamine (2 mg/kg) vs. lower dose ketamine (0.2 mg/kg), both administered intramuscularly (IM) in conjunction with psychotherapy. They found abstinent rates at 1, 3, 6, 12, 18, and 24 months to be notably greater in the higher dose group compared with the lower dose group. In a follow-up study, Krupitsy et al. (2007) measured abstinence rates. The authors evaluated the efficacy of single vs. repeated sessions of ketamine-assisted psychotherapy in increasing abstinence from heroin. The randomized participants to either 1 or 3 sessions (2mg/kg IM given at 1 month intervals). The authors found 50% of participants from the multiple sessions group were abstinent at the 1 year follow-up compared to a notably reduced number in the single treatment group.
To investigate ketamine’s potential to assist with opioid detoxification, Jovaisa et al. (2006) conducted a randomized controlled trial in which participants were given either saline placebo infusion or 0.5 mg/kg/h of IV ketamine prior to rapid opiate antagonist induction under general anesthesia. The authors found that ketamine could suppress the physiologic response to opioid withdrawal. However, this was unrelated to treatment outcome at 4-month follow-up.
Malchow et al. (2020) considered ketamine's anti-hyperalgesic properties, and conducted a study that sought to establish a novel ketamine assisted opioid detoxification program aimed at safely decreasing both opioid use while simultaneously addressing chronic pain. Their study included 41 veterans with chronic noncancer pain and on chronic opioids who received ketamine assisted opioid detoxification. The study found new evidence that the utilization of a standardized ketamine infusion protocol coupled with a rapid opioid detoxification is very effective, results in a high rate of prolonged opioid reduction, decreases chronic pain, minimizes opioid withdrawal using strictly non-opioid analgesics, and decreases depressive symptoms.
I think that your clinic, and most K clinics play up the viability of ketamine as a treatment to charge people these outrageous prices. Ketamine is a great reliever of symptoms, and with targeted psychotherapy can be a catalyst for change, but ime it definitely does not CURE anything. I have been using K IV to the specs of the PTSD studies for years and while i have copped a crazy ketamine habit, i still suffer from ptsd, anxiety, depression etc. --- IMO it's roll is to break someone out of a long term depressive crisis, but the help it gives is, like ibogaine, a process interrupter - it will give you peace of mind to get out of bed and start up an actual treatment course. that is my feeling anyhow.
I've seen the small studied examples of nueronal growth etc, but i remain skeptical as to how much of this translates into real world long term help.
I know from first hand experience that dissociatives can help tap into normally rigid identity patterns and change them. It goes that deep. I have felt lifelong psychosomatic tensions dissolve in my skull, my back, etc. I've felt the way i feel from inside change altogether in a way i couldn't hope for, or even conceptualize. Ketamine and other dissociatives can help against psychic oppression and torture. People who get stiffened up with twisted hunched backs and necks and shit from chronic fear and despair. That's the type of stuff that can amazingly be worked with, or at least intervened with. It's more than symptom relief. However, i understand not everyone responds that well.
I know from first hand experience that dissociatives can help tap into normally rigid identity patterns and change them. It goes that deep. I have felt lifelong psychosomatic tensions dissolve in my skull, my back, etc. I've felt the way i feel from inside change altogether in a way i couldn't hope for, or even conceptualize. Ketamine and other dissociatives can help against psychic oppression and torture. People who get stiffened up with twisted hunched backs and necks and shit from chronic fear and despair. That's the type of stuff that can amazingly be worked with, or at least intervened with. It's more than symptom relief. However, i understand not everyone responds that well.
I call it symptom relief because - at least in my own experience - the changes are not lasting, I get fantastic relief during the duration and immediately after but imo it’s the effects of the drug as opposed to structural change. Also - as time has gone on and tolerance and everything else has made the benefits I receive dwindle on an exponential line. Very sad tbh.
I find it interesting that dissociatives at least on lower recreational dosages don't actually dissociate myself, they don't induce dissociation like in trauma but rather disable my ability to feel negative emotions, anger, pain, anxiety etc and induce kind of a carefree, euphoric and a bit empathogenic state.
Yeah it's remarkable that ketamine doesn't require monitoring of vital signs but I've seen the requirement of exactly this listed for Sprava, for as little as 50-74mg. They're stupid.
definitely hey! I'm not one for doing lines of ket like other people, i prefer to have small bumps and just feel like I'm floating on a little cloud of carefree. The IV dose is the equivalent of ~55-60mg insufflated per hour every hour so it's not quite hole level - if my eyes are open and I'm eg eating or talking to people it's still fairly *relatively* normal feeling, sorta numb body buzz and feeling like I'm not quite all 'there' but when I close my eyes that changes. Laying in bed listening to music is an incredible experience on the medical grade shit.
