I don't really get it. Why not just go with ketamine? Is it that the approval takes too much money which other companies could then reuse (the investement does not lead to benefits)?
Has esketamine been overhyped?
21–30 of 51 posts
Re: Has esketamine been overhyped?
#22Holy shit: > there are concerns about the drug’s withdrawal effects after three of the study’s participants committed suicide within 20 days of its end It doesn't say how many people committed suicide from the control group, but regardless, 3 suicides sounds pretty bad for an anti-depressant. Who would approve a drug like this? The cynic in me says an addictive drug with severe withdrawal effects is exactly what phar…
I cannot imagine being severely depressed, entering a study for it since I'm resistant to most of the drugs, finding one that works.... and then having to stop the thing that works and return to a crappy mind state. Only it is worse because I now have withdrawal symptoms on top of my severe depression, which already put me at risk for suicide. In my opinion, the issue isn't that there is dependency nor that there is…
I understand that. I was on prozac for years. I chose to come off it because it was messing me up, otherwise I'd have been happy to take it for the rest of my life (why not?)
I was aware that if the blackness returned and going back onto prozac failed to work (which can happen) then my lifespan would be a few months at the most.
People without really bad depression can't understand how bad it can be. Death really is better.
Re: Has esketamine been overhyped?
#23There's nothing wrong with bolstering the Psychiatrist's armamentarium with a novel drug that could help with clinical edge-cases of depression. This article was unfairly biased.
"Could" is nowhere close to good enough for a drug with potentially serious side-effects.
Oh I dunno. A potentially serious side effect of clinical depression is death. See my other comment https://news.ycombinator.com/item?id=20572927
The side effects of prozac and gamanil for me weren't at all nice but they were far better than the blackness.
In those circumstances, 'could' could be quite good enough for me.
Re: Has esketamine been overhyped?
#24Earlier quoted context omitted.
A lot of chemicals are "50%" of each other but completely different. That's not how chemistry works. Water is H₂0. Hydrogen peroxide is H₂0₂. I wouldn't substitute one for the other.
Do you know of any examples where a racemic mixture has an effect dramatically different from what you'd expect from a combination of the enantiomers' effects?
Thalidomide. One enantiomer is a great morning sickness drug, the other causes catastrophic birth defects.
Re: Has esketamine been overhyped?
#25I don't really get it. Why not just go with ketamine? Is it that the approval takes too much money which other companies could then reuse (the investement does not lead to benefits)?
Yes, that's exactly the reason. They are filtering racemic Ketamine just so that they can patent and upsell it at exorbitant rates.
Re: Has esketamine been overhyped?
#26Earlier quoted context omitted.
A lot of chemicals are "50%" of each other but completely different. That's not how chemistry works. Water is H₂0. Hydrogen peroxide is H₂0₂. I wouldn't substitute one for the other.
Do you know of any examples where a racemic mixture has an effect dramatically different from what you'd expect from a combination of the enantiomers' effects?
I'm not sure I understand the question[0] fully but thalidomide? https://en.wikipedia.org/wiki/Thalidomide
"Thalidomide is provided as a racemic mixture of two enantiomers; while there are reports that only one of the enantiomers may cause birth defects, the body converts each enantiomer into the other through mechanisms that are not well understood."
[0] because a racemic mixture (https://en.wikipedia.org/wiki/Racemates) is a 50/50 mix of enantiomers: "In chemistry, a racemic mixture, or racemate [...] has equal amounts of left- and right-handed enantiomers of a chiral molecule" so if you took a racemic mixture surely you'd be getting a combination of the enantiomers' effects?
Re: Has esketamine been overhyped?
#27Earlier quoted context omitted.
> it's a enantiomer of ketamine, it's literally 50% of the molecules in ketamine I’m not a biologist or a chemist. Why does this imply the chemical is as safe? What is the benefit? It seems like a blatant patent grab to bypass the low profit margins of ketamine. Is there evidence otherwise?
The short answer is it can be both (ie safe, beneficial and effectively a patent grab). It is also unlikely that an enantiopure chemical is less safe then it’s racemic counterpart and not unlikely that it is beneficial (this is not without precedent... this is also chemistry 101 and I don’t feel this is the forum for it)... The doubt is not so much the safety but is the benefit of the enantiopure version worth the co…
Per my comment above, thalidomide is a clear exception. This stands even if the chirality changes within the body.
Re: Has esketamine been overhyped?
#28I don't really get it. Why not just go with ketamine? Is it that the approval takes too much money which other companies could then reuse (the investement does not lead to benefits)?
Yes, that's exactly the reason. They are filtering racemic Ketamine just so that they can patent and upsell it at exorbitant rates.
Can the results be used ti justify off-label use of normal ketamine?
Re: Has esketamine been overhyped?
#29Earlier quoted context omitted.
The short answer is it can be both (ie safe, beneficial and effectively a patent grab). It is also unlikely that an enantiopure chemical is less safe then it’s racemic counterpart and not unlikely that it is beneficial (this is not without precedent... this is also chemistry 101 and I don’t feel this is the forum for it)... The doubt is not so much the safety but is the benefit of the enantiopure version worth the co…
Per my comment above, thalidomide is a clear exception. This stands even if the chirality changes within the body.
That was an example on the other direction. A pure chirality was safe, but a racemic mixture was dangerous. Here we know the racemic mixture is safe, which strongly suggests that either chirality in isolation is also safe.
Re: Has esketamine been overhyped?
#30Earlier quoted context omitted.
A lot of chemicals are "50%" of each other but completely different. That's not how chemistry works. Water is H₂0. Hydrogen peroxide is H₂0₂. I wouldn't substitute one for the other.
Do you know of any examples where a racemic mixture has an effect dramatically different from what you'd expect from a combination of the enantiomers' effects?
Amphetamine, for one. Levoamphetamine or dextroamphetamine provide two different physiological experiences (think coffee vs meth). The effects profile of racemic amphetamine is markedly different and much easier to handle physiologically than just dextroamphetamine by itself (the most common isomer found in amphetamine prescription products).
From a perspective of safety, I don't have any reason to suspect esketamine to be any worse. However from a psychological perspective, we could be talking pretty big differences in some individuals where subtle changes in behavior or thought can have cascading effects on mood.
But... that's why we're testing its efficacy, right? It's stupid not to try, and these test subjects are willing. One of the two isomers will be better in some categories. Could be that both together are the way to go. Having only encountered racemic ketamine I can definitely understand its uses in treating depression.