I did a full 6 week course of ketamine therapy. It was really good, and I would recommend it if you're open minded. It's not for everyone, and the lasting (a year+) benefits aren't really measurable (maybe I'm different? maybe I'm not, maybe I've just gotten older). I'd like to go again and see if it can help with my obsessive existential dread.
Absolutely, I have a partner who has had severe PTSD and went through a great month-long program, she's overcome many longstanding fears and triggers and has made huge strides in being able to feel that she is living her life once again.
I wonder what the age limit is on stuff like this. So many young folks experiencing crippling anxieties that are impacting their ability to navigate the world at an age where it's going to have longstanding ramifications for relationships and careers.
I have a close acquaintance who uses ketamine to manage depression and Complex PTSD. My experience as a bystander is that the depressive symptoms reoccur periodically regardless of the use of ketamine. The depressive symptoms seem to be caused by the PTSD, and ketamine does not seem to alleviate the PTSD.
I'm saying this as a huge fan of the positive impact of ketamine.
There are some symptoms that seem like they need more rewiring.
C-PTSD is probably the simplest way to summarize what I’ve been dealing with (I’m not totally comfortable with the label).
I’ve done 20 ketamine sessions over the past 2 years (the last one about 5 months ago). I agree with you that a lot of the immediate relief from an infusion can fade after not that long. However, combined with some of the other work I was doing there was a slow accumulation of benefits and new perspectives on life.
Overall, the infusions definitely helped… it hasn’t been easy going though, and I have been continuing to work on myself.
A few months ago, I finally found a therapist who I felt was actually helping me. I had tried a few different therapists in years past and it wasn’t that helpful. My current therapist uses a lot of “somatic therapy” in her work, which I think is really important. With trauma, talk alone won’t get you very far.
I’ve made a lot of progress since November when I started seeing her. I think the Ketamine and the work I had been doing on my on own “prepped” me in a certain sense.
Your friend might benefit from finding a good somatic therapist.
I did 2 surveys and a phone consult then a baseline depression survey before my first infusion.
I go to the clinic and go in my room and they give me my IV then the doctor hangs the ketamine mix bag, hooks it up and leaves. The rooms are dark and they have colored lights or a dim light. I wear an eye mask.
I pay extra to receive talk therapy during the infusion so I have a therapist with me the whole time. We do a ceremony to start each infusion and set the intent just before the effects start.
Depends on the place, there really isn't much regulation for it where I went. I made an appointment, signed all the papers and got started. It's very expensive ($400-$600 a week).
They have a head doctor and then an anesthesiologist that handles the actual infusion.
There is the "trip" side affect which lasts about 30-45 minutes. Then there is some wobbly legs and slow speech for an hour or two after. I had no side-affects besides those.
physical sensations: Yes. I often feel like a going on a journey. I've stood at the top of an endless drain pipe, holding hands with my brain, before jumping in.
colorful emotions: Yes. I've gone inside a rainbow and swam in a lake of my own feelings
The biggest thing you do is disconnect from your self. I've become the particles I'm made of and often lose the sense of what it is to be human or if I am human or not.
The trip itself is fun. It'll get scary if you don't let yourself go, but it was really manageable. You are heavily sedated obviously, so you can't drive or do much after. Mentally its exhausting, and akin to spending all night studying. You will probably have a headache for the rest of the day.
> Then, patients received a first 40 minute intravenous infusion of ketamine (0.5 mg/kg) or placebo 0.9% (saline solution) in addition to their current treatment.
This really shouldn’t be labeled as double blind.
1.The nurse administering knew if it was placebo or active (for safety reasons).
2. It would immediately become obvious to the subject if they were injected with salt water or ketamine.
3. Within minutes it would become obvious to everyone in the room if the patient was injected with salt water or ketamine.
Some trails are impossible to be double blind. That’s okay, there are other ways to address concerns of internal validity. Pretending like this trail is double blind does not address any internal validity concerns, and only raises concerns about the researchers understanding of experimental design.
Injecting someone with another psychoactive drug would not be a placebo. We would be comparing the efficacy of {other psychoactive drug} and ketamine. That's not to say this experiment has no value, it's one of the many experiments we should run to help build the case for ketamine.
The classic gold standard is to randomly assign subjects to groups. Then give one group a sugar pill, give the other group the treatment pill. Neither to patient, the person administering, or the person recording the results know who got the treatment who got the placebo. This is not possible with ketamine, psilocybin, MDMA, LSD, etc. That's fine, we can still build a strong body of experimental evidence of their efficacy. It bothers me when clearly non-blind non-mask experiments are labeled as double-blinded, which we see often in this body of research, this study included.
There is precedent for this; it's called "active placebo." For example, I think some of the psilocybin trials used methylphenidate as an active placebo comparison condition.
