Special K, a Hallucinogen, Raises Hopes and Concerns as Treatment for Depression | Hacker News Reader

Special K, a Hallucinogen, Raises Hopes and Concerns as Treatment for Depression

nytimes.com

89 pointsapplecore71 comments

It's amazing what great lengths some people will go to to stop others who might feel good from using a substance or performing an activity they are completely unfamiliar with. In America, at least, this seems to be much more ingrained in the culture than just about anything else. The really sad part is that even if this is in pursuit of saving lives, like the therapy mentioned in the article and many others, most people have absolutely no qualms about speaking out against it or trying to stop it. It seems, if it were up to the prevailing mindset in this country, everyone should live in absolute misery and pain. Drug companies wanting to develop non-generic drugs for profit reasons is one thing that's at least understandable, but the people who support such hate of others' potential at an enjoyable (or at least not horrific in the case of depression) life is just disgusting.

In the case of drugs, it's because most chemical compounds have more than one effect on the body. While something might alleviate one problem it can create an entirely different problem. Without a thorough understanding of what it's going to do to someone it would be deeply unethical for a chemist or a doctor to give someone a drug. This is not limited to illegal or untested drugs - it's unethical for a doctor to prescribe entirely legal drugs without knowing what they're giving.

Absolutely true, but the phama industry and plenty of politicians across the spectrum go to great lengths to even prevent research into these substances.

So this justifies hating others' pleasurable activities enough to send them to jail? I'm not seeing the connection.

I don't think that's it. It doesn't match what I see or what I hear. What I see & hear are that "Drugs are bad, mm'kay?" And while, yes, I'm referencing a comedy show, I'm referencing the whole idea from the show, including the idea that people have been just so hammered by the propaganda that what they know is "Drugs are bad, mm'kay?" and can't even make a half-logical anymore after decades of thoughtless propaganda on the topic.

And, even more importantly, the second-order effects that people know they are socially expected to posture the belief that drugs are bad means that people say it all the harder so they look even holier than the person next to them, by being seen to condemn it even harder.

But I never hear anybody say "Omigosh, those guys might have a good time on a therapy drug, that can't be stood for!" That is, frankly, giving them too much credit, much as I hate to say it. Long before they're thinking that deeply about it, they've already hit the "Drugs are BAD!" button and stopped thinking about it. Behold the perils of demanding that nobody be allowed to think about certain things.

How fortunate that this is the only case of that pattern in American culture.

I think this is a big part of it as well, though it's hardly unique. I don't think it's the whole story as what I'm describing does not only apply to drugs. In various times and places it has applied to music (jazz, rock, electronic at different times), dancing, sex, food, playing sports, and really just about any pleasurable activity. I think perhaps some of the Puritan roots are just all too alive and well. Also, it's not so much about thought but about feelings. That's why no one usually says it out loud. Also, I think the people that think in this way are aware of what they're thinking to some extent and in many cases, even realize the negative intent they're wishing upon others.

While it's certainly very true that there are people who just want to ruin everyone else's fun out of spite, this situation is more complicated because there really are problems with uncontrolled administration of drugs, even ones we have studied for other purposes. There a many reasons why people in the article are stressing the need for trials.

Even if we just stick to ketamine, there are many questions. First, is this better than the current standard of care? Is it better in the short term, long term, or both? How much better? Should we discontinue drugs like SSRIs altogether? Are people dying (committing suicide, in this case) because this is a fringe treatment and not the standard of care?

Second, while we clearly already use it as an anesthetic, we don't know what the effects or dangers might be for this kind of use. Is repeated administration (as seems necessary) a health problem? Are side effects like hallucinations just temporary, or is the brain altered in some way permanently? There are drugs that, the longer and more frequently you take them, the more likely you are to have actual permanent problems (some antipsychotics, for example).

Doing any kind of controlled study with humans is inherently difficult, and in some cases impossible (this is why we know so little about nutrition). But not doing controlled studies and carefully assessing the value of a treatment can be just as catastrophic as ignoring something that seems to work. And you can't go with your gut on these things, or we end up with antivaxers and dead people when we should have just done the study(s) the right way from the start.

Your argument is basically that it's generally a good idea to make sure a medical treatment is safe and effective before undertaking it. That's hardly controversial. What does not follow at all is that Ketamine should be banned, or that medical researchers should have to jump through D.E.A hoops to do research.

