Ketamine has 'fast-acting benefits' for depression • Hacker News Board

Re: Ketamine has 'fast-acting benefits' for depression

#201

Post by Sukotto » Mon, Apr 16, 2018, 11:57 PM UTC

rincebrain wrote: post #140

I've posted this in other ketamine news stories before, but I'm offering it as a firsthand testimonial here. Ketamine was both the best and most depressing depression treatment option I've ever tried. Within a couple of weeks after having had the initial round of six treatments in two weeks, I was the most functional and productive human being I've _ever_ been - things that used to be impossible or utterly agonizing…

That reminds me of the short story "Beginner's Luck" By Poi Lass.

It is part of a series examining what happens to people that discover they have a minor super-power.

  It was...possibly the single worst experience of my life,
  feeling that slip away, and now having recent 
  crystal-clear memories of how much that fog had been
  complicating my life.

I should warn you that the overarching theme of this story aligns almost perfectly with this comment.

http://web.archive.org/web/20061112225415/http://www.subreal...

Re: Ketamine has 'fast-acting benefits' for depression

#202

Post by 6nf » Tue, Apr 17, 2018, 1:54 AM UTC

toomanybeersies wrote: post #159

mmcwilliams wrote: post #120

Earlier quoted context omitted.

Do you have a source on that 1/2 gram number? My reading has lead me to believe that a typical therapeutic dose for these treatments is between 60-75mg. I could be way off, though.

I was looking at studies earlier today, and the upper limit (assuming a 100 kg person) was 0.5 g from one of the studies.

That can't be right, 0.5g will knock out a horse for many hours

Re: Ketamine has 'fast-acting benefits' for depression

#203

Post by cosmie » Tue, Apr 17, 2018, 4:21 AM UTC

dmix wrote: post #166

nylonstrung wrote: post #144

Earlier quoted context omitted.

Ketamine and its analogs are known to have a rapidly developing and profoundly durable (some even say permanent) tolerance, and I find this is often glossed over, especially when studies don't evaluate it over a long enough time period I think Ketamine itself isn't a real solution but hopefully some of the isolated metabolites will be

> tolerance. I find this is often glossed over This was specifically and prominently addressed by the article: >> However, at 25 days the effects had levelled out. >> The study's authors suggest it could offer an effective rapid treatment for people severely depressed and at imminent risk of suicide and could help in the initial stages of treatment, as most anti-depressants take four to six weeks to become fully effe…

I think the durability of that tolerance was what the parent was pointing out.

As in, it's potentially only useful as a bridge treatment once. If you decide to lapse your long term anti-depressant after several months and suddenly need another bridge treatment as you ramp back up again, the durability of the tolerance from your initial ketamine treatment would prevent it from being useful the second time.

Re: Ketamine has 'fast-acting benefits' for depression

#204

Post by anythingnonidin » Tue, Apr 17, 2018, 4:47 AM UTC

topmonk wrote: post #200

anythingnonidin wrote: post #4

Main upsides of Ketamine for depression vs typical antidepressants (SSRIs, etc) - Ketamine seems to have a much larger effect size (-~0.99 [1] vs -~0.35 for typical antidepressants [2]) [If anyone spots an error, please let me know] For context, an SMD of 0.2 is small, >0.5 is medium, and >0.8 is large.[3] To me this seems to be by far the most important/interesting thing: Ketamine seems to have a much stronger antid…

> - Ketamine seems to have a much larger effect size (-~0.99 [1] vs -~0.35 for typical antidepressants [2]) [If anyone spots an error, please let me know] I've heard that 35% figure bandied about for awhile now. Does this take into account multiple SSRI's? If one took Welbutrin and it didn't work, for example, and then one decides to try Paxil, is there still a 35% chance that Paxil will work? (both Paxil and Welbutr…

Not sure about your questions, sorry. Perhaps try asking on reddit.com/r/askdrugnerds. And a minor correction to your comment: The ~0.35 is showing standardized mean difference which is more a measure of how much it reduces someone's depression by, as opposed to what you're asking about which is about what % of people respond to a given treatment.

Re: Ketamine has 'fast-acting benefits' for depression

#205

Post by GordonS » Tue, Apr 17, 2018, 11:54 AM UTC

hssys wrote: post #83

TTPrograms wrote: post #22

If you're an American, every time you read a new article on Ketamine for depression your thought should be "Jeese, healthcare is screwed up". Pharma companies don't benefit from getting Ketamine approved (since it's no longer patent protected), so no one is putting it through FDA for depression. As a result insurance will never cover it (under the current model). The reason this treatment isn't mainstream isn't becau…

If that is the case then why is this not widely available in the UK?

Healthcare in the UK moves at a snail's pace. NICE requires a lot of evidence before they will permit new treatments. The bigger issue though are the "Daily Mail politics" of using drugs that can be abused - it's seen as politically toxic with a particular segment of voters. Take cannabis as an example - it was moved back to class B years ago, purely for political reasons. And as other nations are starting to use it therapeutically, we still seem light years away.

