"The move heralds a shift from the Prozac era of antidepressant drugs."
March 6, 2019 4:39 PM Subscribe
Spravato!! “The cost for a one-month course of treatment will be between $4,720 and $6,785”
posted by Auden at 4:48 PM on March 6, 2019 [2 favorites]
posted by Auden at 4:48 PM on March 6, 2019 [2 favorites]
Could Help Millions
not at those prices.
posted by valkane at 4:51 PM on March 6, 2019 [60 favorites]
not at those prices.
posted by valkane at 4:51 PM on March 6, 2019 [60 favorites]
It bothers me how language changes once something gets monetized by the pharmaceutical industry. Like a year ago ketamine was a "horse tranquilizer" "abused" by drug addicts for a party high. Now it's a "depression drug" which will "help millions".
I've seen ketamine almost instantly help someone with brutal depression so I absolutely believe this may well be a very good thing which can quickly improve the lives of people who suffer treatment resistant depression. But I'm so tired of this angel/devil dichotomy. You see it with amphetamines, you saw it with pot, and now we see it with ketamine.
(And yes, $5000-$6000 a pop is bullshit. Stuff is dirt cheap).
posted by Justinian at 4:51 PM on March 6, 2019 [85 favorites]
I've seen ketamine almost instantly help someone with brutal depression so I absolutely believe this may well be a very good thing which can quickly improve the lives of people who suffer treatment resistant depression. But I'm so tired of this angel/devil dichotomy. You see it with amphetamines, you saw it with pot, and now we see it with ketamine.
(And yes, $5000-$6000 a pop is bullshit. Stuff is dirt cheap).
posted by Justinian at 4:51 PM on March 6, 2019 [85 favorites]
The cost for a one-month course of treatment will be between $4,720 and $6,785...
And it’s all but guaranteed no insurer is going to add it to their approved formulary for many years to come.
While I approve any advancement in depression treatment, I can’t help feeling just a bit jaundiced about this. Regular old generic ketamine has been showing great promise. But, along comes a weaker-but-patented version and it’s headlines galore. Twas ever thus, I suppose. I just hope this doesn’t slam the door on further use/study of good old regular ketamine.
posted by Thorzdad at 4:52 PM on March 6, 2019 [29 favorites]
And it’s all but guaranteed no insurer is going to add it to their approved formulary for many years to come.
While I approve any advancement in depression treatment, I can’t help feeling just a bit jaundiced about this. Regular old generic ketamine has been showing great promise. But, along comes a weaker-but-patented version and it’s headlines galore. Twas ever thus, I suppose. I just hope this doesn’t slam the door on further use/study of good old regular ketamine.
posted by Thorzdad at 4:52 PM on March 6, 2019 [29 favorites]
Lol did they literally just fuck with ketamine a little bit so they could patent it and make it more expensive?
Hahahaha
Hahah
Ha
*menacing Gritty skate-by*
posted by schadenfrau at 4:53 PM on March 6, 2019 [136 favorites]
Hahahaha
Hahah
Ha
*menacing Gritty skate-by*
posted by schadenfrau at 4:53 PM on March 6, 2019 [136 favorites]
That's what they did, yes.
posted by Justinian at 4:54 PM on March 6, 2019 [10 favorites]
posted by Justinian at 4:54 PM on March 6, 2019 [10 favorites]
... Lol you beat me to it
[Side note I’d suggest people interested in ketamine-approaching treatments for depression look into ethanol extracts of the 800 year old Chinese herbal combination known as Yue Ju Wan (aka Escape From Restraint)
posted by Auden at 4:55 PM on March 6, 2019 [18 favorites]
[Side note I’d suggest people interested in ketamine-approaching treatments for depression look into ethanol extracts of the 800 year old Chinese herbal combination known as Yue Ju Wan (aka Escape From Restraint)
posted by Auden at 4:55 PM on March 6, 2019 [18 favorites]
By making us rich, you may experience relief for your symptoms of depression. We know we will! Snort, cackle, ha ha ha, kaching! There there hum? Big brother pharma making the street, profitable and legal, so we can bilk medicare, medicaid, and insurance plans. Oh in case they won't buy this, you will.
posted by Oyéah at 5:00 PM on March 6, 2019 [4 favorites]
posted by Oyéah at 5:00 PM on March 6, 2019 [4 favorites]
Oh yeah, and you will still be taking your old meds too.
posted by Oyéah at 5:02 PM on March 6, 2019 [1 favorite]
posted by Oyéah at 5:02 PM on March 6, 2019 [1 favorite]
There are plenty of unpatented ketamine analogues already available if you know where to look that work just as well. I, uh, heard...
Fresno 4ever
posted by downtohisturtles at 5:02 PM on March 6, 2019 [12 favorites]
Fresno 4ever
posted by downtohisturtles at 5:02 PM on March 6, 2019 [12 favorites]
I've been prescribed intranasal ketamine. It cost me $125 for at least a months supply (I could have stretched it to two probably given my general tendencies with psych drugs). I opted not to take it and am on a different drug that has similar properties to ketamine (another glutamatergic agonist) and it's been instrumental for my mental health. There are also lozenges that can be formulated that work super well for depression, from self reports I've heard.