What does not follow at all is that Ketamine should be banned, or that medical researchers should have to jump through D.E.A hoops to do research.

Ketamine isn't banned. And it's not all that controlled compared to other drugs (Schedule III). You'd have a harder time running a trial for morphine than you would for ketamine.

OK, schedule III isn't so bad, but afaiac, if I can't buy it at Walmart, it's banned.

All of the questions you've listed are reasons for further study and analysis and the publication of the results of such.

They are not reasons for criminal penalties for END USERS who choose to proceed without that data. If a doctor proceeds without that data, sure - they're in a position of trust.

But to throw someone in jail because they injected something into their own body that they personally believed (even erroneously) would help them is complete lunacy.

"Penalties against possession of a drug should not be more damaging to an individual than the use of the drug itself." —Jimmy Carter

I think the reason you see people criticizing psychotropic drugs is that they don't work. Ok, you'll probably say the drugs are saving lives, and how can you criticize that? But if you look at any of the studies, you'll see that the drugs are not any better than placebo, plus the drugs have terrible side effects. And nobody understands why the drugs work, or don't work, about as well as placebo. And if the drugs are only as good as placebo, or worse, and are addictive and in some cases even CAUSE depression, why are the drug companies selling them? Because money. That's why people criticize the drugs, with good reason.

It's weirder than that: https://en.wikipedia.org/wiki/Decline_effect

This doesn't explain the exact same behavior related to other pleasurable activities that people engage in like music, dancing, sex, food, etc. I don't think it has anything to do with drugs and everything to do with people's hate of others' pleasure.

Not to mention that that your claim that they don't work is unsubstantiated.

I have never done ketamine. But a hit of MDMA was kind of instrumental in lifting me out of twenty years of depression.

Which is interesting because of the SSRI I'm on all MDMA did was make me grind my teeth really bad. I want to try it again but don't want to stop the SSRI to do so.

From my understanding, SSRI's negate the effects of MDMA. So you can't do both.

https://www.erowid.org/chemicals/mdma/mdma_info9.shtml

This can also cause serotonin syndrome, which can cause serious damage to your brain and untreatable side effects. Not a safe combination.

Using MDMA and and SSRI together is a bad combination.

https://www.erowid.org/chemicals/mdma/mdma_info9.shtml

You took MDMA while on an SSRI? You really should research a drug's mechanism of action and how multiple drugs may interact before taking them together.

Im not a medical professional, I just want to give you a quick overview so you don't repeat that mistake. Do your own research.

- An SSRI (Selective Serotonin Re-uptake Inhibitor) blocks your brain's re-uptake of serotonin and effectively increases your brain's levels of serotonin.[1]

- MDMA acts as a presynaptic releasing agent of serotonin. Increasing the amount of serotonin in the synaptic cleft (space between neurons).[2]

- That means the two of these drugs combined can cause a huge spike in serotonin and potentially lead to serotonin syndrome (toxicity).

Be safe.

[1] https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_i...

[2] https://en.wikipedia.org/wiki/MDMA

I was never on a SSRI for my depression. For many reasons, the biggest one being that I was way too broke to see a doctor and get a prescription during a lot of that point in my life, never mind pay for it.

Another place where ketamine has been used "off label" has been in the treatment of Complex Regional Pain Syndrome (CRPS) formerly called Reflex Sympathetic Dystrophy (RSD), "causalgia", or Reflex Neurovascular Dystrophy (RND).

http://en.wikipedia.org/wiki/Complex_regional_pain_syndrome#...

Edit: I'm not sure why this nytimes article is being considered "news" on HN since topic has been discussed here quite a few times over the last three years.

https://news.ycombinator.com/item?id=4043198

https://news.ycombinator.com/item?id=4615602

https://news.ycombinator.com/item?id=5116706

https://news.ycombinator.com/item?id=5758647

https://news.ycombinator.com/item?id=7522343

I'd say it's news. It's a recent article, and those other threads are years old.

Still Called RSD by many :) I am upvoting and commenting to spread awareness about CRPS. It is one of the most terrible disorders that a human can ever endure and it is insane that the use of ketamine has not been accepted as a non-expiremental treatment for it. My wife just finished a two day ketamine booster yesterday, and without the use of ketamine she would not be able to walk or even open and close her hands. Nothing else has ever helped her CRPS and ketamine has improved her quality of life in immeasurable ways. Yet we still have to pay for every single dollar of every single treatment out of pocket. So glad we are forced to pay for insurance that won't even acknowledge thousands of dollars a year of medical spending for necessary treatments.

