Comment by atomical | Hacker News Reader

Comment by atomical | Hacker News Reader

Most doctors are performing infusions with a loading procedure where the patient has six infusions in the span of two weeks. Then the patient is offered what they refer to as maintenance. The space between maintenance doses is a decision made by the patient. Some doctors prescribe additional anti-depressants to help patients sustain the effect until their next infusion. One of the problems with this treatment is that there aren't any studies that show this is effective long term.

I have had ketamine treatments at two different clinics and the procedure and methods varied. There were differences in monitoring and safety protocols.

Initial doses could run anywhere from $2100-$6000. One maintenance dose could be $300-$1000. Hopefully Rapastinel will be approved by the FDA soon and wipes out small industry that is partial to unproven science. Don't be influenced by the hype. Please try everything else before you try Ketamine infusions.

Edit: I also want to mention that there isn't any proof that Ketamine is anything but short acting. See this review by Cochrane: http://www.cochrane.org/CD011611/DEPRESSN_ketamine-and-other...

I've done this as an amateur. Medical grade ketamine isn't the hardest thing to find and I do not have the money to do it professionally.

A few years ago I remember my first time taking ketamine at all I went from near suicidal to feeling completely fine pretty much over night.

I think that the "side effects" as the article put it are actually pretty helpful. The dissociation gives you a sort of third person view of your problems and life that is very helpful in my opinion.

I found that eventually it stops being as effective but I think there has been some permanent changes. My lows don't feel as low anymore. I still have down periods but they're no where as bad as they used to be.

More recently I've just stuck to antidepressants (I take an NDRI) and vitamin D3.

I've tried some analogs of ketamine (2fdck, dck) and hope they take a look at some of them to see if there can be similar effects.

> Medical grade ketamine isn't the hardest thing to find

How do you know the quality?

I wouldn't trust it for injection unless it came in medical vial. It's on the darknet, though more expensive than powdered Ketamine.

How do you trust anything you get on the darknet?

I think the easiest answer is by testing it. I don't think a purity and substance test isn't that expensive.

You roll the dice, having learned the odds are in your favour.

"The primary sources of street Ketamine in China include diversion or theft of legal pharmaceuticals from medical or veterinary licit trade with some supplies also manufactured in clandestine laboratories (United Nations Office on Drugs and Crime, 2010). It is therefore believed that the purity and the quality of street ketamine is high (no research data available) contributing to its increasing popularity among drug users in China." (2014)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4004368/

In any system where an actor can be either honest or dishonest but certain qualities of correctness can be probabilistically ascertained, consensus is often a great replacement for trust.

In the case of an anonymous decentralized marketplace, vendor attributes like product quality can be ascertained by achieving consensus in the form of ratings and reviews.

Ultimately, without running the product through a mass spectrometer yourself, you are going to have to defer trust, so consensus aims to reduce the likelihood of dishonesty over an average.

For people in some parts of the world, the level of trustworthiness gauged from online marketplaces can supersede the level of trust given to local vendors.

Take Amazon for example, which, while not anonymous, uses consensus to assure quality in the form of validated reviews. Many people already prefer shopping by reviews than by trial-and-error at brick and mortar stores.

How do you trust anything funded by companies who desire slanted research? You trade one governing body for another. In the darknet's case, you lean on consensus and ratings.

I'd be interested to know what you've exhausted.

Obviously Lexapro and friends.

And the tricyclics. And novels.

Nardil or Parnate?

Zoloft, remron, stratera, and a few I can't remember. Also tried Ritalin for ADHD though not sure I have that vs being depressed making me unable to focus. Found modafinil and armodafinil better for that purpose. Currently take bupropion. Wouldn't take a maoi inhibitor due to the diet restrictions. Have also tried 5htp but stopped when I started getting brain fog.

Haven't tried a tricyclic that I can remember. Won't take an ssri again because brain zaps scare me and zoloft made me feel like a zombie.

In the dissociative corner I've tried, ketamine, dck, 2fdck, MXE, 2oxopce 3meopce, 3meopcp, 3hopce, 3hopcp, Ephenidine, dxm, PCP, MXP and N2O. Would love to try Xenon but good luck with that.

I've had friends suggest trying microdosing but that doesn't seem sustainable to me.

Is the NDRI you are taking bupropion?

Yup. XR version.

I've come to see depression partially as a semi-stable brain-state with reinforcing feedback. Some of that feedback may be chemical while some is psychological (thought or feeling). It may even persist once the major stimuli that got to that state have been removed. As such, any intervention that pops the patient out of that state could be permanent so long as the other things that led there don't happen again. Or if those things are still present, any intervention will be short lived.

