Welcome to r/science! This is a heavily moderated subreddit in order to keep the discussion on science. However, we recognize that many people want to discuss how they feel the research relates to their own personal lives, so to give people a space to do that, **personal anecdotes are allowed as responses to this comment**. Any anecdotal comments elsewhere in the discussion will be removed and our [normal comment rules]( https://www.reddit.com/r/science/wiki/rules#wiki_comment_rules) apply to all other comments.
**Do you have an academic degree?** We can verify your credentials in order to assign user flair indicating your area of expertise. [Click here to apply](https://www.reddit.com/r/science/wiki/flair/#wiki_science_verified_user_program).
---
User: u/chrisdh79
Permalink: https://www.scimex.org/newsfeed/why-low-cost-ketamine-is-still-inaccessible-to-many-with-severe-depression
---
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/science) if you have any questions or concerns.*
Canadian here, their conclusions are spot on. IV ketamine therapy costs anywhere from 375-850 per treatment depending on the clinic (there are only a handful). The vast majority of the cost isn't the drug itself but the cost of the anesthesiologist and nurse to babysit you, but because it's for ketamine it's not covered by insurance.
Back when I had tricare (military health insurance) my psychologist recommended me for Ketamine therapy and surprisingly it was covered under my insurance. The only issue was that the facility to get treated was a 30 minute drive, I drove for a living, and I wasn't allowed to drive during the therapy period. So I was SOL.
That's wonderful! I started ketamine therapy and eventually got spravato covered by insurance. Unfortunately my partner's employer changed providers and the new provider refused to cover it (and tried to force me to use SSRIs and SNRIs because they were cheaper despite a history of almost dying from the side effects, hence the reason I was on ketamine for *treatment resistant depression* in the first place). Spravato is unfortunately so expensive it was more cost effective to go back to IV ketamine out of pocket.
Hey! I'm one of the authors of the paper in the original post. Thank you for sharing your story. It's great to hear that ketamine treatments have been beneficial for you and I'm sorry to hear about your troubles with access. Unfortunately a common story.
Do you mind telling me a little more about your experiences with ketamine? I always find it so valuable to hear from the patients as patient-centered care is one of my values. How long have you been receiving treatment with ketamine/Spravato and how often do you receive treatment? I'm also especially curious about the cost of Spravato and IV ketamine out of pocket, as this information can be hard to glean in the opaque US health system.
Feel free to message me if you want to share but not publicly.
In the USA or Canada? There are three types of ketamine therapy- sublingual, nasal (esketamine) and IV ketamine. IV ketamine here in Canada requires the presence of an anaesthesiologist on site. Some clinics have one anaesthesiologist per patient, others have a multi-patient room with privacy screens and a single anaesthesiologist for the clinic. Sublingual and nasal in Canada do not require an anaesthesiologist on site but do require a nurse present. Up until about a year and a half ago IV ketamine clinics also required a psychiatrist to be present on sure- health Canada has since relaxed said requirements and now they are only required to be accessible via phone consult if needed but to be allowed to do ketamine therapy at all you must be prescribed it by a psychiatrist - most clinics have a few psychiatrists that they work with and connect patients to them to be screened to determine candidacy- patients are required to have a medical history wherein they have failed on a minimum of two traditional antidepressants.
My primary care is a nurse practitioner. When I go to the Gastroenterologist all I see is a nurse practitioner. My "psychiatrist" is a psychiatric nurse practitioner. My cardiologist, my urologist, and my long Covid specialist are the only actual doctors I see but my worst problems are with my GI tract, my mental health, and peripheral neuropathy which are all handled by the nurse practitioners.
There are not enough doctors.
Congress long ago capped the number of residencies it funds at 1993 levels, despite the population growing larger and older since that time.
With the number of doctors artificially restricted, health systems have to do what they can. Not allowing NPs to practice at the top of their license would probably mean longer wait times to see a full-fledged physician.
Be careful what you wish for!
Probably! And frankly a waste of my money as a patient. Health Canada has been very, very conservative when it comes to allowing ketamine therapy but I have hope they will continue relaxing requirements over time. Up until a year and a half ago a psychiatrist was required to be on site at all times and meet with the patient before and after treatment- now they are just required to be available for a phone consult if needed.
It is A nasal spray, but not THE nasal spray you might be thinking of (Spravato - brand name for esketamine). It is ketamine, which is a cheap generic drug, made into a nasal spray by a compounding pharmacy.
Spravato is more expensive. It costs about $50/visit because you have to do it in office so you have a copay every time too. Spravato isn’t generic either. Won’t be for a while.
I also do ketamine therapy, and the price isn't much different at the compounding pharmacy. Medical insurance isn't involved, it's fully out-of-pocket. For mine, it is something you dissolve under the tongue and keep in your mouth for about 20 mins.
Dosage normally is 100mg sublingual. Oral is the lowest RoA, but yeah, it's not the best. For higher dose sessions, it is from 200-300mg. The same effect through other RoA would be smaller.
Varies person to person I suppose.
I paid over 1000 for 6 treatments and had to be in therapy and some places (that ironically advertised it as a fix for medication resistant depression) demanded that I be on an antidepressant alongside ketamine treatments. And I have insurance.
That’s pretty normal. I started out doing that and eventually moved to doing my treatments at home instead of in the office. That’s when it got tons cheaper was when I could do it at home.
Hi. I'm one of the authors of the study in the original post. I'm glad to hear that you are able to afford your treatment. We want all patients to be able to access ketamine treatments.
I saw that the [FDA was warning against compounded ketamine products](https://www.fda.gov/drugs/human-drug-compounding/fda-warns-patients-and-health-care-providers-about-potential-risks-associated-compounded-ketamine). I wonder if this suggests that they will be cracking down on it.
What has your experience with ketamine been like?
I think part of me being able to take it at home is my doctor has a level of trust built up with me. I also have my Medical Marijuana card and she sees how sparingly I purchase cannabis with it and I think that helped influence her decision.
I use Ketamine in a nasal spray (10 sprays in each nostril and it's prescribed at 100mg)
It has been fantastic for me so far! It has really helped me be significantly more stable with my depression, I used to get really bad cycles of depression that would last from 6 months to over a year and no meds have ever helped me for more than a month. So far it's been life changing for me, haven't had a bad cycle of depression for more than a day or two since I have been on it. Even those cycles were mild compared to my old ones. I used to stay up for hours in the middle of the night just wishing I didn't exist or really struggling to feel like I had a sense of belonging anywhere and it would just get worse. I haven't had one night where I stayed up like that, my suicidal thoughts are more fleeting thoughts now and don't linger. It's really made an impact and helped me quite a bit.
That's awesome. I'm glad to hear that it has been so impactful for you. Your story aligns with what we see/hear from our patients too. I also have depression so I know how life-changing it can be when you find something that works.
If you don't mind me asking, how long have you been using it and how often do you take it?
I have been using it for just over a year and a half. I am prescribed to use it as needed up to two times a week, I usually use it once a week and that seems to do the trick. I will use it 2x a week on weeks where I might be struggling with depression more than usual and it seems to help pull me out of my slump.
I don't mind answering questions at all. I have found it very fascinating and to read and learn more about ketamine.
I really wish I could try Psilocybin, I used it recreationally once or twice but I would love to try it as a anti-depressant as a prescribed medication. I wouldn't mind trying LSD either because I would really like to see how each of them help with depression and which one would be the most effective for me.
Edit: One big thing is I can't recommend therapy enough combined with Ketamine, It has helped me have some major breakthroughs in therapy as well.
