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PostPosted: Mon Sep 16, 2013 4:07 pm 
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Hello Again Everyone.

This is a very long post.

As you can imagine, I am very pro-suboxone. I believe that it has helped me regain my sanity after years of suffering from mental illness. I also believe that Suboxone has been proven to be an effective drug for the treatment of opioid dependence. Like many of you, I would like to see the limitations on physicians and patients be lifted and I believe that Suboxone should be embraced by the recovery community as an acceptable route to sobriety and an acceptable drug for sobriety maintenance. We are all familiar with the statistics of rehab programs. I maintained my sobriety for years without medication but it was a struggle. I have struggled even more with mental illness. Suboxone has made a real difference in my life and many more people could benefit from its use if the politics would change and the FDA would lift the restrictions on the drug.

When I think about how difficult it has been for suboxone to gain entry into the market as a treatment for addiction, I am infuriated by articles such as the ones I have included in my post below. These have been snatched from Scientific American. Here they discuss how the Anesthetic Drug Ketamine is being prescribed off-label by physicians for the treatment of depression. There is a sub-culture of doctors that are rallying together to get this drug fast tracked for the treatment of depression. What upsets me most is that this drug can and will be abused when it floods the market. There is no ceiling, there is no opioid blocker and there are no limitations on physicians prescribing it off label for depression. If you had a chance to read my post in the introduction section you will understand that I want suboxone to be prescribed off label for depression. In fact, I want suboxone to be approved by the FDA for the treatment of depression. But this is a long long story. I have included these articles that I found in Scientific American that describe the frenzy that has erupted around Ketamine. I am very pleased that this drug is effective and it may save many people from the hell of depression and mental illness. What I don't understand is why this drug Ketamine is being fast tracked when suboxone (which is far less dangerous) is highly restricted and safer methods of suboxone (under the skin implants) are being denied by the FDA.

I totally understand the difference between these two drugs, Ketamine and Suboxone and the different molecular mechanisms that contribute to its efficacy. What I don't understand is why a drug for depression is being fast tracked and a drug for addiction is being put on the back burner. I believe that suboxone is being "profiled" and "pigeonholed" and as patients in recovery we are being marginalized because drugs for drug addicts doesn't sound very good. One of the patients being prescribed Ketamine had this to say, “I’m the guy in a burning car who is unconscious and there is somebody who could rescue me, and they have to smash out the window with a hammer or ax, and the people who are discouraging ketamine use are the ones who are saying: ‘Don’t hit that window because you might hit Dennis and you might hurt him.’ But if you don’t break the window with the ketamine ax, I’m going to die a horrible death. That’s how I view things.”

In the statement above, you could substitute the drug Suboxone for the drug Ketamine and the same scenario would be true. Why is the government so hell bent on restricting physicians who are willing to use the "suboxone ax" to save us?

Enjoy.

Theresa


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From Club to Clinic: Physicians Push Off-Label Ketamine as Rapid Depression Treatment, Part 1
By Gary Stix | September 11, 2013 | Comments6

New types of drugs for schizophrenia, depression and other psychiatric disorders are few and far between—and a number of companies have scaled back or dropped development of this class of pharmaceuticals. One exception stands out. Ketamine, the anesthetic and illegal club drug, is now being repurposed as the first rapid-acting antidepressant drug and has been lauded as possibly the biggest advance in the treatment of depression in 50 years.

A few trials by large pharma outfits are now underway on a new, purportedly improved and, of course, more profitable variant of ketamine, which in its current generic drug form does not make pharmaceutical marketing departments salivate.

Some physicians have decided they simply can’t wait for the lengthy protocols of the drug approval process to be sorted out. They have read about experimental trials in which a low-dose, slow-infusion of ketamine seems to produce what no Prozac-like pill can achieve, lifting the black cloud in hours, not weeks.

With nothing to offer desperate, sometimes suicidal patients, physicians have decided against waiting for an expensive, ketamine lookalike to arrive and have started writing scripts for the plain, vanilla generic version that has been used for decades as an anesthetic. Ketamine, it seems, has captivated a bunch of white coats with the same grassroots energy that has propelled the medical marijuana movement.

No formal tally of off-label ketamine prescriptions has been made. But Carlos Zarate of the National Institute of Mental Health, a leader in researching ketamine for depression, receives numerous e-mails from physicians and patients. “It’s being used in many states,” Zarate says. “I know of [people in] California, New Jersey, Pennsylvania, New York, Texas Florida and around the world, Australia, Germany, the U.K.”

Physicians are allowed to prescribe drugs off-label—in other words, uses for which they have not received approval from a regulatory agency. The practice is widespread: in fact, ketamine itself is often administered for chronic pain, a use never approved by the U.S. Food and Drug Administration.

Legalities aside, not every physician thinks ketamine has met the required thresholds of safety and efficacy to become a mainstay of a walk-in clinic. “Clearly, the use of ketamine for treatment-resistant depression is not ready for prime time,” says Caleb Alexander, a physician who is a professor of epidemiology at Johns Hopkins University and co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. “We have remarkably little solid scientific evidence to support its use in nonexperimental settings, that is to say, to support its use beyond research settings.”

Ketamine has a well-known side effect of inducing a trancelike state that club aesthetes dub the “K hole”—the reason it is known in clinical terminology as a “dissociative” anesthetic. Some users get sucked into the vortex spun by Special K, Vitamin K, “jet,” “special L.A. coke,” “K,” or one of the drug’s other monikers, The physician and neuroscientist John Lilly, known for his work on dolphin communication, almost drowned under the influence while immersed in his own invention, the sensory deprivation tank and had to resuscitated by his wife. Undeterred, Lilly continued binging, at one point injecting himself almost hourly for three weeks. Others haven’t been as lucky and have succumbed fatally to what Lilly’s wife called “the seduction of K.”