Sure, but as a scientist conducting an experiment I will be able to determine who is dosed with psilocybin and who is doses with methylphenidate >90% of the time, thus removing the observer mask. I think the average patient would be able to tell if they were dosed with psilocybin or methylphenidate, even if they were drug naive, thus removing the patient mask.
I'm not saying it's impossible to conduct good experiments on these substances. I'm saying that they require special considerations of internal validity and it's incorrect to call this study (iv ketamine vs iv saline water) double blind.
The person assessing the depression response in the psilocybin studies is not in the room with the person while they are under the influence of the substance. The ratings are done on a different day. It's two different people to preserve blinding.
My psychiatrist administers IV ketamine treatments for depression. (I don't use those; regular antidepressants work for me.) I'm not sure what dosage she uses, but from what she's told me, it's not a drug trip, and a lot of people don't feel any different during the treatment.
Mmh, not sure. I received a prescription for a drug from my doctor, now I use (or 'take') that drug/medicine once a day.
It's common for those wordings to be used because often it literally is a handing over of drugs you're talking about - with sickness you're more likely to talk about the moment a medical person said to start using a drug than to tell people about the actual use because it's usually more interesting.
The person is saying their doctor administers this treatment to other people, but not to them. And that the doctor has said the patients receiving the treatment do not experience a drug trip.
> My psychiatrist does IV ketamine treatments for depression. I'm not sure what dosage she uses, but from what she's told me, it's not a drug trip, and a lot of people don't feel any different during the treatment.
At 0.5mg/kg intravenous, there's no way that people wouldn't feel anything. It's not necessarily a "drug trip", but pretty much anybody can tell the difference between that large of a dose of ketamine vs. a saline solution.
For trials in cases like this, it's common to use a group which receives either a smaller dose of the drug or a drug that is intended to mimic some of the subjectively observable side effects.
I’m sorry but you are strongly over exaggerating the (side) effects of i.v. ketamine. It’s not a dose that sends you in a K hole. It’s way less than that. Some get sedation and some do get dissociative symptoms which can unmask the study arm of the patient. Approximately one out of ten got at least one of those side effects. Sedation can be mimicked with midazolam, so if you use that as placebo, you get 90 % of the patients that are not obvious, which medicine they got. I do agree that a better ”placebo” would be good to use.
The problem with ketamine and suicidality studies is that suicides - thankfully don’t happen very often - so we have no direct evidence that ketamine prevents suicides. Of course if it would only alleviate suffering and wouldn’t increase the rate of suicides, that would be a win too.
> I’m sorry but you are strongly over exaggerating the (side) effects of i.v. ketamine. It’s not a dose that sends you in a K hole. It’s way less than that.
0.5 mg/kg intravenous. For frame of reference, a small recreational dose is between 5-25 mg (insufflated[0]), and a larger recreational dose (for people targeting a "k-hole") is more like 50-100mg. For clinical depression (ie, not this study, but for a similar purpose), the fixed dose is 84mg (not weight-based).
So assuming a 75kg individual, that would be a 37.5mg intravenous dose, which is definitely going to provide a noticeable effect for any ketamine-naive user (ie, someone who does not already have a tolerance for the drug from recent prior use).
> The problem with ketamine and suicidality studies is that suicides - thankfully don’t happen very often - so we have no direct evidence that ketamine prevents suicides.
That's not really a problem - suicidal ideation is a strong enough predictor for suicidality and mental health that it's common to use as a biomarker. In other words, nearly anything that reduces suicidal ideation is presumed to reduce suicidality (on a large scale) - it's not necessary to wait months or years to see what happens (and in fact, depending on the specifics of the study, it can be considered unethical to do so).
Source: former clinical researcher and drug counselor
[0] bioavailability when insufflated is significantly less than other means of ingestion
I agree about you second point. I was too quick to make my comment and I was conflating stuff I've read about nasal esketamine, which didn't have as robust evidence behind it as i.v. ketamine. I should not write comments while holding a baby that is trying to sleep and failing at it.
About the first point, I still disagree with the parent comment. The standard 0,5mg/kg ketamine is given under 40 minutes. I've seen two patients receive it. The room was dimly lit, silent and peaceful, as to not induce or exacerbate any possible dissociative or hallucinative side effects. The patients didn't report any side effects at first and later reported a little sedation. I wouldn't be a able to tell with certainty if they had received a placebo or ketamine, and certainly not within minutes.
Source: psychiatrist in training
Edit: I still think we need hard data about anti-suicide effect and not just surrogate markers. Variability in suicidal ideation is suggested to be a predictor of suicide attempts [1]. If ketamine first gets someone better and later on they relapse, they could, in theory, be at increased risk for suicide. More long term data is also needed about it's long term effects. Note that I do think it's a good thing that ketamine is becoming more available! I will continue to suggest it for e.g. patients with treatment resistant and severe depression.
Thanks, I appreciate your comment and experience. I agree that if one was to get those effects, one would be quite unlikely to suspect placebo. I hope you got the help you needed from ketamine.
