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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

#81

Post by hadmatter »

ketamine wrote: post #36
hadmatter wrote: post #31

Earlier quoted context omitted.

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.

Thanks, I appreciate your comment and experience. I agree that if one was to get those effects, one would be quite unlikely to suspect placebo. I hope you got the help you needed from ketamine.

Re: Ketamine for the acute treatment of severe suicidal ideation

#82

Post by ketamine »

Forbo wrote: post #74
ketamine wrote: post #53

Earlier quoted context omitted.

Clinics in the US seem to all use .5 mg/kg as a baseline

I vouched for your comment since it is relevant. I assume it was dead because you're new.

Email sent. Thank you, stranger :)

Re: Ketamine for the acute treatment of severe suicidal ideation

#83

Post by hadmatter »

officeplant wrote: post #60
adwi wrote: post #27

Earlier quoted context omitted.

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

Going by a friends experience, infusion clinics need to be investigated more regularly by medical professionals. Co-worker went to one for treatment and from her recollection of the event they left her in a dark room with a white noise generator while she went down the k-hole. Terrified the living shit out of her.

That’s awful. I’ve also read about shady clinics in the US that don’t really screen their patients but just give the drug to anyone who pays. E.g. https://www.scientificamerican.com/article/is-the-ketamine-b...

Re: Ketamine for the acute treatment of severe suicidal ideation

#84

Post by after_care »

intenex wrote: post #69

The truly amazing thing here is how powerful the placebo control was, even despite the fact that as someone who's done ketamine IV treatment before, it's pretty obvious when you're on ketamine and when you're not. "At week 6, remission in the ketamine arm remained high, although non-significantly versus placebo (69.5% v 56.3%; odds ratio 0.8 (95% confidence interval 0.3 to 2.5), P=0.7)."

> The truly amazing thing here is how powerful the placebo control was

1. The "placebo" received standard treatment for suicidal ideation.

2. We should expect a natural regression towards the mean. The vast majority of humans do not experience suicidal ideation in a particular day. People with suicidal ideation tend to move towards the standard human experience of not having suicidal ideation over time.

Re: Ketamine for the acute treatment of severe suicidal ideation

#85

Post by hadmatter »

after_care wrote: post #56
hadmatter wrote: post #37

Earlier quoted context omitted.

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…

Maybe you have more experience with patients at this specific dose range than I do. I remain skeptical this could be double blind, but do have less certainty than I originally started with.

I do agree with your skepticity. A better study design could use midazolam as placebo. And I think a good idea would be to ask the participants amd their physicians, which one do they think they received. That would give some idea about how well the double blind design did. Also, many commenters seem to disagree with me, which I also have to be take into consideration. My n is very low as my hospital has just started ketamine treatments.

Re: Ketamine for the acute treatment of severe suicidal ideation

#86

Post by vmception »

sshine wrote: post #40

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…

Its the turn it off, turn it on again treatment, for the brain

Re: Ketamine for the acute treatment of severe suicidal ideation

#87

Post by perardi »

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…

As an occasional recreational drug user: yes, the dosages listed above are spot on. Just for an anecdotal data point.

Re: Ketamine for the acute treatment of severe suicidal ideation

#88

Post by oldstrangers »

agumonkey wrote: post #9
oldstrangers wrote: post #2

I did a full 6 week course of ketamine therapy. It was really good, and I would recommend it if you're open minded. It's not for everyone, and the lasting (a year+) benefits aren't really measurable (maybe I'm different? maybe I'm not, maybe I've just gotten older). I'd like to go again and see if it can help with my obsessive existential dread.

what about how it felt early on / during the therapy ? what about side effects also ?

The trip itself is fun. It'll get scary if you don't let yourself go, but it was really manageable. You are heavily sedated obviously, so you can't drive or do much after. Mentally its exhausting, and akin to spending all night studying. You will probably have a headache for the rest of the day.

Re: Ketamine for the acute treatment of severe suicidal ideation

#89

Post by oldstrangers »

hemloc_io wrote: post #7
oldstrangers wrote: post #2

I did a full 6 week course of ketamine therapy. It was really good, and I would recommend it if you're open minded. It's not for everyone, and the lasting (a year+) benefits aren't really measurable (maybe I'm different? maybe I'm not, maybe I've just gotten older). I'd like to go again and see if it can help with my obsessive existential dread.

What's the process for this like? Been curious about the current state of psych medicine.

Depends on the place, there really isn't much regulation for it where I went. I made an appointment, signed all the papers and got started. It's very expensive ($400-$600 a week).

They have a head doctor and then an anesthesiologist that handles the actual infusion.

Re: Ketamine for the acute treatment of severe suicidal ideation

#90

Post by oldstrangers »

ketamine wrote: post #41
oldstrangers wrote: post #2

I did a full 6 week course of ketamine therapy. It was really good, and I would recommend it if you're open minded. It's not for everyone, and the lasting (a year+) benefits aren't really measurable (maybe I'm different? maybe I'm not, maybe I've just gotten older). I'd like to go again and see if it can help with my obsessive existential dread.

It immediately relieved my existential dread. I fear the next infusion will be intense, however.

Ohhh that's encouraging. I was supposed to go for a "booster" session ages ago but kept putting it off.
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