In the low doses administered in off-label clinics, side effects are rare or mild. “If I closed my eyes, images would present themselves like the opening credits of Dr. Who, with a tunnel of light,” says one patient.” Even so, a prospective patient must be carefully screened and turned away if there is any history of psychotic episodes.

In prescribing ketamine for depression, clinicians take it upon themselves to determine proper treatment protocols through trial and error, either by consulting colleagues or reading the methods sections of scientific papers that report the results of preliminary experimental trials not intended to evaluate the drug for clinical use. The risks are worth taking, say some psychiatrists, particularly if a patient has tried psychotherapy and one antidepressant after another with poor results—and any mention of electroconvulsive therapy produces a look of abject terror.

“I have patients who will try anything that is reasonably safe, says David Feifel, the physician who heads Adult Psychiatric Services at the University of California, San Diego, Medical Center. Feifel read the major study by Zarate in 2006 and decided to put in place one of the first clinical programs anywhere for ketamine therapy. After receiving approval from the hospital’s pharmacy and therapeutic committee, Feifel and his team began providing ketamine therapy on a routine basis in 2011. So far, 50 people with depression that did not respond to other treatments have been willing to pay out of pocket for the infusions. As many as three times that number, some from outside the U.S., have made inquiries.

Feifel shared some e-mails: “So many days I wake up and want to die, but not today,” wrote one patient after the therapy. “Thank you so much for this day of hope and contentment. It was the most beautiful day I can remember. I was a new person today and I’m looking forward to tomorrow, which is something I never say.” Another wrote: “I wanted to go out to eat last night and go for a walk today—both things I haven’t wanted to do for years.”

Feifel estimates that seven out of 10 patients have improved, a substantially higher number than respond to Prozac and other conventional antidepressants and a rate comparable to reports in experimental studies. Side effects have been minimal—and the high from the drug, no problem. “If anything, the patients enjoy that,” Feifel says.

Feifel does not see himself in the role of proselytizer. Whether ketamine becomes a depression breakthrough depends on overcoming treatment effects that often last just a few weeks, even with multiple infusions. “This is in my opinion the biggest challenge, whether this is really going be a game changer for depression or a limited tool is if we can figure out how to make this a durable benefit,” he says.

Feifel always lays out multiple treatment options tailored to a particular patient, not just ketamine alone. He might, for instance, try to disabuse patients of misconceptions about the dangers of electroconvulsive therapy. The hospital is also exploring other new approaches: transcranial magnetic stimulation, a magnetic field trained on a brain area affected by depression; and treatment with scopolamine, another anesthetic that may possibly offer patients quick mood relief.

Off-label prescribing of ketamine does not usually take place at major university hospitals like U.C. San Diego Medical Center but, rather, in small clinics, some of which appear to be largely devoted to dispensing the drug. “There’s nothing else they have to offer really,” Feifel says. That one-track approach has the drawback of possibly leaving a patient who doesn’t respond to ketamine feeling even more desperate.

Read part 2 about patients with major depression who pay thousands of dollars of uncovered medical expenses for ketamine treatment at small clinics and physicians’ offices.

Image Source: Wikimedia Commons


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Is Ketamine Right for You? Off-Label Prescriptions for Depression Pick Up in Small Clinics, Part 2
By Gary Stix | September 12, 2013 | Comments1

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Dennis Hartman, a 47-year-old former business executive for an Illinois gaming company, described the diagnosis he had been given as “major depression disorder with severity of the extreme, social phobia and generalized anxiety disorder,” something he had lived with for more than 30 years. He had tried Prozac-like drugs, an earlier generation of antidepressants, tranquilizers, mood stabilizers, supplements, meditation and psychotherapy. Nothing helped.

Last year he set a date and made a plan for how he would take his own life. He had given himself some time to get his affairs in order to cause as little distress as possible to his family. One night last fall before the date he had mentally set for himself, Hartman was up at 3 A.M., distraught and unable to sleep. Milling about the Web, he came upon an article about ketamine, an anesthetic and hallucinogenic club drug that is being intensively researched because of growing evidence that it can rapidly relieve major depression. He read about a study underway at the National Institutes of Health that was enrolling patients. He called the next day and was quickly accepted.

“I received a single infusion as part of that study,” Hartman says, “and I achieved 100 percent remission—a complete relief of all symptoms, which for me was dysphoria, anhedonia, extreme anxiety, cognitive impairment, very severe physical fatigue—I felt normal and healthy and happy within three or four hours after the infusion.”

The study protocol only allowed for one infusion—and the dramatic transformation began to gradually wear off beginning three weeks later. During that time Hartman, still at NIH as researchers conducted brain imaging and other studies, began a determined search of the Internet for a physician who might be willing to provide more ketamine, despite cautions conveyed by researchers that the drug was still experimental and had never been approved by the U.S. Food and Drug Administration for depression.

Hartman didn’t have far to look. Grassroots ketamine prescribing is on the upswing (read part 1), as physicians channel some of the same DIY-sentiment behind the medical marijuana movement, even while drug companies try to figure out ways to create a new class of antidepressant derived from ketamine’s chemical makeup. Ketamine itself holds little interest to pharma outfits because of its generic status. A raft of studies has shown that the compound can provide rapid reversal of symptoms for patients who have not responded to psychotherapy or the standard line of antidepressants.

