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Oral ketamine for treatment-resistant depression

philipos33 said:
My depression has beem ruthless, and the pain even worse....I drew the genetic short straw, when it came to natural endogenous opiods, endorphins, enkephalins, sorry for the spelling...the drs are really startimg to believe that certain depressions, should be treated with opiods...of course the drug companies got it backwards, ie cymnalta for pain and depression....no opioid. ? What can we do.
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Cymbalta actually seemed to help my depression somewhat, but it caused me to have soaking night sweats and crazy muscle spasms in my neck, which I haven't encountered with any other drugs.
 
I just sent this to my shrink (who also works at a psych hospital), but thought I would post it here as observations on ketamine's subjective antidepressant effects and the depressed state of mind. It makes me wonder how much of ketamine's apparent longer-term benefits after the drug has washed out of your system are the result of cognitive/behavioral changes where after undergoing repeated self-reflection with an undistorted mirror, you learn to label distorted thoughts as such, as opposed to long-term upregulation or remodeling.

I had an incident yesterday that was rather disturbing to me. I went ballistic after receiving a Christmas card from a high school friend yesterday, only to do a complete 180 after taking some ketamine. I think it demonstrates how distorted things can get in my head and how ketamine seems to temporarily un-distort my thinking. If you happen across someone who comes in to the hospital actively suicidal, you might try this, as it seems to bring some strange, brief clarity, but perhaps enough clarity and leverage to undermine the original distorted reasoning behind the suicide attempt. Luckily, my friend seems forgiving and sanguine about the whole thing.

I am starting to obsess a bit about bladder symptoms again (weird twinges and sensations, but no pain during urination, etc.), but am soldiering on for the moment.

X.


Hey,
I know that it absolutely wasn't your intent, and this is terribly embarrassing, but it's hard for me to describe the amount of despair that your Christmas cards of the last few years have caused me. Could you please take me off your generic communication list until further notice? I'm in a terrible place, and it seems like the only times I hear from my friends are when they want something from me (e.g., moving help), or to provide evidence that their lives are fulfilling in every way that mine is empty and barren. I am so sorry that I can't seem to draw on whatever inner strength is required to relate to broadcast communications from my friends in the benign way in which they were intended to be received, but I seem utterly incapable at the moment.
I do genuinely value you as a friend, and would welcome any communication of a more personal nature in the future, but if you could take me off the broadcast list, I think it would make things easier on me, especially during the holidays. Please don't take offense; it is clearly a problem with me, not you.
Thanks/love/sorry,
XXXX
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and hours later, after a dose of ketamine, I sent this:

Honestly, you can disregard that last email. My brain is working overtime to kill me with thought distortions, it appears.
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with a longer explanation this morning:

Ugh, thanks for understanding. It's hard to explain what's happening in my brain right now, but it seems to be almost borderline psychotic delusions (and hallucinations to boot) resulting from unipolar depression. I started intranasal ketamine (yes, that Special K) about a week ago, and it's the first thing that I've responded to, but I haven't found a way to dose it such that it maintains efficacy throughout the day. As I'm sure you can imagine, it's not particularly conducive to driving, working, or being a functioning member of society.
As an example of what was happening yesterday, a single dose in the evening brought me from feeling actively suicidal to being able to (within minutes of administration) objectively evaluate my thoughts and feelings and dismiss them as super distorted, only to start all over again when the dose wore off. I've always tried to evaluate everything rationally and objectively, and I feel kind of like John Nash when he said that he accepted his "messages from space" delusions as valid because they came to him in the same way as his mathematical ideas. However, under the influence of ketamine, I see brief glimpses of the grossly distorted leaps of logic, improperly applied statistical analyses, etc. It's all rather horrifying to not know which of your core beliefs are valid from one moment to the next, and especially when the murkiness is cleared by ketamine, which is so poorly understood and causes hallucinations and delusions in its own right.
Please bear with me as I try to figure this out.
Love,
XXXX
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My shrink is on board with IV infusions, and I met the nurse tonight who will be performing them starting in February pending malpractice insurance updates, etc. She seems pretty cool; not like you need to be my best friend to start an IV, but as long as we're likely to be spending large chunks of time together, it's a bonus. At the end of the meeting she grabs a notepad and says there's a website she wants me to check out, and hands a sticky note to me. In neat cursive:

Erowid.com

Thanks for the protip. :D
 
b0rken sprayers

Hey guys, I'm having a bad time with these compounded intranasal sprayers. The ketamine is crystallizing out of the solution and clogging the spraying mechanism. Here, you can see the crystalline ketamine that was clogging the sprayer on my laptop after I broke the top off the provided sprayer to pour the contents into an empty Afrin bottle. How can I keep the ketamine in solution so it doesn't clog the sprayer? Heat gently in the microwave? Add saline? Any advice would be much appreciated.

http://imgur.com/QBRRsGP
 
They were given to me in a ziploc bag of 4 sprayers (1 month supply) with instructions to refrigerate. Honestly, I'm too lazy (depressed?) to follow the instructions, so I've been keeping the one I'm using out at room temperature with the remaining sprayers in the produce drawer of the fridge. But, even the room temperature sprayers are crystallizing out of solution. Is there a good reason these need to be refrigerated, or does the pharmacy just like warning stickers? I'm assuming that these solutions don't include preservatives, but what grows in ketamine? It seems awfully acidic.
 
