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News Bluelight Research on Ketamine as a Treatment for Depression and PTSD

Bluelight Research on Ketamine as a Treatment for Depression and PTSD


Bluelight would like to congratulate Tharcila Chaves and her colleagues on their recent publication: The use of ketamine to cope with depression and post-traumatic stress disorder: A qualitative analysis of the discourses posted on a popular online forum. The paper was published in The American Journal of Drug and Alcohol Abuse.


The abstract is quoted below:

Background
Because of the shortcomings of traditional pharmacotherapy for major depressive disorder and post-traumatic stress disorder (PTSD), there has been growing interest in the rapid mood-enhancing effect of ketamine.

Objectives
To analyze what has been posted about ketamine use for dealing with self-reported depression and/or PTSD on one of the biggest international message boards on the internet.

Methods
Qualitative study with online observation of threaded discussions on Bluelight. In-depth online searches were conducted in 2018. Twenty-nine threads, with a total of 708 units of analysis, were selected and subjected to content analysis, where, via a coding process, the units of analysis were organized into nodes.

Results
Despite having several negative effects (e.g. dizziness, nausea and inability to talk), the examined discourses suggested that the use of ketamine to elevate mood was both efficient and worthwhile. Intranasal use was the most common route of administration mentioned. We traced how the mood enhancement caused by ketamine is perceived: the loss of pleasure disappears, as well as the depressed mood; the markedly diminished interest in activities vanishes and motivation comes back. From all the posts analyzed, only two reported negative outcomes (i.e. no mood-enhancing effect). The most mentioned adverse event was damage to the urinary bladder and the kidneys in cases of misuse.

Conclusion
Although online research of user-generated content has its limitations in terms of reliability and validity, the present study adds relevant information on the use of ketamine for managing depression and PTSD, whether this use is done legally or not.



Annotated version of the final paragraph in the conclusion of the article is quoted below:

Ketamine appears to be a potential tool in managing depressive symptoms. The increasing popularity of ketamine clinics and the FDA approval of esketamine for TRD (treatment resistant depression) say a lot about the current status of off-label ketamine: it seems to work in several situations and people are already benefiting from it (not only people living with depression or PTSD; another popular off-label use of ketamine is for treating chronic pain). Ketamine has the potential to benefit a big group of patients who do not respond to the available therapies. It is considered by the World Health Organization an essential medicine and restricting it has harmed patients, with no reduction in recreational use. More scientific research is needed, naturally, but there is already a substantial amount of data suggesting that ketamine is effective and safe. “If they don’t bring us the treatment, we will make it ourselves”, a T1 member stated (Bluelight quote from thread no. 1). From the black market to the white coat, ketamine as a mood enhancer has been presenting positive results in handling depression and PTSD, giving a novel approach to the pathophysiology and therapy of these conditions.


I think we should be proud to have contributed to an article that advocated greater availability of ketamine as a medicine for depression and PTSD. :)


Note that the full-text article is behind a paywall, but if you have issues accessing and want the pdf, send an email to [email protected]
 
Well apparently we have no treatment-resistant depression or PTSD patients around these parts! Nice to know!

Obviously I've gone down this rabbit hole now to an extent since my last post above. If for no other reason than to answer my own questions in said post in part.


Before I begin:

I don't know if this actually matters to anybody but it may be worth noting that the link to BL shown in the study no longer works. I can only assume that there used to be a thread entitled "Bluelight Research Standards" and which has been renamed or removed since the study was done. The BL link to which the study links (in the references section no. 50 is shown below).


It's a pleasure. Just remember me if I ever decide to want a username change is all (like getting my alt back which I'm still fuming about! :ROFLMAO: ).


Moving on to the actual topic.

While there's hope with this drug: it's not the miracle, nor any permanent, cure. I've seen so many websites in just the past few days where it's purported to be such. Fact of the matter is: most all proper studies and research papers are very specific in noting that Ketamine treatment is to be in ADDITION to other and ongoing treatments.

In spite of some few general claims to the contrary: the immediate mood lift and cessation of suicide ideation is pretty short lived. But there doesn't seem to be much dispute about the immediacy part though. And that's important. And here's why. Antidepressants (the usual suspects) can in and of themselves actually accentuate depression and suicide ideation upon beginning treatment. Therefore: it makes sense to treat with Ketamine infusion when starting a treatment with antidepressants (the usual suspects). That's if the price of said Ketamine infusions isn't enough to push you over the edge to start with!

To have any type of lasting effect (which and for my reasons given above is arguable): multiple infusions over time are required so far as I can tell. And NOWHERE are they cheap.