Drugmakers have begun trials of ketaminelike pharmaceuticals. Some physicians, though, have decided that desperate patients simply can’t wait years for completion of clinical trials and regulatory approval. Prescribing a drug for a use other than the one for which it was approved—in other words, off the label—does not break any laws. That has given psychiatrists and anesthesiologists in the U.S. the latitude to begin prescribing ketamine from their offices or to set up small specialty clinics for dispensing the drug.

After he left the study Hartman went first to a physician in San Diego and later ended up at New York Ketamine Infusions in New York City where he received six treatments, at $525 apiece, which again achieved relief of the depression symptoms. Clinics like the one Hartman went to take their message to customers with direct, very direct, advertising. A drug company can get saddled with fines reaching into the megamillions if its sales reps promote a drug off-label. Nothing, however, stops a physician who prescribes off-label from buying an ad. Plugging ketamine resembles a cross between highway billboards trumpeting physicians offering Botox and drug company direct-to-consumer ads. The New York Ketamine Infusions Web site has a link titled: “Is Ketamine Right for me?” On the home page, the phrase “Dramatic Improvements in Mood within Hours flashes on the screen. A Massachusetts clinic offers a “revolutionary and promising new treatment” from a Dr. Ablow [first name omitted], identified on the site as “America’s most well-known psychiatrist.”

Acknowledging the amateurish marketing tone, Hartman says he will be “first in line” when the FDA approves a ketaminelike drug for depression, but for the moment the clinics are essential for him to deal with the profound anguish that has beset him his entire adult life. “When I’m talking to friends and family and people who have not heard my story, I try to make it an easy, brief metaphor,” he says. “I’m the guy in a burning car who is unconscious and there is somebody who could rescue me, and they have to smash out the window with a hammer or ax, and the people who are discouraging ketamine use are the ones who are saying: ‘Don’t hit that window because you might hit Dennis and you might hurt him.’ But if you don’t break the window with the ketamine ax, I’m going to die a horrible death. That’s how I view things.”


Physicians are treating more and more patients like Hartman. A Santa Barbara physician, Robert Early, had been interested for years in finding alternatives to electroconvulsive therapy for patients who didn’t respond or were petrified of the side effects. When a pivotal study on ketamine and depression was published in 2006, Early, then at Baylor College of Medicine in Houston, saw an opportunity and started doing the procedure within six months. There and in Santa Barbara, Early has administered the therapy to some 125 patients—having prescribed it more than 700 times to that group.

An Arizona entrepreneur may have the most ambitious vision for supplying ketamine: Gerald Gaines started a company last year called Depression Recovery Centers with a single clinic in Scottsdale. As the name suggests, Gaines wants to make a brand out of walk-in clinics for depression, perhaps expanding nationwide, making them as common as suburban kidney dialysis centers.

A Harvard MBA who was instrumental in the launch of Sprint PCS, Gaines has suffered from lifelong manic-depressive episodes—and has numerous family members who have also wrestled with depression. Gaines became involved with the medical marijuana business, with the hope that some of the multitude of compounds that can be isolated from the plant’s leaves might be extracted to help with mania. He still donates money for this line of research but has given up for the moment on the idea that a pot-derived depression drug will arrive anytime soon.

Instead, he became intrigued with research on ketamine, which led to his opening the Scottsdale clinic. So far, the clinic has treated 30 patients under the care of an anesthesiologist and a psychologist. Most patients require more than one infusion, and the clinic has delivered in excess of 200 infusions since it opened. (The clinic posted “Tiffany’s Transformation Day” on Vimeo about one patient’s before-and-after experience.) Gaines himself is a customer. “I’ve been symptomatic for 45 years and have had two or three depressions every year, except for the last year, when I’ve had none,” he says. “I’ve had five treatments in last 12 months, and that’s the typical pattern of what we’re seeing for bipolar disorder.”

The cost of each infusion, at $750, is not covered by insurance. “Our target market very unfortunately—anybody who knows me knows I don’t feel good about this—is the top 10 percent of family income individuals,” Gaines says. A course of treatment typically costs $4,000 and can range up to $15,000—and may need to be repeated as the effects wear off.

Absent large-scale clinical trials, ketamine for depression will remain a form of drug development based on testimonial and anecdote. Drugs in the pipeline at major pharmaceutical companies may help fill in some of the blanks, but the first one may not arrive before 2017 and questions linger about whether these rejigged versions of ketamine will be any better than what is currently available from off-label clinics.

Read about the plans of Johnson & Johnson and other large pharma companies to cook up ketamine-derived blockbusters.

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Ketamine, a Darling of the Club Scene, Inspires Development of Next-Generation Antidepressants, Part 3
By Gary Stix | September 13, 2013 | Comments2

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Ketamine induces growth of tiny protuberances on a rat neuron (bottom) to allow it to better connect with neighbors.

Recent experimental research showing that the anesthetic and club drug ketamine can relieve depression quickly has intrigued a number of major pharmaceutical companies. Depression, it goes without saying, affects huge numbers and a fundamentally new and effective pharmaceutical approach to treating the disorder hasn’t emerged in decades.

The enthusiasm for ketamine is such that physicians, often working out of small clinics, have already started prescribing low doses of the generic anesthetic off-label for fast relief of le cafard—and drug companies are contemplating whether to get into the act by creating new drugs based on ketamine’s biochemistry (Read part 1 and part 2).

