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Comment by pw | Hacker News Reader

My girlfriend receives ketamine treatment for her depression, so I’ve the results first hand. It’s truly astounding. She’s seen more improvement from the ketamine than from a decade of psychotherapy and traditional psychopharmacology.

The only downside is the cost (it’s not covered by insurance) and the potential that there are long term side effects that have yet to be discovered. We pay $375 for a 40-minute infusion. The recommended initial course is six infusions over two weeks. After that a booster or two is usually needed very two to six weeks. (It’s been about every three weeks for my girlfriend.)

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Can confirm. I’m in a similar boat.

Some other tidbits of information:

- only thing that seemed to work even after TMS and other treatments.

- New pathways (SF and San Mateo locations) is really good.

- more and more treatment places opening up in different cities etc.

- uber assist or drive the patient home (full lucidity afterwards but you don’t want to drive).

- long-term benefits aren’t apparent after the first two treatments. After the third it seemed to last for 2-3 days. After the fourth longer.

- it really seems like a ‘break out of depression’ breakthrough treatment. Though no cure all (talk therapy or a good support system is important too).

- ketamine is used for many purposes (anesthesia, etc.). When given for depression it’s given in much low dosages (presumably without harmful liver or kidney side effects).

- usually the patient listens to music with headphones while the infusion is in progress.

- a nurse monitors BP and heart rate etc., but so far there have been no compications other than a nurse who was bad at putting in an IV (once).

- feel very thankful for it.

- I could see it going mainstream in the near future.

Do you have any idea what the dosage is? Is it an immersive 'K-hole' dose where you go deep and become unresponsive for a bit? Or are the infusions smaller doses just meant to build up the anti depressive afterglow effects in the body?

Where are you getting this treatment from? Did you directly ask for it?

New pathways ketamine treatment center. There’s a handful of other providers in the Bay Area too. Referred by psychiatrist (and internally recommended after TMS didn’t have beneficial effects - works for some though).

And yeah I’m not sure about the dosage. I know it’s much less than ketamine for pain management or for anesthesia. I’ll try to ask next time.

How easy would it be to do this at home by snorting half a gram but over the course of an hour?

half a gram seems pretty excessive to me. if you snorted that over the course of an hour, with zero tolerance, you'd very likely knock yourself out.

I was just going by the amounts someone mentioned.

Half gram would knock you out cold.

A better "close to k-hole" dose would be 100mg. At least based on our experiences 100mg would get some people in the hole, while it took some others 50mg - 100mg more.

Thanks for the info, do you know if they allow people to come in on their own? I don't really want to try to get my doctor to refer me.

> We pay $375 for a 40-minute infusion

Having no knowledge on the matter, what's the price comparison to just buying ketamine illegally and taking it without a doctor's help?

Depression is like (or possibly is) a form of chronic pain. People suffering from it severely might be willing to do anything for relief. Here's good information that a currently-illegal drug can help but if you want to do it legally you might need to take on a third job just to pay the costs.

It reminds me a bit of the South Park episode[0] where 'concentrated dose of about $180,000 shot directly into the bloodstream' is discovered as the cure to AIDS. Volunteers inform poverty-stricken Africa that all those suffering from AIDS have to do is inject themselves with piles of cash.

[0]https://en.wikipedia.org/wiki/Tonsil_Trouble

Ket will set you back anywhere from $50-$150 per gram, depending on where in the world you are, and is of varying quality. It looks like they're using up to 1/2 a gram for treatment.

I think the most of that $375 goes towards staffing costs, rather than the drug itself. Ketamine though legitimate channels costs about $5-$10 per gram from what I've heard.

I think that the new part of this publication that they now have an easy to administer nose spray.

Do you have a source on that 1/2 gram number? My reading has lead me to believe that a typical therapeutic dose for these treatments is between 60-75mg. I could be way off, though.

It's .5mg/kg, so even 50 mg is enough for a pretty big guy. 500mg would knock you out for awhile. He might be misplacing a decimal there.

I was looking at studies earlier today, and the upper limit (assuming a 100 kg person) was 0.5 g from one of the studies.

That can't be right, 0.5g will knock out a horse for many hours

> It looks like they're using up to 1/2 a gram for treatment.

Typically they use 0.5mg/kg. I think you may be confusing milligrams (mg) with grams (g).

I was told when I had it done that almost all of the cost was the paid time for a trained professional to do the IV, since ketamine for medical purposes costs on the order of cents per gram or less.

My doctor uses a sedative also to make sure you don't freak out during the treatment. I think most doctors do this. You need to factor that into the cost too.

Sedatives (probably benzodiazepines) are also very inexpensive (on the order of less than a dollar) compared to the $375 figure.

> Having no knowledge on the matter, what's the price comparison to just buying ketamine illegally and taking it without a doctor's help?

It's way cheaper on the black market. The actual cost of manufacture isn't very high, and I don't think it falls under any patents needing licensing. Probably you're mostly paying for the labor.

Doesn't ketamine stimulate growth in the same areas of the brain that exercise does, and does therapy prescribe routine daily exercise?

I can imagine there being a great short term benefit to ketamine, as people who are severely depressed can't exercise due to the depression. Has there been any mention switching from ketamine to daily exercise, or doing both?

