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My Dr recommended that I try ketamine for my depression. I have bipolar 1, anxiety and depression. I've heard of this being a street drug so I'm nervous to try it. I wondered about others experiences. 

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It is actually a pharmaceutical, sometimes diverted to the street. It is used at varying doses to have different effects. Generally known as an anesthetic, common in veterinary practice. In some countries it is used on people but for the most part we have developed better drugs for anesthesia. Common in anesthesia on felines.

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Signed up for it in 9 days time.Everything I've heard and read says that IV is the best route. There's a group called ketamine advocacy network that might be worth a look...have lots of FAQs. The problem with the IV is it's ludicrously expensive. My upcoming treatment will cost almost 2500 and maintenance after that is almost 500 per session. The other issue is infusion centers can be tough to find. The nose spray is cheaper but some say less effective. I think I got a quote of 225 per session for that but I don't thinks it lasts as long cuz the IV is 5 treatments (or 6). Don't be nervous...it's perfectly safe as you get pure uncut drug especially in the IV. it's actually used often for twilight sedation in oral surgery or as a pain med in other countries. Supposedly it helps anxiety too but there isn't as much data on that 

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@Iceberg wow, that's expensive...i wonder if my insurance would cover it. So there's no pill form? My Dr just mentioned it as an option but didn't say what form it would be in. I've tried so many different meds, I'm very treatment resistant. I also have had severe akathesia with several meds so that's always a fear when I try something new. Do you know if that's a side effect of this? Can I ask what you would be on it for? I'd love to hear about your experience with it once you start. Sometimes I feel like it's better being stuck in depression and anxiety than always trying new stuff but I know my Dr would like me to. Trintellix is the only thing that has helped me but I still have a ways to go.

 

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3 minutes ago, Carrie26a said:

@Iceberg wow, that's expensive...i wonder if my insurance would cover it. So there's no pill form? My Dr just mentioned it as an option but didn't say what form it would be in. I've tried so many different meds, I'm very treatment resistant. I also have had severe akathesia with several meds so that's always a fear when I try something new. Do you know if that's a side effect of this? Can I ask what you would be on it for? I'd love to hear about your experience with it once you start. Sometimes I feel like it's better being stuck in depression and anxiety than always trying new stuff but I know my Dr would like me to. Trintellix is the only thing that has helped me but I still have a ways to go.

 

I do sympathize with this. Sick of trying, waiting 

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I will do my best to check in either on this thread or. The one I started a while ago. There is no pill that I've heard of, and there is no set maintainance schedule either...because it's still "experimental" they don't have a set formula, each doctor kinda does their own thing. Ex my nasal spray guy only does one treatment, the IV places tend to do more, sometimes 5 or 6 over two weeks. Akathisia is not a side effect..you actually get more relaxed...some people even dissociate...but if you do it in a specialty place they have an antidote in case that starts to freak you out. However I've heard that it's actually somewhat pleasant. I'm taking it for BP depression as an alternative for ECT to see if it works so I can just use it in the future instead of all the ECT shit. As far as trying something new- it's not like a med with carryover side effects. For the majority of people there are no serious side effects. If you do get something weird all they have to do is stop the IV. They say the effects wear off after 30 min of stopping it. You do have to hold some meds but typically just for a day. It sucks tho that it the antidepressant effects can wear off as fast as a week. If you get multiple IV treatments it can last several weeks longer (assuming your in a position to afford it) while nose spray is 7-10 days, 2 weeks if your lucky. I highly doubt insurance will cover it. Mine won't and I have pretty good insurance. Because it's off label the insurance companies can justify not reembursing you. However they do give you receipts so you can submit and hope you get lucky. The great thing is you basically know if it'll work in 48 hours...instead of wasting time letting a new mes build up or having to try ECT 6 times.  

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I wanted to try it, PDoc recommended it but without insurance it's incredibly expensive....

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9 minutes ago, BrianOCD said:

I wanted to try it, PDoc recommended it but without insurance it's incredibly expensive....

