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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by brynb on February 18, 2013, at 15:32:35
Is anyone aware of common side effects w/ Ketamine treatment?
Has anyone experienced side effects with Ketamine treatment? And, is it supposed to help or aggravate irritability?
Thanks,
b
Posted by johnLA on February 18, 2013, at 16:13:18
In reply to Ketamine and side effects, posted by brynb on February 18, 2013, at 15:32:35
hi b-
i only did 1 infusion. felt nothing except during the infusion; a little 'stoned.'
i did nasal spray a few times and felt a calmness.
had no irritability after either applications though.
no help there sorry. but, from what i read for those that the ketamine works it seems to be calming/relaxing.
of course at higher doses the drug can act very differently; hallucinations, paranoia, etc. but, again, that is at much higher doses than what you are doing.
what is your doc saying about the way you are feeling after? this treatment is all relatively new. maybe a lower dose? just thinking out loud.
hang-in there.
john; your buddy on the left coast :)
Posted by sigismund on February 18, 2013, at 16:29:55
In reply to Re: Ketamine and side effects, posted by johnLA on February 18, 2013, at 16:13:18
Probably quite a low dose, well under 25mg, probably well under 10mg.
It is the weirdest stuff at higher doses.
You might feel a little strange, mentally and bodily, but there should be nothing to worry about, especially with the first few doses.
By which I mean I came to dislike it, but the doses were much higher.
Posted by brynb on February 18, 2013, at 16:33:24
In reply to Re: Ketamine and side effects, posted by johnLA on February 18, 2013, at 16:13:18
john!
hi my friend...so good to hear from you! thanks for your feedback :-).
i'm definitely very calm during treatment, but i've been irritable, maybe more than usual, in the days following. i'll ask my pdoc tomorrow. i'll also ask about the spray.
ketamine is definitely helping w/ the depression, though. (but if it's not one thing, it's another; i just can't win...)
how are you faring these days? did you try viibryd? or anything new?
let me know how you're doing.
good to see you :).
-b
Posted by brynb on February 18, 2013, at 17:02:25
In reply to Re: Ketamine and side effects, posted by sigismund on February 18, 2013, at 16:29:55
> Probably quite a low dose, well under 25mg, probably well under 10mg.
>
> It is the weirdest stuff at higher doses.
>
> You might feel a little strange, mentally and bodily, but there should be nothing to worry about, especially with the first few doses.
> By which I mean I came to dislike it, but the doses were much higher.
sig-i'm told my injections are 30mg, then another 30mg 30 minutes later, then 20 mg about 30 minutes later again. so 80mg over an hour and a half.
-b
Posted by jrbecker76 on February 18, 2013, at 22:04:09
In reply to Ketamine and side effects, posted by brynb on February 18, 2013, at 15:32:35
> Is anyone aware of common side effects w/ Ketamine treatment?
>
> Has anyone experienced side effects with Ketamine treatment? And, is it supposed to help or aggravate irritability?
>
> Thanks,
> bHi Bryn,
I'd also be curious to hear what Dr. Fruitman says about this in his experience with other patients.
As I mentioned in another thread, irritability was listed as a minor SE in a couple studies I read related to ketamine tx for bipolar depression. But only a couple of subjects experienced it though. I can email you those studies if you'd like.
As a side note, I was in a clinical trial for a new glutamatergic antidepressant drug (mGlu 2/3 antagonist). I experienced both headaches and irritability as side effects. Generally speaking, I am sensitive to most antidepressants in regards to causing irritability though.
Just to reiterate for those not following the last thread, you remarked that you've struggled with irritability prior to initiating treatment but that it has been made worse by the ketamine injections. In terms of the enhanced irritability after the infusions, does it eventually abate/fade or do you find yourself with it for the next few days or week and beyond?
You also mentioned that you have some baseline cognitive dysfunction. I'm wondering if you have noticed an increase in disorganized thought, word recall, attention, or memory (aside from the first few hours after an injection) now that you've had a few more treatments under your belt.
Lastly, would you say ketamine is beneficial or detrimental for anxiety alone?
I hope that the next few weeks of treatment will work out the kinks for you.
JB
Posted by brynb on February 19, 2013, at 5:54:52
In reply to Re: Ketamine and side effects » brynb, posted by jrbecker76 on February 18, 2013, at 22:04:09
> > Is anyone aware of common side effects w/ Ketamine treatment?
> >
> > Has anyone experienced side effects with Ketamine treatment? And, is it supposed to help or aggravate irritability?