The compounding pharmacy is willing to replace the defective sprayers for free, but I'm still wondering about the wisdom of storing them in the fridge. Does anyone know if this happens with IV ketamine vials stored in the fridge? Surely this must be a solved problem.
 
I would imagine you don't have to refrigerate sealed, sterile ketamine vials. In fact, refrigeration would be unwise because the solubility of ketamine changes with temperature... if you cool a ketamine solution down it will crystallise.
 
The concentration in the nasal sprays was simply too high, it's not your fault. Lower temperatures should cause it to fall out faster, but if some of it crystallized even at room temperature they need to lower the concentration.

I'm curious as to how your depression has been developing since you are taking ketamine. Could you tell us how long exactly you were using it at what frequency and dosage and what progress you observed? Have you ever laid it off and noticed any changes for the worse? I'm very worried about that, since I am considering treating myself with iv racemic ketamine about once per week myself, I've been through countless antidepressants and anticonvulants now and nothing really helps except for ketamine (well bupropion and lamotrigine are doing a good job as well, but it simply isn't enough for me to function).
 
arctica said:
The compounding pharmacy is willing to replace the defective sprayers for free, but I'm still wondering about the wisdom of storing them in the fridge. Does anyone know if this happens with IV ketamine vials stored in the fridge? Surely this must be a solved problem.
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We store all of our IV Ketamine at room temperature, and within a couple of months after diluting the potency drops considerably. They probably want you to store in the fridge so the drug doesn't break down too much.

Even the 100mg/ml solution never drops out at room temperature though. We found an old bottle over 15 years old and everything was still in solution.
 
endotropic said:
We store all of our IV Ketamine at room temperature, and within a couple of months after diluting the potency drops considerably. They probably want you to store in the fridge so the drug doesn't break down too much.
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That's odd, I've had ampoules that were 10 years past expiration, not stored properly at all and still gave me a k hole at 90mg of the s isomer. Since I momentarily cannot get injectable solution, I will have to prepare my own ampoules for months in advance, so this is of some concern.
 
crOOk said:
That's odd, I've had ampoules that were 10 years past expiration, not stored properly at all and still gave me a k hole at 90mg of the s isomer. Since I momentarily cannot get injectable solution, I will have to prepare my own ampoules for months in advance, so this is of some concern.
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We don't bottle our injection solutions under vacuum, so the air in the bottle probably causes them to go off more quickly than your ampoules. That's my guess anyways, all I know is the loss of potency is obvious on our end.
 
sekio said:
The experimental protocol I saw for depression was 0.25 mg/kg S-ketamine, or 0.5mg/kg racemic (so about 30mg of the racemate), intravenously over ~40 minutes, six infusions over four weeks.
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You really think that would be better than just IMing it?
 
red22 said:
You really think that would be better than just IMing it?
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The protocols I've seen for ketamine infusion call for terminating the injection if signs of dissociation/hallucination appear. If nothing else the slow I.V. infusion allows for careful titration and termination in case of unwanted side effects. The slow infusion might have added benefits beyond that, but I haven't seen anything conclusive in that regard.
 
I took ketamine orally one time with a friend. We didn't get off using that ROA.
 
Wait, so you're supposed to be paying $900 for a single shot when entire vials from Mexico can be had for less than a tenth of that price?

I'm not trying to come off as insulting I just want to know the logistics behind this. Seems a little draconian to be making people pay that just because they're desperate enough or scared to get their own supply or whatever. Why so fucking expensive?
 
After reading the previous page I'm actually impressed that you can do so many tests I'd never think would be available for patients. I've recently had my first ever EEG done, 11 years after I first went to a psychiatrist.
 
Sorry to drag up old thread but it is most appropriate here i think:
Is it known what gives K low oral BA? If it is just mostly first-pass metabolism wouldn't that be good since as was suspected for longer but now confirmed it is the mono and/or dihydroxynorketamine (?) metabolites that are AD. Or would it still be too highly plasma bound or partial to fatty tissues so that most can get lost before reaching the brain with enteral route?

I may try a micro dose of DCK to see if i notice it helping...
 
Is Ketamine treatment reserved for those who have never experienced response of any kind, to any other kind of treatment?

As in - a noradrenergic partial responder.

Could ketamine be considered in that instance?

Where other treatments have incited response, but not full remission.

There are actually legit legal clinics administering treatment in the UK - as there are in the US.
Which I would consider but - would the potential administration of ketamine mean a patient must come off all other medications?
Specifically - mianserin and reboxetine.
 
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