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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by chumbawumba on July 21, 2013, at 17:14:55
So I had a ketamine treatment yesterday. 40 mg, intramuscular. It was a little mind-bending, felt very stoned for about half an hour. It was kind of like smoking pot or taking mushrooms but with a shorter duration. Felt fairly sober an hour later although a little wobbly. Mild nausea for the rest of the day. No immediate relief from depression.
Felt pretty restless last night and couldn't get to sleep which is unusual for me. Ended up taking doxylamine to get to sleep. Woke up today feeling fairly decent which is also unusual for me. Usually I wake up with crushing dread and depression. My sleep was uneventful which was a nice change. No early morning wakening or the excessive dreaming which I usually suffer from.
All in all, so far I am not impressed. It gave me some relief though. Will update in another 24 hours. Pdoc said that some people take 48 hours to respond.
I'm not really too keen on having a psychedelic experience every time I get treated. If I were to continue this course of treatment I'd probably request a compounded nasal spray so I could take a much lower dose and use it daily. I'm not sure anyone knows the safety of using even low dose ketamine regularly though so I'll be giving that some hard thought.
Taking Synthroid but no other psych meds on board.
Posted by poser938 on July 21, 2013, at 21:06:04
In reply to Ketamine...whoa!, posted by chumbawumba on July 21, 2013, at 17:14:55
Ketamine did the same thing for me that Dextromethorphan in cough syrup did. Both just made me dizzy and neither had any effect on my mood. But, my brain isn't in the right way of functioning to be responding to meds correctly, due to some long-term effects from past meds.
I tried it in a range of doses since my psychiatrist had prescribed it in intranasal take-home form.
Posted by SLS on July 21, 2013, at 22:27:42
In reply to Re: Ketamine...whoa!, posted by poser938 on July 21, 2013, at 21:06:04
> Ketamine did the same thing for me that Dextromethorphan in cough syrup did. Both just made me dizzy and neither had any effect on my mood. But, my brain isn't in the right way of functioning to be responding to meds correctly, due to some long-term effects from past meds.
>
> I tried it in a range of doses since my psychiatrist had prescribed it in intranasal take-home form.Are you able to take the ketamine as a series of micro-doses over the course of a half hour? Right now, I am doubtful that IM or intranasal administrations can replicate the IV protocol: 0.5 mg/kg over 40 minutes.
You are not alone in having a brain that has been made less responsive to treatment as the result of prior exposures to psychotropic drugs. This is also my reality. It is likely to be the reality of a great many of the people posting here. Not good.
Each of us must try to sort out the truths of his existence as best he can. That our early exposures to psychiatry's primitive tools led to persistent changes in brain function is one of these truths. It is what it is. It is only the year 2013. This is too early in the evolution of medical science to expect anything better. We want treatments that help more and hurt less. Perhaps ketamine represents a clue as to how this may be accomplished. However, it is really more of an heuristic tool than a workable therapy. I guess administering a series of ketamine treatments while continuing standard antidepressant therapy would have the best chance of producing a remission. Maintenance ketamine treatments could be used if necessary. 10 years from now, we might have an oral form of a drug that produces results similar to IV ketamine treatment, but targets a different site on the NMDA receptor. There are virtually no psychotomimetic side effects. If this drug produces rapid sprouting and strengthening of neuronal dendritic spines like ketamine does, we might have a winner. We'll see.
- Scott
Posted by poser938 on July 21, 2013, at 22:46:39
In reply to Re: Ketamine...whoa! - More to come? » poser938, posted by SLS on July 21, 2013, at 22:27:42
Not only has my brain been made less responsive to medications. It has also been made less responsive to input from the outside world. I don't like being able to keep my eyes closed while I'm driving and feel as much need to open them as I would be if I were sitting on my couch. My pupils don't react to light and dark. My emotions (lack of) don't respond to the world around me.
When a Med like an ssri or a direct agonist puts your neurotransmitter systems in overdrive, this can sometime lead to them just giving out like an overloaded fuse. That seems the case with me. Its not much different than what we all know about antibiotics and how they can make the immune system less responsive to a virus on the attack.
I looked at it the other way around when I started meds in 2005. I thought the future had arrived and that there were immense amounts of knowledge behind psychiatric meds and that they held so much promise. I didn't understand why some were nervous about psychiatry. I figured, heck, if I don't like the Med, I just stop taking it and all will be well.
Posted by poser938 on July 21, 2013, at 22:54:58
In reply to Re: Ketamine...whoa! - More to come?, posted by poser938 on July 21, 2013, at 22:46:39
> Not only has my brain been made less responsive to medications. It has also been made less responsive to input from the outside world. I don't like being able to keep my eyes closed while I'm driving and feel as much need to open them as I would be if I were sitting on my couch. My pupils don't react to light and dark. My emotions (lack of) don't respond to the world around me.
