I Was Paralyzed by Severe Depression. Then Came Ketamine
nytimes.com
nytimes.com
This seems completely insane, especially as the cost of ketamine itself is supposed to be negligible, and what you're paying for is the therapy.. but the therapists role in the treatment is itself virtually nonexistant.. they just hang out and let the medicine do the work (or, in the case of lozenges that patients take a home all they do is write a prescription).
When you factor in that most people who treat their depression with ketamine have to come back again and again every week or two (possibly for the rest of their life), this is a HUGE money maker for ketamine clinics and I don't see how it wouldn't send any but the richest among us in to the poor house.
I've heard some psychiatrists and psychedlic therapy advocates express concern about this and say they want to find some way of making sure that everyone who needs help gets it, regardless of their financial situation, but I don't know if anything ever came of that. AFAIK ketamine treatment is still not covered by insurance.
All the ketamine clinics springing up like mushrooms after the rain seem like a big money grab, and I can't believe they couldn't make the treatments orders of magnitude cheaper.
[1] https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescr...
Note that he's switched to a different URL for his blog; that may be why you couldn't find it -- although I'm pretty sure he mentioned it on the old site several times as well.
There is no standard maintenance treatment interval, but maintenance treatments are commonly practiced. I can’t find anyone recommending 26 treatments of ketamine a year for depression.
AMA, I guess. It was prescribed to me primarily for nerve pain.
Also, did you have to nudge-nudge-wink-wink at the doctor to get this prescription or did they actually believe that you had real nerve pain and that ketamine was the best treatment for it?
This is the first time I've heard of ketamine being used for nerve pain. AFAIK it's mostly used as an anesthetic during surgery.
The way you phrase this makes me think you've already assumed a whole lot about me. The worst part about chronic pain is all of the doctors and other people assuming you're just faking symptoms for a quick fix. Hoping that I've misinterpreted your intention, I'll answer honestly:
> did you have to nudge-nudge-wink-wink at the doctor to get this prescription
The complete opposite: It was suggested by my pain specialist. I had not heard of it being used to treat pain before meeting him. And he's not a "Ketamine practitioner" or an "alternative healer" or whatever, it was a from an MD specializing in pain management within a reputable hospital in Seattle.
> Could you go in to detail on the exact symptoms of this nerve pain?
Bi-lateral burning arm and hand pain and numbness. Severe headaches and neck pain. The symptoms are consistent with conditions such as thoracic outlet, cervical radiculopothy, and median/ulnar/radial nerve compression. However, tests always come back showing completely normal nerve and muscle function, and radiology imaging always shows perfectly normal everything.
It's been a multi-decade journey and I'm really coming to terms with the idea that my brain is just signaling pain even when there's no actual problem or damage. That's the idea behind the Ketamine trial.
Edit: I should add that this was more like a 3rd or 4th line medicinal treatment. All of the typical nerve pain medicines like Amitryptaline, Gaba, Pregabalin, Noortyptaline, etc have responded very poorly in my body and brain.
I have a similar medical history. Having just ruled out another spine surgery, the new plan is to try myofascial release and adjacent. I have no idea if "osteopathy" and such are legit. But at this stage I'll try pretty much anything.
I will now also ask about ketamine.
FWIW: I've dealt with chronic pain for 30+ years, post transplant, and have somehow managed to power thru it. This nerve pain is different; it's like being constantly interrupted, continuous dazing akin to being punched in the face. I've not been able to compartmentalize it.
The only thing that's helped is getting a puppy. Forces me to keep moving.
By the way, I don't think the other commenter was making any assumptions about you - actually just the opposite. Given what you wrote it wasn't clear if you actually suffered from the condition which your doctor prescribed ketamine for or if he made the prescription for nerve-pain knowing it would help you for a different condition. Sometimes doctors do this in order to bypass strict procedures.
Mixed results. I think the idea is for it to "retrain" my nervous system (I'm sure there's a more scientific reasoning / term), but so far it's only provided short term relief.
> All of the typical nerve pain medicines like Amitryptaline, Gaba, Pregabalin, Noortyptaline, etc have responded very poorly in my body and brain.
These things terrify me, not gonna lie.
My mum had a total knee replacement a few years ago that was a partial failure. She ended up with a DVT despite following the exact warfarin regimen they prescribed and avoiding foods with vitamin K for a week or so.
