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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by deniseuk190466 on June 8, 2007, at 15:43:37
I was reading about a new patch that was being studied for Nerve pain and was wondering if they might also use it for depression as it combines amitryptaline and ketamine both used for depression. Does anybody know?
And does having a drug in the form of a patch make it more effective than taking it in tablet form? I know that it would act quicker as it gets into your bloodstream quicker but would it ultimately be more effective?
Thanks.....Denise
Posted by Quintal on June 8, 2007, at 17:51:45
In reply to amitryptaline and ketamine patch, posted by deniseuk190466 on June 8, 2007, at 15:43:37
Do you have a link Denise? Sounds interesting. I'm in a position to try ketamine myself but I'm not liking the sound of those Olney's Lesions it's said to cause.
I don't think the route of delivery would make too much difference to the effectiveness with most drugs once you were at a steady dose and blood plasma levels were stabilized. There's a subtle difference between oral selegiline and the Emsam patch though, but I've forgotten what it is. Someone else will probably know.
Q
Posted by Phillipa on June 8, 2007, at 21:49:23
In reply to Re: amitryptaline and ketamine patch » deniseuk190466, posted by Quintal on June 8, 2007, at 17:51:45
Quintal what are those lesionss? And I like the idea of a patch for every med as you can see it and take it off if the side effects bother you. I know it stays in your system but psychologically you know it's off your body and on it's way out. Love Phillipa
Posted by Quintal on June 8, 2007, at 22:24:57
In reply to Re: amitryptaline and ketamine patch » Quintal, posted by Phillipa on June 8, 2007, at 21:49:23
Yeah I can see why the patch would be more reassuring to people who are concerned about toxicity and adverse reactions. Here is a link to the Wiki article on Olney's Lesions:
Posted by psychobot5000 on June 9, 2007, at 0:37:44
In reply to Re: amitryptaline and ketamine patch » deniseuk190466, posted by Quintal on June 8, 2007, at 17:51:45
There's a subtle difference between oral selegiline and the Emsam patch though, but I've forgotten what it is. Someone else will probably know.
>
> QAccording to my source, the difference is less subtle than you might think. If you filter selegiline through first pass liver metabolism (by taking it in pill form), it produces high levels of various types of amphetamine (l-amphetamine, d-amphetamine, l-methamphetamine, if I remember right). Which isn't all bad, but is perhaps a different effect than you're looking for. As selegiline has a shorter halflife than amphetamines, within a number of hours, the parent drug's blood levels drop very low, but significant numbers are left over for amphetamine metabolites.
With EMSAM, you deliver a much higher level of the parent drug, the blood-levels are fairly stable, and because you avoid first-pass metabolism by not going through the stomach, levels of amphetamine metabolites are much lower. It's a different effect.
Psychbot
PS. I wasn't under the impression that ketamine was a practical option for antidepressant therapy - more a research lead. Well, maybe not!
Posted by Quintal on June 9, 2007, at 1:15:38
In reply to selegiline/emsam details » Quintal, posted by psychobot5000 on June 9, 2007, at 0:37:44
Thank you for the information psychobot, I had a feeling it had something to do with the bypassing the gut/liver metabolism. The selegiline still exerts its antidepressant effect as an MAOI though, but presumably it's more selective and effective at inhibiting the MAO in the brain when delivered this way. This isn't necessarily true for all drugs delivered transdermally though. I guess it depends on how they're affected by first-pass metabolism and whether they have any active metabolites etc? Will look up amitriptyline. Ketamine is a practical option for anyone who can get access to it.
Q
Posted by magicpill on June 9, 2007, at 10:25:42
In reply to Re: amitryptaline and ketamine patch » Phillipa, posted by Quintal on June 8, 2007, at 22:24:57
From the "Controversy" section in the Wikipedia entry:
"There is thus no published evidence at this time (January 2000) that ketamine can produce toxic cell changes in monkeys. The unpublished monkey data that we know about, that of Frank Sharp, actually shows that there is no damage at doses up to 10mg/kg.
White therefore concluded that based on some fundamental differences between rat biology and human biology and because there have only been very few studies done on the occurrence of Olney's lesions, no connection can currently be proved or disproved.[9]"
Posted by Quintal on June 9, 2007, at 14:33:21
In reply to Olney's Lesions hasn't yet been proved » Quintal, posted by magicpill on June 9, 2007, at 10:25:42
Thanks magicpil, I know about the controversy. I don't feel comfortable about experimenting with this drug alone though when there are safer alternatives. I think people considering taking ketamine should be aware of Olney's Lesions.
Q
Posted by Deniseuk190466 on June 9, 2007, at 15:09:21
In reply to Re: amitryptaline and ketamine patch » deniseuk190466, posted by Quintal on June 8, 2007, at 17:51:45
Hi Quintal,
I didn't actually get the information of the web. I read it in the "Daily Mail" an English Newspaper but I'll see if I can find something on the web.
Denise
Posted by rovers95 on June 10, 2007, at 23:25:48
In reply to To Quintal, posted by Deniseuk190466 on June 9, 2007, at 15:09:21
Hi, on the internet i've found numerous citations of a study that shows lamotrigine prevents NMDA antagonist neurotoxicity (and i suspect this would prevent olneys lesions - if these actually do occur!!).
Perhaps if the patients took lamotrigine aswell it would prevent these effects....and at the same time prevent any psychometric effects from the ket???
Just a thought,
rover
Posted by linkadge on June 12, 2007, at 14:13:57
In reply to Lamotrigine prevents NMDA antagonist neurotoxicity, posted by rovers95 on June 10, 2007, at 23:25:48
You can also prevent NDMA antagonist neurotocitity with glycine, which acts as a partial agonist at NMDA receptors.
The effect of lamotigine may be via glycine as lamotrigine increases gylcine.
Linkadge
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