I'm really upset that this is going to be so expensive. Its cousin been a miracle treatment for me, and it's just inhumane that people who aren't obscenely wealthy have to suffer.
posted by sockermom at 5:13 PM on March 6, 2019 [41 favorites]
I'm really upset that this is going to be so expensive. Its cousin been a miracle treatment for me, and it's just inhumane that people who aren't obscenely wealthy have to suffer.
posted by sockermom at 5:13 PM on March 6, 2019 [41 favorites]
They've known about this effect for, what, 20 years?
posted by Bee'sWing at 5:20 PM on March 6, 2019 [6 favorites]
posted by Bee'sWing at 5:20 PM on March 6, 2019 [6 favorites]
Does the $6000 figure include the labor costs for 16 hours of medical supervision? It would be less unreasonable if that’s the case.
posted by vogon_poet at 5:23 PM on March 6, 2019 [1 favorite]
posted by vogon_poet at 5:23 PM on March 6, 2019 [1 favorite]
They didn't really mess with ketamine at all. Ketamine has two isomers, R, and S. "Normal" ketamine is a 50/50 mix of these two called a racemic mixture. What the experiments have found is that S-ketamine, henceforth called esketamine, is more effective than the racemic mixture because R is mostly just a brake pedal applied to S.
So Spravato, or esketamine, or S-ketamine, is nothing really new.
posted by Revvy at 5:26 PM on March 6, 2019 [21 favorites]
So Spravato, or esketamine, or S-ketamine, is nothing really new.
posted by Revvy at 5:26 PM on March 6, 2019 [21 favorites]
Answered my own question, nope, it’s the wholesale price of the spray itself. Too much! I wonder what will happen when some doctor inevitably starts treating people with illegal regular ketamine.
posted by vogon_poet at 5:28 PM on March 6, 2019 [2 favorites]
posted by vogon_poet at 5:28 PM on March 6, 2019 [2 favorites]
just like how adderall (no wait i think its dexadrine actually) ? is an isomer of racemic methamphetamine.
posted by some loser at 5:33 PM on March 6, 2019
posted by some loser at 5:33 PM on March 6, 2019
what I'm saying is that there seems to be a pattern of patenting the racemic drug first, then patenting the isomer when the original patent runs out, and discontinuing the original, so that more money can be made. Because what is the point of big pharma except to make money?
posted by some loser at 5:36 PM on March 6, 2019 [9 favorites]
posted by some loser at 5:36 PM on March 6, 2019 [9 favorites]
In one monthlong study, those on esketamine performed better statistically than those on placebo, reducing scores on a standard, 60-point depression scale by 21 points, compared to 17 points for placebo.
Annnnd here we potentially see the difference between a statistically significant difference and a clinically significant difference. Improving 4 points more than placebo on a 60-point scale doesn't seem worth the risks, to me. I'd rather you just tell me I'm getting ketamine when it's really just sugar water and take the 17 points of improvement.
yes I know it doesn't work like that
posted by brook horse at 5:39 PM on March 6, 2019 [6 favorites]
Annnnd here we potentially see the difference between a statistically significant difference and a clinically significant difference. Improving 4 points more than placebo on a 60-point scale doesn't seem worth the risks, to me. I'd rather you just tell me I'm getting ketamine when it's really just sugar water and take the 17 points of improvement.
yes I know it doesn't work like that
posted by brook horse at 5:39 PM on March 6, 2019 [6 favorites]
just like how adderall (no wait i think its dexadrine actually) ? is an isomer of racemic methamphetamine.
Both are amphetamine. Dexedrine is the dextro enantiomer while Adderall has both enantiomers. It's desoxyn which is (I believe) racemic methamphetamine. Still, they're all relatively similar despite what propaganda would have you believe.
posted by Justinian at 5:44 PM on March 6, 2019 [4 favorites]
Both are amphetamine. Dexedrine is the dextro enantiomer while Adderall has both enantiomers. It's desoxyn which is (I believe) racemic methamphetamine. Still, they're all relatively similar despite what propaganda would have you believe.
posted by Justinian at 5:44 PM on March 6, 2019 [4 favorites]
Dollars to donuts the commercial for this uses music from The Chemical Brothers. Can't wait until they get around to productizing LSD -- so many possibilities!
posted by RobotVoodooPower at 5:56 PM on March 6, 2019 [1 favorite]
posted by RobotVoodooPower at 5:56 PM on March 6, 2019 [1 favorite]
Spravato??? Spread'em Vato!!!
posted by jim in austin at 6:00 PM on March 6, 2019
posted by jim in austin at 6:00 PM on March 6, 2019
Could Help [for] Millions [of $]
posted by His thoughts were red thoughts at 6:32 PM on March 6, 2019
posted by His thoughts were red thoughts at 6:32 PM on March 6, 2019
The cost for a one-month course of treatment will be between $4,720 and $6,785
Cool. Does it come with another nasal spray for "price shellshock"?
posted by turbid dahlia at 6:33 PM on March 6, 2019 [1 favorite]
Cool. Does it come with another nasal spray for "price shellshock"?
posted by turbid dahlia at 6:33 PM on March 6, 2019 [1 favorite]
The cost for a one-month course of treatment will be between $4,720 and $6,785
Bruh, I know a guy who can hook you up for less.
posted by Damienmce at 6:37 PM on March 6, 2019 [5 favorites]
Bruh, I know a guy who can hook you up for less.
posted by Damienmce at 6:37 PM on March 6, 2019 [5 favorites]
This article from Vice has interesting background: Interview with a Ketamine Chemist
posted by Joe in Australia at 6:44 PM on March 6, 2019 [3 favorites]
posted by Joe in Australia at 6:44 PM on March 6, 2019 [3 favorites]
"Could Help Millions"
Was that a typo, and should it have been "Could Make Millions"?
posted by greenhornet at 6:50 PM on March 6, 2019 [6 favorites]
Was that a typo, and should it have been "Could Make Millions"?
posted by greenhornet at 6:50 PM on March 6, 2019 [6 favorites]
The typo was, Could save millionaires.
posted by entropone at 7:14 PM on March 6, 2019 [6 favorites]
posted by entropone at 7:14 PM on March 6, 2019 [6 favorites]
Hey this could change my life
Just let me sell a kidney
brb
posted by Ray Walston, Luck Dragon at 7:18 PM on March 6, 2019 [5 favorites]
Just let me sell a kidney
brb
posted by Ray Walston, Luck Dragon at 7:18 PM on March 6, 2019 [5 favorites]
According to Wikipedia, Esketamine has been used for medical purposes since 1997.