> >
> > Thanks,
> > b
>
> Hi Bryn,
>
> I'd also be curious to hear what Dr. Fruitman says about this in his experience with other patients.
>
> As I mentioned in another thread, irritability was listed as a minor SE in a couple studies I read related to ketamine tx for bipolar depression. But only a couple of subjects experienced it though. I can email you those studies if you'd like.
>
> As a side note, I was in a clinical trial for a new glutamatergic antidepressant drug (mGlu 2/3 antagonist). I experienced both headaches and irritability as side effects. Generally speaking, I am sensitive to most antidepressants in regards to causing irritability though.
>
> Just to reiterate for those not following the last thread, you remarked that you've struggled with irritability prior to initiating treatment but that it has been made worse by the ketamine injections. In terms of the enhanced irritability after the infusions, does it eventually abate/fade or do you find yourself with it for the next few days or week and beyond?
>
> You also mentioned that you have some baseline cognitive dysfunction. I'm wondering if you have noticed an increase in disorganized thought, word recall, attention, or memory (aside from the first few hours after an injection) now that you've had a few more treatments under your belt.
>
> Lastly, would you say ketamine is beneficial or detrimental for anxiety alone?
>
> I hope that the next few weeks of treatment will work out the kinks for you.
>
> JBJB-
Thanks for summarizing that so well. My brain hurts.
It's hard to tell if the irritability is worsened by the Ketamine, because it (along with anxiety) was plaguing me as badly as the depression was at first. I'm going out on a limb and saying it does aggravate it, because I'm particularly grumpy right after and the days following treatment. I fear it's not very beneficial--in fact, the opposite, for irritability/anxiety. I also suffer from headaches and feel they've become more intense.
Just when I thought I had it figured out ;/. I'm more than upset about all this but will address it with Dr. Fruitman today. If you don't mind emailing me the studies, I would like to see them.
Thanks so much, JB.
-b
Posted by brynb on February 19, 2013, at 5:58:15
In reply to Re: Ketamine and side effects » brynb, posted by jrbecker76 on February 18, 2013, at 22:04:09
also, re: cognitive SE's, it's my attention span that's gone. i can't even watch t.v. or read a magazine.
-b
Posted by jrbecker76 on February 19, 2013, at 12:02:41
In reply to Re: Ketamine and side effects » jrbecker76, posted by brynb on February 19, 2013, at 5:54:52
> > > Is anyone aware of common side effects w/ Ketamine treatment?
> > >
> > > Has anyone experienced side effects with Ketamine treatment? And, is it supposed to help or aggravate irritability?
> > >
> > > Thanks,
> > > b
> >
> > Hi Bryn,
> >
> > I'd also be curious to hear what Dr. Fruitman says about this in his experience with other patients.
> >
> > As I mentioned in another thread, irritability was listed as a minor SE in a couple studies I read related to ketamine tx for bipolar depression. But only a couple of subjects experienced it though. I can email you those studies if you'd like.
> >
> > As a side note, I was in a clinical trial for a new glutamatergic antidepressant drug (mGlu 2/3 antagonist). I experienced both headaches and irritability as side effects. Generally speaking, I am sensitive to most antidepressants in regards to causing irritability though.
> >
> > Just to reiterate for those not following the last thread, you remarked that you've struggled with irritability prior to initiating treatment but that it has been made worse by the ketamine injections. In terms of the enhanced irritability after the infusions, does it eventually abate/fade or do you find yourself with it for the next few days or week and beyond?
> >
> > You also mentioned that you have some baseline cognitive dysfunction. I'm wondering if you have noticed an increase in disorganized thought, word recall, attention, or memory (aside from the first few hours after an injection) now that you've had a few more treatments under your belt.
> >
> > Lastly, would you say ketamine is beneficial or detrimental for anxiety alone?
> >
> > I hope that the next few weeks of treatment will work out the kinks for you.
> >
> > JB
>
> JB-
>
> Thanks for summarizing that so well. My brain hurts.
>
> It's hard to tell if the irritability is worsened by the Ketamine, because it (along with anxiety) was plaguing me as badly as the depression was at first. I'm going out on a limb and saying it does aggravate it, because I'm particularly grumpy right after and the days following treatment. I fear it's not very beneficial--in fact, the opposite, for irritability/anxiety. I also suffer from headaches and feel they've become more intense.
>
> Just when I thought I had it figured out ;/. I'm more than upset about all this but will address it with Dr. Fruitman today. If you don't mind emailing me the studies, I would like to see them.