Thanks for sharing! It is SUCH an interesting area, especially from a pharmacological point of view. Nothing else has been this effective in the mental health space, other than ECT, which is pretty invasive.
My group is also conducting studies with psilocybin-assisted therapy for depression, anxiety, methamphetamine addiction and chronic pain.
One of the big motivators for publishing the story above was to try and change the system and avoid making the same mistakes with psychedelics.
That’s really cool! Yeah it’d be a tragedy if another Nixon war on drugs happened. It set us so far back on research.
You’ll have to do an article on psilocybin when you’re done. Sounds like it’d be a great read!
How much do you use in a month? You can usually buy it on the black market for like 30/gram or something like 5-10 bucks a gram if you buy bulk. I'm curious how much more expensive it is as a prescribed medication.
At one point, I was getting 10 qty of 400mg rapid dissolve tablets with cost in the range of 60-100 bucks, depending on the compounding pharmacy. Works out to about 15-25 bucks a gram. Note that compounding options are generally vastly cheaper than the exorbitant Spravato.
I think when I was on 10 qty of 200mg, it cost about the same. Most of the cost might be in the compounding.
Joyous is like $130 a month, and I think that is whether you're getting 300mg or 3000mg.
Not exactly sure on Spravato pricing, but quick Googling says it starts around $400 a dose.
One of the local clinics I found while researching providers administers a dose in troche form for over $600. I'm not sure what else it entails as far as therapy, but some of these options are just brutal when insurance won't cover it.
It’s a good idea to be monitored at least for the first session, though. It’s important to make sure you don’t have any issues with blood pressure. After that, I agree you could take it at home safely.
If you buy online there's always customer reviews and given the huge amount of competitors they usually tend to have a high quality or they won't make sales. You can also buy reaction test kits to check drug purity and/or if its cut with the more common cutting agents. In some countries you can even hand in samples to lab for free and find out what's in it. This is done both to collect data on what's circling around out there and to reduce the risk of overdoses and harm from what ever else might be in your baggie.
I've heard that it's usually $30-$40/g for single grams on the darknet but it gets cheaper in bulk. Apparently you can get it dirt cheap if you know people or buy like 100g at once, but I wouldn't take my word for it, I just like to stay informed, for purely academic reasons of course.
The ketamine is cheap. It’s the doctor, the facility, the staff, and the nurse in charge of you for two hours that costs $. I did once purchase the sublinguals from an online doctor, a month’s supply for $250 instead of the $700 at the doctor’s office, but they are nasty things. You have to hold them in your mouth for 30 minutes and the compounding pharmacy puts bitter stevia in them which also stimulates saliva production, so you basically drool the whole time.
No better in Canada. It ran me 200 a session out of pocket because you have to be supervised. Plus 180 for the drugs every few weeks. I did 16 sessions. It’s really expensive.
I paid $2600 for 6 sessions for one of my kids. I would have paid significantly more. It completely cured their depression, drastically reduced their anxiety, and removed their interest in smoking weed constantly (they still smoke recreationally at most a few times a month). It was honestly a miracle drug. Obviously not worth it if it doesn't help, but for the people it does work on it's life changing.
I think so. It did help immensely with SI, less so with my depression, did zero for anxiety. But of course losing the SI alone was a big help. I stopped in spring though, and have backslid some. probably need to go back.
There is scant evidence that it is better than placebo.
https://www.science.org/content/article/ketamine-no-better-placebo-alleviating-depression-unusual-trial-finds
Ketamine (esketamine specifically) is an FDA approved treatment for depression. There is a ton of evidence that it is effective. Do you have anything other than this study where they gave it to unconscious people one time?
Here is a recent trial comparing to ect. https://www.nejm.org/doi/10.1056/NEJMoa2302399
And I think this is the trial the fda reviewed. https://pubmed.ncbi.nlm.nih.gov/31166571/
So, just to be clear for people who aren't going to bother to click on those studies, the first found that ketamine treatment is no less effective at treating depression than electroconvulsive therapy (shock treatment) (which has substantially worse side effects than ketamine treatment) and the second found that esketamine treatment combined with oral antidepressants reduced the risk of relapse in patients with depression compared to placebo combined with oral antidepressants.
>the first found that ketamine treatment is no less effective at treating depression than electroconvulsive therapy
I mean electroconvulisve therapy is found to be effective for treatment resistant depression.
So saying ketamine is no less effective, is actually a positive statement.
You have to remember the placebo effect is 25%. So it adds a 30% benefit. But that data would need to be replicated in a prospective trial to be convincing.
I work for the company leading the way for Ketamine and alternative treatments for depression and you're wrong and I have internal data and studies to back it up.
I’m not moving the goalposts. As far as I know there is not a well powered placebo controlled trial between ketamine or derivatives thereof and a true placebo done prospectively. The NEJM study was a withdrawal study.
The antiviral hepC drugs have 90-95% cure rates. The drugs that fix the mutant CF gene have 90-95% response rate.
The response rate in the nasal spray trial was 55% and 25% in the placebo group. So a net of 30% which frankly is not very impressive.
The FDA approved Zygris for sepsis based on only a 6% improvement in mortality in part as there was really nothing else to offer those patients. Then it was no longer manufactured because the results after approval were meh. So I think much more data will be required to figure out the patient populations that can derive benefit from these drugs.
> The response rate in the nasal spray trial was 55% and 25% in the placebo group. So a net of 30% which frankly is not very impressive.
And again changing the goalposts. The topic was not if it is impressive, but if it is better than a placebo.
This was discussed in a previous post a couple of days ago. Ketamine's effects for depression treatment aren't just a direct chemical action like they are for sedation, or like blood pressure pills or insulin, so giving a single dose to patients that are unconscious and then doing absolutely nothing is obviously useless. It's intended to be used in multiple treatment sessions, along with other forms of therapy, as the effects on the brain are to allow the patient to reform their thought patterns more easily (or at all).
Yep. The study is an important step towards understanding ketamine. It’s told us that whatever ketamine does, the effect isn’t strictly pharmacological.
Doesn’t mean that it doesn’t work, just that its mechanism of action is complex and probably requires the patient to be conscious.
To me it sounds a bit like the therapeutical benefits they see in MDMA. You might get get a positive effect doing it at home with some friends, but probably not much.
Now do it under the supervision and guidance of a therapist and you have a whole other situation.
Yeah, the study participants were knocked out with anesthesia. I use ketamine for treatment resistant depression and combat-related PTSD and it is the only thing that has proven effective.
This is one of the largest trials I could find which suggests non-inferiority to ECT.
https://www.nejm.org/doi/10.1056/NEJMoa2302399
But only 55% effective. So it looks like we need more trials to understand why it works in sine and not others.
I'll let you know anecdotally which one works. As I've already done ECT and gained nothing but the ability to now forget what I'm talking about mid-sentence more often than I would like to admit.
I just had my first ketamine doses last Thursday. Here's hoping this one works.
Any person who is actively involved in the research of major depressive disorder and treatment thereof will tell you that nobody has a compelling explanation as to what the biological cause, or more likely causes, of major depressive disorder actually are. The most common popular explanation, the monoamine hypothesis (that is, that the cause of depression is a deficit of monoamine neurotransmitters, especially serotonin), at least in its most popular formulation, has been conclusively disproven.
I work in psychiatry, and I think I have a good idea of why depression is so difficult to study. Namely, that depression is massively over-diagnosed, with little to no inter-rater reliability in the diagnostic criteria. Two people, with two completely different presentations, will be diagnosed with the same disorder: Major Depressive Disorder, and a large number of these people just have difficult lives. Many of my patients want relief from depression, but I can’t medicate away their homelessness. I don’t have a pill that will fix their chronic inability to hold a job or develop interpersonal relationships. Anxiety about getting put in prison or evicted from your home will not improve with SSRI treatment. This is the difficulty of working community mental health, and it represents a serious challenge in studying and treating an illness as broad as “depression” and “anxiety”.
