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Comment by Natsu | Hacker News Reader

Yes, ketamine can shut off depression like a light switch. That's really, really good for the population it works for. Of course, it can also cause psychosis.

As someone who nearly got murdered in their sleep by someone on one such ketamine-caused psychosis, I think that caution is warranted when prescribing it. Waking up to take a knife away from a crying person is not something I would recommend to others.

I've heard that there are studies on a metabolite of ketamine that's supposed to avoid the psycosis. I really hope that works so we get something this powerful without the downside.

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Without making light of your experience, the behavior you witnessed is simply not possible to induce with the dosing range used by licensed ketamine treatment clinics. So yes, too much of a good thing is bad.

Ketamine clinics use doses much lower than that which is used for general anesthesia, and ketamine is used for general anesthesia all over the world on a daily basis. It's on the World Health Organization's Essential Medicines List and has a very safe 50+ year track record.

Also don't take powerful drugs off-label, with no monitoring or supervision, and expect them to do the same thing they would at controlled doses in a controlled environment.

I take doctor prescribed ketamine at home. It's incredibly safe and as a bonus it's much more comfortable to be laying in your own bed.

They let people take it at home now? We had to go into a clinic and they would monitor you the entire time. There was a couch to lay on, but not much in the way of amenities.

I've been taking lozenges for over 2 years now.

We didn't! It was a licensed esketamine trial under medical supervision for treatment-resistant depression.

> Without making light of your experience, the behavior you witnessed is simply not possible to induce with the dosing range used by licensed ketamine treatment clinics.

This was a licensed esketamine (s-ketamine) trial under medical supervision which, as you might imagine, left us excluded from the trial afterwards.

So I am going to have to disagree with you regarding whether or not that is possible at theraputic doses. I realize that it's normally safe, and I hope that it helps a lot of people.

> This was a licensed esketamine (s-ketamine) trial under medical supervision which, as you might imagine, left us excluded from the trial afterwards.

Do you feel like the experts are being disingenuous with the safety of this drug? I am not taking sides here - I am genuinely curious of your opinion since you seem to know something others don't.

I feel like this is probably a rare side-effect that people should know about. I hope it doesn't affect many people, and for those it does affect, that the psychosis doesn't turn out like this.

Could you link the trial or any data about it? Genuinely curious.

I don't know specifically which trial it was, but you can google for esketamine trials because that's their brand name for s-ketamine.

Good video on the difference between infusions and nasal, and s vs r isomers. https://www.youtube.com/watch?v=ejjAszofgvA They are essentially different drugs and may explain the reaction.

> the behavior you witnessed is simply not possible to induce with the dosing range used by licensed ketamine treatment clinics

There's a growing trend of clinics prescribing take-home lozenges. Some of them are giving patients 30 or more lozenges at a time, with the expectation that they'll use them once or twice a week.

Of course, some patients take multiple doses at once. Browsing subreddits on the topic shows plenty of stories of people escalating their doses or asking for strategies to convince their doctors to prescribe more.

Unfortunately, I think it's going to get worse before it gets better. Too many unscrupulous doctors are realizing the profit potential for dispensing Ketamine prescriptions in exchange for $300, 20-minute telehealth visits.

That's terrifying. The trial we were in used esketamine dosed via inhalation. You could not take any of it home and the doctors controlled all doses.

I'd be suspicious of those who wanted more and more of the drug. It made her so dizzy and sick there's no way she'd want more.

I almost wonder if you can detect who is abusing it by how much they enjoy it...

Basically the premise of the mini-series The Night Of

Set and setting comes from Mindset and setting. Sounds like that person wasn't using K correctly (they were abusing it). I don't feel as if your anecdote applies to many others in a controlled setting.

You would be wrong about that, it was a licensed esketamine trial under strict medical supervision.

strict medical supervision is sometimes a terrifying experience. Set and setting matter but so does any drugs they are currently on. I would say that your experience is atypical.

As I understand it, the "K hole" was terrifying, the setting for taking this was a doctor's office that let you relax on a couch afterwards.

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