These infusions are effective at BELOW anesthesia levels (0.5mg/kg and possibly up to 1mg/kg). Heroic one time doses don't count. Unless you're wanting to get high of course (I assume anyway i.e. never been on my radar this stuff).

It's true that an Esketamine (an isomer of Ketamine) nasal spray was approved by the FDA. Unfortunately: the cost of said nasal spray is off of the charts and caused much consternation. And in looking up current pricing: not much seems to have changed since its being brought to market either. Multiple doses at certain intervals throughout a day can be required and that can add up REAL quick over a given period (month).

Somebody noted earlier on in this thread that they were refused treatment due to their use of benzodiazepines. Well. There's a good reason and studies done as to why this is the case. In short: benzodiazepines attenuate Ketamine's effects thus making a Ketamine infusion a waste of time and money. To this end, and included as a link on the link below, there's a whole paper on this (depends on how much and how badly you want to know about all of this i.e. it's pretty detailed). The link, and paper, is entitled "The Antidepressant Effect of Ketamine Is Dampened by Concomitant Benzodiazepine Medication".

The link below has some external links that some may find interesting (in addition to the above). The website itself also has some more interesting information and questions and answers. I've been through it/them at length. And although Ketamine infusions are their business: I can say with relative personal confidence that the information is open and honest i.e. they're not overselling and claiming miracles is my point and nor are they hiding anything either. In addition: I provide the link to their literature (for Professionals) page in order to make the same available here (other choice would be to download all and upload to another site and I ain't in the mood for doing that).





It should be noted; I'm not a medical professional. The above simply my own attempt to separate some of the wheat from the chaff in this regard is all. And If I've erred in my endeavors: I'm pretty sure a professional will chime in and rip me a new one. But until that happens: the above is my take. And it goes without saying that any that have had such treatments and whose actual and real mileage is totally different compared to my take: your criticism and correction is welcome and valued (if not by me then at least by others that come across this! :ROFLMAO: ).


As a side note and something that jumped off of the page at me when reading the paper entitled "The Antidepressant Effect of Ketamine Is Dampened by Concomitant Benzodiazepine Medication" referenced above:

"Moreover, BZDs (benzodiazepines) have been identified as a possible causative factor for treatment resistance in depressed patients."

There's a little nugget you don't see mentioned all too often! Although there is a link in the paper to another study on this very topic.

Enjoy.
 
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Shame it is so expensive. Sounds like a really good jump start to get your body going until the AD's can kick in. Why do the treatments that people need the most seem to be out of range to the people that need them most. Guess you have to be rich or have killer insurance to get any relief.

Nice post and interesting about the benzo contraindication. Makes sense, though.
 
Shame it is so expensive...

Why do the treatments that people need the most seem to be out of range to the people that need them most. Guess you have to be rich or have killer insurance to get any relief.
Yeah. Ain't that the truth.

Come to think of it: I'm handling this badly and shooting myself in the foot! For sure that commission check from J&J ain't gonna be in the post this month! Not after my last post anyway! 😭

Now where's that "One Pot Synthesis Of Veterinary Special-K In Minutes" book that I found the other day? :unsure:

Ya'll can call me "Dr. K. (PhD)" from now on! :ROFLMAO:
 
I'm on about my 5th Spravato treatment. I'm on a Valium taper ( 4mg per 24hours atm ) and it works very well for me

Also am a daily user of kratom. I can't say I feel bad atm though it's no magic bullet
 
I'm on about my 5th Spravato treatment. I'm on a Valium taper ( 4mg per 24hours atm ) and it works very well for me

Also am a daily user of kratom. I can't say I feel bad atm though it's no magic bullet
Your 5th Spravato treatment? You must be financially loaded! What's there to be depressed about? :ROFLMAO: I take it you're going to be receiving my J&J commission checks from now on to boot? :ROFLMAO:

On a serious note: thanks for posting. It's nice to hear from somebody that is actually being treated with it and that is having positive and as advertised results. And let's be honest: when it comes to depression or PTSD the means justifies the ends. If you have to keep the treatment up for a lifetime and it works well then so be it. :)

I think what got my nose out of joint really was a fair number of depression , anxiety, and suicide support group websites extolling the virtues and miracles of Ketamine infusion treatments and only telling half of the story. When somebody is looking at sites such as those: the last thing they need is to be disappointed or to find out that for most said treatments are financially out of reach. I'd go out on a limb and say that most that have arrived at those sites are not simply perusing them to pass the time.

Thanks again for posting. I sincerely wish you the best.
 