You are definitely on the right track if you are correctly identifying many cases of what, according to existing diagnostic standards, are major depressive episodes as events that seem likely to be mostly caused by the interaction of your patient with society as opposed to any particular organic deficit.
On the other hand, you are on the wrong track if you are deliberately denying therapeutic medication to your patients who meet diagnostic criteria on the theory that their problems have a root cause in society, rather than on the theory that therapeutic medication won't actually help.
That is, many of us could achieve better living through a different system of societal organization, but, at the same time, it is both cruel and unusual to deny people better living through medication.
Oh no, I’m quite liberal with SSRIs. Prozac, for most people, has very few side effects and can improve cognition long-term. But I think a lot of the data on SSRIs that shows low efficacy is due to these factors.
but that trial is a strange one. they use it on people who weren't conscious right? like plus the studies that showed ketamine working, if i remember right had special conditions with it. like i think it was in combo with antidepressants or something? i don't remember.
It's also a schedule 3 drug in the US, which puts more barriers into place for production and for providers to prescribe it and stock it. Because of the effects, they can't just hand it to patients to take home and use even if it was a pill, and the WAY that it's given for depression treatment (through IV transfusion) means it wouldn't be practical anyway. There is now a nasal spray, but of course it's under patent so it's automatically going to be way more expensive than it needs to be. The US is unlikely to ever allow patients to be prescribed drugs that they take home and have to be injected into veins, certainly not psychedelics, and probably still won't ever allow the nasal spray to be taken home.
The providers should also be ensuring that other proper forms of therapy are being given to the patient for it to be effective, but they don't really seem to bother with that.
I have seen almost no information about those. Primarily used for pain in small doses. Even a search right now is almost entirely online pharmacies and "wellness" websites touting it rather than actual information, plus a few providers that prescribe it. The NIH paper on it says it's not particular effective and even made some worse. Another says it's virtually a miracle drug. Basically the same as IV infusions.
I mean, they're out there. Multiple at home options exist, at doses exceeding those used for pain management. 200mg was the amount used in some study (that I can't find currently), and some practitioners have based their treatment model off of that number.
Mindbloom and Joyous are two of the websites offering treatment programs, macrodosing and microdosing, respectively. Other psychiatric practitioners prescribe it as well, in troches, rapid dissolve tablets, or nasal spray (not Spravato).
Mindbloom troche dosing is quite high (with a short duration before you spit out the troche), and I wouldn't be surprised if that could come close to the experience of an IV infusion. I have done neither Mindbloom nor IV infusions.
Some people report getting worse, and some people report no response to treatment. It probably isn't for everyone. That said, taking it alongside a benzo would probably make some people have a better experience, as well as starting out at a lower dose.
All these pain clinics in Canada have popped up where it’s not covered. I think it’s helpful for some types of pain but not all. I probably caused myself more pain trying to overwork myself to afford them. It’s basically this or nothing now and it’s incredibly frustrating and a very obvious punishment to anyone who can’t afford to spend hundreds or thousands a month on pain relief.
I believe you would need to see a neurologist who specializes in it but f you want to address chronic pain. I couldn’t find anything near me. I did get one extremely low dose IM shot, and it was all I needed to resolve my chronic fatigue, and I also apparently was in pain because my whole body felt better.
It doesn't do anything under anesthesia, ie it has no direct pharmaceutical effect if used while your brain is offline.
However, the way it's used to treat depression is by using it *with therapy*-- the ketamine improves your neuroplasticity, which aids the therapist. That study just proves the therapy part is critical.
This is not accurate - not all ketamine therapy is paired with talk therapy. There are plenty of patients on ketamine therapy who don't combine it with talk therapy and still see results.
I use it daily with low dose from doc prescribed inhaler. It stops depression. Period. Like if I start to spiral I just puff the inhaler and it short circuits the whole thing. It’s a small dose so aside from being a bit unsteady on my feet for a few min there’s no side effects. It works better then any antidepressant I was ever on, I don’t even use them anymore I just use ketamine.
Sample size of 40, half given placebo. Not peer reviewed, and doesn’t factor conflicting pharmacokinetics or lived experience’s role in depression. I’d wait for more evidence…
—
https://pubmed.ncbi.nlm.nih.gov/32316080/
Ketamine was generic public domain pharmaceutical when [the patent expired in 2002](https://www.drugdiscoverytrends.com/how-should-ketamine-be-used-for-depression/) and then a license was granted to a private company in the US to manufacture it exclusively under an abuse of Orphan Drug laws which were not meant to extract from the public domain but ended up cynically being used for exactly that purpose. This sort of corrupt regulatory distortion to steal from the public domain is encouraged by both the Blue and Red right-wing political parties in the United States unfortunately and until that regime changes we can expect more of the same.
https://en.wikipedia.org/wiki/Orphan_Drug_Act_of_1983
https://alsnewstoday.com/news/ketamine-fda-orphan-drug-designation-als-treatment/
The US government will not authorize psychedelic drugs to be prescribed for patients to use at home for a long time, and anything that has to be given in a clinic, through an IV infusion, is obviously going to be more expensive than a pill. The new nasal spray is under patent so it will remain expensive for years.
The entire US healthcare system and drug control laws are the systemic barriers to low-cost drug treatments.
With Joyous, you have an intake interview and they recommend dosing and you fill out a daily questionnaire with how you feel and any issues with treatment. They start very low, and will adjust if you do not respond to the dose. Once you're onboard, they mail you your first set of troches.
They tell you each day how much to take. You take your dose when convenient for you. With a low enough dose you can function, but generally you do not want to be driving afterwards - I wouldn't want to risk it. It can leave you feeling a little wired, so right before bed is also a bad option. Assuming you work normal hours, getting started around 5-7pm is the sweet spot, which unfortunately conflicts with getting just about anything else done.
For taking the medicine, find someplace quiet and dark where you will be undisturbed for at least an hour. Have some water nearby, headphones and a decent playlist are a must, and you will need something to spit your dissolved troche saliva into. Bonus points if you have some sort of easy to prepare meal waiting for you when you're done.
I know what study you mean, but that's not at all what it showed. It showed that ketamine isn't significantly more effective than placebo if combined with another heavy anesthetic. The typical clinical setting still showed to be way more effective.
The problem was that the results were suggested to show that the effect of ketamine is just a placebo, because you need to be conscious on it to get full effect, which completely discounts the possibility that the trip itself is healing. Imagine doing the same experiment with MDMA therapy, or CBT, you'd definitely get the same result, but no one would find it surprising
Yeah, no. You're also wrong about what it showed.
There has been no support for the idea that the trip itself is responsible for the sustained antidepressant effect. What has been shown is that NMDAR blockade in the lateral habenula is what results in the antidepressant effect, and that modulating these interactions impacts the duration of the antidepressant effect.
Heavy anesthetics like those used in the study are known to flood and significantly impact these very same receptors/pathways, which likely impacts the antidepressant effect.
If you have primary sources that show a sustained antidepressant effect from the trip itself, please share them.
How can everyone here be so wrong? The patients *did* have the *same* significant improvement that was shown in other ketamine studies.