They originally prescribed hydrocodone+tylenol for the pain, but she couldn't take it for long because it would exacerbate her tinnitus. She can't take oxycodone because she vomits almost immediately. So they tried her with tramadol.
To this day, I have no idea if it was the combination of emotional and physical distress, or the tramadol, but within a 24 hour period of her first dose, she ended up in the ER with what would be later diagnosed as transient global amnesia. I've read that can be a rare side effect of the drug, but the practitioners I spoke with suggested that was impossible (and maybe they're right; it was almost certainly coincidental).
That said, I don't trust these medications. Certainly not when my relatives seem to have a strange array of reactions! For her part, she's sworn off ever taking tramadol again, and had me destroy what was left with the water-activated polymer packets they provide. That's how paranoid she was in the immediate aftermath of that "adventure."
I am curious and don't mean to pry: Have you found at least some relief with the Ketamine?
Assuming this is a real thing and not anecdata, expect ketamine to be covered in Europe long before it's covered in the U.S. Unfortunately our system is a huge mess and incredibly slow and expensive compared to Europe when it comes to approving new treatments.
I think it might be further along than your comment suggests. "site:nih.gov esketamine" if you want to peruse what's been done
https://qz.com/1889308/why-isnt-ketamine-approved-as-an-anti...
This is the same medical specialty that brought you: Pain pill clinics (opiates) Interventional pain clinics (scams) And now ketamine for rip-off prices.
Of course this isn't the best solution (the best solution would be for drugs to be legalized), but if you're strapped for cash and ketamine is having a seriously positive impact on your life, then I think it probably makes sense.
[1] https://en.wikipedia.org/wiki/Reagent_testing
[2] https://dancesafe.org/product/complete-set-of-all-8-testing-...
A perfect, near-instantaneous solution to depression button is a compelling button indeed.
Take care.
I have lost two friends to it and another one went to the hospital multiple times. Considering that I am just one data point, I find that these are a lot of connections to people who had fatal events due to ketamine usage. This is not including the people I know who had a mild and severe addiction.
Since you mention daily dose requirements, I would add that that is really the health risk here, since you would need double or triple the dosage (to get the psychoactive effects) after just a couple weeks of daily usage and it keeps increasing. This really puts a strain on your body until it will just fail to work anymore.
Also if you use it in sub-anasthetic doses it can really fuck your head after a while and lead to dissociative episodes or even disorders as well as anxiety and paranoia and a loss of the `sense of reality` (like most other drugs do).
Additionally it should be mentioned that
- the neurotoxicity of Ketamine is not really explored
- most street `Ketamine` is not that at all but often research chemicals which are even less explored health and addiction wise
Unfortunately, when searching reddit for it the first result was a pretty negative review: [1], though it seems like it was the result of some miscommunication. That was followed by some positive reports, but without much detail.
It was also interesting to learn that there's an r/TherapeuticKetamine
[1] - https://www.reddit.com/r/TherapeuticKetamine/comments/hb619w...
Major turn-off.
[0] (in Dutch, under "De Markt"): https://www.rijksoverheid.nl/binaries/rijksoverheid/document...
Reforming medical costs means reforming the legal system and that ain't gonna happen. The lawyers make the laws. In the legislature and in the judiciary. I can't think of a politician in the US who has said so since Carter.
If insurance was kept honest, if it was a true free market system where there was an immutable ledger where all insurance companies in real time had to post every action/response they make as to who/what they approve/deny/delay etc, then competitors could come in when they notice how many billions of profits there are each year - meaning that more people or procedures could be covered.
But yes, there are multiple industrial complexes playing together to maintain the status quo.
If what you're saying is accurate -- $400-1000/week or two -- then that certainly is expensive. But it's not like mental health treatment is affordable in the first place. (Well, it's better now than in the mid-2000s, possibly due to my better insurance?)
I offer no advice on how to write this kind of stuff, but i'd like to bring up the point that my situation , as someone who is paralyzed, is totally different than the situation of someone who is clinically depressed.
Paralysis might be a nifty way to explain the 'inability to act' in non-clinical situation, but 1) it's confusing when talking within medical contexts and 2) it equivocates experiences between those that fall under the adjective -- I don't know anything about clinical depression, and I have my doubts that this experience taught the author anything about clinical paralysis.
