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Comment by kaikai | Hacker News Reader

Your anecdata doesn’t match up with current ketamine research. The protocol for depression is really different than using it for a party drug. Same for mdma for things like ptsd- it’s paired with therapy that helps you work through things. You’re right that just taking drugs isn’t enough, but please don’t discount medical treatment that changes the lives of many people.

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It matches up with the experience of anyone who has ever taken these drugs.

These drugs, taken with a good group of people, always lead to a therapy-like experience. And as GP comment said, they give you the ability to clearly identify what bothers you in life and what to do about it. The only difference between 'medical' sessions and 'recreational' ones is that you're talking to a therapist instead of friends. Having done both, friends are generally the better option.

Actually acting on that information to improve your life is a completely different task, and without taking that step, these drugs do nothing for mental health long term.

There is no difference between 'medicine' and 'drug' other than some regulatory body slapping a label on it. Especially the case with psychedelics where early pioneers performed and documented way more experimentation than FDA-approved research could ever hope to cover.

I've been taking intranasal racemic ketamine for a year. It's not a replacement for therapy - it's treatment for organic depression. As far as we can tell, the people like me who need ketamine don't have any effective alternatives, since their depression isn't simply exacerbated situational depression, but is driven by biologic processes, specifically involving inflammation. This isn't about drug induced insight - it's about brain chemistry.

There is absolutely difference between medical and recreational ketamine use, since the actual chemistry is unrelated - the high of the ketamine is not related to it's beneficial effect. Moreover, my ketamine use and schedule wouldn't make sense recreationally. The dose is just enough to be debilitating - the equivalent of 1/4-1/2 a line.

Ironically, due to the unfortunate nature of contemporary american society, regulatory capture has resulted in the FDA approved ketamine (s-ketamine aka esketamine) treatment being more inebriating and less effective antidepressant than recreationally consumed ketamine - which, being unpatentable is consequently unprofitable. A less inebriating, more effective antidepressant r-ketamine is 'in the wings', in order to let pharmaceutical companies milk as much money as they can from this otherwise cheap and effective drug. Hopefully psychiatrists will see through this, and start prescribing off-label ketamine once they have seen the effect that esketamine has on their treatment resistant patients.

The problem is not that psychiatrists won't prescribe off-label ketamine.

The problem is that insurance companies won't cover off-label drugs, and ketamine is too expensive for most people to pay for out of pocket.

Actually the problem is that doctors won't prescribe racemic ketamine - unless it's taken intravenously and consequently require medical supervision - which comes with medical malpractice insurance.

I would hazard that this is the main reason why most doctors are comfortable prescribing IV ketamine rather than intranasal or subcutaneous (both of which are currently prescribed self administration methods for depression). Otherwise the risk is all on them.

My intranasal (ie - same as esketamine) ketamine prescription is $70 every six weeks.

I've never heard of this before. What dose and what schedule is that dose on? Is it combined with any other treatments? How has it helped you? Do you have any sources describing this mode of treatment? Any evidence of said inflammation or its subsequent reduction after treatment?

Also, recreational use != party druggies. I put recreational in quotes because authorities etc. see no difference between self-medication and party time. Based on what you said, you could go get ketamine from a street dealer and continue the same dosage/schedule 'recreationally'.

I'm not saying all recreational drug use is theraputic. I'm saying the difference between 'street drug' and 'medicine' is decided mostly on politics and the profitability profile of the substance rather than its therapeutic efficacy. Also see: marijuana.

60mg every 3 days. I don't believe it's a common treatment modality - though my doctor has some other patients on it. The primary sensation I experience on an ongoing basis is the the elimination of the sensation of abstract physical pain that I experience with negative thoughts and mood. The process is not inherently anti-inflammatory: while high dose IV ketamine are used to treat inflammatory diseases, as I understand it, the dose I'm taking doesn't directly affect inflammation, but works by modulating glutamate signaling. The relationship between inflammation and mood isn't yet clear to science, but we know that it is likely involved in many cases of treatment resistant depression.

Third hand, I know of people who are taking black market ketamine to treat depression, though I don't know what schedule they are following. There's a definite 'cliff' at the third day, as the ketamine wears off.

