Ketamine for Treatment Resistant Depression (Question about absorbtion)

[industriald]

Hello all,

This is my first post but I am a long time reader. I really value how the members here are open and helpful.

I am currently on a trial taking Ketamine for Treatment Resistant Depression.

Aside from the Depression, I have Complex PTSD and ADHD and am Morbidly Obese. The PTSD comprises social anxiety, nightmares - all that "great" stuff.

I have struggled with depression for a long time, back to primary school. I am in my late 20's now.

I have been on Ketamine for roughly 6 months now. I am having treatment weekly, and they do two treatments in one day, spaced 3 hours apart.

As part of the study they are doing they have changed a couple of parameters around. They've gone from administering the ketamine solution sub-lingually to just swallowing it. They've also gone from twice a day to just the once.

I have had depressive symptoms start to return since the changes in the treatment regime.

I have read that there is a different in bio-availability in the two methods, but here's the reason for my post...

When I was 15 I had lap-band surgery and within 2 years I had lost all my excess weight. These were the greatest years of my life.

After 5 years, the lap-band slipped due to the physically demanding job I had at the time. 2 years later I had a lap-band done again, and the surgery went wrong and it had to be removed because it was placed wrong. I then underwent a Sleeve Gastrectomy and then it was re-done this year. I put all the weight back on as the surgeries have not worked. Which is a shame because the first lap-band worked perfectly.

Anyway, I have a theory that due to the anatomy of my stomach, including the drastic reduction in size and scar tissue, that swallowing the ketamine is resulting in sub-therapeutic dose.

I have discussed this with the Psychiatrist and they just don't know what effect my stomach anatomy would have.

What do you think? I'd be very interested in having a discussion on this especially anyone that is in the same situation.

Apologies for the long post,

Kind regards

Industriald

 

[Morphling]

Did you suffer nerve damage from the surgery? AFAIK, that's the only way absorption would be affected, insofar as some people who have severe digestive problems.

I wouldn't know how to help you with that either, I'm not a doctor, just following logic here...

 

[Solipsis]

If you swallow the ketamine, the part that is not absorbed from the stomach can be taken up in the gut right after that, IIRC via the portal vein where it undergoes first-pass metabolism. This yields norketamine which may very well be less effective as an anti-depressant. I'm not sure what's up with your stomach anatomy but it is possible that it causes less ketamine to be absorbed before undergoing first-pass metabolism. But I personally doubt the difference there would be more than marginal to slight. The surgeries probably have more effect on the capacity of your stomach than how food is taken up, but reduced area surface could be a small factor, I really don't know.

What is the rationale behind switching from sublingual to oral administration? Is that considered to be a more smooth tapering step rather than actually just weaning you off in general?

If I were you I would not focus on the consequences of having abnormal GI anatomy but instead on the effect of the trial's progress on your depression symptoms... it would be very curious and strange if your stomach situation was all that significant, it seems to me like it would have been an exclusion criterium for participation in the trial.

Are you just wondering about this or is getting treatment of your depression back on track where you ultimately want to go with this? I can imagine that is top priority.

Start looking for someone who doesn't use drugs him/herself who is okay giving you weekly K in a way that works, though it is a little inappropriate of me to suggest playing your own psychiatrist. Definitely discuss this with him or her. And remember that I am a psychedelic drugs forum moderator and not your healthcare moderator and I am just thinking out loud here.

 

[industriald]

Thank you both for the replies, yes I am just wondering about this and I want to get my depression treatment back on track.

I think my psychiatrist would be open to going back to sub-lingual, as he says that some patients prefer it that way.

Personally I can't stand the taste of the stuff, so keeping it under your tongue for 5 minutes is definitely not the most pleasant experience.

I guess the proof is in the pudding so to speak, will see how it goes when I go back next week.

Cheers guys

Industriald

 

[Solipsis]

You could I.M. it.. I personally don't consider it creepy or myself a junkie when I do it though I.V. injections do creep me out. If you do it medicinally it would be as if you were a part-time diabetic.
Of course plugging (rectally) or snorting (intranasally) are also options that are parenteral - thus bypassing the first-pass metabolism. But I don't even know if norketamine is inactive as an anti-depressant, I am probably biased (I don't like ketamine after-effects and experiences I mostly associate with norketamine). However plugging may be inconsistent (there can be loss).. Drip with snorting is still utilized via the oral route.

Or you could just, you know... suck it up (figuratively speaking) and just put it in your 'tonguepit'. Maybe you will learn to associate positive effects with it that will improve taste, but maybe the AD effects are subtle by comparison (not like an euphoric rush)

 

[industriald]

Due to the nature of the administration of the drug, there's not really any chance of being able to take it any other way that sub-lingual or orally. I have never taken any drugs that weren't prescribed for me, so I wouldn't even know where to start finding an illicit source and I am not quite comfortable with the risks involved.

The amount that they are giving is enough to feel a bit of a high type effect, but not a dissociative effect.

I am a bit lost here, but you've given me some info I can use to do further research, thank you.

Cheers

Industriald

 

[Solipsis]

In that case I don't want to encourage you. Be careful, these are not things to play around with and I'm sorry if I gave the impression that self-medication like what I was imagining is a norm. You are on a forum for discussion of many drugs and bona fide medicinal therapy is underrepresented here. Remember that if you are comparing advice from other people with different drug use related norms with your own background and situation.

Either way good luck.

 

[industriald]

Solipsis, I do appreciate your advice and it has definitely given me some information to start going forward. I believe that every patient should be well informed and do their own research. Unfortunately most doctors are good at keeping patients in the dark and many people place blind trust in their doctors.

I certainly am not ignorant in the fact that many drugs used to treat various conditions are also used socially, I also take valium and dexamphetamine and am well aware of the potential for abuse, in fact I have openly discussed drugs of dependence with my Psych.

Thanks again,

Industriald