It sounds like those patients were in a very nice calm place. During my K infusions (30-50mg/hr for 7 days) for chronic neuropathic pain I was in a single room in a hospital. There was enough to see and hear that the mind took them and ran with them. I had a fight with a shower curtain because it said I wasn't clean yet. I had conversations with my toothbrush and hairbrush. It took 24 hours for my daughter's reporting that a puppy had died to make sense.
And I'm not drug naive by a very long shot. On my 2nd infusion there was an older gentleman across the hall from me who had never had anything stronger than scotch whiskey. He was not having a good time at all.
7 days falling in and out of the K-hole while hallucinating is not as much fun as it sounds.
I don't think I am exaggerating the noticeable effects of i.v. ketamine. Patients given i.v. ketamine are advised not to operating an automobile hours after administration. This level of impairment would be noticeable to the patient and the staff administering the treatment.
Advice not to operate an automobile is for minimizing risks. It doesn't mean that most would be unable to handle a car, although it could mean that their reaction times would be slower. The standard way to administer ketamine is to give 0,5 mg/kg under 40 minutes. It would in no way be immediately obvious to everyone in, if someone began to receive ketamine or not. At least I couldn't differentiate them at that point.
Maybe you have more experience with patients at this specific dose range than I do. I remain skeptical this could be double blind, but do have less certainty than I originally started with.
I do agree with your skepticity. A better study design could use midazolam as placebo. And I think a good idea would be to ask the participants amd their physicians, which one do they think they received. That would give some idea about how well the double blind design did. Also, many commenters seem to disagree with me, which I also have to be take into consideration. My n is very low as my hospital has just started ketamine treatments.
IM and IV are going to be very similar. Smaller independent psychologist will do IM while bigger clinics with nursing staff will typically use IV.
At home treatments with sublingual trockies have much less side affects, but differently still noticeable. Nasal spray is the weakest with just some minor body numbing.
Going by a friends experience, infusion clinics need to be investigated more regularly by medical professionals. Co-worker went to one for treatment and from her recollection of the event they left her in a dark room with a white noise generator while she went down the k-hole. Terrified the living shit out of her.
Right it varies greatly depending on dose. If you don't know the exact dose your friend took (they don't sound like an anesthesiologist) then you're insulting someone you likely know much less than.
You generally can’t compare recreational and prescribed drug use, even for the same substance, because the doses tend to be widely different.
A lot of people take amphetamines as a medically prescribed treatment for ADHD (and other conditions such as narcolepsy too). A lot of people take amphetamines recreationally. Studies done on the negative heath consequences for recreational users are largely irrelevant to medically prescribed users, because your average recreational dose is an order of magnitude (or more) higher than the average prescribed dose. Increase the dose ten-told, it acts like a different drug altogether.
Plus, the irregular dosing schedule of recreational users probably isn’t helping either. And many recreational users try to get the drug into their bloodstream as fast as possible (injection, snorting, smoking), while most prescription drugs aim to be released more gradually (oral route, sometimes even extended release or an inactive prodrug such as Vyvanse/lisdexamfetamine)
The person you're replying to, from my interpretation, is saying that their friend had a ketamine infusion at a clinic. Nowhere do they mention recreational use
> Studies done on the negative heath consequences for recreational users are largely irrelevant to medically prescribed users, because your average recreational dose is an order of magnitude (or more) higher than the average prescribed dose. Increase the dose ten-told, it acts like a different drug altogether.
What you're saying applies in other cases, but in the case of ketamine, the recreational dose is one or two orders of magnitude lower than the clinical dose.
You can look at the study yourself to see what dosage was administered, then compare that to user-reported experiences on erowid if you're curious. And the study itself lists out the side effects they experienced.
Are you getting it all at once or as an infusion? Considering this is given as an infusion over 40 minutes, this seems to be a pretty mild dose consistent with mild analgesia and well bellow the recreation and dissociative doses based on all the charts I just pulled up, but I'm not personally experienced with K ;)
I've had K infusions for neuropathic pain, in comparable dosage rates, for up to 7 days at a time.
You certainly notice the effects of IV K. So do other people when you start to talk to a hairbrush. It's a bit draining after a few days though, and not terribly fun.
Inter muscular ketamine treatments were the only thing that helped my severe treatment resistant depression that included suicidal thoughts. They definitely had strong side affects. Complete disconnection, loss of the concept of humanism, I've gone inside a rainbow, held hands with my brain, etc..
The nurse administering it is most certainly liable for what s/he administers. It is a very big no-no to blindly administer a medication of which you cannot reasonably verify what it is. To push a syringe or start a pump of something that "could be ketamine, or could be NS" is walking an uncomfortable line for your license to practice nursing. Right patient, right medication, right dose, right route, right time. If you as a nurse cannot attest to all of the above when you push something, it is in error to push it.