I'm not that familiar with this part of drug patent law, but it sure seems like we could be seeing a generic variant of this very soon (which could explain the high prices -- if Janssen are only expecting a year or two of exclusivity, they basically have to charge this much to cover the cost of the clinical trials -- an overlooked fucked-up part of the system that makes it almost impossible to justify the cost of approving new uses of existing drugs)
posted by schmod at 7:24 PM on March 6, 2019 [7 favorites]
I'm not that familiar with this part of drug patent law, but it sure seems like we could be seeing a generic variant of this very soon (which could explain the high prices -- if Janssen are only expecting a year or two of exclusivity, they basically have to charge this much to cover the cost of the clinical trials -- an overlooked fucked-up part of the system that makes it almost impossible to justify the cost of approving new uses of existing drugs)
posted by schmod at 7:24 PM on March 6, 2019 [7 favorites]
They didn't really mess with ketamine at all. Ketamine has two isomers, R, and S. "Normal" ketamine is a 50/50 mix of these two called a racemic mixture. What the experiments have found is that S-ketamine, henceforth called esketamine, is more effective than the racemic mixture because R is mostly just a brake pedal applied to S.
Close... but "more effective" is only an unambiguously true statement when it comes to anesthesia. R-ketamine appears to contribute to the psychedelic-type effects, and some studies suggest racemic ketamine (nobody seems to make enantiopure R-ketamine as a pharmaceutical at the moment) is more effective as an anisepressant!
posted by atoxyl at 7:36 PM on March 6, 2019 [3 favorites]
Close... but "more effective" is only an unambiguously true statement when it comes to anesthesia. R-ketamine appears to contribute to the psychedelic-type effects, and some studies suggest racemic ketamine (nobody seems to make enantiopure R-ketamine as a pharmaceutical at the moment) is more effective as an anisepressant!
posted by atoxyl at 7:36 PM on March 6, 2019 [3 favorites]
Enantiopure versions of drugs with marginal medical significance are definitely used for an "easy" patent extension but it's not clear to me whether that's the case here or whether there was some notion it would be easier to get approval for the slightly less intimidating side effect profile of S-ketamine or what exactly. But I don't think it was selected based on extensive evidence that it's more effective for this indication.
posted by atoxyl at 7:40 PM on March 6, 2019 [1 favorite]
posted by atoxyl at 7:40 PM on March 6, 2019 [1 favorite]
The rapid antidysphoric effects of ketamine may be mainly or entirely a side effect of its opioid activity. I'd like to see an rct where, as well as ketamine, one of the arms was just a rapid heroin infusion in non-opioid-habituated people. It would be interesting to see how much acute dysphoria remits quickly after a single bolus of milk of the poppy.
I am similarly mildly skeptical about the expensive postpartum depression infusion treatment, brexanolone. It's highly GABAergic, basically similar to barbiturates or benzodiazepines. An active arm in that head-to-head trial might be a similar 60-hour infusion of Ativan. It would be interesting to see how much different postpartum women might feel after 60 hours of continuous Benzos.
posted by meehawl at 8:28 PM on March 6, 2019 [5 favorites]
I am similarly mildly skeptical about the expensive postpartum depression infusion treatment, brexanolone. It's highly GABAergic, basically similar to barbiturates or benzodiazepines. An active arm in that head-to-head trial might be a similar 60-hour infusion of Ativan. It would be interesting to see how much different postpartum women might feel after 60 hours of continuous Benzos.
posted by meehawl at 8:28 PM on March 6, 2019 [5 favorites]
I wonder whether a 300mg dose of Dextromethorphan would have therapeutic benefits. I've done tripping level doses of dex several times and it's always been a very inwardly focussed trip across some kind of inner landscape, and I would program the trip with music. Coming out of the trip was always a period of disorientation and adjustment which led into a lasting feeling of centeredness which continued for a couple of weeks.
I was doing this recreationally, not as therapy, but I could see doing K or other similar drugs (maybe NOT PCP!) as a way to recenter oneself.
Once upon a time I had steady access to LSD and I would do it every Solar Holiday as a sort of ctrl-alt-del reset for myself. Worked wonderfully while it lasted.
posted by hippybear at 8:47 PM on March 6, 2019 [6 favorites]
I was doing this recreationally, not as therapy, but I could see doing K or other similar drugs (maybe NOT PCP!) as a way to recenter oneself.
Once upon a time I had steady access to LSD and I would do it every Solar Holiday as a sort of ctrl-alt-del reset for myself. Worked wonderfully while it lasted.
posted by hippybear at 8:47 PM on March 6, 2019 [6 favorites]
The rapid antidysphoric effects of ketamine may be mainly or entirely a side effect of its opioid activity. I'd like to see an rct where, as well as ketamine, one of the arms was just a rapid heroin infusion in non-opioid-habituated people. It would be interesting to see how much acute dysphoria remits quickly after a single bolus of
The first thing that came to mind when you said this is that it seems inconsistent with the studies that suggested that R-ketamine is a more effective antidepressant (though it looks like this may have been in animal models of depression) than S-ketamine, since S-ketamine is thought to be a stronger opioid agonist. Looking up more research it looks there is also some evidence that preventing AMPA receptor activation renders ketamine ineffective in animal models of depression. I'm not sure it can be assumed that anything that is blocked by naltrexone works by mu-opioid agonism.