Yeah it sucks cuz it Could really help a lot of people 

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That's why some use the nose spray. The one I looked at was $200 less per session 

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One spray no...well I shouldn't say no cuz u can get lucky...but not usually...but Remember it's only one treatment - IV is five or six. They told me they do the nose spray every two weeks PRN. Like I said tho...different doc's may have different protocol. The big difference is the IV has way more bioavailability ...the nose doc told me 50% chance...which i think is cuz the one study that's commonly used was an 8 of 18 response. The IV supposedly has a 70% response. Both can lessen suicidal thoughts 

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@Iceberg thanks for the info! I went to meet with an ECT doc and would like to avoid that too. I see my psych in March so I'll see what my options are then. I hope it works well for you. It's nice to know I'm not alone in all of this. Hopefully insurance will cover this soon.

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Probably never because ketamine is generic so there's no money in getting approval. However, they are working on esketamine (not sure on the spelling there) that would basically be the same as the ketamine nose spray but since it's a new drug it would be approved and insurance could cover it 

And for what it's worth...ECT isn't convenient or fun but it works, it is an option if you can't get/afford the ketamine. I've done ECT twice so I'll be able to compare the two 

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I have had both IV ketamine and IM ketamine (shots). I did not have the infusion schedule that is typically followed in commercial clinics because I was in a medical study. However, I had enough to know for sure that for me, IV ketamine is a game changer. Also and despite that, I did not feel better immediately or even within 48 hours. From what I've read and conversations with psychiatrists studying ketamine, you really need about 6 commercial sessions over 2 weeks to know for sure if it will help. Some people feel better quite quickly and some just take longer to respond. 

I described my experience in response to a post in the depression forum.

I'm not currently receiving any ketamine. When the IM ketamine didn't improve/maintain my mood I dropped out of the study. IV ketamine is out of reach, financially. I've already done ECT, so it's back to the drawing board for me. I have discussed IN ketamine and ketamine lozenges with my pdoc but we decided that since the bio-availability is so much less than IM and even that wasn't enough for me, there is little point in pursuing those options for me.

Good luck with ketamine. Let me know if you have any questions. 

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always comes back to the fucking money. I actually heard that IN had a higher success rate than IM... But If ur doc is skeptical then it's probably not worth the try. Interesting that there giving me 5 sessions instead of the usual 6...hmm I'll have to ask about that.

@Geek did you get any of the psychological weirdness- the dissociation or whatever? 

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2 minutes ago, Iceberg said:

always comes back to the fucking money. I actually heard that IN had a higher success rate than IM... But If ur doc is skeptical then it's probably not worth the try. Interesting that there giving me 5 sessions instead of the usual 6...hmm I'll have to ask about that.

@Geek did you get any of the psychological weirdness- the dissociation or whatever? 

Yeah the money part sucks. If I could drop all my other medical expenses (meds, pdoc and tdoc), I might be able to afford IV ketamine. That’s not realistic though because my depression is partly situational and I will need treatment/support for that as well.

The problem with IN route is the imprecise/variability in absorbed dosage. How much mucus is covering your sinuses today? How dry/moist are your sinuses? How much of what is administered just drips down the back of your throat? Nasal steroids work by delivering the steroid to the exact site requiring treatment and even then their efficacy is impacted by those physical factors.

I did have some transient dissociation and derealization from the ketamine. It lasted 90-120 minutes after an IM shot, decreasing in length and “depth” as the number of shots I’d received increased. It was pretty similar from the IV too, though onset was faster.

I didn’t enjoy or look forward to it, but it wasn’t exactly unpleasant. Mostly I just spaced out. I wasn’t able to read or watch tv or carry on a conversation (I did talk/listen a bit after 60+ minutes, but it was slow and taxing). I usually kept my eyes closed and let my mind wander. Weird but not bad thoughts. Not sure how to describe them. I’ve never been high or drunk (I’m too much of a control freak) so while I imagine it’s similar I can’t compare.

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I first was offered IN but turned it down for all the reasons you just listed. Also I have high BP which can sometimes spike from ketamine so it's better if I'm on a monitor and that they can control the administration better 

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19 hours ago, Iceberg said:

I first was offered IN but turned it down for all the reasons you just listed. Also I have high BP which can sometimes spike from ketamine so it's better if I'm on a monitor and that they can control the administration better 

I do not normally take medication for high blood pressure. I was given a small dose of clonidine to take the night before and day of the ketamine treatments. I was told it was thought to help reduce some of the dissociative symptoms in addition to the hypotensive benefits.

They also took my BP every 15 minutes for 2 hours after every IM treatment. I don't remember the frequency during the infusion, though I was hooked up to a BP monitor and an EKG monitor (I think?) for the entirety.

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