A Johnson & Johnson subsidiary in Europe has gone as far as midstage clinical trials for a ketamine nasal spray. The trial there uses a slightly altered version of ketamine (esketamine, the “s” isomer for techies), which omits part of the molecule and leaves the most pharmacologically active portion in place, enabling less of the compound to be administered. “You can get away with a 30 to 40 percent lower dose,” says Husseini Manji who leads neuroscience research at Johnson & Johnson.

The U.S. Food and Drug Administration has put Johnson & Johnson’s version of esketamine on a fast track for approval, although, even if all goes well, patients may still have to wait a years to get a script. Esketamine, already used as an anesthetic in Europe, is not the only idea on the table. Ketamine appears to work (details still coming in from labs) by blocking a docking site, or receptor, on a neuron—in this case a spot where the essential signaling molecule glutamate attaches. The blockade triggers a complex chemical cascade that ends up restoring an impaired neuron’s ability to communicate with other brain cells.

If that process is multiplied over millions of neurons in two critical brain regions—the hippocampus and the prefrontal cortex—drugmakers hope the blues will lift like a cloud. Johnson & Johnson is working on other projects that tap into ketamine research—one of which is looking at a wholly new drug that targets selected portions of this glutamate receptor in the hope of fine-tuning the antidepressant effects further. Other large pharmas, including AstraZeneca and Roche, are pursuing similar strategies.

If a formal FDA imprimatur is forthcoming, the issue of off-label prescribing may persist. One issue, which must be resolved through clinical trials rather than trial and error at ketamine clinics, is whether a spray works as well as intravenous infusions. The generic non-isomer form of ketamine is already used off-label as a nasal spray and not all reviews are positive. “It helped but not as much as the infusion,” says Dennis Hartman, a patient with depression who sought help from ketamine-prescribing physicians, one of whom provided a spray.

A ketamine-like drug, if approved, will inevitably be more expensive than the generic anesthetic deployed in upstart depression clinics. Esketamine or one of its FDA-sanctioned cousins will probably be covered via a health insurance plan, but insurers’ love of low-cost generics may mean that consideration could still be given to covering plain-vanilla ketamine, even if it hasn’t run the clinical-trial gantlet. In fact, Carlos Zarate, a leading ketamine researcher who works at the National Institute of Mental Health, has even fielded calls from insurers wanting to know more about the generic drug to determine whether to put it on their formularies.

It is also still unclear whether the medical establishment, with a helping hand from law enforcement, may have to come to terms with what might be described as off–off-label prescribing—the depressed patient without insurance who learns about the possibility of a mood-altering quick fix and engages in the unsupervised self administration of Special K purchased in a club or on the street.

Hartman knows someone who went this route. “This personal friend received a ketamine infusion [from a physician],” Hartman says. “He achieved very strong relief, very similar to mine. After he relapsed, he went and sought this illegal form and he did not get the same effect.” If Johnson & Johnson’s esketamine trials result in a salable drug, the company has plans to safeguard it from those who want to divert it for recreational use.

What to do about ketamine is a question being posed everywhere, not just stateside. A New Zealand government official issued a report in July that instructed health boards throughout the country to scrutinize off-label prescribing more closely after a complaint lodged against a ketamine-supplying physician.

Inevitably, the grassroots appeal of an old drug with a new use that might provide hope for the deeply depressed is starting to generate its own social networks. As many as 20 physicians involved in prescribing ketamine interact on the Linked-In group called Ketamine for Psychiatry. Hartman is involved with setting up a new Web site, The Ketamine Advocacy Network, to foster activism among patients—another echo of medical marijuana’s legacy.

The desperation to find new antidepressants means that ketamine will remain an object of fascination for mental health professionals and their patients. In the next five years, regulators and physicians are going to have to figure out how, if at all, the drug fits into the psychiatrist’s pharmacopoeia. In the meantime, doctors and patients are increasingly adopting their own home-grown solutions.

Image Source: Ronald Duman, Yale University


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PostPosted: Mon Sep 16, 2013 9:28 pm 
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Well...what I read of it was interesting. But I must admit, I don't think very many people would stick with it long enough to get to the end!

I do agree with you however, I think the FDA should definitely take a look at suboxone being used for depression. I've just seen too many people come here praising it as the ONLY thing that has helped them. It certainly sounds safer than ketamine!

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PostPosted: Tue Jan 27, 2015 5:09 am 
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Thanks for posting. I admit I can't read it all right now but that is my own fault. I was wondering...this may be a stupid question; (I am very new here) Have you been watching Alkermes with their new depression drug alks5461? I'd be curious to hear yours or anyone's opinion on it as I have dealt with severe 'treatment resistant' depression.
I've been taking Oxyneo 20mg x 3/day for the last two years but am worried its going to run out of steam & I refuse to increase the dose....so I'm really hoping for alks5461 to hurry itself along. That or Ketamine. What intrigues me more than anything is the neuro regenerative effects it seems to have, seemingly reversing the damage done to the brain after chronic depression.
Anyways...feel like I'm rambling now.
Take care everyone.


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PostPosted: Tue Jan 27, 2015 10:55 pm 
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you sure have a long post. but it is interesting.


