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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 27. Go back in thread:
Posted by Phillipa on August 6, 2010, at 14:15:47
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts, posted by europerep on August 6, 2010, at 13:42:40
I actually got excited for some of the long term TRD bipolars from this article. Knew it is recreational and that's a shame if it couldn't help. Darn. Phillipa ps thanks for weighing in the article shows don't believe all you read or hear.
Posted by linkadge on August 7, 2010, at 22:39:42
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts » europerep, posted by Phillipa on August 6, 2010, at 14:15:47
Hard to know what the cognitive effects amount to. I know a lot of K users are polydrug abusers. The other issue is of dose and duration.
There may be a theraputic window. Lithium for instance can be highly neurotoxic above the theraputic level. It kills off brain cells when you go toxic.
I think there is a similar effect with NMDA antagonists. In lower doses, they are neuroprotective, in higher doses, they actually become excitotoxic. The effects in drug abusers therefore is hard to quantify.
Its just going to force many ill patients to the streets to obtain the drug in hopes of relief. It will be another 50 years till anything positive emerges from these studies.
Linkadge
Posted by Phillipa on August 7, 2010, at 23:59:33
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts, posted by linkadge on August 7, 2010, at 22:39:42
Isn't it a shame if it works? Only one Iv also they claim. Phillipa
Posted by Bob on August 8, 2010, at 0:02:36
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts, posted by linkadge on August 7, 2010, at 22:39:42
It will be another 50 years till anything positive emerges from these studies.
>
>
> Linkadge
>Yes, it will be a very, very long time. In the last decade or so I've become increasingly aware of the glacial pace at which true medical advances become available. I'm not sure why I had any other impression, but if you look at the treatments that are available today, they were often decades in development, if not longer. Even if a magical compound was discovered tomorrow, it would take years and years for the necessary experimental and approval processes to take place.
Bob
Posted by europerep on August 8, 2010, at 3:23:04
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts, posted by linkadge on August 7, 2010, at 22:39:42
yes and no. you're right about k abusers of course. also, the k you buy on the street is hardly pure, so the effect of cutting agents needs as well to be taken into account. I don't think the comparison with lithium is accurate though. every substance becomes toxic at some point, but that doesn't mean that every substance has the potential to do good at lower doses. then again, there are individual examples of maintenance treatment where it works:
http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=2600
look at the number of ECT courses this poor woman has had.. it's a shame they didn't realize it wasn't working earlier.
still though, 50 years may be exaggerated. there is an NMDA antagonist in its first phase II trial, so maybe we'll be lucky...
Posted by europerep on August 8, 2010, at 9:33:21
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts » linkadge, posted by europerep on August 8, 2010, at 3:23:04
instead of "has the potential to do good" I should have said "is benign". of course it has the potential to do good, that's what the research shows.. sry, I was distracted..
Posted by Huxley on August 9, 2010, at 1:02:49
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts, posted by europerep on August 6, 2010, at 13:42:40
lol Ketamine.
Wow just wow. Cocaine and Heroin will also help you out with that pesky depression...
Posted by linkadge on August 9, 2010, at 9:05:15
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts » linkadge, posted by Bob on August 8, 2010, at 0:02:36
I was reading a book from 1985 which describes citalopram as a treatment for depression.
25 years ago, citalopram was already known to be an antidepressant.
Today, the top AD is escitalopram, which many docs think is essentially equal to citalopram.
So basically today, our top meds are 25-30+ years old.
Linkadge
Posted by linkadge on August 9, 2010, at 9:14:20
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts » linkadge, posted by europerep on August 8, 2010, at 3:23:04
>I don't think the comparison with lithium is >accurate though. every substance becomes toxic >at some point, but that doesn't mean that every >substance has the potential to do good at lower >doses.
Well I just don't think we have enough data on "theraputic" doses of ketamine to know that it causes permanant cognative dysfunction.
Also, there is (as I was mentioning) a biphasic effect for NMDA antagonists. You will notice studies for both the neuroprotective and neurotoxic effects of NMDA antagonists.
Even the NMDA atagonist Zinc has these properties. In low doses it has inhibitory effects, in higher doses it has excitotoxic effects.
I wouldn't equat this to the toxicity of any drug in general. Sure, citalopram will damage your brain at 1000 times the theraputic dose, but NMDA antagonists can cause neurotoxicity at say as little as 5x a dose which appears to be neuroprotective. Of course, I'm pulling those exact numbers out of nowhere, but the point I'm making is true - that there is a much narrower window for safety with NMDA antagonists then the average drug.
Posted by linkadge on August 9, 2010, at 9:20:49
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts, posted by Huxley on August 9, 2010, at 1:02:49
>lol Ketamine.
>Wow just wow. Cocaine and Heroin will also help >you out with that pesky depression...No, but there is a difference. Its true that cocaine can lift severe depression, but the depression returns as soon as the drug wears off. Ketamine is proving to be somewhat different.