I do get charted for 10mg valium 3 times a day for the muscle tension it can cause, and to quell any anxiety that is a natural consequence of being in that state for an entire week, and also to help me sleep bc for whatever reason it's super hard on ket for me.
My vitals get monitored bc it does raise your blood pressure and temperature a bit (mine are both on the low side, the moment the infusion stops my BP goes back to 95-100/60 and temp drops back to 36) and they have to check your liver function as it can cause abnormalities in the enzymes - temporary ones but if the levels get too high the infusion needs to be stopped, which almost happened to me one time. I take milk thistle, L-carnitine and n acetyl cysteine daily now for mood and cholesterol, they're all hepatoprotective and the last infusion i had my liver enzymes basically didn't change.
I call it symptom relief because - at least in my own experience - the changes are not lasting, I get fantastic relief during the duration and immediately after but imo it’s the effects of the drug as opposed to structural change.
Thanks for describing your experience! Your description of your experience is actually quite consistent with the research. Lee et al. (2015) found that in a meta-analysis, results and measures added to the existing evidence that support ketamine as a novel treatment option for depression, stating that ketamine has been shown to have a high response rate and rapid effect.
Several independent pilot studies demonstrate that after a single intravenous infusion of sub-anesthetic dosages of ketamine, its anti-depressant effects have an onset within hours and are sustained for an average of 4–7 (Ibrahim et al. 2012; Matthew et al. 2010). A systematic review also showed ketamine to be a rapid and effective treatment option for depression, as well as reducing suicidal ideation, with minimal short-term side effects (Reinstatland et al. 2015). Furthermore, evidence reported in the literature from studies with single and multiple doses of ketamine also showed that some subjects might be able to sustain the positive response through a reduction in their depressive symptoms for weeks to months (Murrough et al., 2013a, b)
One interesting thing about ketamine - I'm a smoker, I'll go into hospital being a 10-15 cigarettes a day person. When you're hooked up to the drip, you can't leave the ward so no smoking but once the drip is on i have ZERO craving for cigarettes and I'll come out after the week-10 days with no desire to smoke, like it literally smells and tastes disgusting. Then the stresses of life eventually come and kick me in the metaphorical balls and i'll start again but this next infusion I'm determined that I'll come out a non smoker and stay that way because it's way too goddamned expensive in Australia
@hotgirls.jpg.exe oh yeah I definitely experienced the same, laying down with eyes closed is just more than awesome. I'd lose contact with my body and drift around to music. Rewarding as fuck.
It makes sense that Keta increases your temperature and metabolism, in the time I was abusing deschloro and ketamine I had much enhanced stamina to the point of barely feeling exhaustion as long as I did steadily redose. Eventually the fatigue took over and I became depressed but it took quite some time of multiple doses daily for that. Didn't get any liver toxicity, I got checked up when I was withdrawing from Keta and all was normal. I had the theory that ketalogues / arylcyclohexylamine dissociatives might be steroid mimetics, I've posted this here but got little response.
For what it's worth, as long as I was doing ketalogues along opioids there wasn't much addiction at all. This changed upon cessation. I think that it's safer to stay with ketamine than to use two substances though, this might have added to the exhaustion as opiates deplete testosterone.
I didn't lose my desire to smoke though, rather were cigs amplified to being a hugely euphoric experience. Weird.
I suffer from pretty severe agoraphobia/panic disorder since 2018, it's left me legitimately housebound at times - couldn't even go to check the mail without risking a panic attack and couldn't even be left alone sometimes because the anxiety was so bad. Post ketamine infusion I'm actually able to get out into the world and do normal people things. The rush I get from eg being able to go to the supermarket without that incredible stress and pressure from my brain is nothing short of miraculous. It doesn't last forever no but it gives me a window for being able to get used to doing these things so when the effect starts to wane I've upped my skill points in that area. Unfortunately the covid situation has done a terrible number on my mental health as someone who is immunosuppressed, and living in Melbourne where we spent longer in hard lockdown than anywhere else in the world, so it's a much harder uphill battle right now
@hotgirls.jpg.exe oh yeah I definitely experienced the same, laying down with eyes closed is just more than awesome. I'd lose contact with my body and drift around to music. Rewarding as fuck.
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I didn't lose my desire to smoke though, rather were cigs amplified to being a hugely euphoric experience. Weird.