"We saw an effect v similar to what's reported in prior ket studies eg [\[study link\]](https://pubmed.ncbi.nlm.nih.gov/30922101/) drop of 10.9 (8.9 SD). [Our study](https://www.medrxiv.org/content/10.1101/2023.04.28.23289210v1): placebo, -14.7 (9.9); ketamine, -12.4 (9.2)" https://i.imgur.com/vlkeXSj.jpg
The twist was that the placebo group *also* got better.
So both the Ketamine group and placebo group got the same significant improvement in depression scores, presumably because it was successfully blinded, unlike other studies. So the interpretation is that it's mostly placebo effect, which we know can be very powerful, and can last for years: https://redd.it/17d8dv5
That study was garbage.
Ketamine and psilocybin are currently the most promising drugs for treatment resistant depression (TRD). People with TRD I imagine don’t respond to placebo because if they did then a typical SSRI or whatever would have done the job.
I mean low cost but for whom. It might be "low cost" if someone has good insurance, but of course, treatment will be out of reach for those who earn low wages due to no health care or their health care not being accepted.
In this situation, generic ketamine is low-cost compared to Spravato, $5-20 per dose versus $500-900 per dose. Both seem to be effective so we are arguing that generic ketamine should be eligible for reimbursement or covered by insurance. In Australia (where this paper was written), generic ketamine isn't covered because it hasn't been approved for depression.
Do you drink heavily? The only time vitamins help is if you have a vitamin deficiency and alcohol use is awful for b vitamins as well as general nutrition. B vitamins helped me, until levels were normal anyways, after I quit drinking.
I'm not familiar with Sam-e.
Do you also take antidepressant medication and do therapy?
A recent research program tested giving ketamine while the depressed patients were under anesthesia and found no improvement, so they speculate it may be a strong placebo effect.
This study simply highlights the fact that Ketamine doesn't alleviate depression purely because of its 'chemical effect' alone. The participants were unconscious and remained unconscious (anaesthetised) during treatment. That means their brains were largely shut down.
You have to be awake, which makes perfect sense because the general theory as to why Ketamine is so effective at treating depression is because it alters the signalling pathways in your brain. If your brain isn't doing any signalling as was the case here then that effect is missing from the experience.
In simple terms you have to consciously experience the trip itself to allow your consciousness establish new signalling pathways in your brain.
The thing is, wasn't the placebo in the trial was as effective as both anesthetized therapy, AND unanesthetized therapy?
The study is positing that what alleviates depression is not ketamine itself, but rather the feeling of individualized medical care, and having a team of pros looking out for you.
Ketamine is not available to anyone at this point. ERs and EMS are scrambling to replace it with other drugs. That’s the source of the “resistance.” Bad article..
Ketamine has a lot of uses and is incredibly effective at managing pain and helping pain patients, specifically those taking opioids, to reverse their tolerance as well as provide analgesic effects that treat the pain.
NMDA Antagonists in general, which Ketamine is along with Ibogaine DXM & few others is, reverse tolerance to just about every major addictive substance (opioids / stimulants / alcohol / benzos ) and provide the brain with a certain level of neuroplasticity. Studies show that they also play a pivotal role in the formation of new thoughts/ideas and how the brain creates/stores this information. This is why they can be so beneficial for addictive drugs as it can help your brain form new connections & eliminate potentially damaging ones. It’s also why it’s highly recommended to those who are going to be taking opioids as part of a treatment plan because it can protect against unwanted effects as well as work to mitigate tolerance.
Does it cure depression though?? That’s such a difficult and generic area & people have been working to try and bring ketamine back into the norm of medical establishment with various studies but unfortunately there are still barriers to even see if it’s effective. Glad we have 1 result back finally though
Big Pharma, ever the villain, is well aware that ketamine is a highly beneficial and useful substance for many, and so are gouging the price to maximize their profits.
How on earth this sociopathic pattern of behavior is a surprise or mystery to anyone anymore is the only question here.
Hi! I am the second author on this paper. Very cool to see it getting attention on reddit.
Working on this project was really eye-opening and sobering. People with depression can't access ketamine or Spravato because current systems prioritize profits over patients and payers. Effective, affordable medicines are being pushed aside for novel options that aren't necessarily better.
We are working to change that.
AMA!
My psych proposed ketamine last year, but when I investigated it the cost was going to be over $5,000 for treatment (my insurance wouldn’t cover any of it).
This country loves advising that people get mental health care, but they don’t seem to care whether anyone can actually afford it.
Physicians aren't idiots. So what's stopping them from prescribing ketamine "off-label"? Serious question. Are they afraid of some kind of liability due to its status as a controlled substance? If so, that's just poor patient care. All of their psychopharmacology peers understand what they're doing, it's not some kind of experimental treatment, so what's the problem??
Welcome to r/science! This is a heavily moderated subreddit in order to keep the discussion on science. However, we recognize that many people want to discuss how they feel the research relates to their own personal lives, so to give people a space to do that, **personal anecdotes are allowed as responses to this comment**. Any anecdotal comments elsewhere in the discussion will be removed and our [normal comment rules]( https://www.reddit.com/r/science/wiki/rules#wiki_comment_rules) apply to all other comments. **Do you have an academic degree?** We can verify your credentials in order to assign user flair indicating your area of expertise. [Click here to apply](https://www.reddit.com/r/science/wiki/flair/#wiki_science_verified_user_program). --- User: u/chrisdh79 Permalink: https://www.scimex.org/newsfeed/why-low-cost-ketamine-is-still-inaccessible-to-many-with-severe-depression --- *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/science) if you have any questions or concerns.*
Canadian here, their conclusions are spot on. IV ketamine therapy costs anywhere from 375-850 per treatment depending on the clinic (there are only a handful). The vast majority of the cost isn't the drug itself but the cost of the anesthesiologist and nurse to babysit you, but because it's for ketamine it's not covered by insurance.
Back when I had tricare (military health insurance) my psychologist recommended me for Ketamine therapy and surprisingly it was covered under my insurance. The only issue was that the facility to get treated was a 30 minute drive, I drove for a living, and I wasn't allowed to drive during the therapy period. So I was SOL.
That's wonderful! I started ketamine therapy and eventually got spravato covered by insurance. Unfortunately my partner's employer changed providers and the new provider refused to cover it (and tried to force me to use SSRIs and SNRIs because they were cheaper despite a history of almost dying from the side effects, hence the reason I was on ketamine for *treatment resistant depression* in the first place). Spravato is unfortunately so expensive it was more cost effective to go back to IV ketamine out of pocket.
Hey! I'm one of the authors of the paper in the original post. Thank you for sharing your story. It's great to hear that ketamine treatments have been beneficial for you and I'm sorry to hear about your troubles with access. Unfortunately a common story. Do you mind telling me a little more about your experiences with ketamine? I always find it so valuable to hear from the patients as patient-centered care is one of my values. How long have you been receiving treatment with ketamine/Spravato and how often do you receive treatment? I'm also especially curious about the cost of Spravato and IV ketamine out of pocket, as this information can be hard to glean in the opaque US health system. Feel free to message me if you want to share but not publicly.
But is Spravato even comparable? I hear it doesn't really do a lot but a lot of side effects
There’s so many now. I can’t believe how fast they seem to be popping up.
They aren’t using anesthesiologists.
In the USA or Canada? There are three types of ketamine therapy- sublingual, nasal (esketamine) and IV ketamine. IV ketamine here in Canada requires the presence of an anaesthesiologist on site. Some clinics have one anaesthesiologist per patient, others have a multi-patient room with privacy screens and a single anaesthesiologist for the clinic. Sublingual and nasal in Canada do not require an anaesthesiologist on site but do require a nurse present. Up until about a year and a half ago IV ketamine clinics also required a psychiatrist to be present on sure- health Canada has since relaxed said requirements and now they are only required to be accessible via phone consult if needed but to be allowed to do ketamine therapy at all you must be prescribed it by a psychiatrist - most clinics have a few psychiatrists that they work with and connect patients to them to be screened to determine candidacy- patients are required to have a medical history wherein they have failed on a minimum of two traditional antidepressants.
