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Comment by simon1ltd | Hacker News Reader

I just had a discussion with a friend about this last week.

Some people (we call it addictive personalities, not sure if there’s a better term) seem to get hooked almost right away. Others, can stop whenever they want with little trouble.

The problem is that you don’t know which of those possibilities applies to you without trying it, and then it’s too late. Since my immediate family members have had issues with substances, I assume I would be one of the people with a problem.

That’s the message I’m trying to pass along to the next generation too. You might not have a problem, but you won’t know if you do until it’s too late.

YMMV

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There's even hard data on this with regards to alcohol and cocaine that show that some people are predisposed to have a higher risk of addiction. With alcohol we know it's at least partially hereditary, so people with histories of alcohol abuse in their families are often told to be extra careful. I would love to see more research on this and even the ability to give individuals info on their own risk levels.

The only thing that seems to be near-universally dangerous in terms of addiction are opioids. But even still, most people who try heroin or get prescribed oxycodone never become addicted.

Are people who take antidepressants addicted? The reason I am asking is that opiates can be used as such.

> Opiates promote goal-directed behavior.

> Interestingly, the mechanism of antidepressant action for ketamine may not even involve NMDAR blockage and may instead involve modulation of other CNS binding sites, such as being an agonist (activator) of opioid receptors.

I can see how opiates would help with anxiety and depression, especially for people who do not experience euphoria from it, just enough calmness... which does not actually go away after 2 weeks as it does with benzodiazepines, or without the cognitive deficits.

If you look at online forums (/r/TherapeuticKetamine) for depressed patients taking doctor prescribed ketamine you notice a few things:

1) Dose escalation as tolerance builds. Either through increased dosages or attempting another ROA like rectal to temporarily increase bioavailability.

2) Patients are usually upset if they don't have a dissociative experience.

3) Many patients wish that they could afford IV treatments and to do them much more often.

4) Many patients claim that oral and intranasal ketamine doesn't work for them despite studies showing that it does work well. Obviously oral ketamine won't cause the rather extreme disassociation of IV ketamine.

All the signs are there. And yes you are right about the euphoria. I have experienced it but it's not a topic that often comes up. People are more interested in talking about the woo woo stuff.

The same moderator runs all the ketamine subreddits -- even those where people are addicted and sharing advice on how to get high. Sort of a bias / conflict of interest, right?

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