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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

#21

Post by boomboomsubban »

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.

Re: Ketamine for the acute treatment of severe suicidal ideation

#23

Post by AdamH12113 »

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.

Sorry, poor wording. I meant that my psychiatrist runs a ketamine clinic and administers IV ketamine treatments to patients.

Re: Ketamine for the acute treatment of severe suicidal ideation

#24

Post by chimeracoder »

hadmatter wrote: post #20
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 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 purpose), the fixed dose is 84mg (not weight-based).

So assuming a 75kg individual, that would be a 37.5mg intravenous dose, which is definitely going to provide a noticeable effect for any ketamine-naive user (ie, someone who does not already have a tolerance for the drug from recent prior 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.

That's not really a problem - suicidal ideation is a strong enough predictor for suicidality and mental health that it's common to use as a biomarker. In other words, nearly anything that reduces suicidal ideation is presumed to reduce suicidality (on a large scale) - it's not necessary to wait months or years to see what happens (and in fact, depending on the specifics of the study, it can be considered unethical to do so).

Source: former clinical researcher and drug counselor

[0] bioavailability when insufflated is significantly less than other means of ingestion

Re: Ketamine for the acute treatment of severe suicidal ideation

#25

Post by after_care »

hadmatter wrote: post #20
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 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.

Re: Ketamine for the acute treatment of severe suicidal ideation

#26

Post by encoderer »

hadmatter wrote: post #20
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 p…

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?

Re: Ketamine for the acute treatment of severe suicidal ideation

#27

Post by adwi »

encoderer wrote: post #26
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…

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.

Re: Ketamine for the acute treatment of severe suicidal ideation

#28

Post by Terry_Roll »

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 depression can actually be lots of things, but it has one overriding common element which is people remembering.

So unless people get something like dementia where recent memories seem to fade first and the earliest memories come back, I fail to see how K can help treat depression.

As for suicide ideation, well look around at what constitutes 1st world medical care! If you dont buy into the smiley faces because you might have grown up around medical professionals and heard the back office chats you might think twice about the authenticity of so called medical professionals! Not only that, its just a job for most, leave it at the door when your shift finishes, which is easier said than done especially if a dying patient seemed nice and innocent compared to an unpleasant angry dying patient.

I really dont know why we dont have legal euthanasia because being experimented on in the name of science is not something I'd let others do to me if I can help it, I am aware that some argue it would be a direction towards eugenics, but that goes on already in stealth with some medical procedures.

Re: Ketamine for the acute treatment of severe suicidal ideation

#29

Post by after_care »

phren0logy wrote: post #15
after_care wrote: post #11

Earlier quoted context omitted.

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.

Sure, but as a scientist conducting an experiment I will be able to determine who is dosed with psilocybin and who is doses with methylphenidate >90% of the time, thus removing the observer mask. I think the average patient would be able to tell if they were dosed with psilocybin or methylphenidate, even if they were drug naive, thus removing the patient mask.

I'm not saying it's impossible to conduct good experiments on these substances. I'm saying that they require special considerations of internal validity and it's incorrect to call this study (iv ketamine vs iv saline water) double blind.

Re: Ketamine for the acute treatment of severe suicidal ideation

#30

Post by amelius »

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…

Isn't morphine overdose the best (friendliest) possible euthanizing method?
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