The very first time I did the ket infusion, I decided to finally listen to Melodrama by Lorde and oh man, what an experience. I need to make some playlists for my upcoming infusion
I love smoking on ket if I'm doing it at a party, I was more just making the point that when I'm on the ward waiting for the infusion to start I'll be craving a smoke so bad but it disappears as soon as I get above the 10mg/hr level
I suffer from social and sometimes general anxiety and dissociatives were an one solution for all thingy which led me to abusing them (as said, multiple doses daily). Beginning with DXM in my teenage years, it did go well for years and upon a dose of a disso it was all gone, not just gone but I was really enjoying life and everyday activities. It was the only time where I really had a positive outlook to life. Opioids destroyed it all, funnily enough did I voluntarily get onto opiods because they were easy to get in my country and until then as opi naive I thought of them as being somewhat ultimate drugs given by how many people fall for them and I was in need of something legally prescribeable what ket wasn't back then. But oh boy was I wrong. Opioids are just addiction, the acute effects of morphine were a bit like a dissociative but this vanished very quickly unless the dose was upped steadily. Now I'm living in a country where they don't have ketamine for depression but I might get some anyways and do it by myself.
BTW I found music not just to be so euphoric when listened to under the influence but the tracks retain their euphoria a bit when playing them again while sober.
Thanks for describing your experience! Your description of your experience is actually quite consistent with the research. Lee et al. (2015) found that in a meta-analysis, results and measures added to the existing evidence that support ketamine as a novel treatment option for depression, stating that ketamine has been shown to have a high response rate and rapid effect.
Several independent pilot studies demonstrate that after a single intravenous infusion of sub-anesthetic dosages of ketamine, its anti-depressant effects have an onset within hours and are sustained for an average of 4–7 (Ibrahim et al. 2012; Matthew et al. 2010). A systematic review also showed ketamine to be a rapid and effective treatment option for depression, as well as reducing suicidal ideation, with minimal short-term side effects (Reinstatland et al. 2015). Furthermore, evidence reported in the literature from studies with single and multiple doses of ketamine also showed that some subjects might be able to sustain the positive response through a reduction in their depressive symptoms for weeks to months (Murrough et al., 2013a, b)
id be interested to see studies replicating the same scenarios but many years later in the same patients lives.
As decades have worn by, the relief I get from k has shifted from the weeks/month type duration to literally minutes after a dose. and sometimes just a worsening of intrusive thoughts etc, especially if too much is taken too often.
I support anyone getting this therapy in whatever manner they choose, but on an institutional level I am highly disgusted at what a money racket this has become. I continue to buy street ketamine and formulate it into injections because this big pharma shit of making you sit in a clinic and pay thousands of dollars is against all my values. I do not want to see psychedelic therapy come under the control of this kind of gatekeeping. Furthermore I am skeptical that the high dose IV route is truly the way to go with this.
If the goal is to regenerate synapses in the prefrontal cortex, then long term low dosing is the way to go. At lower doses ketamine acts more like a nootropic. With higher doses you are going to have more deleterious effects on the central nervous system, in my opinion.
I think what these clinicians are doing is ultimately a big experiment. And true to their model, they are using heroic doses on something that doesn't need it.
id be interested to see studies replicating the same scenarios but many years later in the same patients lives.
As decades have worn by, the relief I get from k has shifted from the weeks/month type duration to literally minutes after a dose. and sometimes just a worsening of intrusive thoughts etc, especially if too much is taken too often.
and to be clear - I think it's a fantastic medication with a lot of uses, I think that it's roll in interrupting seriously resistant depression is very real, it's an essential medicine for developing countries as it's one of the only safe ways to anesthetize for surgery that does not also stop breathing -- I ALSO think the K clinics charging thousands of dollars and claiming it will "cure" the brain long term of a wide assortment of disorders is wildly irresponsible and unsupported by the literature. I ALSO think we do not have the benefit of long time frames in the existing research, and I will be really interested to see when we have decade follow ups etc.
I support anyone getting this therapy in whatever manner they choose, but on an institutional level I am highly disgusted at what a money racket this has become. I continue to buy street ketamine and formulate it into injections because this big pharma shit of making you sit in a clinic and pay thousands of dollars is against all my values. I do not want to see psychedelic therapy come under the control of this kind of gatekeeping.
100%. The current crop of clinics trying to tell people in various psychiatric crisis that they just need to fork over 6000$ for a few sessions that literally cost lest than a few dollars to facilitate is fucked up, disservice to the medicine, the patients and everyone but the providers raking in bucks. It reminds me a lot of the "weed doctors" of the early 2ks
and sometimes just a worsening of intrusive thoughts etc, especially if too much is taken too often.