I have spoken to blind friends with similar attitude towards headlines that say things like "Doctors blinded by surprise lack of supplies.". It's not an uncommon sentiment.
Generic adjectives exist to describe this general inability to fulfill needed tasks or ability criterion -- yes, I know that popular use of the words allows this context, but in the interest of those that might read this stuff, understand that it's confusing and in some worst cases potentially insulting.
I'm not a neurologist, but I imagine there's a spectrum there, where other less-severe neurological problem-states (like depression) can get you part of the way to akinetic mutism, and thus you may be fully "paralyzed" in the above sense some of the time, or partially "paralyzed" all of the time.
If you did the slightest bit of digging, I think you'd find that 99% of people mean no offense, and would be deeply apologetic if their "transgression" were brought to their attention.
If you're sensitive enough, you'll find yourself offended all the time.
A lot of people assume blindness means absolutely no sight whatsoever, which isn't true, because quite a large number of legally blind people have eyes that detect some degree of light. Temporary blinding from illness/injury exists. Flashing a bright light into someone's eyes, rendering them momentarily unable to see, is also a very valid and very old usage of "blind" in the English language. Being metaphorically dazzled by something and temporarily unable to respond ties in with the latter meaning and goes way back in its usage.
Paralysis has a similar scale. Many people assume total lack of movement, and "only" having one's lower body unable to move doesn't even immediately register as paralysis in the mental image a lot of people have. People with severe mental illnesses like depression and some forms of schizophrenia are rendered unable to move (it's not a desire to stay still). People can also be temporarily paralyzed through poison or mental shock (as in they literally, physically cannot move out of fear).
Words have range. Context makes their meaning precise. I really hate to bring this word in here, but denying someone with a mental illness the right to use a word is because it's not "real" enough compared to another person's struggle is "gatekeeping". Suggesting words they use to describe their illness is "insulting" is harmful to them.
People getting pissed over things there parents took as inevitable is basically the definition of progress.
This is the first generation where mental health has been considerd a value. While its easy to dismiss there terminology issues i would say a few things:
1. That its hard to imagine the impact of having a defining life challange constantly talked about by strangers callously.
2. Go back and look at historical "political correctness gone mad" arguments.. even just to the 90s. The ones i have found all seem examples of things we would not dream of saying today and for good reason.
3. These apparently low priority discussions are how you really solve the root causes of issues. Its by figurng out how to support the un supported that all of society is elevated.
Throughout history there are many instances where the child generation regresses the status quo by and large, sometimes over multiple generations. Even when there is progress in general, there may be specific aspects of society which do regress relative to the past. All I'm saying really is that we shouldn't look at all forward movement as necessarily moving upward.
I didnt say all progress was good, only that progress has a profile and looking at this specific area: what is it about respecting people and understanding the importance of mental health has not been good.
I literally asked the reader to look at this specific issue.
But i agree not all progress is good and some progress is only temporarily good. E.g. capitalism, advertising, intellectual property
And if i use it at work like this people know i am not meaning it the qymay it sounds but they still correct me.
That discuasion leads me to have better more productive language in the future. If i cannot handle some constructive criticism thats on me.
I know it can be hard for people who are very normalised to a certain way of speaking.. but thems the breaks. Better than actually being paralysed imho.. plus if i come up with another term for this i can use it with an audience that actually includes paralised people and the reference will still make sense.
No body expects perfect. I still swear too much at work and i still accidentally throw in metaphorical adjectives that belong in the past. But i am better at it than my grandpa (not that i ever heard him say cunt :) )
I am not recommending the usage of the word. Just pointing out that my comfort with it doesnt make it okay to use.
Agreed that it probably totally failed to getthe message across.. i guess as someone who grew up in a dialect i am used all kinds of moderation and consideration for the listner, and so i don't buy these hard done by arguments over being respectful. I cannot talk in a way that the thoughts come in to my head outside a ridiculously small number of people and to me, it only adds to the richness of life and my personal growth. Ymmv
We are imobilised, we have lost all the momentum we had. Can we get back some of that dynamism we had prior to change x.. i dont see an issue with finding other ways to talking and if it turns out that those ways of speaking offend people i bet i willlearn somenew perspective when i hear why.
