ketathrowaway

The value the ketamine doc (in my case, both docs have been anesthesiologists) provides, that a psychiatrist doesn't, are:

(1) Safely starting an IV on you

(2) Monitor your heart rate, O2, bp levels during the infusion - sometimes people have problems during infusions, I've never had one, but I feel safer having these treatments knowing my vitals are being monitored

(3) Training to know how to solve emergency health issues you may have during the treatment. I personally value this on-the-spot emergency medical knowledge very highly, but if you don't then I can understand why you might question the value. I am completely and utterly helpless during an infusion, if anything bad happens to me, I will be utterly unable to help myself, even a tiny bit.

(3) Access to pure/safe ketamine

I've never known, or heard of, a psychiatrist that will do all this. They very well may exist but not in my area.

> What is true about IV is you can control the amount that actually gets taken in much better.

I agree 100% with this. Furthermore, being able to carefully control the dose and duration is paramount in getting the effects to last as long as possible.

The effectiveness of ketamine for depression is all about the state it puts your mind in. This is obvious because the drug itself has totally left your body shortly after administration, but the effects can last much longer. In this respect you can think of it as your mind actually healing itself, by being induced to by the ketamine, rather than the ketamine itself impacting your brain's structure. This is different from most conventional psychiatric medicine where the drugs need to build up and remain in your system over very long periods of time to be effective.

Optimizing the dose & duration to get your mind into that state, and for the right amount of time, makes a huge difference in how long the effects last. This is why I prefer using an actual doctor with ketamine depression treatment experience, because they have experience figuring out the right dose & duration for you.

Which doctors, exactly, are you referring to when you say "these doctors you are talking about"?

What makes you think both my doctors don't have clinical experience? (I never stated, you never asked. As it turns out, they both do.) You've turned this conversation into a pissing match about whose doctor is best, which is too petty for me, so this will be my last post in response to you.

> Many of the practitioners aren't even psychiatrists

> ketamine docs want you to see a psychiatrist because they don't want to deal with you

So a ketamine doc that isn't a psychiatrist is bad, in your opinion. And also any ketamine doc who realizes that the situation he's treating requires psychiatry for optimum outcome, recognizes they lack said experience, and makes you go to someone with that experience, is also bad? I'm sorry, but your posts reek more of an anecdotal agenda rather than... science. So, I'm done.

Yes, I am indeed saying you should trust the opinions of people with medical training and experience. Especially doctors that have been treating depression with ketamine for years. Whether or not they're an anesthesiologist or one of the handful of people in the entire world that are both an anesthesiologist and a psychiatrist. (All of my ketamine docs require you to also see a psychiatrist, so that profession is still completely involved for me.)

My previous doctor runs a monthly group meeting where patients get together to discuss their experiences. The vast majority of attendees had positive experiences. So even if you don't trust the doctor, you can trust the living proof of positive outcomes. Sure, you could say that the group self-selects for positive outcomes, but no one claims this treatment is 100% effective, either.

I agree with you that what works best for some may not work the best for others. I disagree that doctors who charge a few hundred bucks for this "don't give a shit" about their patients. I also know that, from personal experience, sublingual ketamine did very little for me (tried that before IV). Doc then suggested IV use, and said most patients end up needing the IV route.

You do not build up a tolerance to ketamine if you follow the treatment protocol, which dictates a lower dose (around 100mg, give or take for body weight), and one infusion every 3-6 weeks.

Source: Been having regular infusions every 3-6 months for 3 years, and it still works for me.

I can't say this enough: experience & anecdotes based on recreational ketamine use /do not apply at all/ to clinical use.

One more thing I'd like to add, my mother has a very similar kind of depression as I do, and ketamine was not effective for her at all. She was on a fairly high, regular dose of opiate medication, and also she's in her mid 50s. Doc said that it doesn't work as well sometimes, for older people. But we couldn't say for sure if it was her age or the opiates, and getting her off the opiates wasn't an option for her unfortunately.

> Is the dose administered during these sessions high enough to cause hallucinogenic effects?

Yes. It isn't effective unless you get well into a hallucinogenic state. The antidepressant effect seems to be maximized by setting the dose such that you are fairly "out there", but not so far out there that you get scared, or pass out. (Ketamine is used all the time as anesthesia for surgery, and they give you a much larger dose than is used in depression treatment, because past a certain dose, you just immediately zonk out 100%. Good ketamine therapy for depression is achieved by feathering the dose between the two extremes of zero effect and passing out.)

Hallucination means a lot of different things, but with ketamine it's pretty specific. It's not the kind of hallucination where you're looking around the room you're in and see things that don't exist. With ketamine you basically disconnect from the world you're in at the moment and go somewhere else entirely, in your own head. You will often not ingest input from your eyes, even if they're open. What goes on inside someone's head at this point varies wildly, I could tell you what it's like for me but not sure how much interest there is in that. I will say though that music has a profound impact on what goes on in my head during an infusion, and is a fun way of customizing the ketamine experience. I particularly love using my AirPods for this, because there are no wires and especially under ketamine, it feels like the sound is coming from inside your head, as opposed to feeling like you're wearing headphones.

> Could you describe what your depressive symptoms were like before/after treatment?

My depression manifest itself in extreme anhedonia, and after my 3rd infusion, I played, and enjoyed playing, a video game again, for the first time in over a year. Also, at that point in my life (3 years ago) I was going through a lot of difficult personal life problems, and dealing with those problems went from "completely insurmountable" before, to "this is shitty but I can figure it out" after.

