Ketamine for depression

[Poolchickk]

Hi all I am new to all of this. Was just wondering if anyone has tried ketamine for treatment resistant depression and if so was it successful?
Thanks....

 

[ketadvocate]

Yes, there are many people who have successfully relieved their treatment-resistant depression with ketamine. IV infusions provide the greatest relief, but some patients find intranasal spray can provide partial relief as well. The Ketamine Advocacy Network (ketaminenetwork.org) has postings from people describing their experiences, as well as an FAQ about the treatment, and a directory of US doctors who offer it. I am one of the success stories. I had severe depression for over 30 years, and by my mid-40s was no longer able to maintain relationships, hold a job, enjoy anything, or even get out of bed most days. Over the decades I tried every variety of SSRIs, tricyclics, MAOIs, as well as years of psychotherapy with 7 different doctors, meditation, mindfulness, acupuncture, etc. Nothing ever helped, and some of the SSRIs made me feel even worse. I heard about a study at the US National Institutes of Health using ketamine to treat depression, and I volunteered. After a single infusion, I experienced 100% relief of all my symptoms within a few hours: anxiety, dysphoria, cognitive impairment, anhedonia, fatigue, etc. You cannot imagine the sensation of decades of suffering draining away rapidly. The relief lasted about two weeks before I began to gradually relapse. After the study, I found a doctor who offers the treatment clinically, and now I get an infusion roughly every two months. No question ketamine literally saved my life, as I was making final preparations for suicide before stumbling across the NIH ketamine research. The mechanism of action is still under study at NIH, Yale, Mt. Sinai, and elsewhere. But this much is clear from the research so far: when a carefully-controlled small dose of ketamine is delivered at a very precise slow rate to the brain, without undergoing first-pass metabolism, it triggers a cascading sequence of delicate events in the brain whose end result is the rapid regrowth of atrophied neurons. IV infusion is the only way to deliver ketamine to the brain in this very precise way. Snorting a recreational dose won't have the same effect. Nor will intramuscular injection, or oral ingestion. All of these other methods cannot precisely control the rate at which ketamine reaches the brain, and they also incur first-pass metabolism, which means some portion of the ketamine will be converted other substances before reaching the brain, and their presence seems to prevent the triggering of that delicate cascade of events. Having a doctor (usually an anesthesiologist) drip it directly into your veins using an infusion pump is the only way to be exact, and to recreate the conditions used in the published research. Still, there are some doctors who prescribe intranasal ketamine spray for depression, and some patients do find at least partial relief through trial and error. I and most people I know who have tried both methods (always under a doctor's care, not recreationally) say infusion is vastly more effective.

 

[Poolchickk]

Thank you very much for your reply Ketadvocate. I am so jealous as I have suffered depression for 20yrs with no relief. We don't have ketamine IV available in Australia for depression, we only have it for pain with only a couple of doctors administering it, can't even get the nasal spray. I have looked into ketamine and it is such a shame as I feel there is not hope when nothing works for certain people, the feeling of depression lifting must be such a great feeling for you and I am so happy you have found relief from such a terrible illness. I thought ketamine would work and hearing your story proves it does, so let's hope it becomes available here very soon. Thank you...

 

[ketadvocate]

Yes, it seems barbaric that this treatment isn't available to the hundreds of millions of sufferers worldwide. Even in the US, where there is growing number of ketamine clinics, most doctors have never heard of ketamine treatment for depression, and those who have are very wary of offering it. Many of the leading US researchers actively discourage its clinical use. These attitudes are partly a result of ignorance, and also a reluctance to embrace the radical new pathophysiological model of depression that ketamine research has revealed. But the most common objection to using ketamine is "We haven't finished studying the long-term safety of repeated ketamine use." But I'm more interested in the consequences of NOT using ketamine: over a million suicides per year worldwide, and 350M living lives of misery that can hardly be called "living" at all.

I don't know much about the Australian medical community, but I have come across a few things over the last couple years that might be useful to you...

Colleen Loo, a psychiatric professor in NSW is conducting research on ketamine for depression. See http://www.blackdoginstitute.org.au/public/research/meetourresearchers/colleenloo.cfm. Perhaps it might be possible for you to volunteer for a clinical trial? Or perhaps she might know of other ketamine studies in Australia that are close to you?

The Royal Flying Doctor Service uses ketamine to sedate patients for transportation. If any doctors in Australia might be willing to consider treating depression patients with ketamine, it will be those who have experience administering the drug and who understand just how safe and harmless it is when used in a supervised medical setting. Perhaps you might get some leads by tracking down a few RFDS doctors (or former ones) and asking them if they know any colleagues who might be willing to consider offering ketamine infusions? Here's one such doctor: http://www.smacc.net.au/committee/assistant-professor-minh-le-cong

Of course, anesthesiologists have far and away the most experience with ketamine, and they understand its outstanding safety profile. In the US, the doctors who offer ketamine infusions are nearly all anesthesiologists for this reason. Perhaps you could track down some anesthesiologists near you and ask if they know of colleagues who might be willing to offer infusions for depression?

In the US and a few other countries (not sure about Australia) ketamine is also widely used in pain management. Certain types of neuropathic pain, including a truly horrible condition called CRPS/RDS, respond to virtually no drugs besides ketamine. In the US, many of these pain doctors (or "pdocs") already perform ketamine infusions regularly for CRPS/RDS patients. Since they already have the experience and infrastructure, some of them now offer the treatment for depression patients, too. Again, it might be worth tracking down some local pdocs to ask if they know any colleagues who might consider this treatment.