>Right patient, right medication, right dose, right route, right time
Can't you achieve all of those by having someone else create the bag and then label it for the patient. The "right medication" is the one they're receiving as part of the study.
It's not like what they need to do is different if it's ketamine or saline.
The parent comment is absolutely correct. This is salt in the medical community by having a nurse that knows exactly what the patient is getting and a different clinician doing the assessment
How does it work in other clinical trials where you take a pill instead of getting an injection? Those are double blind all the time. They watch you take the pill, but they don't know whether it is active or placebo.
For that matter, a quick web search shows that at least some of the (injected) coronavirus vaccine trials were double blind. Seems like enough for someone in the next room to know if the maybe-ketamine injection is placebo, so they can unblind immediately in case of a bad reaction.
Exactly. The label says something along the lines of "IMP-#####" where "IMP" stands for 'investigational medicinal product' and the number is unique and tracked. Below that will be a dosage statement, a label with the patient's name and patient ID on it, and (in the UK at least) the legally-mandated words "keep out of sight and reach of children".
For orally dosed RCTs, often the pill making process is the way the blinding is done -- i.e. they're either in brightly-coloured gelcaps or a film or sugar coating. If it is a double-blind RCT it must be double blind. All of this will have been explicitly examined in the ethics statement for a trial and very, very prescriptively laid out.
That's interesting. I am only speaking from experience working in the ED as an RN and do not have any experience with studies like this that give medications that are not positively known (by myself). What you (and others say) actually does make sense. Thanks.
0.5mg/kg spread out over 40 minutes wouldn’t be as dramatic as you’re suggesting.
> 3. Within minutes it would become obvious to everyone in the room if the patient was injected with salt water or ketamine.
I think you’re mistaking IV infusion for injection. The dose is given slowly over 40 minutes, not as a rapid injection. The patient would barely have any of the drug in their system in the first few minutes. Given the short duration of action, it wouldn’t produce peak levels anywhere near what recreational users experience.
In the sessions I had with IV ketamine, it is very, very noticeable and fairly trippy. The eye mask and the music certainly help, but the ketamine is inducing some crazy sensations.
I don’t remember the exact dosages I received, but I remember it being in line with what I saw others reporting online from their experiences at a clinic.
> 2. It would immediately become obvious to the subject if they were injected with salt water or ketamine.
this is not part of the definition of double blind. There maybe drug effects and there may be placebo effects. If you don't know and the person administering it doesn't know, then the effects you report or measure are what is being studied over the group of people in the study.
> 3. Within minutes it would become obvious to everyone in the room if the patient was injected with salt water or ketamine.
Some vets use Ketamine as part of a multi stage protocol for euthanising animals, other vets just use a single drug protocol but I havent established what that drug is, but it just seems all a bit refined butchery to me!
Ketamine is supposed to be a disassociate drug, which I'm guessing is perhaps like an out of body experience or something. But I cant see how that can help with depression when people dont understand depression can actually be lots of things, but it has one overriding common element which is people remembering.
So unless people get something like dementia where recent memories seem to fade first and the earliest memories come back, I fail to see how K can help treat depression.
As for suicide ideation, well look around at what constitutes 1st world medical care! If you dont buy into the smiley faces because you might have grown up around medical professionals and heard the back office chats you might think twice about the authenticity of so called medical professionals! Not only that, its just a job for most, leave it at the door when your shift finishes, which is easier said than done especially if a dying patient seemed nice and innocent compared to an unpleasant angry dying patient.
I really dont know why we dont have legal euthanasia because being experimented on in the name of science is not something I'd let others do to me if I can help it, I am aware that some argue it would be a direction towards eugenics, but that goes on already in stealth with some medical procedures.
Morphine/Heroin is supposed to physically cause respiratory depression so you stop breathing and I guess the CO2 builds up past the 30% blood saturation point by which stage it takes about 2 mins for the body to shut down. As the CO2 levels reach that 30% blood saturation point, the body becomes increasingly stimulated which is why you see people thrashing around when drowning or asphyxiating. Having done sea rescue to stop someone drowning in rough sea's, you can say goodbye to all the training water rescue people get taught and just hope the panicking person isnt as strong as you and hope your lungs are better than theirs, because they will force you under and you will ingest lots of water so you have CO2 build up which spurs you on to shore ironically.
Obviously (going off things like trainspotting and peoples accounts), opiates are supposed to give you a warm fuzzy feeling as you slip into a deep sleep or unconsciousness I guess but not to sure, never done it not even in an operating theatre.
MAOI's the old style anti depressants are quite sudden in that they are like an on off switch for the brain, you dont remember or feel nothing and I think they were popular with people who wanted to end it, but SSRI's have replaced them as the new anti depressant treatment but their problem is you dont sleep properly on them so they introduce their own problems, but I'm not aware of any end of life properties in SSRI's other than they ruin your sleep and send you off the rails slowly.
