FDA approves ketamine as antidepressant

[asecin]

if you cant afford ketamine, try Yuejo https://www.nature.com/articles/srep13573

 

[Hodor]

The analouge methoxetamine is extremely similar. It was actually designed by a former bluelighter. It was designed to be a physically safer version of the drug in relation to bladder damage. I'm sure it hasn't been studied in relation to depression. From my anecdotal experience it dose have an antidepressant effect.

The idea behind methoxetamine being "safer" than ketamine is mostly based on the assumption that if it is the metabolites that are responsible for ketamine's bladder toxicity, then the simplest way to reduce that toxicity would be to make a stronger, more long-lasting drug. If it takes a much lower dose to achieve a similar "high", and said high can be sustained for a longer duration without redosing, then you're ingesting less material, and therefore forming fewer toxic metabolites.

That said, there are studies on rodents suggesting that if you push the dose high enough (which a lot of people probably did during the peak of the RC boom), it's every bit as toxic as good old ketamine. Heck, mg-for-mg, it may very well be *more* toxic than ket.
Not that it really matters, because MXE is pretty much gone. Not only is it banned EU-wide and scheduled under the UN convention on psychotropics, but it has been *explicitly* banned in China, which is where pretty much all of it was synthesized.

 

[cj]

The idea behind methoxetamine being "safer" than ketamine is mostly based on the assumption that if it is the metabolites that are responsible for ketamine's bladder toxicity, then the simplest way to reduce that toxicity would be to make a stronger, more long-lasting drug. If it takes a much lower dose to achieve a similar "high", and said high can be sustained for a longer duration without redosing, then you're ingesting less material, and therefore forming fewer toxic metabolites.

That said, there are studies on rodents suggesting that if you push the dose high enough (which a lot of people probably did during the peak of the RC boom), it's every bit as toxic as good old ketamine. Heck, mg-for-mg, it may very well be *more* toxic than ket.
Not that it really matters, because MXE is pretty much gone. Not only is it banned EU-wide and scheduled under the UN convention on psychotropics, but it has been *explicitly* banned in China, which is where pretty much all of it was synthesized.

That's a shame it's banned. Its a great drug. Towards the end of me doing phychedlics it seemed like their where a number of different k analouges in the market place. K not being covered by the analouge act makes me suspect a new variation will be or already is on the market

 

[Captain.Heroin]

The idea behind methoxetamine being "safer" than ketamine is mostly based on the assumption that if it is the metabolites that are responsible for ketamine's bladder toxicity, then the simplest way to reduce that toxicity would be to make a stronger, more long-lasting drug. If it takes a much lower dose to achieve a similar "high", and said high can be sustained for a longer duration without redosing, then you're ingesting less material, and therefore forming fewer toxic metabolites.

That said, there are studies on rodents suggesting that if you push the dose high enough (which a lot of people probably did during the peak of the RC boom), it's every bit as toxic as good old ketamine. Heck, mg-for-mg, it may very well be *more* toxic than ket.
Not that it really matters, because MXE is pretty much gone. Not only is it banned EU-wide and scheduled under the UN convention on psychotropics, but it has been *explicitly* banned in China, which is where pretty much all of it was synthesized.

My friend almost died on MXE so I presume it’s no safer especially as it’s quite difficult to fatally overdose on ketamine.

 

[ro4eva]

Regardless of where the Americans here stand within the political spectrum, I think it's fair to acknowledge that prices for Rx drugs in the U.S. seriously need to trend downwards, and fast. Big Pharma has been getting away with ripping y'all off like nowhere else on the planet. My condolences.

 

[asecin]

im pretty sure pharmaceutical companies rip off everyone everywhere not just US. its called "business"!? ever heard of business trying to benefit others but themselves? well, maybe in communism, business is controlled by governments but thats not much better since government only looks after its own interests screwing people over as well

 

[ro4eva]

im pretty sure pharmaceutical companies rip off everyone everywhere not just US.

Not to the extent present within the lower 48. It's gotten so bad that many American citizens now head into Mexico in order to afford their meds.

its called "business"!? ever heard of business trying to benefit others but themselves?

Depends on the type of business(es) you're referring to, but in general, yes, I have, many times. Are you inferring that you have not?

well, maybe in communism, business is controlled by governments but thats not much better since government only looks after its own interests screwing people over as well

Ya know, firefighting used to be privatized in America. But the government had to step in and take control because not everyone could afford to have a fire put out, and it spread to other homes as a result.

 

[cj]

Americans are getting screwed because we can't negotiate as a block. Countries with universal healthcare force drug manufacturers to charge a reasonable price or they just don't use the drug. Its a vast oversimplification but basically what's happening is Americans are fitting the bill for the rest of the world to have cheap drugs. India just disregards copyright and intellectual property laws by manufacturing drugs once they hit the market. They can afford to do this cheaply because they incur zero research and development cost.

 

[sekio]

the dose is only like ~40mg of S-ketamine... psh... how are you gonna K-hole then?

 

[Foreigner]

I did an extensive self-study on ketamine for depression that I posted about here. It is most indicated for depression where past trauma is involved, as trauma causes downregulation of the pre-frontal cortex. Ketamine repairs these synapses, but only at threshold doses. At least, that's what I found for myself.

Jamshyd (RIP), who I referenced in the above link, tried the nasal method as well as the injection method. He found the IM method much more precise and effective. So did I.

It's great that a nasal formulation will be made available to people. It's better than nothing. I just don't think the nasal ROA is as effective. Also if the patient receives a dose higher than threshold (i.e. they get high), I don't know how effective ketamine will be. Ketamine seems to function as a nootropic restorative at sub-threshold doses. Once you start getting high, it does the opposite and there is neural degradation with chronic use.