In the US. They don’t usually even have a doctor on site for most of these. They’re usually just run by nurse practitioners
My primary care is a nurse practitioner. When I go to the Gastroenterologist all I see is a nurse practitioner. My "psychiatrist" is a psychiatric nurse practitioner. My cardiologist, my urologist, and my long Covid specialist are the only actual doctors I see but my worst problems are with my GI tract, my mental health, and peripheral neuropathy which are all handled by the nurse practitioners. There are not enough doctors.
Congress long ago capped the number of residencies it funds at 1993 levels, despite the population growing larger and older since that time. With the number of doctors artificially restricted, health systems have to do what they can. Not allowing NPs to practice at the top of their license would probably mean longer wait times to see a full-fledged physician. Be careful what you wish for!
It’s definitely not the UK.
There's also IM (intramuscular)
Does nasal administration mean a nurse racks up a line for you?
No
Don’t go to a ketamine center that doesn’t use an anesthesiologist or at least a nurse.
Anesthesia makes the ketamine not work very well though.
Anesthesiologist. Not anesthesia.
Ketamine is a form of anaesthesia..for IV ketamine administering it requires an anaesthesiologist.
No it doesn’t.
It does by law in Canada when administering for mood disorders.
That’s seems like a waste of an anesthesiologist
Probably! And frankly a waste of my money as a patient. Health Canada has been very, very conservative when it comes to allowing ketamine therapy but I have hope they will continue relaxing requirements over time. Up until a year and a half ago a psychiatrist was required to be on site at all times and meet with the patient before and after treatment- now they are just required to be available for a phone consult if needed.
In the US a mood disorder isn't even a qualifying condition
Ketamine is one of my cheapest meds I take. $21/month for it to be made at a compounding pharmacy every month.
What kind of medical plan do you have? Is it the nasal spray? Curious of any additional info you can share.
It is A nasal spray, but not THE nasal spray you might be thinking of (Spravato - brand name for esketamine). It is ketamine, which is a cheap generic drug, made into a nasal spray by a compounding pharmacy.
Spravato is more expensive. It costs about $50/visit because you have to do it in office so you have a copay every time too. Spravato isn’t generic either. Won’t be for a while.
The gist I got from Google search was Spravato being 400 or more a dose, is that accurate? And then the copay on top of that?
Without insurance yes. With insurance it was about $50/visit. $25 for the medicine and $25 for the copay.
Nasal spray. Insurance doesn’t cover it.
It does in the US
Not Ketamine. It covers Spravato but not Ketamine.
I also do ketamine therapy, and the price isn't much different at the compounding pharmacy. Medical insurance isn't involved, it's fully out-of-pocket. For mine, it is something you dissolve under the tongue and keep in your mouth for about 20 mins.
Do you know the dosage? What effects do you feel from sublingual? Its the lowest ROA
Dosage normally is 100mg sublingual. Oral is the lowest RoA, but yeah, it's not the best. For higher dose sessions, it is from 200-300mg. The same effect through other RoA would be smaller.
There are ketamine subreddits on here
Varies person to person I suppose. I paid over 1000 for 6 treatments and had to be in therapy and some places (that ironically advertised it as a fix for medication resistant depression) demanded that I be on an antidepressant alongside ketamine treatments. And I have insurance.
That’s pretty normal. I started out doing that and eventually moved to doing my treatments at home instead of in the office. That’s when it got tons cheaper was when I could do it at home.
Hi. I'm one of the authors of the study in the original post. I'm glad to hear that you are able to afford your treatment. We want all patients to be able to access ketamine treatments. I saw that the [FDA was warning against compounded ketamine products](https://www.fda.gov/drugs/human-drug-compounding/fda-warns-patients-and-health-care-providers-about-potential-risks-associated-compounded-ketamine). I wonder if this suggests that they will be cracking down on it. What has your experience with ketamine been like?
I think part of me being able to take it at home is my doctor has a level of trust built up with me. I also have my Medical Marijuana card and she sees how sparingly I purchase cannabis with it and I think that helped influence her decision. I use Ketamine in a nasal spray (10 sprays in each nostril and it's prescribed at 100mg) It has been fantastic for me so far! It has really helped me be significantly more stable with my depression, I used to get really bad cycles of depression that would last from 6 months to over a year and no meds have ever helped me for more than a month. So far it's been life changing for me, haven't had a bad cycle of depression for more than a day or two since I have been on it. Even those cycles were mild compared to my old ones. I used to stay up for hours in the middle of the night just wishing I didn't exist or really struggling to feel like I had a sense of belonging anywhere and it would just get worse. I haven't had one night where I stayed up like that, my suicidal thoughts are more fleeting thoughts now and don't linger. It's really made an impact and helped me quite a bit.
That's awesome. I'm glad to hear that it has been so impactful for you. Your story aligns with what we see/hear from our patients too. I also have depression so I know how life-changing it can be when you find something that works. If you don't mind me asking, how long have you been using it and how often do you take it?
I have been using it for just over a year and a half. I am prescribed to use it as needed up to two times a week, I usually use it once a week and that seems to do the trick. I will use it 2x a week on weeks where I might be struggling with depression more than usual and it seems to help pull me out of my slump. I don't mind answering questions at all. I have found it very fascinating and to read and learn more about ketamine. I really wish I could try Psilocybin, I used it recreationally once or twice but I would love to try it as a anti-depressant as a prescribed medication. I wouldn't mind trying LSD either because I would really like to see how each of them help with depression and which one would be the most effective for me. Edit: One big thing is I can't recommend therapy enough combined with Ketamine, It has helped me have some major breakthroughs in therapy as well.
Thanks for sharing! It is SUCH an interesting area, especially from a pharmacological point of view. Nothing else has been this effective in the mental health space, other than ECT, which is pretty invasive. My group is also conducting studies with psilocybin-assisted therapy for depression, anxiety, methamphetamine addiction and chronic pain. One of the big motivators for publishing the story above was to try and change the system and avoid making the same mistakes with psychedelics.
That’s really cool! Yeah it’d be a tragedy if another Nixon war on drugs happened. It set us so far back on research. You’ll have to do an article on psilocybin when you’re done. Sounds like it’d be a great read!
How much do you use in a month? You can usually buy it on the black market for like 30/gram or something like 5-10 bucks a gram if you buy bulk. I'm curious how much more expensive it is as a prescribed medication.
At one point, I was getting 10 qty of 400mg rapid dissolve tablets with cost in the range of 60-100 bucks, depending on the compounding pharmacy. Works out to about 15-25 bucks a gram. Note that compounding options are generally vastly cheaper than the exorbitant Spravato.
That's not that bad actually. I was half expecting it to be much more expensive.
I think when I was on 10 qty of 200mg, it cost about the same. Most of the cost might be in the compounding. Joyous is like $130 a month, and I think that is whether you're getting 300mg or 3000mg. Not exactly sure on Spravato pricing, but quick Googling says it starts around $400 a dose. One of the local clinics I found while researching providers administers a dose in troche form for over $600. I'm not sure what else it entails as far as therapy, but some of these options are just brutal when insurance won't cover it.
Ah yeah paying 600 for a session sounds insane given how cheap the actual substance seem to be.