>
> Thanks so much, JB.
>
> -bBryn,
How long have you been on Deplin? I gave Deplin a go a couple times a few years ago and experienced significant headaches and irritability issues from it. Although this is not the case for most people, there are a subset of people who react adversely to Deplin and B vitamins. I typically avoid them because they only make me feel worse. Maybe take a holiday from it and see how you feel. It might be a contributing factor.
Also, have you ever tried generic Celexa (Citalopram) in place of the Lexapro. I can't handle Lexapro because it makes me irritable and anxious (regardless of the dose) but Citalopram works really well without any of these issues.
Lastly, as I mentioned, benzos also contributed to my irritability when I used to take them. Klonopin was worse than Ativan in this regard. Not suggesting you should get off of it, but just wanted to suggest that they're probably other adiditive components to what's going on aside from the ketamine.
Also, in regards to your attention span. Are you saying it's worse with the ketamine injections or you were experiencing the same level of distractability prior to beginning the injections?
I'd be curious to hear what Fruitman says in regards to these side effects from Ketamine. I babblemailed you to forward you the articles.
JB
Posted by jrbecker76 on February 19, 2013, at 12:10:05
In reply to Re: Ketamine and side effects » brynb, posted by jrbecker76 on February 19, 2013, at 12:02:41
> > > > Is anyone aware of common side effects w/ Ketamine treatment?
> > > >
> > > > Has anyone experienced side effects with Ketamine treatment? And, is it supposed to help or aggravate irritability?
> > > >
> > > > Thanks,
> > > > b
> > >
> > > Hi Bryn,
> > >
> > > I'd also be curious to hear what Dr. Fruitman says about this in his experience with other patients.
> > >
> > > As I mentioned in another thread, irritability was listed as a minor SE in a couple studies I read related to ketamine tx for bipolar depression. But only a couple of subjects experienced it though. I can email you those studies if you'd like.
> > >
> > > As a side note, I was in a clinical trial for a new glutamatergic antidepressant drug (mGlu 2/3 antagonist). I experienced both headaches and irritability as side effects. Generally speaking, I am sensitive to most antidepressants in regards to causing irritability though.
> > >
> > > Just to reiterate for those not following the last thread, you remarked that you've struggled with irritability prior to initiating treatment but that it has been made worse by the ketamine injections. In terms of the enhanced irritability after the infusions, does it eventually abate/fade or do you find yourself with it for the next few days or week and beyond?
> > >
> > > You also mentioned that you have some baseline cognitive dysfunction. I'm wondering if you have noticed an increase in disorganized thought, word recall, attention, or memory (aside from the first few hours after an injection) now that you've had a few more treatments under your belt.
> > >
> > > Lastly, would you say ketamine is beneficial or detrimental for anxiety alone?
> > >
> > > I hope that the next few weeks of treatment will work out the kinks for you.
> > >
> > > JB
> >
> > JB-
> >
> > Thanks for summarizing that so well. My brain hurts.
> >
> > It's hard to tell if the irritability is worsened by the Ketamine, because it (along with anxiety) was plaguing me as badly as the depression was at first. I'm going out on a limb and saying it does aggravate it, because I'm particularly grumpy right after and the days following treatment. I fear it's not very beneficial--in fact, the opposite, for irritability/anxiety. I also suffer from headaches and feel they've become more intense.
> >
> > Just when I thought I had it figured out ;/. I'm more than upset about all this but will address it with Dr. Fruitman today. If you don't mind emailing me the studies, I would like to see them.
> >
> > Thanks so much, JB.
> >
> > -b
>
> Bryn,
>
> How long have you been on Deplin? I gave Deplin a go a couple times a few years ago and experienced significant headaches and irritability issues from it. Although this is not the case for most people, there are a subset of people who react adversely to Deplin and B vitamins. I typically avoid them because they only make me feel worse. Maybe take a holiday from it and see how you feel. It might be a contributing factor.
>
> Also, have you ever tried generic Celexa (Citalopram) in place of the Lexapro. I can't handle Lexapro because it makes me irritable and anxious (regardless of the dose) but Citalopram works really well without any of these issues.
>
> Lastly, as I mentioned, benzos also contributed to my irritability when I used to take them. Klonopin was worse than Ativan in this regard. Not suggesting you should get off of it, but just wanted to suggest that they're probably other adiditive components to what's going on aside from the ketamine.