But all the while, these chemicals still dont address the fundamental problem with depression which is remembering stuff that causes depression. Maybe depression should be treated more like PTSD, because depression seems to be an ego thing, where as talking to other people, PTSD seems to be more like what people associate as depression.
For bloke's I think the bio mechanical properties of testosterone would help many with PTSD, cant comment for women though, but the risk the police and medical lot dont want is some hulk losing it so the idea isnt entertained AFAIK.
Self preservation of institutions comes before everything else!
Edit: I should add, once CO2 blood saturation exceeds 30% it has a noble gas effect on the body, so anyone who remembers the periodic table should remember what noble gasses are and its why compressed gas companies go to great lengths to not enable pure noble gases getting into the hands of the public.
Biology and chemistry is just the mammalian equivalent of computer hacking.
Any issues with your bladder? Have doctors mentioned anything about the potential damage to the urinary system? This seems to be the scariest side effect.
I'm not OP, but I have some relevant professional (clinical) experience here.
> Any issues with your bladder? Have doctors mentioned anything about the potential damage to the urinary system? This seems to be the scariest side effect.
We're lucky because ketamine has been used for decades in inpatient settings at much, much higher doses than what is being used now for psychiatric purposes, so we have a good sense of its safety profile already.
Urinary tract and bladder issues are noted for long-term and frequent recreational users of ketamine, but not really for anesthetic use. The dosing schedule for psychiatric use is closer to anesthetic use than it is for recreational use.
The effects also are reversible if detected early and use is ceased, so periodic but infrequent treatment is unlikely to result in long-term damage, both because it's not frequent enough to accumulate, and because you can stop if it becomes a problem.
Good luck to you. It helped me a lot. I refresh it every three to four month with a single session and a 2 day of vacation away from everything in another town.
This suggests that ketamine is beneficial for people who are suicidal to prevent them from killing themselves. The claim that is generally made about ketamine and depression is that it can have a short-term resetting effect of someone's depressive symptoms (not necessarily at a suicidal level), making it possible to escape the black hole that otherwise can take weeks, months, years to come out of.
I'm not sure if you're kidding or not, but I do halfway-seriously subscribe to this idea. A lot of things that seem to have anti-depressive effects, ranging from sleep deprivation to TMS and ECT, seem to basically give the brain a whack in the hopes of having it recover into a "better" state.
> The primary outcome was the rate of patients in full suicidal remission at day 3, according to the scale for suicidal ideation total score ≤3. Analyses were conducted on an intention-to-treat basis.
Question: does reducing suicidal ideation reduce suicide? I mean, it sounds like it obviously should, but we've been wrong about this before. Many heart medications to reduce cholesterol worked great at reducing cholesterol without reducing heart disease!
All that said, reducing suicidal ideation is a worthy goal itself, even if it doesn't reduce suicide. I'm a full supporter of seeing this treatment move more mainstream.
I've been getting intramuscular ketamine weekly for my severe & treatment resistant depression while working on making progress towards actual recovery. As with participants in this study I wasn't one of the lucky "I did ketamine a few times and my depression was cured" folk, but it has a huge reduction in frequency and intensity of ideation, as well as pretty much completely removing self harm.
That said it's not a long term solution (because honestly its frustrating due to losing a few hours during the work week, inability to drive, etc) so I'm working with Drs to actually resolve things without regularly being stabbed :D
I wish the gap between clinical treatment and recreational use was bridged, and you could use a nasal spray on your own time a couple evenings a week instead of a daytime injection.
The nasal spray is less effective according to the clinical trials, and is patented minor variation on ketamine so is super expensive (though "hilariously" because ketamine is technically being used off label for treating depression insurance may decline coverage of the cheaper, more effective original)
There's also lozenge form which I believe some clinics allow you to take at home, but not sure of the effectiveness
The truly amazing thing here is how powerful the placebo control was, even despite the fact that as someone who's done ketamine IV treatment before, it's pretty obvious when you're on ketamine and when you're not.
"At week 6, remission in the ketamine arm remained high, although non-significantly versus placebo (69.5% v 56.3%; odds ratio 0.8 (95% confidence interval 0.3 to 2.5), P=0.7)."
FYI: Johnson & Johnson patented the S(+) enantiomer of ketamine and sells it as a nasal spray called Spavato. It's been FDA approved for depression since 2019. Although Spravato costs more on paper than regular ketamine, it's often less expensive for patients since it is covered by insurance (regular ketamine treatments are considered an off-label use and are usually not covered).
It's pretty awful though for a lot of people. Researchers outside of the US have published studies showing that s-ketamine has higher risk of dependency in animal experiments and lower long term efficacy for depression, like on par with placebo. If I'm remembering right there are a number of reasons for this and one of them is that r-ketamine seems to simulate neuroplasticity better, something related to BDNF in certain parts of of hippocampus I think?
While it probably works for some people, it's likely dangerous for many others.
