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Re: Tentative remission on ketamine beckett2

Posted by SLS on January 1, 2023, at 3:18:43

In reply to Re: Tentative remission on ketamine SLS, posted by beckett2 on December 30, 2022, at 16:09:35

> Hi, Scott,
>
> Generally, my physical health is better all around. I 'think' my depression, etc, is heavily weighted toward sleep disturbance and inflammation. With more study, we might find ketamine is effective for certain types of depression and less so for others.

Undoubtedly.

Major Depressive Disorder is really just a set of hetergenous presentations; each with a different gestalt of etiologies.

> A few years from now there will be new treatments from psychedelics and dissociative that will help a suite of MH ailments.

Once, a friend of mine encouraged me to look into intranasal ketamine. It sounded like a whacky idea to me at first, but the idea grew on me. She is an old-timer of Psycho-Babble, but hasn't posted in over a decade. Treatment-resistent. Tried all of the available "traditionally-defined" antidepressants. She decided to take a 8 hour trip to see her old psychiatrist, who happened to be an associate of my doctor in Princeton. The doctor had just begun to treat people with intranasal ketamine. Long story short... My friend, who had spent the better part of her life chasing remission by ingesting all sorts of substances was offered something very different - intranasal ketamine. 3 days after her first dose, she described herself as being in remission. Huh? Same person?

The second phase of using intranasal ketamine to treat depression is to discover the best dosing frequency to maintain remission. Some people dose every day. Some people dose once per week. I think a schedule of one dose every 5 days is showing itself to be the sweet-spot for dosing frequency.

The clinical rule of thumb for establishing the optimal therapeutic dosing for any method of ketamine administration is that the dosage be high enough to produce a mild dissociative state. If, however, the magnitude of the dissociative state is too great, ketamine will fail to exert an antidepressant effect. Check the work of John Krystal from Yale. His work helped to foster the use of ketamine in psychiatry - for both mood and schizoid disorders.

Ketamine is dirt-cheap. Your doctor prescribes the concentration of the ketamine solution and the amount to be administered per nostril. I had my prescription filled at an apothecary in Princeton.

Intra-nasal - Quick, Cheap, Convenient, Effective, Lower rate of response(?), but full remission is possible.

Intra-veneous I.V. - Not quick, Not cheap, Not convenient, Higher rate of response (?).


Optimal schedule for dosing: One treatment every 3-7 days. I am under the impression that one dose every 5 days most often hits the bullseye.

As an aside, both ketamine and memantine block NMDA receptors. I haven't looked into the variability in the binding affinities of both drugs to the NMDA receptor. Whereas ketamine produces an immediate and robust antidepressant when administered as monotherapy, memantine does not. Clinically, ketamine is clearly a more effective tool to treat depression than memantine is.


- Scott4


Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.

 

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