This is not a newspeak situation. This is just listening and trying to cause less pain.
Now a lot more people are coming forward and talking about it, whereas before people would just pretend they were ok, as much as they could. That pretense still happens even now, as there's still a stigma about it, but more and more people are starting to feel safe to come out of the closet.
It doesn't help anyone to tell us them (us) that they just have "extra time and mental capacity on their hands to try to dig up issues where there aren't any".
Not to speak for anyone else, but I've been crazy busy before (and every shade of busy in between) and still been very depressed and had severe trouble coping. Keeping busy might help with mild depression but it rarely works for moderate to severe depression.
Depression is complex and has many different causes that vary from person to person, but if part of the reason for you is that you find life meaningless or find what you do meaningless, then staying busy isn't going to help you. Same if you hate yourself, or if your depression is related to trauma you've suffered, etc.
That doesn't even get in to the "chemical imbalance" theories of depression, which I'm not a big fan of myself so I won't go in to them except to say that just keeping busy might not have enough effect on that either.
Thanks for writing this in such a non judgemental way.
I really didn't care much about such imprecise language but I too am starting to wonder if something needs to be done - and where.
This and similar wordings are what my teachers would refer to as a literary tool (not sure of the correct English translation but it should suffice.)
But it seems a lot of people doesn't understand (and some won't understand) this. This holds true for both writers and readers.
Recently someone said something about a certain well known country being apartheid, so I pointed them to the encyclopedia (not Wikipedia) that describes apartheid. It didn't work. Journalists had said apartheid so apartheid it was. Was it apartheid? Only in the same sense where the bank "robs" someone by not adjusting interest rates in a timely manner: as a way to spice up language.
So I do have my trigger words, too, where I try for people to use them in the right way, but it is pretty much an uphill battle and in my experience usually not worth the time fighting it. Just accepting that words have different meanings for different persons ... and most importantly - go out of discussions, when it is not about the topic anymore, but people fighting over the meaning of words.
But it's not imprecise, it's just metaphorical.
Someone saying they're in hot water does not literally mean they're currently standing in a cookpot or hot tub.
This argument that we may only use words literally feels very Drax-like: "Nothing goes over my head. My reflexes are too fast, I would catch it."
The metaphorical use of paralysis even predates its modern precise medical usage, having meant more broadly enfeebled before relatively recently taking on its specific motor function related meaning--so that would be the medical field assigning a new clear definition to a term with a 2300+ year metaphorical history.
Anyway, please sign my petition denouncing libraries everywhere for putting all these joke books in the humour section. It is a real hassle for melancholics trying to balance out their bile. Then we're getting onto this Jesus fella for all this fancy double-talk about eye debris, I've had specks in my eye before and cornea scratches are a legitimate problem.
Paralysed - inability to act
Blind - unaware of what's going on
The metaphorical meaning was probably intended.
In any case good luck, may research progress (and there was some recently) and find solutions.
I am generally a fan of the occasional self-prescribed party drug, but if you suffer from severe depressive disorder, you should not do this without proper supervision.
(And no, doing a bump off someone’s mailbox key is not proper supervision. Fun! Not medically wise, though.)
Like everything else in life, upsides have to be weighed with the downsides. For people who can't afford clinical ketamine treatment and are depressed, I don't see anything wrong with just buying some ketamine on the black market.
Opiates on the other hand, that's a different story.
This fear mongering on "freedom to use what every you like" should stop. It serves no purpose but keeping prisons full and street drug in bad quality. Why would we want to pay so much tax for that?
Every politician who claims to be in favor of "freedom", but cannot deal with the freedom to use what ever you like is a fraud.
Granted, but is it more or less risky for a person to remain severely depressed, if regular medications don't work?
If we think ketamine therapy will soon be covered by insurance it may be lower risk to wait.
Anyway, do you have a source for that?
Generally, no. Self-administering a psychotherapeutic drug, while isolated and without training, can have the lowest likelyhood of a positive outcome.
Having an experienced guide or trained therapist present - someone to provide appropriate nudges/direction/counseling or sometimes just for company - this is where we often see experiences with huge, lasting benefits.
Shorthand. You can substitute 'is', if that helps.