Justin, my email address is in my hn profile "about" section where you (and everyone) can read it. If you contact me by email, I'll share with you the research and data I've collected. Needless to say, me happening to know of this other off-label use of ketamine is not a coincidence.

Have you tried appealing to your insurance company about coverage?

Insurance companies won't cover most drugs when used "off label". However, the doctor is allowed to appeal by providing peer-reviewed article supporting the use.

It's a hell of a lot of paper work, but most of the folks at insurance companies (I work with them a lot) are pretty reasonable people. Their default is to deny, but if you can build a strong enough case they will often cover it.

It's not like ketamine is all that expensive. Hell, I've seen people get covered for "off-label" use of oncology drugs that are $100K+/yr.

Yes, multiple times to multiple companies. It is not about the cost of the drug itself, it is the cost of administration. This isn't just a bottle of ketamine pills, it is an IV infusion in a hospital setting.

Sorry to hear that! Are you appealing or is your doctor? Just curious.

Both

Alternative headline: "Ketamine, a commonly used anaesthetic drug long on the WHO's list of essential medicines, raises hopes and concerns as treatment for depression"

But that headline would be way too long.

Not only that, it's not a hallucinogen. It's a /dissociative/ anesthetic. About the only other thing commonly used that has similar effects is dextromethorphan hydrobromide - the primary ingredient in over the counter cough syrup.

It's a dissociative hallucinogen.

http://en.m.wikipedia.org/wiki/Hallucinogen

Just goes to show that the difference between medical use and recreational use is really in the set, setting, dosage, and means of ingestion!

Ketamine is already very commonly used medically, because it is relatively safe (compared to other similar dissociative anesthetics) and has a very short half-life, making it a good choice for certain procedures.

Unlike many anesthetics, ketamine does not suppress breathing much. Combined with the fact that it is a bronchodilator, it can be used in many situations for which other anesthetics would be risky or inappropriate.

If you've had a colonoscopy[0], there's a good chance you've already had ketamine, just not in the same doses that you would have taken at a club!

[0] Which, if you're over the age of 50, you should do! Colon cancer is very treatable if it's caught early.

I had noticeable psychosis courtesy of ketamine in the ICU after being run over by a truck. Likely having a broken pelvis etc. didn't contribute to a positive trip, of course, but I would be very reluctant to take it again (not that anyone asked at the time - or that I could have answered sensibly). But like most psychoactives, dosage is key...

The WHO lists ketamine as a "essential medication" since it is an ideal anesthetic for countries with limited resources. It's quite safe (doesn't depress breathing) and effective.

However, as you noticed, many folks who are treated with ketamine find the experience very unpleasant. Unless there is a good reason for using it as an anesthetic, doctors typically go with other drugs.

If you've had a colonoscopy[0], there's a good chance you've already had ketamine, just not in the same doses that you would have taken at a club!

Maybe it's different outside the US, but they don't use ketamine for colonoscopies. Or if they do, it's quite rare. Ketamine can produce quite unpleasant effects in patients.

Sedation for colonoscopies is usually a sedative like midazolam and an opioid like fentanyl.

Thanks for the interesting comment. It looks like propofol is pretty commonly used for colonoscopy sedation in the United States, not without controversy.

http://www.ncbi.nlm.nih.gov/pubmed/15990942

http://www.medscape.com/viewarticle/778967_8

http://www.ncbi.nlm.nih.gov/pubmed/15768182

http://www.latimes.com/opinion/la-ol-propofol-colonoscopies-...

They're also looking into using buprenorphine (which I take daily as suboxone as treatment for my previous addiction) for depression. Anecdotally, it's pushed my horrendous depression into remission entirely since I began on it.

http://www.psychiatrictimes.com/major-depressive-disorder/qa...

One thing I don't see in the comments is direct testimony (standard caveats apply).

Anecdotally, I can tell you this works. And it's not just incremental improvement, it's a night and day difference.

I wouldn't normally comment on this but it seems unethical not to when so much is at stake.