It appears to provide prompt relief of depression at doses lower than what would typically be used to get high. The AD effect can occur independantly of a high. Also, the effect does not immediately wear of when the drug wears off.
Some reports suggest that patients remain symptom free for a week or more after a single treatment.
Also, other NMDA antagonists (devoid of hallucinogenic potential) have rapid acting antidepressant effects.
Posted by Huxley on August 9, 2010, at 19:12:04
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts » Huxley, posted by linkadge on August 9, 2010, at 9:20:49
Did you know that a massive trauma to the head can also provide a significant AD effect?Of course it has long lasting effects on important brain functions but apparently that is not a deterent in treating depression.
You speak of medications like you know what you are talking about, like you understand how the human brain functions and what intended and unintended effects these drugs have in the short and long term.
The leading scientists on the human brain confess to barely knowing how it functions yet psycho babble contains several resident experts that can diagnose you and give you an online pseudo prescription.
Posted by SLS on August 9, 2010, at 19:27:47
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts, posted by Huxley on August 9, 2010, at 1:02:49
Hi Huxley.
> lol Ketamine.
> Wow just wow. Cocaine and Heroin will also help you out with that pesky depression...Depression is quite a bit more painful and debilitating than it is "pesky" for many of its sufferers. For people who do not respond to standard treatments, the use of a drug representing a new paradigm represents hope. I'm glad ketamine is being investigated. Perhaps ketamine itself will be a disappointment. However, those properties that produce an antidepressant effect might be instructive in inspiring new paths to treating depression.
- Scott
Posted by ed_uk2010 on August 10, 2010, at 14:18:53
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts » Huxley, posted by SLS on August 9, 2010, at 19:27:47
>Perhaps ketamine itself will be a disappointment. However, those properties that produce an antidepressant effect might be instructive in inspiring new paths to treating depression.
Would you try ketamine Scott?
Posted by SLS on August 10, 2010, at 14:39:57
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts » SLS, posted by ed_uk2010 on August 10, 2010, at 14:18:53
> >Perhaps ketamine itself will be a disappointment. However, those properties that produce an antidepressant effect might be instructive in inspiring new paths to treating depression.
>
> Would you try ketamine Scott?I might if I knew more about it. Dosage is important and there is likely to be a narrow therapeutic window. It has been suggested that ketamine might "jump-start" the antidepressant responses to other agents. I would be interested in this.
Interestingly, the NIMH has studied the instantaneous antidepressant effects of procaine challenge. Infrequently, a patient would have a psychotic reaction to it. However, for others, this short response was the only experience of euthymia that they could recall ever having. There is much that could be learned from understanding the antidepressant response to procaine, even though it is impractical to use it clinically.
- Scott
Posted by ed_uk2010 on August 11, 2010, at 14:37:36
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts » ed_uk2010, posted by SLS on August 10, 2010, at 14:39:57
>I might if I knew more about it.
I know what you mean. Even if the antidepressant effect of a single dose lasted for several days, I have no idea what would happen in the long term after repeated doses.
Posted by Huxley on August 11, 2010, at 18:44:46
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts » Huxley, posted by SLS on August 9, 2010, at 19:27:47
> Hi Huxley.
>
> > lol Ketamine.
> > Wow just wow. Cocaine and Heroin will also help you out with that pesky depression...
>
> Depression is quite a bit more painful and debilitating than it is "pesky" for many of its sufferers. For people who do not respond to standard treatments, the use of a drug representing a new paradigm represents hope. I'm glad ketamine is being investigated. Perhaps ketamine itself will be a disappointment. However, those properties that produce an antidepressant effect might be instructive in inspiring new paths to treating depression.
>
>
> - ScottI think you have failed to detect my sarcasm.....
I am well aware of how painful and debilitating depression can be so don't bother taking that angle.I question psychiatry's methods, because they are directly effecting millions of peoples lives and they don't seem to answer to anybody when they get it wrong. They deserve to be questioned.
You seem to find this confronting and seem to be negative of anyone who doesn't accept the general wisdom of psychiatry.
If you are at all familiar with what ketamine can do... the wrong dose, to high or to low then you would understand why I am skeptical about it.
I have seen Ketamine leave people with permanent drug induced psychosis that resembles schizophrenia.
SLS you seem to offer a lot of advice to people here on what drugs to take.
Tell me this though, do you understand the human mind? Do you understand what effects the drugs that you are recomending have on peoples minds?
Posted by SLS on August 12, 2010, at 5:17:23
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts, posted by Huxley on August 11, 2010, at 18:44:46
> > Hi Huxley.
> > > lol Ketamine.
> > > Wow just wow. Cocaine and Heroin will also help you out with that pesky depression...> > Depression is quite a bit more painful and debilitating than it is "pesky" for many of its sufferers. For people who do not respond to standard treatments, the use of a drug representing a new paradigm represents hope. I'm glad ketamine is being investigated. Perhaps ketamine itself will be a disappointment. However, those properties that produce an antidepressant effect might be instructive in inspiring new paths to treating depression.