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PostPosted: Wed Jan 28, 2015 10:11 pm 
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First off I don't disagree that suboxone may work as an antidepressant for some people, and maybe it should be marketed off label for this use.
However comparing taking suboxone on a daily basis with monthly take home scripts is a little different than comparing ketamine treatments for depression. The ketamine treatments that are available right now do it in an inpatient program. Patients are hooked up iv with ketamine and monitored by a doctor the entire time. The treatments start out for two days straight, then move to 3-4 treatments a week. All under the supervision of a doctor, they are there to control any adverse effects and the abuse potential is nonexistent because there are no take home doses. At least for my relative who has been participating in it. The treatments reduce over time until you only need one treatment a month. Eventually some patients go down to one treatment a year.
I'm not saying that suboxone shouldn't be considered for use in major treatment resistant depression. But the ketamine is a little different as far as the risks because it is done under a doctors supervision, and there are no take home doses.
For me personally the suboxone makes my depression worse, but I know many people who have had great improvement with their depression since starting subs.

Below is a brief summary of how ketamine is used for the treatment of depression:

https://trifectahealthnyc.com/our-servi ... epression/


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PostPosted: Wed Feb 18, 2015 9:21 am 
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I don't think Suboxone should be prescribed for depression. This is because, in the long term, I feel it didn't work at all to stave off my symptoms of bipolar depression. And the long term effects on the endocrine system - ie the low testosterone many people come on this forum and complain about - potentially induces depression.

Not to mention the long term dependence people are locking themselves into. Some people claim that it's not addiction. But the cravings people experience for opioids once they stop taking Suboxone tells another story. These same cravings and urges to dose up aren't experienced when people stop taking SSRI/SNRI.

I also have suspicions that the antidepressant effect of Suboxone is moreso because of its mu-opioid receptor affinity (ie the initial "buzz" people get) than any kappa-antagonism. It'd be interesting to hear of any long term studies into its antidepressant effect, whether it can be sustained for months and years, or whether it diminishes when the users tolerance matches the dose given.

Once upon a time opiates were prescribed for a plethora of psychiatric conditions with amazing results. That is until they became tolerant to the opium's effects, and needed more and more to keep their psychiatric symptoms at bay. In the end the doctors were left with a heap of patients both mentally unwell, and now addicted to opioids.

Before my relapse into addiction, my doctor was putting me on all kinds of old anti-depressants to try to lift me out of my depression. Tricyclics, MAOI's. None seemed to work for any length of time. This was all while I was on 12mg of Suboxone. Another doctor checked my T-levels and they were very low. This was after 2-3 years on Suboxone.

Now I'm off Suboxone, SSRI treatment seems to be working a lot better. I'm not depressed, and on a stable regimen of Lithium/Zyprexa and Pristiq. And my hormones and sex drive have returned completely.

Personally, I'd get ECT over going back on Suboxone should my depression return.


Last edited by TeeJay on Thu Mar 30, 2017 6:35 pm, edited 1 time in total.

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PostPosted: Wed Oct 07, 2015 11:05 pm 
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day_to_daze wrote:
First off I don't disagree that suboxone may work as an antidepressant for some people, and maybe it should be marketed off label for this use.
However comparing taking suboxone on a daily basis with monthly take home scripts is a little different than comparing ketamine treatments for depression. The ketamine treatments that are available right now do it in an inpatient program. Patients are hooked up iv with ketamine and monitored by a doctor the entire time. The treatments start out for two days straight, then move to 3-4 treatments a week. All under the supervision of a doctor, they are there to control any adverse effects and the abuse potential is nonexistent because there are no take home doses. At least for my relative who has been participating in it. The treatments reduce over time until you only need one treatment a month. Eventually some patients go down to one treatment a year.
I'm not saying that suboxone shouldn't be considered for use in major treatment resistant depression. But the ketamine is a little different as far as the risks because it is done under a doctors supervision, and there are no take home doses.
For me personally the suboxone makes my depression worse, but I know many people who have had great improvement with their depression since starting subs.

Below is a brief summary of how ketamine is used for the treatment of depression:

https://trifectahealthnyc.com/our-servi ... epression/


QFT. I completely agree, you took the words out of my mouth. I think the OP is looking at Ketamine the way they don't like other people to look at Suboxone. I am very pro Suboxone for addiction (and it shows promise as an anti depressant) but I am also pro Ketamine for depression. IMO if something works, it works and thats great, as long as there is fewer people out there struggling with mental illness, I am completely OK with the methods.


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PostPosted: Wed Oct 14, 2015 1:35 am 
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I just watched a brief documentary segment on ketamine for treatment-refractory depression and it seems there's a few misnomers in the OP. The patients in this trial would come into the clinc and be given a very low dose of ketamine (1/10th the anaesthetic dose) under the supervision of a clinician and an anaesthetist. They'd be monitored carefully for 2 hours and kept in an environment where sensory input was limited (a dim room with little movement) to minimise the risk of hallucinations (which were rare anyway given the dose).

Then once the initial effect of the ketamine wore off, they were assessed on their depression rating. And nearly all the patients had remarkable improvements.

Here's the thing though. That anti-depressant effect would last 2 weeks! And the guy they followed for the doco, you could see just by his facial expressions and how fast he was walking that there was a marked imrpovement in mood.

It's a shame that because it's linked to the party-scene that there will be all kinds of political barriers preventing this drug from reaching the people who need it.


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PostPosted: Sun Mar 20, 2016 2:26 am 
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I tried ketamine once. But i had extremely severe hallucinations and disassociation i started screaming and sobbing. Ive never tried drugs or even alcohol before so i had nothing to compare it to. I dont know though if possibly my doctor did it wrong because i spoke to a ketamine expert who has done thousands of infusions( my psychiatrist had only done it on six people) and told me to not do it again with my doctor because I shouldnt have had hallucinations like that. But yeah it didnt help with depression but dunno if it was the doc or just me.