> If its just chemical why is counseling necessary?
It isn't just chemical.
Nothing Ive read suggests there is some talk therapy or integration side to this. Like some guides say close your eyes and listen to music. Almost everything I've read talks about its interaction with glutamate other chemicals.
Ketamine can be intense. I would not like to take a clinical dose of K, while in a depressed state, sans supervision.
https://pubmed.ncbi.nlm.nih.gov/28749092/
> Ketamine is most commonly administered in the dose of 0.5 mg/kg, but some patients may respond to doses as low as 0.1 mg/kg, and others may require up to 0.75 mg/kg.
This is about 40mg for someone my size. Its not a khole
Even if a small percentage of people have experiences like the author, I think that easily makes it worth pursuing this avenue.
Can you elaborate?
I'm just trying to temper my expectations.
Additional monitoring and analysis are always needed, as with any medical treatment. Depression can be a fatal illness, so avoiding effective treatment until the field is more "mature" may cost lives.
3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder in military veterans, firefighters, and police officers: a randomised, double-blind, dose-response, phase 2 clinical trial https://pubmed.ncbi.nlm.nih.gov/29728331/
Psilocybin with psychological support for treatment-resistant depression: six-month follow-up https://pubmed.ncbi.nlm.nih.gov/29119217/
Here's a counter-example to my claim, FYI. Trial of Psilocybin versus Escitalopram for Depression https://www.nejm.org/doi/10.1056/NEJMoa2032994
The last psilocybin one is interesting. I listened to a podcast with a psychiatrist who was doing a study of treating depression with psilocybin and he believed the effectiveness was in a handful of therapy sessions with large doses, rather than a series of smaller ones. Perhaps that could explain the last paper you shared.
Not ideal, but if it has the potential to change your life for the better, the risk is probably worth it.
How many treatments have you had? Did you go into the “k-hole”? It seems that having the right setting and the state of mind matters. Doctors are still doing a lot of guesswork and stumbling around to find the most effective approach.
Also, although assumed to be transformational, there are now indicators that ketamine’s anti-depressive effects might be tied to the opioid system of the brain, rather than the psychedelic, altered-state experiences, which most patients don't remember anyway.
Finally, the article peculiarly omits if they have been in ongoing ketamine therapy since that time frame. Phrasing neither denies or confirms this;
> In May 2021, 15 years after dropping out of high school, five years after beginning ketamine treatment, I graduated from college.
Don't get me wrong, I'm happy that they have found a treatment that works, and it might as well be rational to use this therapy to ratchet out of a deep disease state. But we also need a balanced account of the durability of the effects, its downstream consequences and therefore a better idea of its mechanism of action. Without such an account, uppers like amphetamines and cocaine would also be considered to "treat" depression, except for terribly short durations and with unsustainable side-effects. To what degree ketamine is different, we are yet to find out.
What’s your reference to patients not remembering their experiences?
What’s your reference to ketamine being tied to the opioid system? Never heard that. In fact there is a lot of research that shows it works differently.
Honestly, your comment seems totally misinformed. It’s like you’re just confusing ketamine with some other drug.
You're welcome to call and conduct your own survey, I have no way to document mine for you.
Clinics don't tend to detail their procedures at this level online but I found a random internet one for you: https://www.universityhealthsystem.com/~/media/files/clinica.... You should check page 8, item b "Prior to administration of the first bolus, patients will receive midazolam 1 mg IV push."
> What’s your reference to patients not remembering their experiences?
That's what versed (midazolam) specifically does. It is used in other outpatient procedures like endoscopies too.
> What’s your reference to ketamine being tied to the opioid system? Never heard that.
Literally the first Google result for "ketamine opioid" is https://med.stanford.edu/news/all-news/2018/08/ketamines-ant.... There is tons of other primary research too.
> Honestly, your comment seems totally misinformed.
Sorry to hear you feel that way but I know what I am talking about. I wish you researched a bit more on your own before writing your comment.
Read the responses to this paper. It has been pretty much debunked. As summarized here: https://onlinelibrary.wiley.com/doi/full/10.1111/pcn.12902
“ However, there has been much debate about this paper.217-221 In contrast, pilot data from Yale University demonstrated that pretreatment with naltrexone did not affect the antidepressant actions of ketamine in patients with depression and alcohol use disorder.222-224 Further clinical trials using a large sample size are needed to better understand whether opioid receptor activation is necessary for ketamine’s antidepressant actions in patients with depression.