I have medicare and I think my doctor was surprised that the insurance Ok'd it.

It's 700 dollars per week. I asked my doctor about the regular ketamine HCL nasal spray and he said it's much cheaper, but not approved. I have heard of tele docs ( whom exactly I don't know ) Rx'ing Ket. nasal spray and/or troches. He mentioned that the Ketamine HCL was "not approved" so does that mean he can or can't Rx it?

I don't get how this crap works
 
I have medicare and I think my doctor was surprised that the insurance Ok'd it.

It's 700 dollars per week. I asked my doctor about the regular ketamine HCL nasal spray and he said it's much cheaper, but not approved. I have heard of tele docs ( whom exactly I don't know ) Rx'ing Ket. nasal spray and/or troches. He mentioned that the Ketamine HCL was "not approved" so does that mean he can or can't Rx it?

I don't get how this crap works
Good morning.

And lovely to hear from you. And thanks for the update. Just the kind of thing that gets me going down rabbit holes! 🙂

First instinct when seeing your update: follow the money!

In short:
  • Janssen Pharmaceuticals, part of J&J, split the ketamine molecule and patented it as esketamine (it was not possible to patent ketamine itself as it had already been patented in 1966 by Parke-Davis for use as an anesthetic in humans and animals and said patent expired in 2002).
  • Esketamine is the active ingredient of Spravato®.
  • Spravato® is a registered trademark worldwide, belongs to Janssen Pharmaceuticals, part of J&J, and is the brand name of esketamine.
  • It is covered by no less than three US patents and nineteen International patents.
  • In addition and in the USA the research data etc. is also protected. In short this just means that any other company that intends to produce a generic at some point in the future would have to do their own research and clinical trials etc. and which is cost prohibitive. In Canada this has been rejected and pretty recently too (see below).
So that's the summary!


Here's the information from the FDA's so-called "Orange Book":



But now (earning my keep here i.e. in defense of big pharma.):

Let's bear in mind that it costs somewhere around $1B USD to bring a drug to market nowadays give or take. By comparison and in the 1960's (when Fentanyl was first synthesized by none other than Dr. Paul Janssen) it only cost $75M to bring a drug to market and hence the need for patents and the like. Controversial issue of course (and possibly even more controversial in this case) but were it not possible for big pharma. to obtain patents and protection in order to recoup their R&D costs and make a profit then they'd not invest in new pharma. Also the reason why the first to market and brand names are always expensive. It's arguable in this case though i.e. ketamine existed long before esketamine. And there's more than a few articles and papers floating around that call into question the validity of the clinical trials in this instance.


The general consensus and argument re: ketamine vs. esketamine (for example) seems to be that big pharma. is creating analogs and patenting the analogs. Probably good and well generally speaking and that's the way it works but, as noted, contentious in this instance. There's also an argument being made that ketamine itself for this application has not been given a fair rub vs. esketamine (for example). Full disclosure though i.e. most of the arguments in the case of the latter are being made by ketamine clinics and who obviously have a vested interested in ketamine infusion treatments i.e. Spravato® obviously doesn't suit.


Canada ruling (loads on info. on patents and data protection and the ramifications thereof):



Last but not least Spravato even got its own website :ROFLMAO: :

 
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@dalpat077 Most of my free time is taken up studying these things, and I have studied ketamine recently. I was asking my doctor about the cheaper ketamine HCL spray, he admitted it was cheaper but "not approved" for use in depression.

I have been told that some of these tele docs have Rx'd ketamine HCL nasal spray ( once per day I think ) so I wonder how they are going about this if it's not approved? Pharmacist just going along because it's a money making tele doc business connected with a compounding pharmacy? or is he doing something putting "For Migraine" on the prescription?

I was at my Grandmother's once, and looked near the sink and she had some beloved ketamine HCL 50mg per spray nasal spray. I took one hit, but didn't take it because I don't do those types of things, but obviously from what I've seen doctors can Rx ketamine for various things. I think they just side step it and say "this is for X approved ketamine indication"

Thanks for your extensive reply though
 
Good morning.

Apparently you and I are the only two interested in this! I would have thought that by now one of our resident medical professionals (there's been one or two that have claimed to be such) would have chimed in and given us the low down on how prescribing actually works. Anything I say on the topic is pure conjecture.