>
> When a Med like an ssri or a direct agonist puts your neurotransmitter systems in overdrive, this can sometime lead to them just giving out like an overloaded fuse. That seems the case with me. Its not much different than what we all know about antibiotics and how they can make the immune system less responsive to a virus on the attack.
>
> I looked at it the other way around when I started meds in 2005. I thought the future had arrived and that there were immense amounts of knowledge behind psychiatric meds and that they held so much promise. I didn't understand why some were nervous about psychiatry. I figured, heck, if I don't like the Med, I just stop taking it and all will be well.Err, actually I got that mixed up with antibiotics. Its bacteria that antibiotics deal with.
Posted by Phillipa on July 21, 2013, at 23:01:55
In reply to Re: Ketamine...whoa! - More to come?, posted by poser938 on July 21, 2013, at 22:54:58
I'm glad I stuck to my guns and never took the therapeutic dose of ad's just low doses. Now the benzos I different story but still only low dose & I believe in them. Phillipa
Posted by Jeroen on July 22, 2013, at 10:12:22
In reply to Ketamine...whoa!, posted by chumbawumba on July 21, 2013, at 17:14:55
my doc sais ketamine can make you psychotic, i hope this doesnt happen to you of course. and you get well instead :)
please keep us updated, btw is this really necessairy to do it intravenious?
Posted by chumbawumba on July 22, 2013, at 13:22:39
In reply to Re: Ketamine...whoa!, posted by Jeroen on July 22, 2013, at 10:12:22
Still no real improvement after 48 hours. Very disappointing. I got the full IV dose of 0.50 mg/kg (40 mg At my body weight) all at once intramuscularly. I'm not sure what difference it would have made to get that 40 mg intravenously over the course of an hour versus getting it all at once intramuscularly. Maybe the psychedelic effects are less intense if you spread it out with an IV?
I probably won't try it again since I got almost nothing out of it.
Posted by Iansf on July 22, 2013, at 13:45:09
In reply to Re: Ketamine...whoa!, posted by chumbawumba on July 22, 2013, at 13:22:39
I've not heard of giving ketamine intramuscularly, Only intravenously, orally and nasally. It probably would make it less psychedelic, but I'm thinking it would also make it much less effective.
> Still no real improvement after 48 hours. Very disappointing. I got the full IV dose of 0.50 mg/kg (40 mg At my body weight) all at once intramuscularly. I'm not sure what difference it would have made to get that 40 mg intravenously over the course of an hour versus getting it all at once intramuscularly. Maybe the psychedelic effects are less intense if you spread it out with an IV?
>
> I probably won't try it again since I got almost nothing out of it.
Posted by chumbawumba on July 22, 2013, at 14:24:34
In reply to Re: Ketamine...whoa! » chumbawumba, posted by Iansf on July 22, 2013, at 13:45:09
It was intensely psychedelic. Bordering on unpleasant. Maybe if I hadn't been depressed in the first place I would have enjoyed it but being in a funk I was in no mood to take a journey.
Why would intramuscular be a less efficient means of delivery? There are numerous recreational users who use this delivery method.
Posted by SLS on July 22, 2013, at 17:13:30
In reply to Re: Ketamine...whoa!, posted by chumbawumba on July 22, 2013, at 14:24:34
Ketamine must be delivered in a way that produces a steady blood concentration that remains within a narrow window for some minimum amount of time. If you go even a little too high in dosage, you forfeit the antidepressant response. In addition, the consequence of the short half-life of ketamine is a very short window of time within which the blood concentration would be therapeutic if the drug were delivered via IM injection, intranasally, or orally.
The values currently being worked with are: ketamine IV = 0.5 mg/kg body weight x 40 minutes.
Dose-response:
- Low dose = glutamate release decrease
- Intermediate dose (therapeutic) = glutamate release increase
- High dose = glutamate release decreaseIntravenous administration has been the most successful method to administrate ketamine for treating depression because it can reliably deliver the right amount of drug.
I wonder if ketamine could be delivered transdermally or orally using a controlled-release. I guess it depends upon how narrow the therapeutic window is.
- Scott
Posted by sigismund on July 22, 2013, at 17:21:56
In reply to Re: Ketamine...whoa!, posted by chumbawumba on July 22, 2013, at 14:24:34
You had a recreational dose if I recall correctly. (25 - 50mg?? It is a long time ago.) I was a bit surprised it was so high. IV or IM is equally effective for delivery of the drug, though I do not have a clue about the AD thing.
It is a strange effect, isn't it? Words not being able to describe it, psychedelic will have to do. That physical thing is amazing, the physical perception of moving toward what is in your field of vision and then, after you remind yourself that you are after all not moving and hence will not collide, something happens. Do you become part of the thing you thought you would collide with? I ended up disliking it.