posted by atoxyl at 8:58 PM on March 6, 2019 [1 favorite]
The first thing that came to mind when you said this is that it seems inconsistent with the studies that suggested that R-ketamine is a more effective antidepressant (though it looks like this may have been in animal models of depression) than S-ketamine, since S-ketamine is thought to be a stronger opioid agonist. Looking up more research it looks there is also some evidence that preventing AMPA receptor activation renders ketamine ineffective in animal models of depression. I'm not sure it can be assumed that anything that is blocked by naltrexone works by mu-opioid agonism.
posted by atoxyl at 8:58 PM on March 6, 2019 [1 favorite]
This is great news for those of us in functional countries with proper healthcare who can have new medication subsidised so it's affordable for all who need it.
posted by Merus at 9:35 PM on March 6, 2019 [9 favorites]
posted by Merus at 9:35 PM on March 6, 2019 [9 favorites]
I read the link text on this post, and genuinely thought it was a joke and clicking it would lead to a picture of a balloon.
posted by davejay at 9:44 PM on March 6, 2019 [1 favorite]
posted by davejay at 9:44 PM on March 6, 2019 [1 favorite]
The weird part is that "the Prozac era" isn't all that long. And going back, we're still within living memory of not having any drug treatment for depression. Imiprimine was first introduced in the late 50s.
(Well, I lie. Booze was and is still an off-the-counter treatment for depression for a lot of people.) Hopefully the side-effects of inhaled, exceedingly overpriced special K are better.
posted by fifteen schnitzengruben is my limit at 10:46 PM on March 6, 2019 [4 favorites]
(Well, I lie. Booze was and is still an off-the-counter treatment for depression for a lot of people.) Hopefully the side-effects of inhaled, exceedingly overpriced special K are better.
posted by fifteen schnitzengruben is my limit at 10:46 PM on March 6, 2019 [4 favorites]
I’ve been getting ketamine treatments for nearly three years now. Started with three times a week for two weeks, and now I go every four or five weeks. After having been on Prozac, Lexapro, and just about every other class of antidepressant for 25 years, I had hit rock bottom during a lengthy, brutal withdrawal from klonopin. I had been reading about ketamine for years, and was ready to travel overnight for treatments, because the closest clinic was six hours away. Then a new clinic opened 30 minutes away from where I live.
I had been hoping that ketamine would be a miracle cure for my depression and anxiety, and during the initial course of six treatments in two weeks I felt terrific — like a weight had been lifted, a weight that was such a part of me that I didn’t realize that it could be lifted.
That initial feeling did not last, but since then ketamine has worked for me in a more subtle way. I still suffer from depression and anxiety, and still take Lexapro. Since starting to reduce, and then completely get off of, klonopin, anxiety has at times been almost crippling — extreme fear and existential dread. Ketamine seems to help the most with this — for three weeks or so after each infusion, I’m less anxious. Not free of anxiety, but life is a little easier.
The fourth and (sometimes fifth) week between treatments is a bit tougher, which seems to me to be an indicator that the ketamine treatments work — it does wear off. However, I realize that my reasoning, regarding this as an indicator, may be faulty.
So, in short: ketamine seems to work for me, but it’s not a miracle cure. I’m lucky to be able to afford it (though not easily), and to have an understanding wife who is able (and willing) to drive me to and from my treatments, since you’re not allowed to drive yourself.
The nasal spray should help make the treatment more widely accessible. The clinic I’ve been going to has run through four nurses in three years, and for a while has had to use a temp nurse. During that short time, I developed an appreciation for the skill of inserting an IV. A nasal spray will obviously help in this area. And for me, if insurance covers anything it will be a win.
Also: I tolerate the treatments very well. I enjoy the high and mild hallucinations, and think the time in this state helps me think and cope. (For me it’s like some mushrooms I took a few times in college — much less intense than acid. Often it feels like I’m floating, and music is incredibly rich and vivid, but I never entirely lose a sense of self.) But others experience it differently.
posted by young_simba at 5:05 AM on March 7, 2019 [11 favorites]
I had been hoping that ketamine would be a miracle cure for my depression and anxiety, and during the initial course of six treatments in two weeks I felt terrific — like a weight had been lifted, a weight that was such a part of me that I didn’t realize that it could be lifted.
That initial feeling did not last, but since then ketamine has worked for me in a more subtle way. I still suffer from depression and anxiety, and still take Lexapro. Since starting to reduce, and then completely get off of, klonopin, anxiety has at times been almost crippling — extreme fear and existential dread. Ketamine seems to help the most with this — for three weeks or so after each infusion, I’m less anxious. Not free of anxiety, but life is a little easier.
The fourth and (sometimes fifth) week between treatments is a bit tougher, which seems to me to be an indicator that the ketamine treatments work — it does wear off. However, I realize that my reasoning, regarding this as an indicator, may be faulty.
So, in short: ketamine seems to work for me, but it’s not a miracle cure. I’m lucky to be able to afford it (though not easily), and to have an understanding wife who is able (and willing) to drive me to and from my treatments, since you’re not allowed to drive yourself.
The nasal spray should help make the treatment more widely accessible. The clinic I’ve been going to has run through four nurses in three years, and for a while has had to use a temp nurse. During that short time, I developed an appreciation for the skill of inserting an IV. A nasal spray will obviously help in this area. And for me, if insurance covers anything it will be a win.