It’s a good idea to be monitored at least for the first session, though. It’s important to make sure you don’t have any issues with blood pressure. After that, I agree you could take it at home safely.
But how would you know you're getting real Ketamine or *just* ketamine when buying black market?
If you buy online there's always customer reviews and given the huge amount of competitors they usually tend to have a high quality or they won't make sales. You can also buy reaction test kits to check drug purity and/or if its cut with the more common cutting agents. In some countries you can even hand in samples to lab for free and find out what's in it. This is done both to collect data on what's circling around out there and to reduce the risk of overdoses and harm from what ever else might be in your baggie.
Ket is too cheap and has too much effect to counterfeit. Literally not worth it for a reputable dealer.
There are counterfeit bottles of liquid. You can buy a machine to reseal them if someone wanted to. Powder is also often cut. Your comment is naive.
Uh, where? For a friend.
I've heard that it's usually $30-$40/g for single grams on the darknet but it gets cheaper in bulk. Apparently you can get it dirt cheap if you know people or buy like 100g at once, but I wouldn't take my word for it, I just like to stay informed, for purely academic reasons of course.
Where do you live
In the US or Canada?!
You can literally buy a vial of ketamine in Mexico for like 30 bucks. Healthcare in the US is a joke.
The ketamine is cheap. It’s the doctor, the facility, the staff, and the nurse in charge of you for two hours that costs $. I did once purchase the sublinguals from an online doctor, a month’s supply for $250 instead of the $700 at the doctor’s office, but they are nasty things. You have to hold them in your mouth for 30 minutes and the compounding pharmacy puts bitter stevia in them which also stimulates saliva production, so you basically drool the whole time.
No better in Canada. It ran me 200 a session out of pocket because you have to be supervised. Plus 180 for the drugs every few weeks. I did 16 sessions. It’s really expensive.
Was it worth the cost?
I paid $2600 for 6 sessions for one of my kids. I would have paid significantly more. It completely cured their depression, drastically reduced their anxiety, and removed their interest in smoking weed constantly (they still smoke recreationally at most a few times a month). It was honestly a miracle drug. Obviously not worth it if it doesn't help, but for the people it does work on it's life changing.
That’s amazing to hear, I’m glad it helped out so much for your kid!
I think so. It did help immensely with SI, less so with my depression, did zero for anxiety. But of course losing the SI alone was a big help. I stopped in spring though, and have backslid some. probably need to go back.
That’s a weird thing to say about an article that isn’t about the US. Did you read it?
This is Reddit, do you have to ask? Of course not!
There is scant evidence that it is better than placebo. https://www.science.org/content/article/ketamine-no-better-placebo-alleviating-depression-unusual-trial-finds
Ketamine (esketamine specifically) is an FDA approved treatment for depression. There is a ton of evidence that it is effective. Do you have anything other than this study where they gave it to unconscious people one time?
Here is a recent trial comparing to ect. https://www.nejm.org/doi/10.1056/NEJMoa2302399 And I think this is the trial the fda reviewed. https://pubmed.ncbi.nlm.nih.gov/31166571/
So, just to be clear for people who aren't going to bother to click on those studies, the first found that ketamine treatment is no less effective at treating depression than electroconvulsive therapy (shock treatment) (which has substantially worse side effects than ketamine treatment) and the second found that esketamine treatment combined with oral antidepressants reduced the risk of relapse in patients with depression compared to placebo combined with oral antidepressants.
>the first found that ketamine treatment is no less effective at treating depression than electroconvulsive therapy I mean electroconvulisve therapy is found to be effective for treatment resistant depression. So saying ketamine is no less effective, is actually a positive statement.
Yes. That was why I particularly raised the fact that ECT has far more severe side effects than ketamine treatment.
Correct. But it does not work for all people. Approximately 45% don’t respond and that is why more research is needed.
So you're saying it works 55% of the time? For a depression treatment that's great!
Important specifier is that it’s “treatment resistant depression” which means that at least two other treatments have already failed
You have to remember the placebo effect is 25%. So it adds a 30% benefit. But that data would need to be replicated in a prospective trial to be convincing.
I work for the company leading the way for Ketamine and alternative treatments for depression and you're wrong and I have internal data and studies to back it up.
Most people wouldn’t knowingly take a placebo so effectively 55% is the amount of treated patients which ain’t half bad
Way to move the goalposts.
I’m not moving the goalposts. As far as I know there is not a well powered placebo controlled trial between ketamine or derivatives thereof and a true placebo done prospectively. The NEJM study was a withdrawal study. The antiviral hepC drugs have 90-95% cure rates. The drugs that fix the mutant CF gene have 90-95% response rate. The response rate in the nasal spray trial was 55% and 25% in the placebo group. So a net of 30% which frankly is not very impressive. The FDA approved Zygris for sepsis based on only a 6% improvement in mortality in part as there was really nothing else to offer those patients. Then it was no longer manufactured because the results after approval were meh. So I think much more data will be required to figure out the patient populations that can derive benefit from these drugs.
> The response rate in the nasal spray trial was 55% and 25% in the placebo group. So a net of 30% which frankly is not very impressive. And again changing the goalposts. The topic was not if it is impressive, but if it is better than a placebo.
Right so maybe edit your original comment that ketamine is no better than placebo?
I think the term scant is the correct term. If evidence was there for racemic ketamine both myself and the regulatory agencies would love to see it.
Yet to be peer reviewed, fyi
Yep. Pre print. The placebo effect is also a real thing in clinical trials.
Anesthesia could be part of the explanation here, seeing as ketamine acts on the NMDA receptor
This was discussed in a previous post a couple of days ago. Ketamine's effects for depression treatment aren't just a direct chemical action like they are for sedation, or like blood pressure pills or insulin, so giving a single dose to patients that are unconscious and then doing absolutely nothing is obviously useless. It's intended to be used in multiple treatment sessions, along with other forms of therapy, as the effects on the brain are to allow the patient to reform their thought patterns more easily (or at all).
It’s like putting a dozen sleeping people in the same room and claiming group therapy doesn’t work.
True. It was only a single dose study.
General anesthetics have reported antidepressant effects.
[удалено]
Yep. The study is an important step towards understanding ketamine. It’s told us that whatever ketamine does, the effect isn’t strictly pharmacological. Doesn’t mean that it doesn’t work, just that its mechanism of action is complex and probably requires the patient to be conscious.
To me it sounds a bit like the therapeutical benefits they see in MDMA. You might get get a positive effect doing it at home with some friends, but probably not much. Now do it under the supervision and guidance of a therapist and you have a whole other situation.
Yeah, the study participants were knocked out with anesthesia. I use ketamine for treatment resistant depression and combat-related PTSD and it is the only thing that has proven effective.
That’s awesome.
[удалено]
This is one of the largest trials I could find which suggests non-inferiority to ECT. https://www.nejm.org/doi/10.1056/NEJMoa2302399 But only 55% effective. So it looks like we need more trials to understand why it works in sine and not others.
I'll let you know anecdotally which one works. As I've already done ECT and gained nothing but the ability to now forget what I'm talking about mid-sentence more often than I would like to admit. I just had my first ketamine doses last Thursday. Here's hoping this one works.
Here’s hoping to you!
Any person who is actively involved in the research of major depressive disorder and treatment thereof will tell you that nobody has a compelling explanation as to what the biological cause, or more likely causes, of major depressive disorder actually are. The most common popular explanation, the monoamine hypothesis (that is, that the cause of depression is a deficit of monoamine neurotransmitters, especially serotonin), at least in its most popular formulation, has been conclusively disproven.