Re: Ketamine has 'fast-acting benefits' for depression

#206

Post by sedeki » Tue, Apr 17, 2018, 11:55 AM UTC

rincebrain wrote: post #198

sedeki wrote: post #191

Earlier quoted context omitted.

Seroquel for clinical depression, really? I thought it only was used to treat psychotic episodes (I’ve taken it for that specifically). Oh well, you learn something new every day.

I've heard it being used as an augment for people who have trouble with other treatments, or if they're also looking for synergies with the other effects of it. A couple of antipsychotics or even more esoteric drug types are used (off-label and otherwise) for antidepressant effects, often at dosages lower than they'd usually be thought to be effective for whatever the primary usage would be. Why does it work? Ask aga…

Where I live (Sweden), there are rigid restrictions on what a psychiatrist can prescribe, in the sense that off-label prescriptions aren’t a thing what so ever.

What you said makes perfect sense to me. My reply was just me being surprised by someone who apparently got an antipsychotic for clinical depression alone (... which turned out to not be the case, but yeah...)

Re: Ketamine has 'fast-acting benefits' for depression

#207

Post by ada1981 » Tue, Apr 17, 2018, 1:53 PM UTC

nylonstrung wrote: post #152

ada1981 wrote: post #97

Earlier quoted context omitted.

I over came decades of suicidal depression (as well as schizophrenia and bipolar) with a self concocted protocol which included psychedelics and now don't take traditional meds. I read the OPs intention as "use K to get the person back from the bottom of depression and then leverage that boost in mood to start a habit of excersize" That seems reasonable and a good approach. You want to reinvest the motivation and bet…

Can you explain your protocol? That's pretty promising. I've had some good results to date but not sure how to use them in a more disciplined way to create permanent results

I'd be happy to Skype with you for 20 minutes sometime. You can email me a@175g.com

Re: Ketamine has 'fast-acting benefits' for depression

#208

Post by Steel_Phoenix » Tue, Apr 17, 2018, 3:56 PM UTC

nylonstrung wrote: post #144

rincebrain wrote: post #140

I've posted this in other ketamine news stories before, but I'm offering it as a firsthand testimonial here. Ketamine was both the best and most depressing depression treatment option I've ever tried. Within a couple of weeks after having had the initial round of six treatments in two weeks, I was the most functional and productive human being I've _ever_ been - things that used to be impossible or utterly agonizing…

Ketamine and its analogs are known to have a rapidly developing and profoundly durable (some even say permanent) tolerance, and I find this is often glossed over, especially when studies don't evaluate it over a long enough time period I think Ketamine itself isn't a real solution but hopefully some of the isolated metabolites will be

The supplement and drug industries are constantly finding ways to provide chemistry that will be most specific and bio-available. While this certainly has benefits, I worry that by bypassing precursors, we also often bypass important regulatory steps the body uses to avoid damage.

The idea that taking something that fixes a symptom, but then creates a permanent tolerance, makes me think that getting that chemical too directly in the past may have caused the tolerance that caused the initial symptom.

Re: Ketamine has 'fast-acting benefits' for depression

#209

Post by GordonS » Tue, Apr 17, 2018, 4:50 PM UTC

goldenkey wrote: post #33

DrScump wrote: post #13

Is the mechanism of action known?

One part of it, at least for me, is the psychadelic "converging on rebirth" feeling. It's a very geometric type of high, most likely due to the NMDA agonism, induced dissociation / depersonalization. Much shorter duration than LSD, and less chance of bad thoughts/actions since you are pretty much sedated and unable to panic. Ketamine is really therepeutic mentally.

The doses given therapeutically are lower than recreational ones.

Re: Ketamine has 'fast-acting benefits' for depression

#210

Post by cel1ne » Tue, Apr 17, 2018, 9:17 PM UTC

rincebrain wrote: post #196

_bdog wrote: post #190

Earlier quoted context omitted.

This easily explained: Ketamine seems to repair some kind of cell damage, thereby increasing neural plasticity. That is a huge asset, but long endured depressions leave many unhealthy neural circuits over the years. These have be unlearned one by one, which takes time. Ketamine increases freedom of thought and emotion, but you still need a goal and long-term plan to precisely target and unwork all the patterns that c…

Neuroprotective behavior is one of the theories I've heard about ketamine's efficacy, as well as lithium's, but that doesn't explain the immediate gross improvement, just the eventual semi-permanent tolerance in some cases. In my case, while it was effective, I was a much more productive and healthy person than I'd ever been, cleaning up lots of mess and accumulated dross I'd never been able to convince myself to go…

Humans feature meta-cognition. I suspect you felt better and more relaxed due to the mechanism, and that in turn gave you another big boost by showing you that you are still capable to feel and act different.