Also: I tolerate the treatments very well. I enjoy the high and mild hallucinations, and think the time in this state helps me think and cope. (For me it’s like some mushrooms I took a few times in college — much less intense than acid. Often it feels like I’m floating, and music is incredibly rich and vivid, but I never entirely lose a sense of self.) But others experience it differently.
posted by young_simba at 5:05 AM on March 7, 2019 [11 favorites]
Damn. This could've really helped me.
posted by IShouldBeStudyingRightNow at 5:11 AM on March 7, 2019
posted by IShouldBeStudyingRightNow at 5:11 AM on March 7, 2019
Fucking pharmaceutical companies. Those fuckers are all going to hell.
posted by corvikate at 5:37 AM on March 7, 2019 [3 favorites]
posted by corvikate at 5:37 AM on March 7, 2019 [3 favorites]
I've been receiving ketamine infusions for my depression fairly consistently over the past two years, and they've saved my life and given me quality periods of happiness and productivity. But like young_simba, it's not a cure all and can be very hit or miss on how much relief I get (if any) post infusion. That's remarkably frustrating, but after dealing with depression since grade school and enduring countless meds and combinations, hospitalizations, and ECT, it's been a godsend. I also have a supplementary ketamine nasal spray which is mildly helpful for anxiety attacks or a breakthrough migraine (also kept at bay by the infusions), but it's mostly worthless to me on its own.
I do think that the dissociative and hallucinagenic aspects of the treatment are vastly underestimated. I have zero idea what, if anything, is going on with the actual action of ketamine on my brain, but the infusion experience has been remarkable. I have ongoing problems with generalized anxiety largely from long-standing complicated grief and existential fears. And I cannot express the clarity and peace I've experienced thanks to the ketamine. And yeah, it comes back and I have a hard time post-infusion understanding how it all made sense, but I have a new sense of calm and faith that I'm safe and there's a logical unity to everything. My hope is that this part of the treatment is embraced, not suppressed or approached as a problem that needs to be solved. I can totally understand where it is scary to some people (I still remember repeatedly asking my husband if I was dead during my first infusion). But I think if accompanied with adequate preparation beforehand and an ability to process it afterwards if necessary, it could offer some essential intangibles that severely depressed people desperately need.
And to that end (among other reasons), I'm skeptical of the hype surrounding esketamine. But although I have zero interest in switching, I hope it does give many suffering relief and leads to broader studies of Ketamine and hallucinagenics. And in the process, I hope the stigma around those drugs comes down so people can actually benefit from these types of transformative experiences.
posted by Allie Katamari at 6:29 AM on March 7, 2019 [9 favorites]
I do think that the dissociative and hallucinagenic aspects of the treatment are vastly underestimated. I have zero idea what, if anything, is going on with the actual action of ketamine on my brain, but the infusion experience has been remarkable. I have ongoing problems with generalized anxiety largely from long-standing complicated grief and existential fears. And I cannot express the clarity and peace I've experienced thanks to the ketamine. And yeah, it comes back and I have a hard time post-infusion understanding how it all made sense, but I have a new sense of calm and faith that I'm safe and there's a logical unity to everything. My hope is that this part of the treatment is embraced, not suppressed or approached as a problem that needs to be solved. I can totally understand where it is scary to some people (I still remember repeatedly asking my husband if I was dead during my first infusion). But I think if accompanied with adequate preparation beforehand and an ability to process it afterwards if necessary, it could offer some essential intangibles that severely depressed people desperately need.
And to that end (among other reasons), I'm skeptical of the hype surrounding esketamine. But although I have zero interest in switching, I hope it does give many suffering relief and leads to broader studies of Ketamine and hallucinagenics. And in the process, I hope the stigma around those drugs comes down so people can actually benefit from these types of transformative experiences.
posted by Allie Katamari at 6:29 AM on March 7, 2019 [9 favorites]
I recently switched to a mood stabilizer (for depression) that has been helping tremendously, but I've always been curious about psychedelic drugs for treatment. I had one of the most affirming experiences of my life on LSD many, many years ago and I have probably not felt the same positive self-image since. I hope, before I'm dead, I am able to experience that again, and it wouldn't be terrible if it was medically supervised and repeatable this time.
posted by Sophie1 at 7:02 AM on March 7, 2019 [2 favorites]
posted by Sophie1 at 7:02 AM on March 7, 2019 [2 favorites]
I forget now where I first ran into this the other day, but it included an interview with a Janssen spokesperson that was *immensely* dismissive about the potential for abuse.
I've been around people recreationally ingesting this stuff a few times, and while I'm glad it has some potential benefits, I sure don't see the appeal.
posted by aspersioncast at 7:29 AM on March 7, 2019
I've been around people recreationally ingesting this stuff a few times, and while I'm glad it has some potential benefits, I sure don't see the appeal.
posted by aspersioncast at 7:29 AM on March 7, 2019
The appeal is a relief from depression.
posted by Sophie1 at 7:33 AM on March 7, 2019 [7 favorites]
posted by Sophie1 at 7:33 AM on March 7, 2019 [7 favorites]
Disturbingly, in the past couple of days I've been seeing ads in my facebook feed decrying ketamine as "another gateway drug for the opioid crisis" developed by big pharma with nefarious motives, etc. etc. Fb knows that I'm a leftie (which is probably why these ads are getting targeted at me), and I'm perfectly happy to jump on the drug company hate train. At the same time, I make a conscious effort to stay away from the more anti-science woo-woo conspiracy aspects of the left (don't @ me). Regardless of the circumstances around its licensing and marketing, it's a drug that (all the available evidence says) has helped many people with their mental illness and has the potential to help many more. To see it used as a money-making, propaganda-laden football kicked around by inscrutable anonymous rich internet bastards who give zero shits about improving people's lives is incredibly galling.
posted by dendrochronologizer at 7:35 AM on March 7, 2019 [1 favorite]
posted by dendrochronologizer at 7:35 AM on March 7, 2019 [1 favorite]
Depression really should be seen as an emergency. I understand why it isn't -- it's hard to understand if you've never had it, and those in the midst of it sometimes can't summon the ability to ask for help, and of course the stigma. But it's a terrible and life-threatening disease, and having one more treatment is a good thing.