Kenji Hashimoto and others have published numerous papers about this. It's not exactly under-researched. The incentives in the US are horribly misaligned.
Quite honestly it's upsetting that spravato even exists and there ought to be a huge class action lawsuit about this.
Yea, I agree. I wish there was some kind of organization that would seek FDA approval for racemic ketamine treatment of depression. It's cheap, and widely available. Unfortunately, without the incentive for a patentable product, it's unlikely to ever happen.
118 comments
[ 6.5 ms ] story [ 230 ms ] threadhttps://youtu.be/nC2fBe6U7lg
I'm saying this as a huge fan of the positive impact of ketamine.
There are some symptoms that seem like they need more rewiring.
I’ve done 20 ketamine sessions over the past 2 years (the last one about 5 months ago). I agree with you that a lot of the immediate relief from an infusion can fade after not that long. However, combined with some of the other work I was doing there was a slow accumulation of benefits and new perspectives on life.
Overall, the infusions definitely helped… it hasn’t been easy going though, and I have been continuing to work on myself.
A few months ago, I finally found a therapist who I felt was actually helping me. I had tried a few different therapists in years past and it wasn’t that helpful. My current therapist uses a lot of “somatic therapy” in her work, which I think is really important. With trauma, talk alone won’t get you very far.
I’ve made a lot of progress since November when I started seeing her. I think the Ketamine and the work I had been doing on my on own “prepped” me in a certain sense.
Your friend might benefit from finding a good somatic therapist.
I did 2 surveys and a phone consult then a baseline depression survey before my first infusion.
I go to the clinic and go in my room and they give me my IV then the doctor hangs the ketamine mix bag, hooks it up and leaves. The rooms are dark and they have colored lights or a dim light. I wear an eye mask.
I pay extra to receive talk therapy during the infusion so I have a therapist with me the whole time. We do a ceremony to start each infusion and set the intent just before the effects start.
They have a head doctor and then an anesthesiologist that handles the actual infusion.
what about side effects also ?
colorful emotions: Yes. I've gone inside a rainbow and swam in a lake of my own feelings
The biggest thing you do is disconnect from your self. I've become the particles I'm made of and often lose the sense of what it is to be human or if I am human or not.
This really shouldn’t be labeled as double blind.
1.The nurse administering knew if it was placebo or active (for safety reasons).
2. It would immediately become obvious to the subject if they were injected with salt water or ketamine.
3. Within minutes it would become obvious to everyone in the room if the patient was injected with salt water or ketamine.
Some trails are impossible to be double blind. That’s okay, there are other ways to address concerns of internal validity. Pretending like this trail is double blind does not address any internal validity concerns, and only raises concerns about the researchers understanding of experimental design.
But I suspect that would take many years to get through the permitting apparatus, if it was at all possible.
The classic gold standard is to randomly assign subjects to groups. Then give one group a sugar pill, give the other group the treatment pill. Neither to patient, the person administering, or the person recording the results know who got the treatment who got the placebo. This is not possible with ketamine, psilocybin, MDMA, LSD, etc. That's fine, we can still build a strong body of experimental evidence of their efficacy. It bothers me when clearly non-blind non-mask experiments are labeled as double-blinded, which we see often in this body of research, this study included.
I'm not saying it's impossible to conduct good experiments on these substances. I'm saying that they require special considerations of internal validity and it's incorrect to call this study (iv ketamine vs iv saline water) double blind.
[Edited to clarify.]
It's common for those wordings to be used because often it literally is a handing over of drugs you're talking about - with sickness you're more likely to talk about the moment a medical person said to start using a drug than to tell people about the actual use because it's usually more interesting.
At 0.5mg/kg intravenous, there's no way that people wouldn't feel anything. It's not necessarily a "drug trip", but pretty much anybody can tell the difference between that large of a dose of ketamine vs. a saline solution.
For trials in cases like this, it's common to use a group which receives either a smaller dose of the drug or a drug that is intended to mimic some of the subjectively observable side effects.
I do not know what a trip is or is not supposed to be like but it was a very wild sensation.
The problem with ketamine and suicidality studies is that suicides - thankfully don’t happen very often - so we have no direct evidence that ketamine prevents suicides. Of course if it would only alleviate suffering and wouldn’t increase the rate of suicides, that would be a win too.
0.5 mg/kg intravenous. For frame of reference, a small recreational dose is between 5-25 mg (insufflated[0]), and a larger recreational dose (for people targeting a "k-hole") is more like 50-100mg. For clinical depression (ie, not this study, but for a similar purpose), the fixed dose is 84mg (not weight-based).
So assuming a 75kg individual, that would be a 37.5mg intravenous dose, which is definitely going to provide a noticeable effect for any ketamine-naive user (ie, someone who does not already have a tolerance for the drug from recent prior use).
> The problem with ketamine and suicidality studies is that suicides - thankfully don’t happen very often - so we have no direct evidence that ketamine prevents suicides.