It functions differently at different doses. You could theoretically do neurological harm with chronic recreational doses, and then repair the damage with sub-threshold doses. K-holes have a different function entirely.

A lot of people report that when they do the IV therapy or get k-holed, they feel better for a while and then their depression returns. It's because people with chronic depression do better with chronic, sub-threshold dosing. You want to repair the synapses without blasting them. It's delicate work. Also cocomittant use of other drugs will create an unpredictable effect on this approach. Really, people doing K therapy should not be taking any other mind altering substances, Rx or otherwise.

I stopped using ketamine for unrelated reasons, but I might revisit this again. I got to the point where I only needed a 10mg IM shot once a week to avoid depression. However, since then I have discovered that magnesium (in the form of magnesium sulfate IM injections) has been much more instrumental to avoiding depression. As it turns out, magnesium regulates the same NMDA receptor voltage gates that ketamine acts upon in the pre-frontal cortex. In the future, I will do magnesium injections alongside my ketamine IM therapy because I know they will work well together.

The biggest thing ketamine did for me was it got rid of that depressive brain fog that keeps your thoughts running in loops and prevents you from seeing solutions. Psychedelics like LSD and mushrooms were a big feature in my life at that time, along with cannabis, but none of them helped my depression like ketamine.

The problem with the nasal formulation is that it's ridiculously expensive, almost $5000 USD. Probably similar in Canada, where it was also approved. This means that, ironically, it's more cost effective for me to buy street ketamine and formulate my own injections again. Unfortunately my old supplier of pure K disappeared so this won't be an easy task.

I don't have enough experience with the (S) enantiomer to know the difference between it and the racemic version. The research I've read shows that the (S) is a stronger dopamine reuptake inhibitor, which is partially similar in action to how SNRIs like Cymbalta work. So if you have experience with SNRIs working for your depression, then the (S) may work well for you.

I think there can be different reasons for depression and not all of them reside in the brain. For example some people whose depression is helped by stimulants may have an endocrine problem, which is rooted in mineral deficiencies or something to do with the HPA axis. Ketamine would do jack for these people. It's best for people who have brain damage from PTSD.

 

[ro4eva]

A very interesting read, Foreigner. Thanks for sharing that.

 

[Gregorio888]

Agreed, very interesting to read Foreigner.

As to the price issue, I'm afraid that is true with any legal ketamine treatment for depression that was ever going to receive FDA approval. CJ explained in post #30 in this thread a large part of this problem for prescription drug expenses in the US versus other countries. The good part about FDA approval is that people, like myself, who don't have access to Ketamine can start receiving it. And that as phase 4 trials start rolling out, if those phase 4 trials continue to show good response rates, insurance companies will be forced to start covering most of the cost, (or maybe they already are? I'm not exactly sure how that works.) So that $5000 bill will be dramatically cut on the patient's end (and the price will (hopefully) lower the more people use it, and it will eventually go generic.) Maybe not as cheap, depending on your health plan, versus black market costs, but a lot of people could benefit from this, since many of those who need it know nothing about the black market, would incorrectly treat themselves with sub quality product, and expose themselves to dangers they don't understand, and incorrectly use treatment protocols (not to mention break the law.)

As for my statement/rant about drug prices in the US. When I was a child I knew a man who was a physicist and multimillionaire. He saw an opportunity to potentially create 2 different drugs, which would go on to save and improve lives to this day. He assembled his team (since he really just had money and vision, he needed biologists to create the drug using never before used techniques for human use.) The drugs were a hit and still are today, and he was more than happy to sell his shares of the company off for I don't know how much money, probably $50-$100 million or so (I really don't know here.) He treated his employees and their families very well, and once they were able to successfully make the drug, they pushed through FDA approval as fast as possible and were delivering their product the day after its approval. He was an intelligent, kind, millionaire, who saw a chance to make a ton of money, and save 10s (100s?) of thousands of lives in the process. (I'm not saying he's perfect, if he was he could have given the drug away for free minus the research/employee costs, but he bet a huge sum of his money, and the other companies racing towards creating the same or similar drug all failed, so it was a big gamble.)

Unfortunately, that's not the type of person who owns that company today. It's run by your stereotypical BigPharma jackasses. One CEO laid off thousands of employees, while at the same time purchasing his SECOND PRIVATE JET, with the companies money, for HIMSELF PERSONALLY. The company still works on important products, but it isn't run by the type of person who helped found it with other investors, and ran it as its first CEO, it's run by "I need to 2 jets for inexplicable reasons, while I fire tons of people at the same time" type of people. And unfortunately that is the majority of the pharmaceutical industry (the top-level corporate side at least.)

It is true that people drastically under estimate the research and development costs of drugs significantly. And people like the man I knew as a child took a huge financial risk, as did many others for other companies, all of which failed as I said earlier. And betting big money usually means losing big money or making big money. But most of the industry (at the high end corporate side at least) is run by people in it for profit. Making "me too" drugs like Nexium and Pristiq, which offered ZERO value over there predecessors (and weren't expected to,) except that they could be sold for way more money, but because we can't bargain for prices, like cj said, we're stuck with the price tag they give us.

If the government would just change that rule, prices would drop here in the USA dramatically, wealthy countries around the world like Canada and England would have to pay some what more but not a ton, and things would be even out. Then we need to incentivize companies trying to create something truly new and important, and de-incentivize companies that make SSRI #87 or whatever, hopefully spurring them to look for truly different drugs. /Aaaaanndddd there's my rant of the day.