> I think you have failed to detect my sarcasm.....
Perhaps you failed to execute sarcasm in a way that would be obvious.
> I am well aware of how painful and debilitating depression can be so don't bother taking that angle.
I didn't know that I had an "angle". Perhaps you could detail what that angle is and what I might be attempting to prove to you.
> I question psychiatry's methods, because they are directly effecting millions of peoples lives and they don't seem to answer to anybody when they get it wrong. They deserve to be questioned.
That is exactly what the authors of ketamine studies are doing. They are questioning the status quo.
> You seem to find this confronting and seem to be negative of anyone who doesn't accept the general wisdom of psychiatry.I don't know how I effect negativism, but if you are accusing me of being more trusting than distrusting of the motivations of psychiatric medicine, I would agree with that statement.
> If you are at all familiar with what ketamine can do... the wrong dose, to high or to low then you would understand why I am skeptical about it.
You might want to review more closely the post that I submitted here:
http://www.dr-bob.org/babble/20100731/msgs/958161.html
> I have seen Ketamine leave people with permanent drug induced psychosis that resembles schizophrenia.
Would you care to provide more evidence of the irreversibility of a psychotomimetic reaction? Amantadine and memantine can produce psychosis infrequently, but I am not aware of these NMDA antagonists doing so irreversibly.
> SLS you seem to offer a lot of advice to people here on what drugs to take.
> Tell me this though, do you understand the human mind?Perhaps you could enlighten me as to where I am deficient in this.
> Do you understand what effects the drugs that you are recomending have on peoples minds?
Not as much as the understandings that modern biological psychiatry offers.
Any perspectives that you are willing to offer will be appreciated.
- Scott
Posted by Huxley on August 13, 2010, at 0:14:48
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts » Huxley, posted by SLS on August 12, 2010, at 5:17:23
I posted a reply to this but it seems to have been removed.
Posted by 10derHeart on August 13, 2010, at 1:33:28
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts » SLS, posted by Huxley on August 13, 2010, at 0:14:48
> I posted a reply to this but it seems to have been removed.
I don't know what happened to your reply to Scott, but I highly doubt it was removed. Only Dr. Bob or a deputy can remove a post, and there are no active deputies at this time. Dr. Bob rarely (if ever) removes posts unless a poster posts while blocked. I was a deputy for several years and he never did so, not even when posters pleaded with him to remove (their own) posts.
Possibly you closed the posting window without confirming? It's happened to me.
Posted by SLS on August 13, 2010, at 5:44:31
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts » SLS, posted by Huxley on August 13, 2010, at 0:14:48
> I posted a reply to this but it seems to have been removed.
I'm sorry that you lost all of your work. As 10derHeart indicated, Dr. Bob rarely, if ever, removes a post.
- Scott
Posted by Huxley on August 15, 2010, at 19:11:52
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts » Huxley, posted by SLS on August 13, 2010, at 5:44:31
> > I posted a reply to this but it seems to have been removed.
>
> I'm sorry that you lost all of your work. As 10derHeart indicated, Dr. Bob rarely, if ever, removes a post.
>
>
> - Scott
>
>Hi Scott,
I dont have enough energy to post it all again.
That argument was probably going nowhere interesting anyway so I guess we can just disagree.
Posted by europerep on August 16, 2010, at 3:24:45
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts, posted by Huxley on August 15, 2010, at 19:11:52
I did not know that ketamine as it is available now is a racemate:
Posted by paulk on August 22, 2010, at 16:14:10
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts, posted by Huxley on August 9, 2010, at 1:02:49
> lol Ketamine.
> Wow just wow. Cocaine and Heroin will also help you out with that pesky depression...
Actually, Cocaine is a SNRI.. not that it works any better than the pharmas. There may even be a place for the use of opiates as a head med.If water is abused, it also can kill you - sure hope the fact that ketamine is used as a street drug doesn't keep it from being considered in low dosage creams..
Posted by huxley on August 24, 2010, at 1:43:57
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts, posted by paulk on August 22, 2010, at 16:14:10
> > lol Ketamine.
> > Wow just wow. Cocaine and Heroin will also help you out with that pesky depression...
>
>
> Actually, Cocaine is a SNRI.. not that it works any better than the pharmas. There may even be a place for the use of opiates as a head med.
>
> If water is abused, it also can kill you - sure hope the fact that ketamine is used as a street drug doesn't keep it from being considered in low dosage creams..
>
>ongoing use of kettamine causes psychosis even in small doses.
Posted by europerep on August 24, 2010, at 3:26:33
In reply to Re: Ketamine IV yields swift AD Effect To Bipolar Pts, posted by huxley on August 24, 2010, at 1:43:57
>
> ongoing use of kettamine causes psychosis even in small doses.
>sources? what are small doses? street ketamine is practically never pure, etc. etc...
This is the end of the thread.
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