That's not really a problem - suicidal ideation is a strong enough predictor for suicidality and mental health that it's common to use as a biomarker. In other words, nearly anything that reduces suicidal ideation is presumed to reduce suicidality (on a large scale) - it's not necessary to wait months or years to see what happens (and in fact, depending on the specifics of the study, it can be considered unethical to do so).
Source: former clinical researcher and drug counselor
[0] bioavailability when insufflated is significantly less than other means of ingestion
About the first point, I still disagree with the parent comment. The standard 0,5mg/kg ketamine is given under 40 minutes. I've seen two patients receive it. The room was dimly lit, silent and peaceful, as to not induce or exacerbate any possible dissociative or hallucinative side effects. The patients didn't report any side effects at first and later reported a little sedation. I wouldn't be a able to tell with certainty if they had received a placebo or ketamine, and certainly not within minutes.
Source: psychiatrist in training
Edit: I still think we need hard data about anti-suicide effect and not just surrogate markers. Variability in suicidal ideation is suggested to be a predictor of suicide attempts [1]. If ketamine first gets someone better and later on they relapse, they could, in theory, be at increased risk for suicide. More long term data is also needed about it's long term effects. Note that I do think it's a good thing that ketamine is becoming more available! I will continue to suggest it for e.g. patients with treatment resistant and severe depression.
[1] https://www.sciencedirect.com/science/article/abs/pii/S01650...
.5 mg/kg
I was numb all over, my lips tongue and throat were numb.
I melted in to the chair and felt like I was up down and sideways at the same time.
You would not be able to tell immediately but I put on my blindfold within 7 minutes due to effects starting.
And I'm not drug naive by a very long shot. On my 2nd infusion there was an older gentleman across the hall from me who had never had anything stronger than scotch whiskey. He was not having a good time at all.
7 days falling in and out of the K-hole while hallucinating is not as much fun as it sounds.
A friend of mine did it last week and he described it as the most intense experience of his life. He’s 40 and he has experience with other drugs.
I think possibly you don’t know what you’re talking about?
It was more intense and less intense at the same time because I did not know what to expect.
At home treatments with sublingual trockies have much less side affects, but differently still noticeable. Nasal spray is the weakest with just some minor body numbing.
A lot of people take amphetamines as a medically prescribed treatment for ADHD (and other conditions such as narcolepsy too). A lot of people take amphetamines recreationally. Studies done on the negative heath consequences for recreational users are largely irrelevant to medically prescribed users, because your average recreational dose is an order of magnitude (or more) higher than the average prescribed dose. Increase the dose ten-told, it acts like a different drug altogether.
Plus, the irregular dosing schedule of recreational users probably isn’t helping either. And many recreational users try to get the drug into their bloodstream as fast as possible (injection, snorting, smoking), while most prescription drugs aim to be released more gradually (oral route, sometimes even extended release or an inactive prodrug such as Vyvanse/lisdexamfetamine)
What you're saying applies in other cases, but in the case of ketamine, the recreational dose is one or two orders of magnitude lower than the clinical dose.
How numb does it make you. My mouth and throat being numb was very surprising.
You certainly notice the effects of IV K. So do other people when you start to talk to a hairbrush. It's a bit draining after a few days though, and not terribly fun.
However, I have no idea how other sedations feel, so who knows if they are a good placebo. Could be.
I read it as the nurse preparing the IV's knew if it was a placebo, it doesn't really say that the same nurse administered the IV's.
Can't you achieve all of those by having someone else create the bag and then label it for the patient. The "right medication" is the one they're receiving as part of the study.
It's not like what they need to do is different if it's ketamine or saline.
For that matter, a quick web search shows that at least some of the (injected) coronavirus vaccine trials were double blind. Seems like enough for someone in the next room to know if the maybe-ketamine injection is placebo, so they can unblind immediately in case of a bad reaction.
For orally dosed RCTs, often the pill making process is the way the blinding is done -- i.e. they're either in brightly-coloured gelcaps or a film or sugar coating. If it is a double-blind RCT it must be double blind. All of this will have been explicitly examined in the ethics statement for a trial and very, very prescriptively laid out.
> 3. Within minutes it would become obvious to everyone in the room if the patient was injected with salt water or ketamine.
I think you’re mistaking IV infusion for injection. The dose is given slowly over 40 minutes, not as a rapid injection. The patient would barely have any of the drug in their system in the first few minutes. Given the short duration of action, it wouldn’t produce peak levels anywhere near what recreational users experience.
In the sessions I had with IV ketamine, it is very, very noticeable and fairly trippy. The eye mask and the music certainly help, but the ketamine is inducing some crazy sensations.
I don’t remember the exact dosages I received, but I remember it being in line with what I saw others reporting online from their experiences at a clinic.
this is not part of the definition of double blind. There maybe drug effects and there may be placebo effects. If you don't know and the person administering it doesn't know, then the effects you report or measure are what is being studied over the group of people in the study.
