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Amygdala connectivity predicts ketamine treatment response

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Re: Amygdala connectivity predicts ketamine treatment response

#41

Post by trashface »

bheadmaster wrote: post #7
jonnycomputer wrote: post #5

Ketamine has turned out to be a pretty effective treatment for episodes of severe depression, particularly when there is a risk of suicide; one reason is that it starts having an effect in hours instead of days or weeks like SSRIs do. See Jessica Gilbert's work over at NIH [1]. One of the big focuses of clinical neuroscience is to find features in the brain that will predict treatment responses (to cognitive behavior…

This sounds really promising, but one thing that worries me is that ketamine is a sort-of painkiller (dissociative anesthetic). When heroin was first discovered, it was hailed as a wonder-drug, and it was also considered an effective treatment for severe depression. However, after some time, people realized that its addictive properties and high range of potential tolerance make it backfire pretty badly after a certa…

Recreational users take it at far higher doses and that is why they are they are primarily at risk for addiction and other health complications. https://astralcodexten.substack.com/p/drug-users-use-a-lot-o...

Re: Amygdala connectivity predicts ketamine treatment response

#42

Post by bheadmaster »

chimeracoder wrote: post #39
DontchaKnowit wrote: post #26

Earlier quoted context omitted.

I dont think its a fallacy. Its definitely a consideration. Ever met an nmda receptor agonist addict? its real shit. It aint pretty. And ive definitely seen it done as a sort of depression-relief-addiction. Had a close friend who I found out had been drinking like 2 or 3 bottles of cough syrup (over the counter, dextromethorphan) daily. She had a hell of a time kicking it. Idk if she ever did. People on these type of…

> I dont think this is an idea that can be dismissed trivially as a fallacy. "Opiates are dangerous and they are anesthetics; therefore ketamine is dangerous because it's an anesthetic" is, literally, a textbook logical fallacy. If you'd like to argue that ketamine is dangerous based on some other reasoning, go ahead, but that doesn't change the fact that OP's logic is prima facie fallacious. > Ever met an nmda recep…

> "Opiates are dangerous and they are anesthetics; therefore ketamine is dangerous because it's an anesthetic" is, literally, a textbook logical fallacy.

Except that I never made that exact argument. Textbook strawman fallacy.

Re: Amygdala connectivity predicts ketamine treatment response

#43

Post by cmrdporcupine »

curioussavage wrote: post #32
cmrdporcupine wrote: post #21

Earlier quoted context omitted.

Thanks for bringing this up. It's super important. And also makes me why other drugs in this class (dissociatives) aren't being looked more aggressively. Dextromethorphan -- in common cough syrup -- is one example. It has other side effects (nausea, etc.) but doesn't have the bladder destructive issues associated with ketamine.

Auvelity, a drug that combines dextromethorphan and bupropion (included to keep the dextromethorphan in the system longer) was just made available this quarter.

I kind of .. DIY'd this combination myself for a bit.

It allows you to take a much lower dose of dextromethorphan and so have fewer undesirable side effects. It helped me cope with some chronic physical pain I was suffering with at the time (in addition to depression).

Re: Amygdala connectivity predicts ketamine treatment response

#44

Post by cmrdporcupine »

curioussavage wrote: post #32
cmrdporcupine wrote: post #21

Earlier quoted context omitted.

Thanks for bringing this up. It's super important. And also makes me why other drugs in this class (dissociatives) aren't being looked more aggressively. Dextromethorphan -- in common cough syrup -- is one example. It has other side effects (nausea, etc.) but doesn't have the bladder destructive issues associated with ketamine.

Auvelity, a drug that combines dextromethorphan and bupropion (included to keep the dextromethorphan in the system longer) was just made available this quarter.

"Although Axsome has not yet announced a price, it’s anticipated that it will be a relatively expensive product compared with generic SSRIs and SNRIs, which are very well-established on the MDD market. With a comparatively high expected price, Auvelity may see its use restricted by payers to second and later lines of therapy."

This is insane gouging, as you could literally make it yourself by getting a prescription for generic bupoprion and some store-bought cough medicine.

Re: Amygdala connectivity predicts ketamine treatment response

#45

Post by PTcartelsLOL »

engined wrote: post #25
jonnycomputer wrote: post #8

Earlier quoted context omitted.

Good question. Ketamine has been a party drug for quite a while now, and as far as I know, hasn't been shown to be particularly dependency-inducing, though low-dose ketamine over the long term might be ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236511/ ) Also, as far as I know, ketamine treatment isn't intended as an ongoing medication, like an SSRI, but as a treatment for acute episodes of depression. I might b…

The WebMD article is referencing esketamine, also known as Spravato, which is an FDA authorized form of ketamine. It's generally indicated for longer-term use in patients with Treatment Resistant Depression (TRD), and has really good results on par with ketamine (IV or intramuscular). At Lumin Health, we treat about 80% of our patients with esketamine, and the rest with ketamine (generally only if they don't meet esk…

1k/month? How much quantity is that? Black market prices in Europe is like €20/g only going down with the more you buy.

Re: Amygdala connectivity predicts ketamine treatment response

#46

Post by engined »

robocat wrote: post #34
engined wrote: post #25

Earlier quoted context omitted.

The WebMD article is referencing esketamine, also known as Spravato, which is an FDA authorized form of ketamine. It's generally indicated for longer-term use in patients with Treatment Resistant Depression (TRD), and has really good results on par with ketamine (IV or intramuscular). At Lumin Health, we treat about 80% of our patients with esketamine, and the rest with ketamine (generally only if they don't meet esk…

Any comments on https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescr... - presumably the doubts Scott had have now been answered?

In general, esketamine has been shown to have about the same efficacy as ketamine for Treatment Resistant Depression (TRD) and MDD. There seem to be some minor differences in bioavailability between esketamine and ketamine, but from experience, if one work, the other will, and if one doesn't, the other won't. Anecdotally, we've seen great results in a matter of weeks with patients who have had no success through numerous antidepressants, TMS, ECT, and other treatments.

There is a long-term trial now in its 4th year with esketamine (https://clinicaltrials.gov/ct2/show/NCT02782104). I'm not sure how much has been published yet, but early data I saw supported immediate relief and long term benefit over the 4 years.

In terms of it being a sinister ploy by pharma, it's definitely priced higher than its ketamine generic counterpart, but for the vast majority of our patients, ketamine treatment out of pocket (since its not covered by insurance) is absolutely unaffordable, and pursuing the insurer-covered version of treatment is a high-value option.

Re: Amygdala connectivity predicts ketamine treatment response

#47

Post by csnover »

chimeracoder wrote: post #35
csnover wrote: post #31

Earlier quoted context omitted.

> Correct. What you are saying is true for almost all drugs: recreational doses are typically higher than clinical doses. Ketamine is the exception. To clarify: my understanding is that ketamine acts as a dissociative hallucinogen at lower doses and an anaesthetic at higher doses, so taking a higher dose will just knock someone out instead of giving them the dissociative/hallucinogenic effects. > The clinical dose fo…

> Ketamine is normally dosed based on body weight[0]. For depression IV, the dose is 0.1–0.75mg/kg/40mins, most commonly 0.5mg/kg/40mins If we're being specific, the FDA-approved treatment of ketamine for depression is a fixed 84mg dose. It is not adjusted for body weight. (I did invite irony by saying that it wasn't a typo - it's 84 and 56 for redoing, not 86 and 54).

Thanks for the clarification! Since you’d mentioned IM administration it didn’t cross my mind that you were talking about Spravato. That typo is regrettable, but unimportant to your point that the nasal spray does indeed use two fixed doses.
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