Hi, what is your profession?

Engineer/Programmer. I had a bout of depression some time ago and had an amazing time watching my own thought processes and reading about psychology. I hope to write about my experience some day.

I can definitely see this being true. Likely why things like psychedelics can help but only for a few months. Also would explain why CBT works as well as it does. I actually wrote something on the looping nature of my own depression that was in the form of a loop.

If you feel like sharing it, I would be grateful!

https://pastebin.com/K7yR1Yhz

Looping and recursion go together nicely don't they? ;-)

That's a ridiculous price to pay for ketamine. Though I'm hoping that cost includes a doctor's supervision and stuff?

$6000 would buy me enough Special K for several life times ...

> Though I'm hoping that cost includes a doctor's supervision and stuff?

Supervision by a nurse. It's usually contracted out.

> $6000 would buy me enough Special K for several life times ...

If it's not the same procedure (IV) with a compound that is pure you might not be getting any of the benefits.

> If it's not the same procedure (IV) with a compound that is pure you might not be getting any of the benefits.

At the same time since insurance doesn't cover this the only real option for people who don't have that kind of money (myself included) is black market self-administration or more traditional therapies which may not be as effective.

> or more traditional therapies which may not be as effective.

It's not proven. There are a few articles and a few success stories. It isn't a panacea. The cost is only an issue after someone has tried many traditional therapies.

Med grade K pops up for about 140 USD a gram. It's not hard to get insulin needles. There are guides on how to IV on the internet.

This would likely last much shorter then an infusion as there's a limited options for setting a running IV as opposed to just a single injection.

That's US street price. On the dark web you can get medical grade for $20 a gram.

And from a veterinarian in Central America for less than $5 a gram. Is there a difference between "medical grade" and what is used for animals?

Animals rarely sue their doctors.

I said medical to differentiate it from street k which comes as a powder and is usually cut which is bad for injection.

And there shouldn't be a difference between animal and human ketamine.

Your "medical grade" could be fake on the darkweb, who knows what you are getting?

"In the village of Boshe, underground laboratories are producing ketamine cheaply in large amounts." from:

http://www.bbc.com/news/av/world-asia-china-33472971/inside-...

I also wouldn't be trusting the packaging wasn't fake (or refilled).

The darkweb is generally safer than buying shit from random people in real life

Don't think it'd be worth the trouble.

They'd more likely produce the powder as that's easier to conceal for shipping or more likely just make DCK which is still legal.

Just use a test kit

No you can't. Powder is 60-70 USD, vial liquid is 120-140 USD. If you want to import from South Africa it can be that cheap but that stuff sucks.

Street ketamine is usually from vets..

According to my psychiatrist, you are paying for the malpractice insurance of a doctor performing unestablished medical treatments.

That might be misinformed, although $2-6k per infusion is very very high. That price is simply providing a high profit to the provider

There is a group of doctors who provide ketamine therapy and they've created some resources for interested patients. They say cost should be $400-800 per infusion and outline the drivers: http://www.ketamineadvocacynetwork.org/cost/

Fwiw, $800 is the price I was quoted.

You're paying for the risk that the doctor is taking. It's going directly into his pocket though. That's why regional prices are so far apart.

There are providers who charge $2k+ per dose, but providers can charge much less and still make a profit. For a list of cheaper providers see here: http://www.ketamineadvocacynetwork.org/provider-directory/

Cost info here: http://www.ketamineadvocacynetwork.org/cost/

Wow, rapastinel: I dont kniw how I haven't cone across that before but thank you for mentioning it. I'm astonished something so close to "done" is so atypically effective. I know too much about these things to throw around the term "miracle drug" but it looks very well inside the "game changer" territory.

Why is medical grade ketamine so expensive when the street stuff is dirt cheap? That sounds like an unbelievable ripoff.

Street stuff is cut, and you're not paying someone to inject it into you.

U got scammed for that price

One infusion for me in a clinic in Florida was 500$ and a one month supply for maintenance was 30$

Supply of what? Intranasal?

What about the “K-hole” effect? Have you ever delayed one of your maintenance treatments for significantly longer than what you would consider “normal” (for yourself of course)?

I enjoy K-holes though it's been a while since I've gotten to one.

One thing people don't realize is that ketamine tolerance is very long and hard to get rid of. It's easy to find reports from recreational users of it lasting years.

K-hole effect happens to people who abuse ketamine. The treatment can still be very unpleasant though. I sweat profusely and puke.

I haven't experienced any tolerance and the effect is not actually lasting a month as I had hoped.

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