I've always heard that Special K is a dissociative, not a hallucinogen. This has been confirmed with my experience with it as well. It's the only drug I've every tried where I can float above myself and look down on my body, but I've never seen anything that really wasn't there, no matter how much I've taken.

Not arguing the hallucinogen/dissociative labeling but wouldn't imagining the view from above your body count as seeing something that was generated entirely in your head? I mean...unless you were somehow actually floating above yourself which seems fairly unlikely (what with your eyes remaining in your head and all).

I don't know that it isn't a hallucinogen, but I've always heard that it's not.

Although, I wouldn't consider an out-of-body experience a hallucination, because it's not adding anything to the scene. I think it's more of a perspective shift, based on what you already know about yourself and your surroundings. I wonder if it could be experienced by someone who has (hypothetically) never looked at themselves in a mirror, or someone who is blindfolded and moved into a different setting that they were not previously familiar with.

I've experienced plenty of hallucinations, and the out-of-body experience from K was dramatically different for me. If felt more like a dream state, rather than a mostly normal state where my eyes were playing tricks on me (LSD and the like).

". It's the only drug I've every tried where I can float above myself and look down on my body" would certainly be a hallucination.

Ketamine is both a dissociative (it makes you feel disconnected from your body) and a hallucinogen (it can cause visual patterns or images to appear that are not parsimonious with what you would normally see).

It becomes far more hallucinogenic (or psychedelic preferentially) when you "khole".

Cool. Thanks for the clarification. Whatever it is, it sure is "special". (in a good way)

If anyone is interested in the sordid history of the prescription and prohibition drug dichotomy, I highly recommend "This is Your Country on Drugs."

The book details how the drug war came to be as a political and economic tool to expand government power and create pharmaceutical monopolies, not primarily for consumer safety.

Thanks for the recommendation.

My mother has had Ketamine injections for fibromyalgia. It wasn't successful in managing her pains.

I have done Ketamine once, and all I felt was... drunk. As opposed to psilocybin which changed my worldview heavily and taught me a lot about myself.

Everyone reacts different to medications, that's why there are so many of them, and why it's sometimes a problem for people with chronic problems to find the right one. I'm on my third anti-anxiety med, and I think I've finally found the right one, after the prior one made my depression worse and sapped what little motivation I had. There's no magic bullet in pharmaceuticals, that's one of the reasons there is constant research into the subject. More availability means a greater chance to find the drug that works.

Yes!

Don't get me wrong, I'm very happy that health professional are taking a look at drugs that are taboo. There is a wealth of potential in a lot of those substance!

On a side note, why does the following always get disclosed as a downside?

>Besides the psychoticlike effects, ketamine can raise blood pressure and heart rate.

Doesn't exercise or even caffeine do the same? Is it even worth mentioning this side effect unless it's for an abnormally long period?

If you already have problems with either of those you would want to know about them being possible side effects

Why mention the "psychoticlike" effects? Don't sleep or alcohol do the same?

Psychotic effects can have lasting mental damage to those susceptible to mental illness, just as heightened blood pressure and heart rate might be a problem for someone susceptible to cardiovascular disease.

Being treated for severe depression means you are susceptible to mental illness, and the chances that you're getting adequate exercise or eating food that isn't killing you are incredibly slim. You're also probably on medications that make you tired, hungry and alter your metabolism in mysterious ways.

These are the considerations you and your doctor have to take into account when devising a treatment plan. The full disclosure of side effects will help.

Increases in either heart rate or blood pressure are major cardiovascular risks. There were a couple drugs that went through the FDA a couple years ago that didn't get approved because they increased blood pressure.

Exercise does increase blood pressure, but it's not associated with an increased risk of cardiovascular events. Don't know the details about caffeine, but I would assume the risk isn't that great.

Funny, this is new but there is this article from 2010: http://www.nytimes.com/2010/08/10/health/10depress.html?_r=0

Could have sworn Ketamine was classified as a dissociative. Maybe I was wrong.

You're not wrong - it's a terrible clickbait headline.

http://www.bbc.co.uk/newsbeat/29811499 http://www.bbc.co.uk/newsbeat/25186316

Exercise extreme caution, the article doesn't even seem to acknowledge the seriousness of this at all...

I don't think the article is suggestion people sniff 5+ grams a day every day for long periods, which is required to get the serious bladder problems as mentioned in those articles

Some of these users seem to be drastically abusing the drug: "He said at the height of his addiction, he was taking it for 23 hours a day." The others don't really specify if they were taking it in large quantities.