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PostPosted: Sun Oct 09, 2016 10:16 am 
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Interesting.

Ketamine dials down the NMDA receptor, which is thought to be responsible for neural plasticity. Neural plasticity refers to the ability of the brain to change and adapt, which is important for learning, and recovery from injury. These are good things, but plasticity has a dark side, too: it plays a role in certain features of addiction, including tolerance and withdrawal; and it plays a role in certain chronic pain syndromes. Ketamine is being studied for both.

Current thinking about depression and NMDA is that you want to enhance NMDA function, to improve plasticity, facilitate thinking and learning, and improve decision-making. This might be how Prozac and Seroquel work. Ketamine has the exact opposite effect, yet is thought to have antidepressant activity. How can this be?

I think the goal people have in mind, basically, is to reduce dithering. "Dithering" refers to the state of anxiety that occurs when you can't make a decision, and find yourself endlessly obsessing over your alternatives, with no resolution in sight. The hope is, less dithering results in less anxiety which results in less depression.

There are two possible ways to deal with dithering:

1. Make a decision, and then let it go.
2. Realize it's all the same, don't make a decision, and let it go.

The second choice sort of sounds like "stop thinking," but it's not; it refers to a different style of thinking. The first example being the style of thinking where you see more clearly the differences between things, and the second, where you see more clearly how things are related.*

Looking past chemicals, we see that psychoanalysis favors the first style of thinking; meditation, the second. Or, if you're a spiritual type (or you're in a 12-step program), the same could be said about whether redemption comes from good works, or from forgiveness and grace. Same concept. Whether you decide to go to analysis or yoga, whether you decide to start going to church or to stop going, is all a matter of style. Depends on the person, and the nature of the questions that need answering.

As to one's choice of medication, well, there are chemicals that enhance either mode of thinking. I suppose the theory is that ketamine might enhance the second. I'll believe it when I see the data, glowing testimonials notwithstanding. Not holding my breath.





-------
*To be more specific, I refer to different strategies for resolving a paradox.

You have two options: A or B. What's your call? There are two possible approaches.

The first, which I call the deterministic approach, results in a simple answer. You pick one, and only one of your four possible responses. (And there are four: A, B, both, neither.) Best approach when action is called for.

The second, which I call the quantum approach, is called for when it is not possible to come up with one valid answer. This might occur under the condition of false premises, or when a system can exist in more than one state at a time. We encounter such paradoxes in religion and philosophy all the time, and occasionally in science (eg, particle-wave duality). It is a feature of human psychology, because people can want more than one thing at a time, and people can have both good and bad features at the same time.

The form of the answer might be

1. Invalid question due to false premise. (A has no relationship to B, or is not its exact opposite)
2. Not A, not B. (Valid, but pointless question)
3. Always A, always B.
4. Not A, not B, but C.

These are examples of "thinking outside the box." In order to do that, you have to get out of the box first. But you still have to think.


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PostPosted: Fri May 19, 2017 3:44 am 
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I'm going to be experimenting with ketamine for depression in the coming week or two. Will let you guys know how it goes.


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PostPosted: Sun May 21, 2017 7:54 am 
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the ketamine talked about here is given in a drs office under supervision, but many people abuse ketamine or special k as its known. so i could see how the potential for abuse could be constrewed. (sp?)
also, why would ketamine be prescribed for off label uses when suboxone is not. i was prescribed atenolol, a blood pressure medicine, for migraines before any actual migraine medication. i took the point of the post to be why is is common for other drugs to be prescribed as off label, but not subs?

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PostPosted: Sun May 21, 2017 9:54 pm 
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Maybe it's because Sub is dependence forming, whereas Ketamine doesn't have the same potential for physical dependence? There is potential for psychological dependence, but IMO it's not very common. I've come across many people who have abused K occasionally in my life, but only one or two people who became addicts.


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PostPosted: Tue Aug 08, 2017 7:57 pm 
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This is probably going to be a touch controversial so I'll tell the backstory.

I asked my Dr earlier in the year about the possibility of experimenting with ketamine for my treatment resistant bipolar depression periods that usually last for 1-2 months each year. The depression is nasty to the point I can barely work or function, and sometimes even becomes a bit psychotic which is when I struggle to answer simple questions like "What have you been up to?" The depression is nasty enough to make having a corporate career difficult, as not many employers are accommodating of people who need to take 1-2 months off a year, especially given I can never tell exactly when it's going to happen to plan around it. I've been on nearly every anti-depressant to try and treat these periods, and still they manage to eventually return regardless of the treatment.

He entertained the idea, and said he's willing to do a very controlled experiment with sublingual ketamine. He explained the procedure, that it would involve a compounding pharmacy to make the sublingual pellets, and that I'd likely require to take one every few days at least, given the beneficial results of ketamine usually fade over a few days. He then went into the cost, given the first one or two administrations of ketamine would be monitored by him, plus the cost of the compounding pharmacy, getting scripts for the ketamine. I was looking at $1600 AUD just to get started. Given it's experimental, this stuff isn't covered by our PBS.

I walked away thinking "$1600" ? I could get a gram of pure Dutch K for $80 US. After a week or two pondering, that's exactly what I did, and planned to leave it in my drawer until my depressive period kicked in (usually around April each year). Given it keeps quite well, I'd just leave it sitting there for a rainy day. It's still sitting there.