>
> Also, in regards to your attention span. Are you saying it's worse with the ketamine injections or you were experiencing the same level of distractability prior to beginning the injections?
>
> I'd be curious to hear what Fruitman says in regards to these side effects from Ketamine. I babblemailed you to forward you the articles.
>
> JB
>Oh yeah, noticed you were also trialing Vitamin D. I got similar irritability issues from taking it as well. So does Zinc, for that matter. It's really a bummer being so sensitive to all this stuff.
Posted by SLS on February 19, 2013, at 13:18:01
In reply to Re: Ketamine and side effects » jrbecker76, posted by jrbecker76 on February 19, 2013, at 12:10:05
Perhaps you would do better with tianeptine. I don't know. You might not be a SSRI responder.
How did you react to Zoloft?
What about MAOIs?
I am seriously considering using deep TMS as a treatment to accelerate my response to medication. I don't think ketamine represents much more than an intriguing and potentially important heuristic observation, much as sleep deprivation is. It can produce a dramatic antidepressant effect transiently, but what do you do with it? If ketamine were observed to work synergistically with other drugs to make them work better and longer, I would agree that it has a clinical application. Do you know of any studies like that?
From what I have seen, there is a narrow therapeutic window for ketamine administration. One must be brought to the point of delirium without becoming unconscious. This can only be accomplished with the precision offered by infusions. Ketamine does not produce an antidepressant effect when used at dosages that are too high or too low. Injections just don't accomplish this as well as infusions do. I'm looking forward to the development of an oral agent by Naurex that acts as a partial agonist at the glycine binding site of the NMDA receptor / channel. It should have a wider therapeutic window and avoid psychotomimetic side effects. In the meantime, I am hoping that my impressions of ketamine are wrong, and that it does have practical applications to treat depression. I just haven't seen it yet.
Do you think that adding magnesium to ketamine would be helpful? What about memantine?
- Scott
Posted by jrbecker76 on February 19, 2013, at 14:21:05
In reply to Re: Ketamine and side effects » jrbecker76, posted by SLS on February 19, 2013, at 13:18:01
> Perhaps you would do better with tianeptine. I don't know. You might not be a SSRI responder.
>
> How did you react to Zoloft?
>
> What about MAOIs?
>
> I am seriously considering using deep TMS as a treatment to accelerate my response to medication. I don't think ketamine represents much more than an intriguing and potentially important heuristic observation, much as sleep deprivation is. It can produce a dramatic antidepressant effect transiently, but what do you do with it? If ketamine were observed to work synergistically with other drugs to make them work better and longer, I would agree that it has a clinical application. Do you know of any studies like that?
>
> From what I have seen, there is a narrow therapeutic window for ketamine administration. One must be brought to the point of delirium without becoming unconscious. This can only be accomplished with the precision offered by infusions. Ketamine does not produce an antidepressant effect when used at dosages that are too high or too low. Injections just don't accomplish this as well as infusions do. I'm looking forward to the development of an oral agent by Naurex that acts as a partial agonist at the glycine binding site of the NMDA receptor / channel. It should have a wider therapeutic window and avoid psychotomimetic side effects. In the meantime, I am hoping that my impressions of ketamine are wrong, and that it does have practical applications to treat depression. I just haven't seen it yet.
>
> Do you think that adding magnesium to ketamine would be helpful? What about memantine?
>
>
> - Scott
>Hi Scott.
You bring up a lot of interesting questions.
In terms of my own SSRI response, I would say that I respond to all of them in terms of impacting my mood on some level. When I say that, I mean that I do better on them rather than off of them. Unfortunately, most of them can cause significant side effects ranging from anergia, fatigue, heightened distractability, mild irritability, apathy, not to mention other non-CNS related SEs. As I mentioned, I do quite well on Citalopram, relatively speaking. Zoloft definitely made me the most irritable and anxious, Lexapro fell somewhere in the middle, and Fluoxetine to a less extent. I did a little better on the SNRIs (Cymbalta a little more so than Effexor) but the SNRIs also caused more ruminative behavior. Overall my favorite is still Citalopram. I do well in combo with a very low-dose of Nefazodone in the mix. Although my dx is MDD, I am most likely a soft case of BPII (there is some family history there). So this probably explains my med sensitivities. In terms of other classes, I have not done as well on tricyclics in comparison to the monoaminergic reuptake inhibitors and other newer classes. As for MAOIs, I concur with my pdoc in believing that I could not tolerate them.