> 3. Within minutes it would become obvious to everyone in the room if the patient was injected with salt water or ketamine.
also not part of the definition of double blind.
Ketamine is supposed to be a disassociate drug, which I'm guessing is perhaps like an out of body experience or something. But I cant see how that can help with depression when people dont understand depression can actually be lots of things, but it has one overriding common element which is people remembering.
So unless people get something like dementia where recent memories seem to fade first and the earliest memories come back, I fail to see how K can help treat depression.
As for suicide ideation, well look around at what constitutes 1st world medical care! If you dont buy into the smiley faces because you might have grown up around medical professionals and heard the back office chats you might think twice about the authenticity of so called medical professionals! Not only that, its just a job for most, leave it at the door when your shift finishes, which is easier said than done especially if a dying patient seemed nice and innocent compared to an unpleasant angry dying patient.
I really dont know why we dont have legal euthanasia because being experimented on in the name of science is not something I'd let others do to me if I can help it, I am aware that some argue it would be a direction towards eugenics, but that goes on already in stealth with some medical procedures.
Obviously (going off things like trainspotting and peoples accounts), opiates are supposed to give you a warm fuzzy feeling as you slip into a deep sleep or unconsciousness I guess but not to sure, never done it not even in an operating theatre.
MAOI's the old style anti depressants are quite sudden in that they are like an on off switch for the brain, you dont remember or feel nothing and I think they were popular with people who wanted to end it, but SSRI's have replaced them as the new anti depressant treatment but their problem is you dont sleep properly on them so they introduce their own problems, but I'm not aware of any end of life properties in SSRI's other than they ruin your sleep and send you off the rails slowly.
But all the while, these chemicals still dont address the fundamental problem with depression which is remembering stuff that causes depression. Maybe depression should be treated more like PTSD, because depression seems to be an ego thing, where as talking to other people, PTSD seems to be more like what people associate as depression.
For bloke's I think the bio mechanical properties of testosterone would help many with PTSD, cant comment for women though, but the risk the police and medical lot dont want is some hulk losing it so the idea isnt entertained AFAIK.
Self preservation of institutions comes before everything else!
Edit: I should add, once CO2 blood saturation exceeds 30% it has a noble gas effect on the body, so anyone who remembers the periodic table should remember what noble gasses are and its why compressed gas companies go to great lengths to not enable pure noble gases getting into the hands of the public.
Biology and chemistry is just the mammalian equivalent of computer hacking.
I just started IV ketamine infusions at .5 mg/kg for depressions.
I am not finished with my treatment yet.
Ask me anything if you would like.
> Any issues with your bladder? Have doctors mentioned anything about the potential damage to the urinary system? This seems to be the scariest side effect.
We're lucky because ketamine has been used for decades in inpatient settings at much, much higher doses than what is being used now for psychiatric purposes, so we have a good sense of its safety profile already.
Urinary tract and bladder issues are noted for long-term and frequent recreational users of ketamine, but not really for anesthetic use. The dosing schedule for psychiatric use is closer to anesthetic use than it is for recreational use.
The effects also are reversible if detected early and use is ceased, so periodic but infrequent treatment is unlikely to result in long-term damage, both because it's not frequent enough to accumulate, and because you can stop if it becomes a problem.
I am a man and it did immediately reduce my libido. Not in the same way SSRIs did. Will be curious to see if that is a lasting effect or not.
I was only nauseous for maybe 1 minute but I can see it being terrible for folks with motion sickness.
https://www.nih.gov/news-events/nih-research-matters/how-ket...
Question: does reducing suicidal ideation reduce suicide? I mean, it sounds like it obviously should, but we've been wrong about this before. Many heart medications to reduce cholesterol worked great at reducing cholesterol without reducing heart disease!
All that said, reducing suicidal ideation is a worthy goal itself, even if it doesn't reduce suicide. I'm a full supporter of seeing this treatment move more mainstream.
That said it's not a long term solution (because honestly its frustrating due to losing a few hours during the work week, inability to drive, etc) so I'm working with Drs to actually resolve things without regularly being stabbed :D
There's also lozenge form which I believe some clinics allow you to take at home, but not sure of the effectiveness
"At week 6, remission in the ketamine arm remained high, although non-significantly versus placebo (69.5% v 56.3%; odds ratio 0.8 (95% confidence interval 0.3 to 2.5), P=0.7)."
While it probably works for some people, it's likely dangerous for many others.
Kenji Hashimoto and others have published numerous papers about this. It's not exactly under-researched. The incentives in the US are horribly misaligned.
Quite honestly it's upsetting that spravato even exists and there ought to be a huge class action lawsuit about this.
A few papers: https://pubmed.ncbi.nlm.nih.gov/32224141/ https://pubmed.ncbi.nlm.nih.gov/26327690/