Finally, if you ever have reason to travel to NZ, there is at least one doctor who is treating depression patients with ketamine: http://www.otago.ac.nz/dsm/people/expertise/profile/index.html?id=821. Just like his counterparts in the US, he ran into resistance, and even had to defend himself against a regulatory inquiry: http://www.odt.co.nz/news/dunedin/280719/wary-psychiatrists-avoiding-label-use-ketamine. I hope it has not caused him to stop offering the treatment.

 

[Abject]

Not sure what first pass metabolism has to do with the effects of ketamine but oral is the only ROA that it comes into play. Insufflation, IM, literally any ROA that is not oral does not have to factor in first pass metabolism.
IM/IV is the best way to do Ketamine, followed by insufflation. All other ROA's have low bioavailability.

DXM is an OTC dissociative with anti-depressant qualities.. good luck getting ketamine for depression (legally, in australia)

 

[ketadvocate]

Abject, regarding first-pass metabolism, I'm not a doctor or researcher so I can only parrot what they tell me. I've had conversations about this question with the folks at NIH, one of the Mt. Sinai researchers, and my own doctor who has over 100 ketamine infusion patients. They've all told me that some degree of first-pass metabolism does indeed occur with those other ROAs. It might not be a huge amount of first-pass metabolism, depending on which ROA we're talking about. But any first-pass metabolism will quickly produce some quantity of norketamine, which is the first metabolite. The presence of norketamine might interfere with achieving the delicate conditions that trigger the sequence of events described in the research (NMDA antagonism --> increased mTOR signaling --> increase in BDNF --> synaptogenesis --> antidepressant effect). To my knowledge there is no conclusive research on this narrow point. But anecdotally, the people I've chosen to trust as experts say non-IV ROAs mean some first-pass metabolism, and that means some norketamine, and that might reduce the degree of antidepressant effect.

 

[Abject]

Enhanced BDNF expression and synaptic plasticity through NMDA glutamate is an interesting hypothesis for a/d effects, and I would think Tianeptine would be getting more attention as it can achieve this indirectly, and is not a dissociative/euphoric drug,

The first pass metabolism is blood from your GI tract being sent to your liver. If it is not in your GI tract, if you did not eat it; that is, you could use any other ROA from subling and buccal to IM or rectal and none of them will involve first pass metabolism because they're not oral. If you take a CYP3A4 substrate or inhibitor it will alter the peak plasma level, and the metabolism (therefore the metabolite norketamine) but that's getting off topic as oral ket is a dumb idea.

 

[tripnotyzm]

I can definitely see some sort of benefits in this area in relation to Ketamine use...
**Use... not abuse ;-)

 

[Poolchickk]

Thank you everyone for your input. Unfortunately here is Australia it is only allowed for us via iv for pain management, I have however had a referral written to one of these pain management clinics and filled in all the 20 page questionnaire and sent it off so I will see what happens next. My only other option I feel as nothing is working with this depression is to try and seek it out illegally. I don't think it will be easy to find though.

 

[lovepsychadelics]

There are clinical trials being conducted at Griffith university in QLD. This is trial phase though. How do I know? Patients have been attending these trials from private psychiatric hospitals. Not available for general use as far as I know... yet. First pass metabolism involves the liver not the stomach BTW. Basically it means the drug is filtered by the liver before reaching the blood brain barrier as Abject has already stated. That does mean that IM, rectal administration, SC, etc will bypass first pass metabolism to a greater extent but all blood eventually passes through the liver and kidneys. However, with these routes, the blood brain barrier has already been saturated by the drug before the liver is reached. Sorry for bad grammar and spelling, I'm tired.

 

[BananaCognac]

I'm from Melbourne and I was recently admitted (4weeks ago) to hospital for a 7 day ketamine infusion for chronic back pain. I was admitted at 4pm but the infusion didn't begin til midnight (my pain doc was way behind). I should mention that I suffer from depression (20mg lexapro). I was started on 4ml per hour to be titrated to a max of 28ml per hour. I noticed a huge lift in mood after 12 hrs at this stage I had no idea it was the ketamine.. After two days my mood was probably at its peak in terms of feeling happy and in a good mood (I was on 12ml per hour at this stage). I was very chatty with nurses and the patient next to me which is unlike me as I'm an introvert. By the 4th day (now on 20ml) I did notice my mood levels decline a little and then just plateu until I was out three days later.
so in a nutshell ketamine worked very well for my depression at small doses and 4 weeks on it's still helping.

 

[drancer]

Well every time I've come out of a K-Hole, for the next week or so I am feeling pretty chippy. You get that 'back from holidays' kind of glow where stress levels are reset and everything is less mundane. It's a nice attitude re-adjuster for me when I feel like I am stuck in a rut. The only downside is that my nose doesn't agree with me and I get non stop hayfever-like sneeze fests unless I take antihistamines for 3 days afterwards.

 

[NewBlue24]

Hi All, I am new to Bluelight. I ran across this thread on Ketamine. I have also researched the same thing. Can Jamshyd or anyone else with knowledge, give some insight as to how Ketamine Infusion worked on their depression AND the anxiety? How does an NMDA blocker like Ketamine works for the anxiety? I have researched extensively, and it shows how Ketamine has 'robust' anxiolytic effects. Is this true? And if so, how is that? Any ideas and input would be greatly appreciated. This is a great site.