As for Ketamine, yes, I would call it an academic's antidepressant. By this, I mean it obviously comes with quite a few barriers for wider treatment implementation (e.g., in-office administration and related costs, addiction potential, short therapeutic window, etc). That being said, some research clinics have had patients on long-term maintenance ketamine quite successfully for a while now (see UCSD for example). Many of these patients, once stabilized, end up only needing maintenance dosing somewhere between 2-3 x a week to only a 1-2x per month. By the way, almost all of the trials have not demonstrated that dissociation are other issues have been a problem - either during the infusion or hours/days afterwards. I do have a bit of skepticism that the ~70% response rate in ketamine trials will end up being confirmed in larger clinical trials (but for now, a meta-analysis of smaller trials has indeed confirmed this high level of response). I think there is definitely a subset of patients (see JohnLA's threads) that will not respond, and maybe even be detrimental to their mood.
so I'm not ready to drink the koolaid on this quite yet, especially since researchers are hyping the ketamine phenomenon as the most exciting thing that has happened to psychopharmacology in the past 50 years. But I would tend to agree with the sentiment that this is quite a seachange for the field Although Ketamine will probably not ever be prescribed to a wide clinically depressed population, the stimulus of the clinical research beyond the monoamines is something that was drastically needed in the virtual standstill of the psychiatric pipeline just a couple of years ago. Now companies like Roche, J&J, Astra-Zeneca and a few others are testing a number of glutamatergic drugs. As you know, some are testing IV-administered "ketamine-like" drugs (e.g., Naurex and AZ), while others are looking towards oral agents (J&J, Roche, Naurex). As I mentioned earlier, I was in a trial for one of Roche's drugs they are testing (a mGlu 2/3 antagonist). I unfortunately was plagued with more SEs than anything else (as a side note though, preliminary feedback from my trial site remarked that subjects are responding). Perhaps this is a sign I won't be a responder to ketamine. Who knows. But since there a few different glutamatergic mechanisms they are testing out it's likely one of the mechanisms of action under investigation will prove worthy.
As for the fate of ketamine iself, will it eventually become more than just a fad? Well, think of it this way, they've showed response in one trial with non-responders to ECT. So imagine the cost-effectiveness of administering ketamine instead of ECT from an insurer's point of view. So yes, I could be convinced that ketamine will eventually find a place in the treatment spectrum, even if it's just as a protocol for inpatient hospitalizations with suicidal ideation or perhaps as another option instead of ECT for TRD individuals. I corresponded with one researcher who has researched the cost-effectiveness of implementing ketamine treatment on a larger scale. She said that it warrants a lot more research which is currently being undertaken. However, she believes that it could be cost-effective if psychiatrists mimicked the way many pain clinics administer infusion drugs to patients. Realize that in most cases, an anesthesiologist is not being used which will help to keep costs down. As for whether other drugs can "extend" the efficacy of ketamine. They are testing riluzole now in a trial to determine that.
JB
Posted by Phillipa on February 19, 2013, at 15:35:18
In reply to Re: Ketamine and side effects » brynb, posted by jrbecker76 on February 19, 2013, at 12:02:41
I don't remember any side effects from Deplin, but recently did start taking D3 and found that it indeed did cause some irritibility in me Phillipa
Posted by jrbecker76 on February 19, 2013, at 16:44:54
In reply to Re: Ketamine and side effects » jrbecker76, posted by Phillipa on February 19, 2013, at 15:35:18
> I don't remember any side effects from Deplin, but recently did start taking D3 and found that it indeed did cause some irritibility in me Phillipa
In regards to Deplin, I think most find it low on SEs. Its effectiveness is also hit or miss with most though. I think I fall into a subset of individuals who find it more detrimental than helpful. This past thread (which you were a part of) is pretty emblematic of my own experience with it...
Posted by brynb on February 20, 2013, at 7:00:25
In reply to Ketamine and side effects, posted by brynb on February 18, 2013, at 15:32:35
Thanks for all the feedback.
I had the worst experience with my ketamine injections yesterday. I flipped out and cried the entire time, didn't know whefre or who I was and thought I really lost my mind.
I forgot to mention that I had forgotten to take Lexapro (kind of intentionally) the last 2 nights, which was my pdoc's explanation (and my hormones) for reacting to K the way I did.
He wants me to go forward with more injections on Friday because I responded so well initially. I don't know anymore.
We also changed my meds; now I'm starting Viibryd, taking a low dose of Saphris at night, Ambien to sleep, and Valium for anxiety.
I'm losing hope again.
-b
This is the end of the thread.
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