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Ketamine for the acute treatment of severe suicidal ideation

bmj.com

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Re: Ketamine for the acute treatment of severe suicidal ideation

#11

Post by after_care »

BurningFrog wrote: post #8
after_care wrote: post #4

> Then, patients received a first 40 minute intravenous infusion of ketamine (0.5 mg/kg) or placebo 0.9% (saline solution) in addition to their current treatment. This really shouldn’t be labeled as double blind. 1.The nurse administering knew if it was placebo or active (for safety reasons). 2. It would immediately become obvious to the subject if they were injected with salt water or ketamine. 3. Within minutes it…

Injecting some other psychoactive drug should work, at least for patients who have never used ketamine before. But I suspect that would take many years to get through the permitting apparatus, if it was at all possible.

Injecting someone with another psychoactive drug would not be a placebo. We would be comparing the efficacy of {other psychoactive drug} and ketamine. That's not to say this experiment has no value, it's one of the many experiments we should run to help build the case for ketamine.

The classic gold standard is to randomly assign subjects to groups. Then give one group a sugar pill, give the other group the treatment pill. Neither to patient, the person administering, or the person recording the results know who got the treatment who got the placebo. This is not possible with ketamine, psilocybin, MDMA, LSD, etc. That's fine, we can still build a strong body of experimental evidence of their efficacy. It bothers me when clearly non-blind non-mask experiments are labeled as double-blinded, which we see often in this body of research, this study included.

Re: Ketamine for the acute treatment of severe suicidal ideation

#12

Post by AdamH12113 »

after_care wrote: post #4

> Then, patients received a first 40 minute intravenous infusion of ketamine (0.5 mg/kg) or placebo 0.9% (saline solution) in addition to their current treatment. This really shouldn’t be labeled as double blind. 1.The nurse administering knew if it was placebo or active (for safety reasons). 2. It would immediately become obvious to the subject if they were injected with salt water or ketamine. 3. Within minutes it…

My psychiatrist administers IV ketamine treatments for depression. (I don't use those; regular antidepressants work for me.) I'm not sure what dosage she uses, but from what she's told me, it's not a drug trip, and a lot of people don't feel any different during the treatment.

[Edited to clarify.]

Re: Ketamine for the acute treatment of severe suicidal ideation

#13

Post by jcims »

mrwaffle wrote: post #6
oldstrangers wrote: post #2

I did a full 6 week course of ketamine therapy. It was really good, and I would recommend it if you're open minded. It's not for everyone, and the lasting (a year+) benefits aren't really measurable (maybe I'm different? maybe I'm not, maybe I've just gotten older). I'd like to go again and see if it can help with my obsessive existential dread.

Absolutely, I have a partner who has had severe PTSD and went through a great month-long program, she's overcome many longstanding fears and triggers and has made huge strides in being able to feel that she is living her life once again.

I wonder what the age limit is on stuff like this. So many young folks experiencing crippling anxieties that are impacting their ability to navigate the world at an age where it's going to have longstanding ramifications for relationships and careers.

Re: Ketamine for the acute treatment of severe suicidal ideation

#14

Post by sandworm101 »

AdamH12113 wrote: post #12
after_care wrote: post #4

> Then, patients received a first 40 minute intravenous infusion of ketamine (0.5 mg/kg) or placebo 0.9% (saline solution) in addition to their current treatment. This really shouldn’t be labeled as double blind. 1.The nurse administering knew if it was placebo or active (for safety reasons). 2. It would immediately become obvious to the subject if they were injected with salt water or ketamine. 3. Within minutes it…

My psychiatrist administers IV ketamine treatments for depression. (I don't use those; regular antidepressants work for me.) I'm not sure what dosage she uses, but from what she's told me, it's not a drug trip, and a lot of people don't feel any different during the treatment. [Edited to clarify.]

You might be in her placebo group.

Re: Ketamine for the acute treatment of severe suicidal ideation

#15

Post by phren0logy »

after_care wrote: post #11
BurningFrog wrote: post #8

Earlier quoted context omitted.