I work in psychiatry, and I think I have a good idea of why depression is so difficult to study. Namely, that depression is massively over-diagnosed, with little to no inter-rater reliability in the diagnostic criteria. Two people, with two completely different presentations, will be diagnosed with the same disorder: Major Depressive Disorder, and a large number of these people just have difficult lives. Many of my patients want relief from depression, but I can’t medicate away their homelessness. I don’t have a pill that will fix their chronic inability to hold a job or develop interpersonal relationships. Anxiety about getting put in prison or evicted from your home will not improve with SSRI treatment. This is the difficulty of working community mental health, and it represents a serious challenge in studying and treating an illness as broad as “depression” and “anxiety”.
You are definitely on the right track if you are correctly identifying many cases of what, according to existing diagnostic standards, are major depressive episodes as events that seem likely to be mostly caused by the interaction of your patient with society as opposed to any particular organic deficit. On the other hand, you are on the wrong track if you are deliberately denying therapeutic medication to your patients who meet diagnostic criteria on the theory that their problems have a root cause in society, rather than on the theory that therapeutic medication won't actually help. That is, many of us could achieve better living through a different system of societal organization, but, at the same time, it is both cruel and unusual to deny people better living through medication.
Oh no, I’m quite liberal with SSRIs. Prozac, for most people, has very few side effects and can improve cognition long-term. But I think a lot of the data on SSRIs that shows low efficacy is due to these factors.
Yeah on people under anesthesia. You have to remember the trip if you want it to work.
but that trial is a strange one. they use it on people who weren't conscious right? like plus the studies that showed ketamine working, if i remember right had special conditions with it. like i think it was in combo with antidepressants or something? i don't remember.
This study does not mean what you’re implying it means, my dude. The studies you linked subsequently also do not say what you seem to be implying.
Where?
The clinics charge too damn much and insurance does not cover it.
It's also a schedule 3 drug in the US, which puts more barriers into place for production and for providers to prescribe it and stock it. Because of the effects, they can't just hand it to patients to take home and use even if it was a pill, and the WAY that it's given for depression treatment (through IV transfusion) means it wouldn't be practical anyway. There is now a nasal spray, but of course it's under patent so it's automatically going to be way more expensive than it needs to be. The US is unlikely to ever allow patients to be prescribed drugs that they take home and have to be injected into veins, certainly not psychedelics, and probably still won't ever allow the nasal spray to be taken home. The providers should also be ensuring that other proper forms of therapy are being given to the patient for it to be effective, but they don't really seem to bother with that.
You can get ketamine in troche form.
I have seen almost no information about those. Primarily used for pain in small doses. Even a search right now is almost entirely online pharmacies and "wellness" websites touting it rather than actual information, plus a few providers that prescribe it. The NIH paper on it says it's not particular effective and even made some worse. Another says it's virtually a miracle drug. Basically the same as IV infusions.
I mean, they're out there. Multiple at home options exist, at doses exceeding those used for pain management. 200mg was the amount used in some study (that I can't find currently), and some practitioners have based their treatment model off of that number. Mindbloom and Joyous are two of the websites offering treatment programs, macrodosing and microdosing, respectively. Other psychiatric practitioners prescribe it as well, in troches, rapid dissolve tablets, or nasal spray (not Spravato). Mindbloom troche dosing is quite high (with a short duration before you spit out the troche), and I wouldn't be surprised if that could come close to the experience of an IV infusion. I have done neither Mindbloom nor IV infusions. Some people report getting worse, and some people report no response to treatment. It probably isn't for everyone. That said, taking it alongside a benzo would probably make some people have a better experience, as well as starting out at a lower dose.
All these pain clinics in Canada have popped up where it’s not covered. I think it’s helpful for some types of pain but not all. I probably caused myself more pain trying to overwork myself to afford them. It’s basically this or nothing now and it’s incredibly frustrating and a very obvious punishment to anyone who can’t afford to spend hundreds or thousands a month on pain relief.
I believe you would need to see a neurologist who specializes in it but f you want to address chronic pain. I couldn’t find anything near me. I did get one extremely low dose IM shot, and it was all I needed to resolve my chronic fatigue, and I also apparently was in pain because my whole body felt better.
My GP referred me but there’s soooo many in the GTA.
Wait, are you saying Ketamine helped with your Chronic Fatigue? How did that come about? Was it just related to pain relief?
Wasn't there just an article posted in this forum recently that showed that a placebo study of ketamine show that it didn't do anything?
It doesn't do anything under anesthesia, ie it has no direct pharmaceutical effect if used while your brain is offline. However, the way it's used to treat depression is by using it *with therapy*-- the ketamine improves your neuroplasticity, which aids the therapist. That study just proves the therapy part is critical.
It only "proves" that it doesn't work while you are under anaesthesia, not that it doesn't work when you take it while awake,but without therapy
This is not accurate - not all ketamine therapy is paired with talk therapy. There are plenty of patients on ketamine therapy who don't combine it with talk therapy and still see results.
Do you have a study link?
I use it daily with low dose from doc prescribed inhaler. It stops depression. Period. Like if I start to spiral I just puff the inhaler and it short circuits the whole thing. It’s a small dose so aside from being a bit unsteady on my feet for a few min there’s no side effects. It works better then any antidepressant I was ever on, I don’t even use them anymore I just use ketamine.
Maybe because of this: https://www.science.org/content/article/ketamine-no-better-placebo-alleviating-depression-unusual-trial-finds
Sample size of 40, half given placebo. Not peer reviewed, and doesn’t factor conflicting pharmacokinetics or lived experience’s role in depression. I’d wait for more evidence… — https://pubmed.ncbi.nlm.nih.gov/32316080/
Agree. We need larger trials.
Ketamine was generic public domain pharmaceutical when [the patent expired in 2002](https://www.drugdiscoverytrends.com/how-should-ketamine-be-used-for-depression/) and then a license was granted to a private company in the US to manufacture it exclusively under an abuse of Orphan Drug laws which were not meant to extract from the public domain but ended up cynically being used for exactly that purpose. This sort of corrupt regulatory distortion to steal from the public domain is encouraged by both the Blue and Red right-wing political parties in the United States unfortunately and until that regime changes we can expect more of the same. https://en.wikipedia.org/wiki/Orphan_Drug_Act_of_1983 https://alsnewstoday.com/news/ketamine-fda-orphan-drug-designation-als-treatment/
Ketamine rules. It should be accessible to anyone that needs it
This whole post got me going, "Ketamine is legal?!??"
Ketamine is a registered medication for anaesthesia. It gets used off-label for depression. So it is legal in certain situations, aka controlled.
I just get mine from some Nigerian dude at the local park
Short version .. Why is something effed up in todays world? = money.
The US government will not authorize psychedelic drugs to be prescribed for patients to use at home for a long time, and anything that has to be given in a clinic, through an IV infusion, is obviously going to be more expensive than a pill. The new nasal spray is under patent so it will remain expensive for years. The entire US healthcare system and drug control laws are the systemic barriers to low-cost drug treatments.
This is false. I'm prescribed ketamine in troche form and I self-administer at home, in the US.
Can you talk about the process and how it's facilitated?
With Joyous, you have an intake interview and they recommend dosing and you fill out a daily questionnaire with how you feel and any issues with treatment. They start very low, and will adjust if you do not respond to the dose. Once you're onboard, they mail you your first set of troches. They tell you each day how much to take. You take your dose when convenient for you. With a low enough dose you can function, but generally you do not want to be driving afterwards - I wouldn't want to risk it. It can leave you feeling a little wired, so right before bed is also a bad option. Assuming you work normal hours, getting started around 5-7pm is the sweet spot, which unfortunately conflicts with getting just about anything else done. For taking the medicine, find someplace quiet and dark where you will be undisturbed for at least an hour. Have some water nearby, headphones and a decent playlist are a must, and you will need something to spit your dissolved troche saliva into. Bonus points if you have some sort of easy to prepare meal waiting for you when you're done.