Posted by linkadge on July 22, 2013, at 21:33:43
In reply to Re: Ketamine...whoa!, posted by SLS on July 22, 2013, at 17:13:30
Low dose = glutamate release decrease
- Intermediate dose (therapeutic) = glutamate release increase
- High dose = glutamate release decreaseLithium within a certain dose range has similar actions. In certain dose ranges it decreases glutamate re uptake and in others it enhances it. I read somewhere that ketamine might be acting through a gsk-3b dependent mechanism.
Linakdge
Posted by linkadge on July 22, 2013, at 21:40:09
In reply to Re: Ketamine...whoa! » chumbawumba, posted by sigismund on July 22, 2013, at 17:21:56
If SLS is right, and the dose (and hence glutamate release) is critical for the effect, I would think that other meds might interfere.
Were you on any other meds at the time? I remember reading that mood stabilizers reduced the AD effect of rtms in bipolar patients.
Also, having an MRI apparently also has an AD effect that is reduced by mood stabilizers.
Posted by linkadge on July 22, 2013, at 21:44:16
In reply to Re: Ketamine...whoa! » chumbawumba, posted by sigismund on July 22, 2013, at 17:21:56
Both high and low glutamate levels likely cause mood symptoms. With long term antidepressant treatment, there is usually a net decrease in glutamatergic function.
Perhaps this is beneficial for anxiety (or mood stabilization) but less so for apathy?
Posted by SLS on July 23, 2013, at 6:58:10
In reply to Re: On other meds at the time?, posted by linkadge on July 22, 2013, at 21:40:09
> If SLS is right, and the dose (and hence glutamate release) is critical for the effect, I would think that other meds might interfere.
That's a great thought.
Certain anesthetics prevent ketamine from increasing GLU release.
- Scott
Posted by chumbawumba on July 23, 2013, at 15:30:25
In reply to Re: On other meds at the time? » linkadge, posted by SLS on July 23, 2013, at 6:58:10
I wasn't on any other meds at the tome save for levothyroxine.
That's interesting about having to be in the sweet spot for it to work, not too high not too low. If one were able to somehow mentally calibrate oneself to how the correct dose feels I suppose one could maintain oneself at the sweet spot blood levels with a nasal spray for a long time.
There is a guy over on another forum who treated himself by giving himself 10 mg of ketamine intramuscular every few hours for a week. He said:
"The goal is to maintain threshold ketamine levels in your brain so that the NMDA receptors remain saturated but not over-stimulated. You will know that saturation is being achieved because eventually hourly doses wont feel like they are doing much. Even the light buzz with each dose is no longer all that present. In my case, day 3 was when this happened."One thing I did notice was that I was more irritable the afternoon after the treatment. Possibly just a tad MORE depressed as well. Although that may be because I was disappointed at not having an immediate response.
Posted by Iansf on July 25, 2013, at 12:07:07
In reply to Re: On other meds at the time?, posted by chumbawumba on July 23, 2013, at 15:30:25
I'm curious to know about the experience of the guy on the other forum. Could you direct us to the site? I'm wondering how he's doing and whether he expects to keep up the injections forever or just for a limited time. Thanks.
> There is a guy over on another forum who treated himself by giving himself 10 mg of ketamine intramuscular every few hours for a week. He said:
> "The goal is to maintain threshold ketamine levels in your brain so that the NMDA receptors remain saturated but not over-stimulated. You will know that saturation is being achieved because eventually hourly doses wont feel like they are doing much. Even the light buzz with each dose is no longer all that present. In my case, day 3 was when this happened."
>
Posted by chumbawumba on July 25, 2013, at 18:01:03
In reply to Re: On other meds at the time? » chumbawumba, posted by Iansf on July 25, 2013, at 12:07:07
I hope I'm not violating the TOS by doing this but here is the guy who self treats using low dose ketamine. He's at the point where about 10 mg of ketamine once a week, adminstered intramuscularly, treats his depression. He's also interested in traditional chinese medicine and has a bunch to say about that in this thread but I skipped over that part.
http://www.bluelight.ru/vb/threads/669468-Experience-with-ketamine-therapy-for-depression
Posted by jrbecker76 on July 30, 2013, at 19:23:08
In reply to Re: On other meds at the time?, posted by chumbawumba on July 23, 2013, at 15:30:25
>
> One thing I did notice was that I was more irritable the afternoon after the treatment. Possibly just a tad MORE depressed as well. Although that may be because I was disappointed at not having an immediate response.
That was exactly my response the next day - more depression and irritability. I also noticed it lingering into the third day as well. There was also a bit of lethargy (more just on the second day) as well as occasional dull headache in the days afterwards.After 4 treatments, the jury is still out on whether Ketamine represents a net benefit for me or not.
This is the end of the thread.
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