Injecting some other psychoactive drug should work, at least for patients who have never used ketamine before. But I suspect that would take many years to get through the permitting apparatus, if it was at all possible.

Injecting someone with another psychoactive drug would not be a placebo. We would be comparing the efficacy of {other psychoactive drug} and ketamine. That's not to say this experiment has no value, it's one of the many experiments we should run to help build the case for ketamine. The classic gold standard is to randomly assign subjects to groups. Then give one group a sugar pill, give the other group the treatment…

There is precedent for this; it's called "active placebo." For example, I think some of the psilocybin trials used methylphenidate as an active placebo comparison condition.

Re: Ketamine for the acute treatment of severe suicidal ideation

#16

Post by aaaaaaaaata »

sandworm101 wrote: post #14
AdamH12113 wrote: post #12

Earlier quoted context omitted.

My psychiatrist administers IV ketamine treatments for depression. (I don't use those; regular antidepressants work for me.) I'm not sure what dosage she uses, but from what she's told me, it's not a drug trip, and a lot of people don't feel any different during the treatment. [Edited to clarify.]

You might be in her placebo group.

I read it as their doctor receiving the treatment, not them.

Re: Ketamine for the acute treatment of severe suicidal ideation

#17

Post by sandworm101 »

aaaaaaaaata wrote: post #16
sandworm101 wrote: post #14

Earlier quoted context omitted.

You might be in her placebo group.

I read it as their doctor receiving the treatment, not them.

"she uses" is an odd phrase for a patient. Patients normally "receive" or "are given". Drug addicts and doctors "use" a drug.

Re: Ketamine for the acute treatment of severe suicidal ideation

#18

Post by chimeracoder »

AdamH12113 wrote: post #12
after_care wrote: post #4

> Then, patients received a first 40 minute intravenous infusion of ketamine (0.5 mg/kg) or placebo 0.9% (saline solution) in addition to their current treatment. This really shouldn’t be labeled as double blind. 1.The nurse administering knew if it was placebo or active (for safety reasons). 2. It would immediately become obvious to the subject if they were injected with salt water or ketamine. 3. Within minutes it…

My psychiatrist administers IV ketamine treatments for depression. (I don't use those; regular antidepressants work for me.) I'm not sure what dosage she uses, but from what she's told me, it's not a drug trip, and a lot of people don't feel any different during the treatment. [Edited to clarify.]

> My psychiatrist does IV ketamine treatments for depression. I'm not sure what dosage she uses, but from what she's told me, it's not a drug trip, and a lot of people don't feel any different during the treatment.

At 0.5mg/kg intravenous, there's no way that people wouldn't feel anything. It's not necessarily a "drug trip", but pretty much anybody can tell the difference between that large of a dose of ketamine vs. a saline solution.

For trials in cases like this, it's common to use a group which receives either a smaller dose of the drug or a drug that is intended to mimic some of the subjectively observable side effects.

Re: Ketamine for the acute treatment of severe suicidal ideation

#20

Post by hadmatter »

after_care wrote: post #4

> Then, patients received a first 40 minute intravenous infusion of ketamine (0.5 mg/kg) or placebo 0.9% (saline solution) in addition to their current treatment. This really shouldn’t be labeled as double blind. 1.The nurse administering knew if it was placebo or active (for safety reasons). 2. It would immediately become obvious to the subject if they were injected with salt water or ketamine. 3. Within minutes it…

I’m sorry but you are strongly over exaggerating the (side) effects of i.v. ketamine. It’s not a dose that sends you in a K hole. It’s way less than that. Some get sedation and some do get dissociative symptoms which can unmask the study arm of the patient. Approximately one out of ten got at least one of those side effects. Sedation can be mimicked with midazolam, so if you use that as placebo, you get 90 % of the patients that are not obvious, which medicine they got. I do agree that a better ”placebo” would be good to use.

The problem with ketamine and suicidality studies is that suicides - thankfully don’t happen very often - so we have no direct evidence that ketamine prevents suicides. Of course if it would only alleviate suffering and wouldn’t increase the rate of suicides, that would be a win too.

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