Recently, we reported that naltrexone did not block the rapid-acting and sustained antidepressant effects of ketamine in a CSDS model or LPS-induced inflammation model.225 If opioid receptors are implicated in the antidepressant actions of ketamine, (S)-ketamine must be more potent than (R)-ketamine in animal models of depression. Therefore, the opioid receptor system might not play a role in ketamine’s antidepressant actions.225”
I'm impressed with your transition from "I've never heard research on ketamine's opioid activity" to "it is pretty much debunked". I suggest you read a bit more and watch for confirmation bias.
On the other hand, psilocybin-assisted therapy involves two sessions three weeks apart and a series of regular therapy sessions leading up to and following trips. Psilocybin + therapy offers the potential of cognitive changes lasting far longer than those available from ketamine.
Aside from these two, MDMA-assisted therapy is having phenomenal gains for treating PTSD, and ibogaine for treating addiction (psilocybin can cure certain addictions, too).
Also, this comes off with a lot of survivor bias, all I can read is "ketamine made me superman".
It's important to remember that modern anti-depressants regulate serotonin and act on the same receptors than psilocybin and other psychedelics that are told to treat depression.
I would rather trust a medical doctor and science than follow an internet trend that encourage the use of drugs. I'm suspecting some have things to gain from drug trafficking, and so they spread information about those substance being better than listening to a doctor. Sorry but I prefer listening to my skepticism.
I think the most intriguing thing I took away from it was that the Esalen Institute was one of the first ketamine clinics - while at the same time hosting backchannel talks between KGB and CIA agents.
It helped me quite a lot at one point, and I have a theory that some of its dissociative effects are a similar mechanism as ketamine.
I would really love to do some more research on the link between the 3, but I feel incredibly out of my depth.
The antidepressant effects of ketamine seem to be more short-lived (though not in everyone... for some there is a long-lasting effect).
Psilocybin therapy seems to have a more long-lasting effect, and some people only need one to three treatments to never need it again, vs ketamine for which many people need many (perhaps indefinite) treatments.
Then there are legal issues to consider. In the US, at least, ketamine can be used legally as off-label treatment for depression. As far as I know that's not the case for psilocybin yet, though you could get legal psilocybin therapy if you're part of a research study.
It's also possible to get psychedelic therapy from an underground therapist.. or maybe you're in a country where it's legal.
I'd suggest finding out as much as you can about both ketamine and psilocybin use in treating depression. There have been a lot of studies done on both, and a lot of good information about this.
Schedule 3 in the USA, so less controlled than, say, Adderall (Schedule 2).
No one knows. It's one of the biggest and most interesting open questions regarding psychedelics: how and why do they work?
What there is a lot of evidence for is that they seem to help a lot of people with very severe depression. The people involved in such studies tend to be ones that have had severe depression for a very long time and have tried many different treatments without success, some including trying electro-convulsive therapy (ECT.. or what used to be known as electroshock therapy), and some of which had had multiple suicide attempts... and psychedelics have helped a significant number of such people -- not everyone, but many.
Another big open question is why it helps some people but not others.
https://www.newscientist.com/article/2269908-benefits-of-mic...
It is psychedelic therapy, not microdosing, which has had many studies showing a profound positive effect on depression.
You may have this backward. Ketamine might not be a psychedelic drug but can yield similar positive outcomes.
ref: https://www.psychologytoday.com/us/blog/the-lucid-mind/20210...
Could you please give a counter-example of what has actually triggered a deep experience for you. Was it an even more potent psychedelic? Or do you just not consider this kind of experience deep? Or perhaps your dosage was very low?
For anybody who is reading naively, don't assume that you won't have a deep experience. Of course ymmv, but the consensus seems to be very different from my parent. Be advised not to take it lightly.
That means that cannabis does not work for my pain, but it means nothing with regard to its effectiveness for others. The same is true of your experience with Ketamine.
It's incredible for identifying & working on your emotional 'triggers'.
Aside: many folks aren't aware ketamine is fairly non-recreational (e.g. zero euphoria)
So label it what you will. But try it & see for yourself.