In musing: I wonder if it's got anything to do with the condition and specific indication? In other words and as I understand things in the US: there's certain conditions that obligate the medical professional to provide treatment (treatment could arguably be a simple prescription). Depression, accompanied with suicidal thoughts or tendencies, being one of them from what I gather. Maybe along the same lines as what has been touted as a root cause of the opioid epidemic i.e. medical professionals having no choice but to write an opioid prescription once pain had been deemed to be the fifth vital sign (and patients were merely required to, subjectively, rate the scale of their pain).

Whatever the case above: it'd be a bit of a shame, I'd say, if ketamine nasal spray was being produced and was legitimately available to Joe Public (with a prescription) given the cost of Spravato® treatments.

I removed my reference, in my previous post, to the Texas online pharmacy for the above reason. I figured that I cannot in good conscious be raising doubts about them when they are indeed registered with the FDA as a "Human Drug Compounding Outsourcing Facility" under Section 503B of the Federal Food, Drug, and Cosmetic Act (FD&C Act). And they're not some faceless and obscure outfit that only has an online presence either (and that only accepts Bitcoin! :ROFLMAO: ) i.e. far from it. And while it's true that the FDA did issue a warning notice to them (after an inspection) that's all it was (albeit that the outcome is still pending according to the FDA's own website). And there's only two recent media articles about them to boot (and in one of them THEY are suing Iowa's State Licencing Board over a hormone of all things). Point being that my making a noise about them is probably unfounded, an overreach, and could be precluding those in need but that cannot afford to pay for Janssen's R&D! :ROFLMAO: And I'm assuming this will elicit yet another (direct) response from a pharmaceutical company! :ROFLMAO: I sure do have a knack for shooting myself in the foot I'll tell you! Oh well. You lot (big pharma.) should have taken me more seriously when I offered my services (but I'm still open to negotiation i.e. posts can be edited or deleted ya know)! :ROFLMAO:

Anyway. Let us all know how you get on if you keep digging. I think this is a rather unique situation and an important topic i.e. the distinction between ketamine and esketamine being indicated for the treatment of depression especially given its prevalence worldwide (according to the WHO) and its sometimes devastating consequences. And while I've nailed my colors to the wall in saying that this isn't the miracle cure that it's made out to be: there's far too much research and scientific information on this for it to be simply dismissed out of hand by the likes of yours truly (me). My only word of caution here, I guess, is to emphasize that nowhere is ketamine or esketamine on its own indicated as a treatment for depression i.e. always (esketamine anyway) indicated and approved (esketamine anyway) for use in conjunction with the other usual suspects (SSRIs, SNRIs, etc.). But that based purely on my own research and reading and interpretation thereof of course. 👨‍⚕️

Like I said. Let us all know how you get on and, more importantly, how you're doing. Because let's face it: you're the only one here that can post informed comments as to the effectiveness of said treatment i.e. I'm merely regurgitating information that's been subjected to a fair amount of mental gymnastics on my part is all.
 
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I've been receiving esketamine weekly since around summer 2020. I'm on disability in the USA, so I'm on Medicare and a part D drug plan. I also have a private Medigap insurance, $3600/yr. My medical bills are completely covered by insurance.
Esketamine and my other multiple drugs me cost about $3700 /yr. I know that people on Medicaid in New York state, low income, can receive esketamine at low cost.

Esketamine has been very successful for me. I have been to stop or decrease some medications and am much more functional. My program has taken lots of work to set up. I have contact with my psychiatrist and therapist weekly. I also benefit greatly from hypnotherapy weekly since 2012.

I have to add on that esketamine makes you quite sleepy and you should not drive yourself home after receiving a dosage. Uber time. This adds to the cost.
 
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I've been receiving esketamine weekly since around summer 2020. I'm on disability in the USA, so I'm on Medicare and a part D drug plan. I also have a private Medigap insurance, $3600/yr. My medical bills are completely covered by insurance.
Esketamine and my other multiple drugs me cost about $3700 /yr. I know that people on Medicaid in New York state, low income, can receive esketamine at low cost.

Esketamine has been very successful for me. I have been to stop or decrease some medications and am much more functional. My program has taken lots of work to set up. I have contact with my psychiatrist and therapist weekly. I also benefit greatly from hypnotherapy weekly since 2012.
Very nice post. Thank you for it. Looks like a success story to me. Sincerely hope things continue to improve for you. :)
 
i would so love to be a part of one of these researches. i know i fit the bill in all respects.
will do the research cause im sick of being sick.
 
they don't allow you to do the program if on suboxone which i found to be really backwards. Lots of people are struggling with addiction who have depression, so i wondered if this company really wants to change things for people or just wants to make a buck.
 
Shit if I weren't taking the CBT route I might look for some don't think they have it aorund here yet tho
 
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