I did test it once though, and it's definitely what it was sold as. I'm not a HUGE fan of ketamine, as it makes a person feel like they've died and gone to another universe. The experience can be quite frightening and profound, nothing like the warm feeling one gets from opioids. It's definitely NOT addictive in the sense we're familiar of the word, though you do hear of some people on the fringes who get addicted.

One thing I noticed from the testing was that for about a week after I had a bit of a goofy lightheartedness to myself that may have been attributed to its anti-depressant effects. It's hard to know though if it will work when I actually need it to though. The other thing I noticed is that my perception was a bit "skewed" in the days after. I was more philosophical, and had a strange way of visually representing my thoughts in my mind that was definitely inspired by the experience. I'd imagine this could be a double edged sword though, as people who take ketamine regularly often score higher for mild delusional symptoms than your average person. You only have to read some John C Lilly to notice this taken to its extreme.

Otherwise the stuff is just sitting there, collecting dust for a rainy day. I haven't told my psychiatrist because he has huge control issues, so I'm being a bit naughty I know. Not many people know I've done this. Maybe a couple of friends and you guys?


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PostPosted: Tue Aug 08, 2017 9:16 pm 
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A coincidence how this subject came up right after me reading an article in Time magazine about depression and the different approaches the medical field has tried and keeps trying. They state roughly 30% of patients do not respond to normal SSRI's. Patients at their wits end come into the doctors office for a Ketamine injection. It is not covered by insurance so it runs between $400-600 per treatment. And they only last maybe three weeks. They lay back in a chair for about 45 minutes until the drug has run it's course. Like any other new treatment people get different results. It's in the August 7th issue if you want to pick it up. Or view it online at http://time.com/4876098/new-hope-for-depression/

I don't pretend to know much about it because I've never suffered from it. My wife does so I do have a vested interest in how the research is progressing.

There is just so much we don't know about how the brain works. Mankind has been battling depression for hundreds of years and still there is not one drug that works for all. Ketamine is also addicting like opiates so there's another problem. Maybe some people would benefit from a low dose of Buprenorphine, but you know what they'll say. "They are addicted to this drug"! And maybe I should really say "dependent" and not addicted. We only know so much. I truly hope and pray mankind will finally have it's answers to this horrible affliction. The world has lost too many loved ones from depression causing suicide. 30% is a much larger number than I expected to read.

Read it all for yourself.

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PostPosted: Wed Aug 09, 2017 1:20 pm 
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TeeJay just wanted to pop in and say I have been addicted to Ketamine. In fact in a "personal journal" packet at my old rehab, there was a question "what was your favorite drug?" and I put "ketamine/methoxetamine". Methoxetamine being a far superior (imo) near chemical analog.

I also know via a route a lot of people would never get their information (personal, cannot say) it certainly can be more addictive than reported. The kicker is ~ does the individual have contact to constant flow of ketamine and in pure form, because most people do not. For most people it comes and goes. It's not as easy to mold your life around, but you figure out the tricks of dosing if you like it and you have the means.

Ketamine and other NMDA compounds like PCP and methoxetamine are ultimate escapism.
It's a niche. But I believe if availability was a different story for most folks then we would have different reporting on abuse.

Granted, It's not like I hold the addiction in the same light as to opioids or benzodiazapenes. There is no real discontinuation syndrom and it is all psychological. But I don't hold anything in the same light as these, either. The kicker is addiction to NMDA compounds such as ketamine is addiction provides a decline into psychosis. It will make a psychotic out of anybody with persistent dosing and they tend to be very snarky motherfuckers.

Sorry for the random post. It's just ~ a lot of people are just now hearing about or becoming intrigued about ketamine these days because of these depression trials. And I feel like I should post a counterweight given this is a recovery forum since I have experience with a lot of ketamine and individuals using it.

I am all for these clinical trials for depression, though. Well, I think all things should be legal in the first place but that's neither here nor there. But I am skeptical in the probability of the outcome that the patient will eventually go down to 1 treatment a year and it will be lasting. To me this sounds like a hopeful treatment plan that makes testing feasible in the first place. I am sure it will happen in some but I don't suspect it will happen in most. But thats just like, my opinion, man.