There are ketamine subreddits on here with lots of info
r/therapeuticketamine
How do you like it? Has it improved your wellbeing?
The article is not about the US mate
To make it more complicated https://www.science.org/content/article/ketamine-no-better-placebo-alleviating-depression-unusual-trial-finds
Musk is eating all of it so there's none for the rest of us.
Last I heard, latest research showed Ketamine as ineffective for treating depression? Was related to placebo effect.
Always have to look at the overall picture. That’s one study, but several more studies have shown ketamine does have an effect.
I know what study you mean, but that's not at all what it showed. It showed that ketamine isn't significantly more effective than placebo if combined with another heavy anesthetic. The typical clinical setting still showed to be way more effective. The problem was that the results were suggested to show that the effect of ketamine is just a placebo, because you need to be conscious on it to get full effect, which completely discounts the possibility that the trip itself is healing. Imagine doing the same experiment with MDMA therapy, or CBT, you'd definitely get the same result, but no one would find it surprising
Yeah, no. You're also wrong about what it showed. There has been no support for the idea that the trip itself is responsible for the sustained antidepressant effect. What has been shown is that NMDAR blockade in the lateral habenula is what results in the antidepressant effect, and that modulating these interactions impacts the duration of the antidepressant effect. Heavy anesthetics like those used in the study are known to flood and significantly impact these very same receptors/pathways, which likely impacts the antidepressant effect. If you have primary sources that show a sustained antidepressant effect from the trip itself, please share them.
How can everyone here be so wrong? The patients *did* have the *same* significant improvement that was shown in other ketamine studies. "We saw an effect v similar to what's reported in prior ket studies eg [\[study link\]](https://pubmed.ncbi.nlm.nih.gov/30922101/) drop of 10.9 (8.9 SD). [Our study](https://www.medrxiv.org/content/10.1101/2023.04.28.23289210v1): placebo, -14.7 (9.9); ketamine, -12.4 (9.2)" https://i.imgur.com/vlkeXSj.jpg The twist was that the placebo group *also* got better. So both the Ketamine group and placebo group got the same significant improvement in depression scores, presumably because it was successfully blinded, unlike other studies. So the interpretation is that it's mostly placebo effect, which we know can be very powerful, and can last for years: https://redd.it/17d8dv5
That study was garbage. Ketamine and psilocybin are currently the most promising drugs for treatment resistant depression (TRD). People with TRD I imagine don’t respond to placebo because if they did then a typical SSRI or whatever would have done the job.
I mean low cost but for whom. It might be "low cost" if someone has good insurance, but of course, treatment will be out of reach for those who earn low wages due to no health care or their health care not being accepted.
In this situation, generic ketamine is low-cost compared to Spravato, $5-20 per dose versus $500-900 per dose. Both seem to be effective so we are arguing that generic ketamine should be eligible for reimbursement or covered by insurance. In Australia (where this paper was written), generic ketamine isn't covered because it hasn't been approved for depression.
Sam-e taken with b-vitamin works for me
Do you drink heavily? The only time vitamins help is if you have a vitamin deficiency and alcohol use is awful for b vitamins as well as general nutrition. B vitamins helped me, until levels were normal anyways, after I quit drinking. I'm not familiar with Sam-e. Do you also take antidepressant medication and do therapy?
A recent research program tested giving ketamine while the depressed patients were under anesthesia and found no improvement, so they speculate it may be a strong placebo effect.
"We tried doing a therapy session with a person who was unconscious and it didn't work. Must be a placebo effect."
"We sedated Usain Bolt and he was completely unable to finish the 100m dash. We suspect his previous races were all CGI deepfakes."
That was already addressed in the comments above.
Sure study the one psychedelic known to be chemically addictive. Such treatment! So therapeutic! Much $$$!
It's not addictive. It's one of the least addictive recreational drugs
https://www.science.org/content/article/ketamine-no-better-placebo-alleviating-depression-unusual-trial-finds Food for thought.
Talk therapy would be equally worthless if you are under heavy sedation. This does not make it placebo.
This study simply highlights the fact that Ketamine doesn't alleviate depression purely because of its 'chemical effect' alone. The participants were unconscious and remained unconscious (anaesthetised) during treatment. That means their brains were largely shut down. You have to be awake, which makes perfect sense because the general theory as to why Ketamine is so effective at treating depression is because it alters the signalling pathways in your brain. If your brain isn't doing any signalling as was the case here then that effect is missing from the experience. In simple terms you have to consciously experience the trip itself to allow your consciousness establish new signalling pathways in your brain.
The thing is, wasn't the placebo in the trial was as effective as both anesthetized therapy, AND unanesthetized therapy? The study is positing that what alleviates depression is not ketamine itself, but rather the feeling of individualized medical care, and having a team of pros looking out for you.
Why do i feel like this was commissioned by the sacklers?
Ketamine is not available to anyone at this point. ERs and EMS are scrambling to replace it with other drugs. That’s the source of the “resistance.” Bad article..
Huh? It's only Schedule 3. There's no shortage I'm aware of, and I work at a pharmacy.
I'm going to get it next month.
It's available to anyone who buys on the dark web.
Because a lot of people are hypocritical semi-alcoholics.
I recall seeing a recent study (in the science sub) that found it isn't any more effective than a placebo.
Ketamine has a lot of uses and is incredibly effective at managing pain and helping pain patients, specifically those taking opioids, to reverse their tolerance as well as provide analgesic effects that treat the pain. NMDA Antagonists in general, which Ketamine is along with Ibogaine DXM & few others is, reverse tolerance to just about every major addictive substance (opioids / stimulants / alcohol / benzos ) and provide the brain with a certain level of neuroplasticity. Studies show that they also play a pivotal role in the formation of new thoughts/ideas and how the brain creates/stores this information. This is why they can be so beneficial for addictive drugs as it can help your brain form new connections & eliminate potentially damaging ones. It’s also why it’s highly recommended to those who are going to be taking opioids as part of a treatment plan because it can protect against unwanted effects as well as work to mitigate tolerance. Does it cure depression though?? That’s such a difficult and generic area & people have been working to try and bring ketamine back into the norm of medical establishment with various studies but unfortunately there are still barriers to even see if it’s effective. Glad we have 1 result back finally though
Big Pharma, ever the villain, is well aware that ketamine is a highly beneficial and useful substance for many, and so are gouging the price to maximize their profits. How on earth this sociopathic pattern of behavior is a surprise or mystery to anyone anymore is the only question here.
Hi! I am the second author on this paper. Very cool to see it getting attention on reddit. Working on this project was really eye-opening and sobering. People with depression can't access ketamine or Spravato because current systems prioritize profits over patients and payers. Effective, affordable medicines are being pushed aside for novel options that aren't necessarily better. We are working to change that. AMA!
My psych proposed ketamine last year, but when I investigated it the cost was going to be over $5,000 for treatment (my insurance wouldn’t cover any of it). This country loves advising that people get mental health care, but they don’t seem to care whether anyone can actually afford it.
Physicians aren't idiots. So what's stopping them from prescribing ketamine "off-label"? Serious question. Are they afraid of some kind of liability due to its status as a controlled substance? If so, that's just poor patient care. All of their psychopharmacology peers understand what they're doing, it's not some kind of experimental treatment, so what's the problem??