With proper safety studies, monitoring, and dosing it seems like there would be less chance of this happening.

From the second link: "Where I used to live, there was nothing to do at all. "We had this mentality of really battering whatever substance we had in front of us. K [ketamine] just seemed to be the best substance we had available."

All of these horror stories you link to sound like people who have been habitually abusing ketamine, taking ever larger doses as they build up a tolerance. Pretty much ANYTHING can be abused; do we ban sleeping pills because you can swallow a whole bottle and kill yourself?

do we ban sleeping pills because you can swallow a whole bottle and kill yourself?

Well, here in China, they only supply 3-5 sleeping pills or so after consultation, and you can no longer buy them over the counter. This is precisely because too many people were killing themselves.

The ketamine depression therapy operates with doses of no more than 100mg, taken once or twice a month.

Ketamine abusers typically consume well upwards of a gram, or a couple, daily.

This is a similar situation as the difference between having two glasses of wine on Sundays, and downing a fifth of hard liquor every day.

Edit: FYA: "Matt developed K bladder after taking as much as 15g of the drug a day."

Yeah...if anything, it's testament to the relative safety of the drug, if taking 150x the therapeutic dose daily did not cause the individual to drop dead right away!

No drug user starts out by saying, "I'm going to get addicted to this." It creeps up on you. 100mg works for a week, then you need 125mg to maintain the effects, then 175mg, and so on. There was a post on reddit about a heroin addicts experience with the drug. It was eery to hear how it becomes part of your life so easily.

I think Ketamine has great potential, but the risk of abuse far outweighs the benefits.

Heroin is very addictive, Ketamine is not.

Tolerance builds quickly and a strong mental addiction develops quickly. Having to take a shit ton constantly means you're pissing brown within a few months and cessation means withdrawals (nothing even close to heroin, but still there).

Source: my friend with a ketamine addiction.

Self control goes a long way. Particularly for something that's not physically addictive.

That it does, but you cannot dismiss the addictive qualities of ketamine with such a statement, because it is an addictive drug. What part of tolerance build up and withdrawals makes you think it isn't physically addictive? Both are physical documented phenomena.

Ketamine certainly is addictive. I reckon the recreational value of K is seriously weakened by this factor. There are better things to trip on, that don't risk compulsive over consumption.

From an above comment: "My wife just finished a two day ketamine booster yesterday, and without the use of ketamine she would not be able to walk or even open and close her hands. Nothing else has ever helped her CRPS and ketamine has improved her quality of life in immeasurable ways."

You think the risk of abuse outweighs the above potential benefits? Seriously?

Additionally, dosage size and frequency greatly affects tolerance development. There is an order of magnitude difference between the amounts being taken recreationally, and the amounts that have been discussed for treatement.

Based on your stance, I assume you also are strongly opposed to the majority of prescibed anti-anxiety, muscle relaxer, and analgesic medication?

Let me clarify my comment as I do think it had a more aggressive tone than I intended.

I think ketamine could work wonders for adults who understand the risks of the medication. But responsible adults like the one referenced in your quote are not the only ones taking this medication. I disagree with the use of ketamine and similar drugs because 1. I think many of these disorders are misdiagnosed. For example, a middle aged man could be having anxiety as a result of low testosterone rather than a chemical imbalance. 2. I've personally known people who took drugs in therapeutic doses(prescribed to them) similar to ketamine. They eventually became very comfortable with the drug and saw no harm in asking doctors for a higher dose and even taking it recreationally "once in a while." As you can imagine, once in a while became more frequent than they had planned.

That being said, I've seen anti-anxiety medications work wonders for people. The drugs are not the problem themselves, but rather the lack of education that surrounds them. People too often want to walk into the doctors office and get a pill to fix whatever ails them. My stance is that a quick conversation with a doctor does not warrant a prescription for something like ketamine, ritalin, klonopin, etc. but there are definitely people who need these drugs.

Depends on why you're taking it. For a lot of people taking it for theraputic reasons, the high feeling is a feeling that one would rather do without. When I first started taking klonopin, it made me not give a shit in the world, which was actually annoying, because I wanted to get into a mindset to actually do stuff, not get high off my ass. Tolerance on the prescribed dose helped me there; I worry less about the stuff that doesn't matter, but I can actually function better.

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