In other words, it helped me deal with my life and enjoy things again, but it didn't turn me into someone who will never experience sadness again. It doesn't mean you'll never have a bad day again, but it does mean you'll be able to handle those bad days a lot better.

> How many sessions did it take before you saw improvement?

The way my doctor recommended starting ketamine treatment was to have 6 doses over the course of 2 weeks (m/w/f, m/w/f), and then after that "as needed", which for me turned out to be every 4 weeks. It was after the 3rd dose in my initial course of 6 that I noticed a significant effect.

> Also, any personal insight on why it was so effective for you? Do you think it helped you view circumstances in your life in a different way (the way other hallucinogens like LSD might)?

I can answer this in two parts.

First, one reason it is effective for me is because I don't take any other drugs that conflict with ketamine. Regular benzodiazepine use, or opiate use, or lamictal (this list is not exhaustive) significantly impact the effectiveness of the treatment. Lamictal completely kills the effectiveness. I had just started on lamictal treatment a month prior to discovering ketamine treatment, and had to come off it for 10 days before starting. Same with benzos.

Second, and this is just my personal theory about my own experience, I think one thing ketamine does that helps me is to get my mind out of ruts. The experience of ego death, or near ego death, that I get with ketamine feels like a complete reset for the problems my brain was relentlessly focusing on before. Afterwards, I still care about those problems, but obsessing over the negative parts of my life abates significantly. I would say that before, my focus on the negative vs positive was quite lopsided to the negative, to the point that I rarely noticed / felt the positives. Whereas now, the two are much more balanced. I still lean a bit towards the negative, but just a bit.

One more personal anecdote: Before ketamine, I was dating a lot, but almost out of desperation because of how extremely lonely I felt, rather than because I was being thoughtful/intentional/patient about finding a great partner. The ladies I dated picked up on this quite easily, and it lead to a lot of negative outcomes. And each negative outcome felt like the world ending, which made things worse. A few months after starting ketamine I tried dating again, and it went so much better. I wasn't as desperate, and I took the time to figure out who I was and what I really wanted, and what I offered. It still took a while before I found the right partner for me, about one year after starting ketamine treatments, but we're happily married!

2-3+ grams a day is crazy. Ketamine from a legit clinic is around 100mg give or take based on body weight, once per 3-6 weeks. If you increase the dose of any safe drug by that many orders of magnitude, yes, your body will be harmed!

> I would just buy some online and insufflate it. Safer than a needle and just as effective.

Insufflation is only "just as effective" if your goal is to get an intense psychedelic high.

If your goal is a strong antidepressant effect, insufflation is extremely less effective than IV-drip-over-40min. This isn't just my opinion, it's the consensus opinion of ketamine docs across the world.

Insufflation helps you for a few minutes to a few days, IV drip method works for 3-6 weeks.

Ketamine's antidepressive effects are by far the most potent when ketamine is administered as an IV drip over a long period of time, like 40ish minutes. If you simply inject it all at once, you will definitely go to la la land, but the duration will be too short.

And if you're talking about starting an IV on yourself... without training, the risks of really bad health issues, including death, are pretty high. Almost no one outside of professional health care has that training. Even if they did, you still need to be monitored by someone else via pulse ox and sometimes blood pressure for safety reasons, and said person monitoring you needs to have the training to know how to help you if something goes wrong. Keep in mind that if ketamine is effective for you, you will end up needing to keep taking it for a long time, typically every 3-6 weeks, or the effects wear off. That frequency multiplies the risks.

In short, I see the ratio of risk to effectiveness for home use ketamine to be emphatically not worth it. Unless you have a partner / friend who has the necessary training.

I know from talking to my doctor that of the $375 I pay, his cost for the ketamine he uses for that one treatment is under 10 bucks. If you've got a medical license, you get access to buy legit pharma drugs very easily. I believe he told me that one vial of Ketamine is something like $20 and there's multiple doses in there.

I pay $375. And at a different doctor, before I found my current one, I was paying $750.

There is a gigantic difference in patient outcome between clinical ketamine use and recreational ketamine use. For a variety of reasons: careful dose control, having an actual doctor involved, etc. But the biggest one is the antidepressant effects of ketamine only really happen when it's administered via IV drip over a course of 45 minutes. The most common use of recreational ketamine is inhaling it, the effects come up too fast and go away too fast for the antidepressive effects to occur.

This has been my experience too. None of the ketamine-based drugs have been as effective as regular ketamine. That said, drug companies will not seek to get regular ketamine FDA approved because they can't patent it. So this is the only way they will go through the process of FDA approval. I hope it leads to regular ketamine being FDA approved for treating depression because only then will it be covered by insurance.

This is not strictly true. Chronic ketamine ABuse can cause urinary tract problems. The doses and frequency used in a clinical session emphatically do not cause this problem. Ketamine has been in regular use since 1970 for a wide range of medical purposes. It's also been on the WHO Essential Medicines List since 1985.

tl;dr - don't need to worry about urinary tract issues unless you're using the drug (1) recreationally; (2) irresponsibly

(Pardon the throwaway; I try to keep my medical history private!)

I started monthly ketamine treatment about 3 years ago for treatment resistant depression. It has helped me immensely. It costs me $375 per infusion.

I tried 1-3 drugs from every class of antidepressant (and a few other types) before ketamine and had limited results. Ketamine, however, has been a godsend.

If anyone has any questions about the treatment, the drug, its effects on me, or anything else, feel free to ask.