However. It's hard to see this as not a money grab on the part of Pharma -- I haven't read anything that leads me to believe esketamine has a significant benefit over ketamine. And it's frustrating to think that they're always trying to divorce any pleasant effects from what they deem the "important" intended effect (see also, Marinol). Heaven forbid a drug meant to treat something that makes you feel awful gives you a little pleasure on the side. (And that pleasure may even have its own beneficial effect.)
posted by fiercecupcake at 7:51 AM on March 7, 2019 [4 favorites]
However. It's hard to see this as not a money grab on the part of Pharma -- I haven't read anything that leads me to believe esketamine has a significant benefit over ketamine. And it's frustrating to think that they're always trying to divorce any pleasant effects from what they deem the "important" intended effect (see also, Marinol). Heaven forbid a drug meant to treat something that makes you feel awful gives you a little pleasure on the side. (And that pleasure may even have its own beneficial effect.)
posted by fiercecupcake at 7:51 AM on March 7, 2019 [4 favorites]
I've been around people recreationally ingesting this stuff a few times, and while I'm glad it has some potential benefits, I sure don't see the appeal.
posted by aspersioncast at 9:29 AM on March 7 [1 favorite +] [!]
Not staring into the mirror wondering when, not if, I'll kill myself is an appeal. I'm not using hyperbole, I imagine some people here can nod along to that sentence.
But I'm not depressed now and actually got treated for ADD with Adderall which has helped immensely.
posted by OnTheLastCastle at 8:41 AM on March 7, 2019 [2 favorites]
posted by aspersioncast at 9:29 AM on March 7 [1 favorite +] [!]
Not staring into the mirror wondering when, not if, I'll kill myself is an appeal. I'm not using hyperbole, I imagine some people here can nod along to that sentence.
But I'm not depressed now and actually got treated for ADD with Adderall which has helped immensely.
posted by OnTheLastCastle at 8:41 AM on March 7, 2019 [2 favorites]
(I think aspersioncast is saying they don't understand the appeal of recreational use. Which is totally valid. I don't get the appeal of cocaine! Why would I want to be MORE wound up?)
posted by fiercecupcake at 8:46 AM on March 7, 2019
posted by fiercecupcake at 8:46 AM on March 7, 2019
Yes, for me 90% of the appeal is not committing suicide and feeling the relief that 12 drugs didn't give me. It's finally understanding what my friends who SSRIs work for is talking about. It's traveling, doing well in school, going to school at all, living on my own, not having panic attacks, being able to clear out the depression voice in my mind or at least make it get quieter. It's unclenching my jaw, problems turning out to solvable instead of insurmountable, being able to start therapy and internalize it's lessons for the first time ever, wanting to see what happens next.
I don't know. I've been on IV ketamine for almost two years now. I don't like to say "it's not a miracle" because that mostly just makes people who hate it feel good about themselves. And that would also be a lie - for me, it was, and is. This approval is so super weird, but thanks for being a good thread about this that isn't full of bad journalism and judgement and fun mean hot takes. Selfish take of my own: it felt better when people didn't know what this was than when the world is now open to everyone having an opinion. It's very weird. But any weirdness at all is worth whatever people won't die or suffer anymore. That's the only thing that should matter.
Fuck the Vox article though. "Is it really an antidepressant?" Well, I mean, I'm not traveling to Midtown to experience side effects I don't enjoy with a needle stuck in my arm at this very moment for the 100th damn time for something that ISN'T,
(my doctor, probably, with the weariness of a man who has been doing this for 20 years: just lie down and stop arguing with people on the internet)
posted by colorblock sock at 8:59 AM on March 7, 2019 [8 favorites]
I don't know. I've been on IV ketamine for almost two years now. I don't like to say "it's not a miracle" because that mostly just makes people who hate it feel good about themselves. And that would also be a lie - for me, it was, and is. This approval is so super weird, but thanks for being a good thread about this that isn't full of bad journalism and judgement and fun mean hot takes. Selfish take of my own: it felt better when people didn't know what this was than when the world is now open to everyone having an opinion. It's very weird. But any weirdness at all is worth whatever people won't die or suffer anymore. That's the only thing that should matter.
Fuck the Vox article though. "Is it really an antidepressant?" Well, I mean, I'm not traveling to Midtown to experience side effects I don't enjoy with a needle stuck in my arm at this very moment for the 100th damn time for something that ISN'T,
(my doctor, probably, with the weariness of a man who has been doing this for 20 years: just lie down and stop arguing with people on the internet)
posted by colorblock sock at 8:59 AM on March 7, 2019 [8 favorites]
Also, I wouldn't be getting ketamine is AskMefi hadn't been so useful when I asked about it! So thank you!
posted by colorblock sock at 9:00 AM on March 7, 2019 [5 favorites]
posted by colorblock sock at 9:00 AM on March 7, 2019 [5 favorites]
Christine Blasey Ford co-authored a study last year which found that the antidepressant effect of ketamine is reduced if you block opioid receptors. IOW, ketamine might work to cheer you up the same way that opioids do, and all of the other stuff it does might just be side effects that make the experience more interesting.
If it turns out to be a bust, that's my guess as to why: We'll find out it works because it's just another opioid, with all the usual problems that brings.
posted by clawsoon at 9:49 AM on March 7, 2019
If it turns out to be a bust, that's my guess as to why: We'll find out it works because it's just another opioid, with all the usual problems that brings.
posted by clawsoon at 9:49 AM on March 7, 2019
It's not "just another opioid," although some synthetic opioids (e.g., methadone) also share similar functions with ketamine and its ilk. It is an NMDA antagonist, which means that it inhibits N-Methyl-D-aspartate receptors. Basically, it tamps down overexcited NMDA receptors in the brain. These type of drugs are not just useful for depression, because NMDA plays a big role in plasticity. They show remarkable promise for Alzheimer's, schizophrenia, and bipolar disorder, in addition to treatment-resistant depression. But you know what? Who cares if it's "just another opioid" or similar? The opioid crisis didn't occur because opioids "bring problems," it occurred because of greed and cover-ups and some really disgusting behavior on the part of the Sackler family.
