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Ketamine for the acute treatment of severe suicidal ideation

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Re: Ketamine for the acute treatment of severe suicidal ideation

#31

Post by hadmatter »

chimeracoder wrote: post #24
hadmatter wrote: post #20

Earlier quoted context omitted.

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 p…

> 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. 0.5 mg/kg intravenous. For frame of reference, a small recreational dose is between 5-25 mg (insufflated[0]), and a larger recreational dose (for people targeting a "k-hole") is more like 50-100mg. For clinical depression (ie, not this study, but for a similar pu…

I agree about you second point. I was too quick to make my comment and I was conflating stuff I've read about nasal esketamine, which didn't have as robust evidence behind it as i.v. ketamine. I should not write comments while holding a baby that is trying to sleep and failing at it.

About the first point, I still disagree with the parent comment. The standard 0,5mg/kg ketamine is given under 40 minutes. I've seen two patients receive it. The room was dimly lit, silent and peaceful, as to not induce or exacerbate any possible dissociative or hallucinative side effects. The patients didn't report any side effects at first and later reported a little sedation. I wouldn't be a able to tell with certainty if they had received a placebo or ketamine, and certainly not within minutes.

Source: psychiatrist in training

Edit: I still think we need hard data about anti-suicide effect and not just surrogate markers. Variability in suicidal ideation is suggested to be a predictor of suicide attempts [1]. If ketamine first gets someone better and later on they relapse, they could, in theory, be at increased risk for suicide. More long term data is also needed about it's long term effects. Note that I do think it's a good thing that ketamine is becoming more available! I will continue to suggest it for e.g. patients with treatment resistant and severe depression.

[1] https://www.sciencedirect.com/science/article/abs/pii/S01650...

Re: Ketamine for the acute treatment of severe suicidal ideation

#33

Post by [deleted] »

Terry_Roll wrote: post #28

Some vets use Ketamine as part of a multi stage protocol for euthanising animals, other vets just use a single drug protocol but I havent established what that drug is, but it just seems all a bit refined butchery to me! Ketamine is supposed to be a disassociate drug, which I'm guessing is perhaps like an out of body experience or something. But I cant see how that can help with depression when people dont understand…

[deleted]

Re: Ketamine for the acute treatment of severe suicidal ideation

#34

Post by ketamine »

adwi wrote: post #27
encoderer wrote: post #26

Earlier quoted context omitted.

Have you had it? A friend of mine did it last week and he described it as the most intense experience of his life. He’s 40 and he has experience with other drugs. I think possibly you don’t know what you’re talking about?

I think possibly commercial “infusion clinics” and medical trials use different doses.

Same dose for me. .5 mg/kg

It was more intense and less intense at the same time because I did not know what to expect.

Re: Ketamine for the acute treatment of severe suicidal ideation

#35

Post by TaylorAlexander »

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.

The person is saying their doctor administers this treatment to other people, but not to them. And that the doctor has said the patients receiving the treatment do not experience a drug trip.

Re: Ketamine for the acute treatment of severe suicidal ideation

#36

Post by ketamine »

hadmatter wrote: post #31
chimeracoder wrote: post #24

Earlier quoted context omitted.

> 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. 0.5 mg/kg intravenous. For frame of reference, a small recreational dose is between 5-25 mg (insufflated[0]), and a larger recreational dose (for people targeting a "k-hole") is more like 50-100mg. For clinical depression (ie, not this study, but for a similar pu…

I agree about you second point. I was too quick to make my comment and I was conflating stuff I've read about nasal esketamine, which didn't have as robust evidence behind it as i.v. ketamine. I should not write comments while holding a baby that is trying to sleep and failing at it. About the first point, I still disagree with the parent comment. The standard 0,5mg/kg ketamine is given under 40 minutes. I've seen tw…

Source: patient taking infusions.

.5 mg/kg

I was numb all over, my lips tongue and throat were numb.

I melted in to the chair and felt like I was up down and sideways at the same time.

You would not be able to tell immediately but I put on my blindfold within 7 minutes due to effects starting.

Re: Ketamine for the acute treatment of severe suicidal ideation

#37

Post by hadmatter »

after_care wrote: post #25
hadmatter wrote: post #20

Earlier quoted context omitted.

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 p…

I don't think I am exaggerating the noticeable effects of i.v. ketamine. Patients given i.v. ketamine are advised not to operating an automobile hours after administration. This level of impairment would be noticeable to the patient and the staff administering the treatment.

Advice not to operate an automobile is for minimizing risks. It doesn't mean that most would be unable to handle a car, although it could mean that their reaction times would be slower. The standard way to administer ketamine is to give 0,5 mg/kg under 40 minutes. It would in no way be immediately obvious to everyone in, if someone began to receive ketamine or not. At least I couldn't differentiate them at that point.

Re: Ketamine for the acute treatment of severe suicidal ideation

#38

Post by btach »

boomboomsubban wrote: post #21
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…

>1.The nurse administering knew if it was placebo or active (for safety reasons). I read it as the nurse preparing the IV's knew if it was a placebo, it doesn't really say that the same nurse administered the IV's.

The nurse administering it is most certainly liable for what s/he administers. It is a very big no-no to blindly administer a medication of which you cannot reasonably verify what it is. To push a syringe or start a pump of something that "could be ketamine, or could be NS" is walking an uncomfortable line for your license to practice nursing. Right patient, right medication, right dose, right route, right time. If you as a nurse cannot attest to all of the above when you push something, it is in error to push it.

Re: Ketamine for the acute treatment of severe suicidal ideation

#39

Post by ketamine »

chimeracoder wrote: post #18
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.]

> 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.…

That is the dose I receive and it is very noticeable.

I do not know what a trip is or is not supposed to be like but it was a very wild sensation.

Re: Ketamine for the acute treatment of severe suicidal ideation

#40

Post by sshine »

This suggests that ketamine is beneficial for people who are suicidal to prevent them from killing themselves. The claim that is generally made about ketamine and depression is that it can have a short-term resetting effect of someone's depressive symptoms (not necessarily at a suicidal level), making it possible to escape the black hole that otherwise can take weeks, months, years to come out of.

https://www.nih.gov/news-events/nih-research-matters/how-ket...

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