Rather unique and interesting case. I'm glad you found something that works for you.

60mg every 3 days. That's was the protocol I followed with auto-prescribed ketamine.

Then I wanted to try every NMDA antagonists existing other than ketamine, like memantine, used as alzheimer treatment, but also ephenidine, diphenidine, methoxphenidine and later MXPr, all present in research chemical scene.

Then I heard about dextromethorphan (DXM) on a drug forum about anecdotical experience on its potential as antidepressive and even read a scientific paper about it. It is used as composent in cough syrop worldwide and, according to country laws, available without legal restriction or not, mainly because it is reputed for its potential of abuse for its dissociative effect.

In Belgium, it is supposed to be unrestricted for possession and use and so I bought 100gr of it on Alibaba for 80€, transport comprised...

The molecule seemed promising because it could act as antidepressive in 2 complemental chimical processes, that you can fine tune with the ingestion of pink (or is it white ?) grapefruit and other citrus having the same chimical properties, leading to the greater degradation or not of DXM while digesting, the product of degradation also having anti-depressive properties on its own, but in a different way.

The package get unfortunatelly blocked at French custom border. Now it seems I'm blacklisted in european custom as most of my order from China is systematically blocked.

Here are some ressources :

https://www.vice.com/en_us/article/9kzkje/dxm-cough-syrup-an...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398352/

https://sci-hub.tw/https://doi.org/10.1016/j.mehy.2011.02.00...

https://mhc.cpnp.org/doi/full/10.9740/mhc.2019.03.076

Edit : Typo and removed an irrelevant reference.

Rubbing ‘medical’ on something doesn’t magically change how it works. And it’s pretty much impossible to take mdma and not engage in talk therapy. I had conversations that went from favorite djs to the time they were raped in middle school with complete strangers. And then you go out and dance. I don’t think a hospital is going to improve the situation much. It’s just a loophole people have to go through to make it socially acceptable.

Certain placebos only work when administered by a doctor in a clinic (heard it on some podcast once). Seems like ketamine could have different effects in different environments.

Ketamine is probably the one drug where the environment doesn’t make a lick of difference because once you drop into the hole, you are on another planet. The outside world may as well not exist.

Only if you take very large doses. Maintenance doses for medical use are tiny; barely enough to feel any effect at all.

What? Talking about hard or traumatizing experiences is NOT the same as working through trauma with a trained therapist. It’s great, and it can be helpful, but just talking about something is the first step.

Also, I don’t why y’all are acting like folks who use things like mdma and ketamine in a medical/therapeutic context haven’t also used them recreationally. It’s different, because the environment, intention, and often the dosage are all different. You taking drugs at a party is not the same, and using absolutist language to say otherwise when there’s actual medical research that contradicts you is an odd choice.

> Also, I don’t why y’all are acting like folks who use things like mdma and ketamine in a medical/therapeutic context haven’t also used them recreationally.

I think questions like this are underappreciated.

I propose that the potential underlying mechanisms of why people behave the way they do are described here, at least in part:

https://en.m.wikipedia.org/wiki/Heuristic

https://en.wikipedia.org/wiki/Thinking,_Fast_and_Slow

I think it's useful to observe how people, particularly intelligent people, interact with these ideas, and the inherent uncertainty involved.

Are people curious about how nature plays out, or are they tied in some way to nature being a particular way? Are they willing to discuss these ideas, and defend their beliefs, or is there something subconsciously repulsive about certain beliefs that renders them unable to discuss it rationally, but instead forces them to revert to defensive techniques like appeal to authority or popular tribal axioms.

Is uncertainty acceptable?

Do therapists actually contribute? I'm sceptical. For me, I got so much of the value from taking MDMA and just knowing my friends were around and actually loved me. Ended so much anxiety. Between Molly and Acid and these folks, I think I'm pretty much safe for the rest of my life.

My understanding is that the ketamine dosages used for treating depression are much, much lower than the dosages used recreationally. (I could be remembering wrong.)

Otherwise, the big advantage of getting a nurse to do it is that they are in a position to treat you if one of the rare but potentially fatal side effects pops up.

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