I've posted this in other ketamine news stories before, but I'm offering it as a firsthand testimonial here.
Ketamine was both the best and most depressing depression treatment option I've ever tried. Within a couple of weeks after having had the initial round of six treatments in two weeks, I was the most functional and productive human being I've _ever_ been - things that used to be impossible or utterly agonizing to complete were as trivial as they "should" be, I was enjoying life, it was great.
After a couple of months of periodic booster treatments, over the course of a week, I felt it completely drain out of me, and no variance or repetition of ketamine treatments has been able to reproduce it since. (We spent months varying dosage levels, frequency, and trying a few OTC things that the doctor had seen synergize ketamine response in people before, to no avail.)
It was...possibly the single worst experience of my life, feeling that slip away, and now having recent crystal-clear memories of how much that fog had been complicating my life.
My girlfriend receives ketamine treatment for her depression, so I’ve the results first hand. It’s truly astounding. She’s seen more improvement from the ketamine than from a decade of psychotherapy and traditional psychopharmacology.
The only downside is the cost (it’s not covered by insurance) and the potential that there are long term side effects that have yet to be discovered. We pay $375 for a 40-minute infusion. The recommended initial course is six infusions over two weeks. After that a booster or two is usually needed very two to six weeks. (It’s been about every three weeks for my girlfriend.)
Main upsides of Ketamine for depression vs typical antidepressants (SSRIs, etc)
- Ketamine seems to have a much larger effect size (-~0.99  vs -~0.35 for typical antidepressants ) [If anyone spots an error, please let me know]
For context, an SMD of 0.2 is small, >0.5 is medium, and >0.8 is large.
To me this seems to be by far the most important/interesting thing: Ketamine seems to have a much stronger antidepressant effect than our current antidepressants.
- Benefits occur within hours rather than weeks
- Doesn't seem to interfere with sexual function, unlike many antidepressants
Main downsides of Ketamine for depression
- Much more expensive and normally not covered by insurance
- It's less well studied
- You have to go in for additional ketamine infusions to maintain the effects, it seems roughly ~1x a month long term
(The SMD for typical antidepressants seems to range from ~-0.13 to ~-0.35, with Tricyclic antidepressants slightly higher at around -~0.42.)
@HN's chemists - I was under the impression regular ketamine use caused irreversible bladder damage - Is that due to much higher recreational dosage vs medical, or would this be something that couldn't be prescribed long-term?
In the late 90s/early 2000s, I went to a lot of raves and everyone who partied and took club drugs used ecstasy and ketamine regularly, often in combination.
A lot of people that I used to hang out with back then are on a private email list now, where we talk about more boring stuff like our families and jobs and so on, since everyone basically aged out of the scene in our early 30s.
I recently made a post about how my mom had been abusive towards me as a kid.
Almost every single person on the email list responded with a similar story of abuse, sometimes of a horrific nature. And almost everyone talked about dealing with trauma and depression their whole lives — and how the rave scene and the drugs they took probably saved them. Several talked about suicide attempts before getting into raves.
I had known these people for almost 15 years and I had never really talked about this except for the random conversation on ecstasy with one or two of them where they or I as sort of worked out our issues with them at an after party or whatever.
I was pretty surprised at how consistent the story was. I know that’s how I felt about the drugs— that the combination of those two (and lsd to a lesser extent) and the community around the music probably saved my life — even though I took a lot of dumb chances and went well beyond the therapeutic info the hedonistic from time to time.
I went from being a lonely, closed up victim of abuse at home and a decade of bullying at school to being outgoing and popular in that scene - even to the point where I learned to DJ and played gigs in front of crowds of 1000+ people.
It helped me not just in the scene but in my personal life and my career. I learned to recognize some of my learned toxic behaviors that pushed people away from me and how to recognize them in other people. I distanced myself from my family and home town friends who had been treating me terribly, and my career took off — even with no degree — and largely because of connections I made in the scene.
I don’t know where I’m going with this, but it seemed transparently obvious at the time that MDMA, LSD and ketamine were near-miraculous substances and deserving of serious scientific study, and it always seemed perverse that the government was doing everything in its power to prevent people from taking them, while at the same time pushing people to take anti depressants and stimulants that were so much less helpful and enlightening.
I haven’t used drugs in nearly a decade and don’t intend to, but I’m glad that researchers are starting to take them seriously.
If you're an American, every time you read a new article on Ketamine for depression your thought should be "Jeese, healthcare is screwed up". Pharma companies don't benefit from getting Ketamine approved (since it's no longer patent protected), so no one is putting it through FDA for depression. As a result insurance will never cover it (under the current model).
The reason this treatment isn't mainstream isn't because "the research is still out" (though that may still be). It's because there are no financial interests to get it over the hoops into the highly convoluted state that enables affordable medical care.
Just as a different perspective ketamine is (and was) pretty common in my circle and the idea that it works as anti depressant slowly faded.
It never really worked for me as that, at least not more than lsd or so would. And some friends claim that it has way less effect on them today even thought it seemed have to worked before.
It may is the abuse (probably higher amount on some occasions) it may are long term effects.
But it surely is not the magic cure some make it out to be.
My psychiatrist was mentioning this to me a few months ago. The data he’s seen mirrors the study referenced here.
This could be a breakthrough for individuals in the midst of major depressions, which are often very hard to treat, considering how long it can take for other anti-depressants to start to work.
Ketamine is an anesthetic. Has anyone compared it to e.g. ibuprofen for this use case? Ibuprofen works very well for me when experiencing depressive symptoms. I'm down to about 2h max per depressive episode (logged at 10-30 depressing thoughts per minute, compared to none after). Mechanism intuitively "feels" inflammatory and looking at my logs seems related to exhaustion due to over-productivity, lack of rest, etc.
How hard would it be to create a ketamine nasal spray at home, if you possess some in powder form?
I've heard that ketamine usage long term can affect your microbiome , which seems to play a much greater role in depression that previously thought . Has anyone had similar experiences?
Don’t get caught in a k-hole or it might have some fast acting disadvantages for depression.
> The nasal spray is now undergoing phase three trials before it can be licensed for treatment.
Can anyone comment on how long it might take for it to hit the market, from this stage?
I'm gonna stick with exercise.
Is the mechanism of action known?
What stereoisomers are used?
Googles ketamine. It's guys snorting something with dollar bills. I think people figured this out already.