I, for one, am totally and completely fine with people taking opiates if they need them, because they live with chronic pain. I'm also totally fine with people like me taking NMDA antagonist drugs, like ketamine, so that they don't have to experience unremitting suicidal ideation. It's been illustrative to see others in this thread discuss their similar experiences with ideation, because that is why I started taking an NMDA antagonist as well. For me, it's been a life-changer.
Healthcare should not be a for-profit enterprise. That is the real issue underlying all of this.
posted by sockermom at 10:16 AM on March 7, 2019 [13 favorites]
I, for one, am totally and completely fine with people taking opiates if they need them, because they live with chronic pain. I'm also totally fine with people like me taking NMDA antagonist drugs, like ketamine, so that they don't have to experience unremitting suicidal ideation. It's been illustrative to see others in this thread discuss their similar experiences with ideation, because that is why I started taking an NMDA antagonist as well. For me, it's been a life-changer.
Healthcare should not be a for-profit enterprise. That is the real issue underlying all of this.
posted by sockermom at 10:16 AM on March 7, 2019 [13 favorites]
I don't know much about it other than what I read here, which suggests that researchers are starting to think ("emerging consensus") that NMDA isn't related to the antidepressant effect:
posted by clawsoon at 11:16 AM on March 7, 2019
In 2016, I wrote Ketamine Research In A New Light, which discussed the emerging consensus that, contra existing theory, ketamine’s rapid-acting antidepressant effects had nothing to do with NMDA at all. I discussed some experiments which suggested they might actually be due to a related receptor, AMPA.Take that for whatever it's worth.
The latest development is Attenuation of Antidepressant Effects of Ketamine by Opioid Receptor Antagonism, which finds that the opioid-blocker naltrexone prevents ketamine’s antidepressant effects. Naltrexone does not prevent dissociation or any of the other weird hallucinatory effects of ketamine, which are probably genuinely NMDA-related. This suggests it’s just a coincidence that NMDA antagonism and some secondary antidepressant effect exist in the same drug. If you can prevent an effect from working by blocking the opiate system, a natural assumption is that the effect works on the opiate system, and the authors suggest this is probably true.
posted by clawsoon at 11:16 AM on March 7, 2019
atoxyl: it looks there is also some evidence that preventing AMPA receptor activation renders ketamine ineffective in animal models of depression. I'm not sure it can be assumed that anything that is blocked by naltrexone works by mu-opioid agonism.
AMPA may be involved, but in rat models naltrexone positively modulates AMPA activity in the limbic system.
I'm mainly skeptical of this particular enantiomer of ketamine because of the obvious rent-seeking cost extraction by the patent holder.
I'm also very skeptical of the the whole IV infusion delivery model for ketamine which just seems to be a way to jack up the price and make it look all medical so you can build out these franchises. Ketamine by IM bolus works really well, is more convenient and quicker to set up, and is used routinely in the field in large parts of the US. And it has similar rapid anti-dysphoria effects. But it would be more difficult to justify just giving someone a shot in the arm and telling them to sit down for a bit and then charge them a few thousand dollars. I've no doubt that when the first LSD/ish 5-HT2A agonists get licensed for treatment of psychiatric symptoms, they'll be similarly embedded in some ridiculously expensive IV or managed in-clinic insufflation model.
posted by meehawl at 11:52 AM on March 7, 2019 [3 favorites]
AMPA may be involved, but in rat models naltrexone positively modulates AMPA activity in the limbic system.
I'm mainly skeptical of this particular enantiomer of ketamine because of the obvious rent-seeking cost extraction by the patent holder.
I'm also very skeptical of the the whole IV infusion delivery model for ketamine which just seems to be a way to jack up the price and make it look all medical so you can build out these franchises. Ketamine by IM bolus works really well, is more convenient and quicker to set up, and is used routinely in the field in large parts of the US. And it has similar rapid anti-dysphoria effects. But it would be more difficult to justify just giving someone a shot in the arm and telling them to sit down for a bit and then charge them a few thousand dollars. I've no doubt that when the first LSD/ish 5-HT2A agonists get licensed for treatment of psychiatric symptoms, they'll be similarly embedded in some ridiculously expensive IV or managed in-clinic insufflation model.
posted by meehawl at 11:52 AM on March 7, 2019 [3 favorites]
I think aspersioncast is saying they don't understand the appeal of recreational use.
Yep, not exactly sure why that was taken as an attack on anybody who uses the stuff for mental health reasons.
Just like lots of other drugs that are beneficial to a number of people, including opioids, which are truly miraculous drugs but have zero recreational appeal to me. Or for that matter getting drunk on gin, which I don't think has any legitimate medical benefit other than keeping me from snapping at people all day.
I'm not talking about clinical doses, I'm talking about a bunch of stoners passing around a plate and doing lines of the stuff and then sitting around drooling.
posted by aspersioncast at 12:01 PM on March 7, 2019
Yep, not exactly sure why that was taken as an attack on anybody who uses the stuff for mental health reasons.
Just like lots of other drugs that are beneficial to a number of people, including opioids, which are truly miraculous drugs but have zero recreational appeal to me. Or for that matter getting drunk on gin, which I don't think has any legitimate medical benefit other than keeping me from snapping at people all day.
