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Earlier quoted context omitted.
And why not just regular old ketamine instead of a dangerous, untested new derivative? The whole system is broken beyond repair.
It is being tested and it's not a "dangerous, untested new derivative", it's a enantiomer of ketamine, it's literally 50% of the molecules in ketamine. And why don't we just use normal ketamine, why test any new drug, to see if it works better than what we had before.
https://www.vice.com/en_us/article/nzdnak/why-ketamine-is-th...
So the half S, half R compound (I assume "esketamine" is S ketamine and "arketamine" R ketamine) is a commonly used drug in every emergency unit, probably in much higher doses than the ones used for depression.
Using the S half only seems a way to get it patented.
The concern seems to be that a nasal spray could lead to addiction beacuse fast assimilation. People that have used it illegally tell me that tolerance builds up very quickly, but they're talking about high (K-hole) doses. They don't use it often, just once in a month and mostly the racemate.
They say esketamine only is weird and a little scary. The R half is what gives the happines feeling and mild hallucinogen effect, while the S half is the cause for depersonalization.
A curious detail: the gq article says it's administered IV, while in vice article it's said that IV is dangerous because laryngospasm.
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)?
Yes, that's exactly the reason. They are filtering racemic Ketamine just so that they can patent and upsell it at exorbitant rates.
Earlier 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?
What you were essentially asking was would 100% of the "bad" enantiomer be significantly worse than a 50/50 mixture. This is the real question here. For there to be a significant difference in this case one of the ketamine enantiomers would need to counteract the other's ill effects.
Disclaimer: although I am a medical doctor, and my first University degree was in organic chemistry and biochemistry, some of this academic stuff is but a hazy memory for me.
Earlier quoted context omitted.
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?
There'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.
And why not just regular old ketamine instead of a dangerous, untested new derivative? The whole system is broken beyond repair.
Holy 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…
It naturally follows that there is a risk factor with starting on antidepressants — because antidepressants might work for you in a way that helps you with your motivation issues before they do anything about your suicidal thoughts, you are at a heightened suicide risk immediately after starting on antidepressants.
It could very well be the case that this is the exact opposite effect — on discontinuation, you could have the suicidal ideation symptoms come back before demotivation does.
Holy 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…
Suicidal ideation is one symptom of depression, but so is demotivation and lack of energy. It's well understood that this depression-induced demotivation is a key factor in keeping depressive people from acting on their suicidal thoughts. It naturally follows that there is a risk factor with starting on antidepressants — because antidepressants might work for you in a way that helps you with your motivation issues be…
First of all, NOTHING is well understood in psychiatry. We are talking about drugs that get approved on a sliver of evidence (if any) on trails being run by some of the most corrupt organizations on the planet. No one understands how or why any anti-depressant works. And saying any of these drugs creates less "demotivation" isn't documented at all.
That being said, we can clearly say anti-depressants (specifically SSRIs) can and do cause suicidal ideation. Yes, suicidal ideation is symptom of depression, but when you give these drugs for non-depression cause such as OCD it still causes suicidal thinking. There is a reason for black box warning on many anti-depressants (and its not because of changes in demotivation).
Earlier quoted context omitted.
Can the results be used ti justify off-label use of normal ketamine?
There are hundreds of Ketamine clinics using it off-label already, the problem is that the insurance won't cover the off-label use and a course of about 10 infusions might cost around $5k at the current rates.
But I thought the goal of the pharmaceutical companies, according to your earlier comment, is to synthesize K to charge exorbitant prices. Aren't prices already exorbitant?
Earlier quoted context omitted.
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.