I know exercise is good for depression, but this is an extremely patronising response to someone else's description of their medical treatment.

Well that'll teach that poor bastard to ask a question here, good job!

Is it possible to ask a question in a patronising way?

I don't know, is it?

I would say yes.

How is it patronising? GP is asking two questions. Maybe there's some subtle subtext that I'm missing, but even then it seems better to assume the more favorable interpretation that he's just asking questions.

Sorry. That wasn't the intent. I could have been clearer.

More, I don't know what ketamine does in the long term to the brain beyond stimulating the parts of the brain that get strengthened during exercise. Maybe it's doing something else and that was the motive for the curiosity. What exactly is ketamine doing in the long run to the brain?

Anecdote alert, but I get about 10 hours of exercise a week and at best it's stopping things getting worse.

How often did you have depression? Especially major depressive episodes where you have trouble to even motivate yourself to move out of the bed or do ANYTHING but just "exist" and even that seems hard?

If the answer is zero (which I think it is) do those who have it a favor and shut up. Depression is hard enough without "you just have to exercise, huahua" comments.

While you are totally right, you could have phrased that a lot better, and don't tell people to shut up.

I over came decades of suicidal depression (as well as schizophrenia and bipolar) with a self concocted protocol which included psychedelics and now don't take traditional meds.

I read the OPs intention as "use K to get the person back from the bottom of depression and then leverage that boost in mood to start a habit of excersize"

That seems reasonable and a good approach. You want to reinvest the motivation and better mood into relationships and behaviors that will continue to compound feeling good.

I'd also recommend Gratitude as a practice and ultimately some sort of somatic work where you are encouraged to go deeply into any uncomfortable feelings with your full body.

Can you explain your protocol? That's pretty promising. I've had some good results to date but not sure how to use them in a more disciplined way to create permanent results

I'd be happy to Skype with you for 20 minutes sometime. You can email me a@175g.com

>do those who have it a favor and shut up

Nothing is more irksome than the trend in public discussions to tell others to "shut up" if they haven't specifically experienced something.

This is a public forum. We're discussing a publicly posted article. The OP brought to the table a valid point. Let them talk.

I'll always remember a quote from a cancer researcher/professor on tv: "You don't have to be an elephant to talk about elephants." Sadly I don't have an elephant's brain so I don't remember the professor's name.

A lot of depressed people who have been able to pull themselves out of the hole can be pretty touchy about stuff like being told to exercise. OP was maybe a bit more aggressive than he needed to be, but it can be a pretty raw feeling, and mental illness has such a stigma.

> If the answer is zero (which I think it is) do those who have it a favor and shut up

I get where you're coming from with this response - if you haven't been there, there is just no way you can understand how desperately bleak things can become.

But if someone is ignorant about mental health, why not try to educate that tell them to "shut up"?

We need to talk about these things, not humiliate and shut down anyone who doesn't understand.

When studies seem to suggest exercise helps, its pretty dangerous to shout down comments like this. Especially when you're completely misrepresenting the question.

The difference is that ketamine shows positive results in clinical trials (even for severe depression) while exercise doesn't, unless you include poor quality trials and you limit results to mild depression.

Whoa. Do you have a link to a meta-study or something like that?

For exercise?

I've posted this before. There's a newer study that has better results.

http://www.cochrane.org/CD004366/DEPRESSN_exercise-for-depre...

---begin

Exercise is moderately more effective than no therapy for reducing symptoms of depression. Exercise is no more effective than antidepressants for reducing symptoms of depression, although this conclusion is based on a small number of studies. Exercise is no more effective than psychological therapies for reducing symptoms of depression, although this conclusion is based on small number of studies. The reviewers also note that when only high-quality studies were included, the difference between exercise and no therapy is less conclusive. Attendance rates for exercise treatments ranged from 50% to 100%. The evidence about whether exercise for depression improves quality of life is inconclusive.

---end

The results are limited for Ketamine too.

http://www.cochrane.org/CD011612/DEPRESSN_ketamine-and-other...

The effects are so significant that I have gifted small amounts of ketamine to close friends who suffer from depression, so that they may store it long term as an emergency last resort to try in the event of irresistible suicidal ideation. It really is a lifesaver.

> and the potential that there are long term side effects that have yet to be discovered.

Not for medical which is maybe what you are referring to. But long term (recreational) ketamine use (abuse) is well known. Perhaps down to the method of injection (nasal) or the impurities in illicit ketamine, but there is a lot of information on bladder problems, stomach cramps along with heavy addiction

it seems likely to be the ketamine - http://ajp.amjpathol.org/article/S0002-9440(16)00073-0/fullt...

That's still cheaper than a private psychologist or psychiatrist (after the initial course).

And public / insurance covered ones are overworked as it is.

The cheapest per infusion cost is around $350 and the most expensive is around $1000. It's not actually cheaper.

Infusion? Goodness grace, I got belonephobia and got scared shitless there. It doesn't have to be administered intravenous. The article is mainly referring to a nasal spray.

Yes, but is just the latest study.

Typical infusion time is 40 minutes. How would one accomplish the same release with a nasal spray?

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