I'm not talking about clinical doses, I'm talking about a bunch of stoners passing around a plate and doing lines of the stuff and then sitting around drooling.
posted by aspersioncast at 12:01 PM on March 7, 2019
(Mea Culpa, btw. Not judging and certainly not trying to cause any distress).
posted by aspersioncast at 12:22 PM on March 7, 2019
posted by aspersioncast at 12:22 PM on March 7, 2019
TIL the average mefite did a lot better than me at O-chem.
posted by lkc at 12:30 PM on March 7, 2019 [4 favorites]
posted by lkc at 12:30 PM on March 7, 2019 [4 favorites]
Found an old bluelight thread with some trip reports on S-ket vs. racemic - looks like there's some disagreement as to what the subjective differences are.
I think one argument for esketamine for this use may be that there seems to be a quicker recovery time.
AMPA may be involved, but in rat models naltrexone positively modulates AMPA activity in the limbic system.
Really what I'm getting at is just that I don't think there's enough known about the mechanism behind the effects of ketamine on mood to come to any strong conclusions yet. And I'm not sure it's fair to assume that any mechanism of action that involves opioid receptors at some stage is directly comparable to that of heroin. There are a a lot of interesting experimental uses of naltrexone. And there are some interesting results regarding exactly how ketamine affects the opioid system.
Ketamine by IM bolus works really well, is more convenient and quicker to set up, and is used routinely in the field in large parts of the US. And it has similar rapid anti-dysphoria effects.
I completely agree with that. Ketamine has been used IM for ages - that it can be, safely, is one of its advantages as an anesthetic as I understand it.
posted by atoxyl at 2:49 PM on March 7, 2019 [3 favorites]
I think one argument for esketamine for this use may be that there seems to be a quicker recovery time.
AMPA may be involved, but in rat models naltrexone positively modulates AMPA activity in the limbic system.
Really what I'm getting at is just that I don't think there's enough known about the mechanism behind the effects of ketamine on mood to come to any strong conclusions yet. And I'm not sure it's fair to assume that any mechanism of action that involves opioid receptors at some stage is directly comparable to that of heroin. There are a a lot of interesting experimental uses of naltrexone. And there are some interesting results regarding exactly how ketamine affects the opioid system.
Ketamine by IM bolus works really well, is more convenient and quicker to set up, and is used routinely in the field in large parts of the US. And it has similar rapid anti-dysphoria effects.
I completely agree with that. Ketamine has been used IM for ages - that it can be, safely, is one of its advantages as an anesthetic as I understand it.
posted by atoxyl at 2:49 PM on March 7, 2019 [3 favorites]
*sigh*
a lot of those drooling stoners will be people self-medicating their mental illness, successfully, even if they don't call it that.
I also don't know how you can write about drooling stoners and then follow that up with a "not judging tho" and maintain an internal sense of consistency, so perhaps experiences of this world are indeed varied.
posted by schadenfrau at 2:56 PM on March 7, 2019 [6 favorites]
a lot of those drooling stoners will be people self-medicating their mental illness, successfully, even if they don't call it that.
I also don't know how you can write about drooling stoners and then follow that up with a "not judging tho" and maintain an internal sense of consistency, so perhaps experiences of this world are indeed varied.
posted by schadenfrau at 2:56 PM on March 7, 2019 [6 favorites]
On a related note (doesn't seem big enough to be it's own FPP), Placebos Can Cure Depression. So Why Don’t We Use Them More Often?
Also, where the hell does one GET placebos, anyway?
posted by jenfullmoon at 3:28 PM on March 7, 2019 [1 favorite]
Also, where the hell does one GET placebos, anyway?
posted by jenfullmoon at 3:28 PM on March 7, 2019 [1 favorite]
Also, where the hell does one GET placebos, anyway
Jenfullmoon, I can set you up, but they're quite powerful, so only take them as needed.
posted by Joe in Australia at 4:00 PM on March 7, 2019 [2 favorites]
Jenfullmoon, I can set you up, but they're quite powerful, so only take them as needed.
posted by Joe in Australia at 4:00 PM on March 7, 2019 [2 favorites]
Thanks, Joe, but I think I already have my own stash of those :)
posted by jenfullmoon at 4:53 PM on March 7, 2019
posted by jenfullmoon at 4:53 PM on March 7, 2019
Does the $6000 figure include the labor costs for 16 hours of medical supervision?
No.
"The drugmaker says those figures don't include administration and observation costs." (source)
posted by mrgrimm at 10:03 AM on March 11, 2019
No.
"The drugmaker says those figures don't include administration and observation costs." (source)
posted by mrgrimm at 10:03 AM on March 11, 2019
Also, where the hell does one GET placebos, anyway?
America's Most Promising Drug Contains No Active Ingredients
posted by mrgrimm at 10:05 AM on March 11, 2019
America's Most Promising Drug Contains No Active Ingredients
posted by mrgrimm at 10:05 AM on March 11, 2019
Also, where the hell does one GET placebos, anyway?
posted by jenfullmoon
From your local witch! *points at self, cackles*
No, really, I study and consciously try to use what we know about effective placebos in practicing magick. It's bonkers what the human body can do with a little convincing.
posted by fiercecupcake at 12:16 PM on March 11, 2019 [4 favorites]
posted by jenfullmoon
From your local witch! *points at self, cackles*
No, really, I study and consciously try to use what we know about effective placebos in practicing magick. It's bonkers what the human body can do with a little convincing.
posted by fiercecupcake at 12:16 PM on March 11, 2019 [4 favorites]
Serendipitously, the BPS Research Digest just published an article: The Placebo Effect, Digested – 10 Amazing Findings.
posted by Lexica at 2:49 PM on March 11, 2019
posted by Lexica at 2:49 PM on March 11, 2019
« Older On Time, Everytime | "and yet I wash myself anyway" Newer »
This thread has been archived and is closed to new comments
posted by sammyo at 4:43 PM on March 6, 2019 [3 favorites]