I can certainly vouch for it's amazing post-dose antidepressant effects.
I do not respond to SSRIs whatsoever.
Would I do testing? No. In my experience, In no case has any post-dose antidepressant effect ever been lasting. And I have used it experimentally for its antidepressant effects before. It's just part of the experience of most NMDA compounds, not just ketamine. Go down the rabbit hole of other NMDA compounds (wont type them here so google does not bring searches here to this post) and you can make news about the antidepressant effect all the same... hell it happens with dextromethorphan, the dissociative in cough syrup. Nearly all NMDA dissociatives do it.

~~~

Cool stuff, since my suboxone induction I have quit my paxil and my resperdal and my life-long depression is nonexistant.


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PostPosted: Thu Aug 10, 2017 12:07 pm 
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Iggy, tell me how you stopped the Paxil. I had a hell of a time getting off of Effexor. It took three tries but it finally happened. Luckily, that drug is made up of small time release balls. Every one was 1 mg when I counted them out. So I used the 10% suggested taper method and finally got results. My doctor was impressed. He said almost no patients of his ever get off it. My next question is "why did you prescribe it to me?" It was prescribed to help with withdrawal symptoms when I tried to stop Suboxone years ago. I never did actually get off it but took the drug in advance so I wouldn't experience the depression side effect.

Paxil too is one of those very strong ones. I just assumed most people were not able to do it like you did. That's why I'm curious.

Good stuff about the K. We learn more and more every day. And I too think maybe all drugs should be legal but I'm afraid of the consequences. In Amsterdam many years ago they made it easier for heroin addicts to get their drugs and needles. I remember seeing all of them dosing/sleeping in the local park. When I was there two years ago they were all gone. I wonder what happened. No one did a report on that one. Again, just curious for the news of the outcome of those addicts.

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PostPosted: Thu Aug 10, 2017 6:21 pm 
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rule62 wrote:
Iggy, tell me how you stopped the Paxil. I had a hell of a time getting off of Effexor. It took three tries but it finally happened. Luckily, that drug is made up of small time release balls. Every one was 1 mg when I counted them out. So I used the 10% suggested taper method and finally got results. My doctor was impressed. He said almost no patients of his ever get off it. My next question is "why did you prescribe it to me?" It was prescribed to help with withdrawal symptoms when I tried to stop Suboxone years ago. I never did actually get off it but took the drug in advance so I wouldn't experience the depression side effect.

Paxil too is one of those very strong ones. I just assumed most people were not able to do it like you did. That's why I'm curious.

Good stuff about the K. We learn more and more every day. And I too think maybe all drugs should be legal but I'm afraid of the consequences. In Amsterdam many years ago they made it easier for heroin addicts to get their drugs and needles. I remember seeing all of them dosing/sleeping in the local park. When I was there two years ago they were all gone. I wonder what happened. No one did a report on that one. Again, just curious for the news of the outcome of those addicts.


Yeah. When I was in rehab, I was put on it. I explained that I still had a horrible impending doom depression in my gut and that I felt resistant to SSRI medications as I have never had anything work. The doctor just asked me if there was anything I would be interested in trying. I have heard that paxil is very hard to come off... and honestly that is why I asked for it. In some twisted logic I figured, well, maybe it's actually pulling some brain chemistry farther than the others if it is hard to get off, so I asked for it. She said she never prescribes it in in-patient settings because it is dangerous if people are not going to or able to take their medication when they get out, as discontinuation syndrome can be bad. I told her it would not be a problem and I intend on sticking with anything that works and that I was desperate.

As per the usual, I think I made up in my head things I thought it was doing. My conception of what paxil did for me changed every two weeks. I hate the fact that I cannot tell what SSRIs are doing to me, but they have discontinuation effects. It bothers me like hell for some reason.

I tried to get off of it two times out of rehab, and after 2-3 days I would cave due to increasing depression and it was like time slowed down and I was experiencing more pain than usual.

Cut to months down the road, I am on suboxone therapy, my paxil was running out and I wasn't paying attention. I had 2 capsules left one day, went to refill the bottle, and didn't realize I had no refills left. I took a whole dose one day, a half the next and a half the day after that. Looking back I should have been a lot smarter in case it went bad, I really didn't try to taper or anything.

Two days off I felt a little 'off'. Instead this time of feeling like I experienced more detail of my depression, I just felt like I experienced more detail of my own cognition. Nothing dramatic just, my mood was more open to interpretation, less blunted.

It was painless. I was on 40mg for like almost a year. Just took 20mg for two days and abruptly stopped. I still cannot tell you what it may or may not have did for me. Except for blunted sex function and side effects trying to come off of it before I had the support of the suboxone.

My depression was completely lifted by suboxone. Maybe it is my dose, I take a total of 24mg a day split into 3.

Painless! I owe it to the suboxone honestly.


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PostPosted: Thu Aug 10, 2017 6:38 pm 
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Coming off strong SSRI / SNRI's is something I'm pretty familiar with, and I do think I have a tip. When I was coming off Pristiq / Effexor, I'd often wait a couple of days until the withdrawal / discontinuation symptoms kicked in, then I'd take one of my old Paxil tablets. Within a couple of hours the symptoms would disappear, but here's the interesting thing. They wouldn't return, at all. Weird huh.

I put it down to the longer half life of Paxil easing the withdrawal from Effexor without causing further withdrawal itself. This actually worked for me multiple times. I discovered this accidentally when I was in such throws of Effexor withdrawal that I took one of my old Paxil tablets simply for relief, then to find symptoms didn't return.

As for coming off long-term Paxil, I'm less familiar with this. But a similar approach MIGHT work, where you find an antidepressant that's of a similar action with a longer half life, and use it to help you get a soft landing. The oft chosen one for this is Prozac as it has a half-life of 2-4 days.

Re iggy's post. I've also met some people that got addicted to K, so I'm cautious. In my case the experience isn't one I particularly enjoy. It's too frightening and unpredictable. And I can also go psychotic without any drugs on board, so I'm ultra careful of any drug I identify could bring that kind of thinking out. To be honest I hope I don't ever have to use the stuff, but it does give me a bit of comfort knowing there's something sitting there that might help me through the deep blue such that I'll still be able to hold my job, and won't go crazy heroin relapse.


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PostPosted: Fri Aug 11, 2017 8:48 am 
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I took Paxil for 10 years at 40mg and stopped cold turkey during my active addiction. I had a month or two of the brain zaps and the weird feeling when you'd turn ur head, it was like a light trail every time I'd move my head side to side. It finally went away and I promised myself I wouldn't ever take anything like that again because of how rough it made me feel in my head and eyes. But honestly what even made me stop taking it was the money I had to pay for it, I was using and always bought opiates with the money I had that should have went to getting my Paxil out of the pharmacy. I took Paxil through my whole pregnancy with my youngest son and years after.

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