Ketamine therapy to treat depression and anxiety

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This is a (slightly edited) repost of a reply I made in another thread:

For me, at least, Ketamine therapy has worked VERY well.
After two+ decades of being misdiagnosed as bipolar, I started Ketamine IV infusions in late 2021 to treat depression and anxiety, and soon saw results, eventually getting close to full remission.

Downsides:
Ketamine will raise blood pressure, so if you have high blood pressure, you’re not a candidate for it.

Some few may develop an abuse problem with Ketamine.

Abuse and maybe even long-term supervised medical use may lead to bladder problems, including even the need to remove the bladder, and maybe even death.

Some patients experience moderate to severe nausea from the Ketamine, which can often be treated with anti-nausea drugs.

Ketamine infusions are VERY expensive (other options discussed below).
Ketamine itself is VERY cheap, it's the whole "medical process" surrounding it that is expensive...

Positive effects are short-lived, requiring redosing regularly (days, weeks, maybe months in between sessions to maintain a positive result, after initial treatments).

“Set and Setting” are CRUCIAL, and if you aren’t in a living situation where positive set and setting can be achieved, your result is likely to be less successful.

Upsides:
Many patients experience very rapid response to treatment.

Ketamine treatments have statistically proven to dampen or remove suicidal ideation to a remarkable degree, at least for a while.

The ”experience” for at least some patients at the high doses and administration rates often used can be nothing short of mind-blowing, to a degree that cannot be well communicated to those who have not experienced it.

Some patients “just” receive Ketamine, and are on their own to take advantage of the “Neuroplasticity” in the aftermath of a treatment, plus whatever direct effects the drug has on the brain (still not perfectly understood, to be sure!)
Some receive talk therapy after a treatment, some even DURING a treatment.

Ketamine acts on the Glutamate neurotransmitter, which few other psych meds do. This is “new territory”.

When I started Ketamine therapy in late 2021, I was paying out of my meager savings, at $400 per IV infusion session at a clinic in Reno, plus travel expenses for the 370-mile round-trip from the tiny town in rural Northern Nevada in which I live. VERY few types of insurance will cover IV infusions of Ketamine, since it is prescribed “off-label”. So almost all patients are paying out of pocket, as I did.

Initial sessions were closely spaced, three a week, as I recall. The goal is to stretch out the interval to as long as possible. I ended up at weeks between sessions before my $$ ran out, and had lingering positive results for a month or so after the last session.

I started in Ketamine therapy to treat what I was still convinced was bipolar disorder, and the incredible “reboot” of my mind in the first week or two led me to reexamine my long-ignored suspicion that I was Autistic, and after a very deep dive into the subject, I had diagnosed myself, and eventually went through a clinical ASD assessment, resulting in confirmation of my self-assessment.

I had been in a variable state of anxiety and depression for years, at times severe, and woke up each morning with an “Oh, f**k, I’m still alive!” sensation. After some weeks of Ketamine therapy, I ended up waking up each day with an attitude of “Wow, another day to learn new things!”. Quite a change, even in the difficult life situation that I was in at the time.

I gradually fell back into deep depression and anxiety, and sought a cheaper way to continue Ketamine therapy. After a LOT of hassle, I ended up with an online provider who prescribes the sub-lingual form of Ketamine. This is cheaper than IV infusions, but still hundreds of $$ per month, in many cases. Although you are self-administering the Ketamine at home, some providers require you to be “supervised” during each session (live, two-way video session). My first sublingual K provider did this, but they were awful at the basic logistics of providing the prescriptions, and I had to move on to another provider. The second provider was much better at the logistics, and does not require me to do any more than report each session to them, with the time, dose and measured blood pressure before the session. My new prescriber provides access to a small number of video-chat talk therapy sessions with each prescription, but I have not taken advantage of that.

Sub-lingually-administered Ketamine is both clinically and anecdotally (in my case) MUCH less effective in some ways. Full remission is rarely if ever achieved, and duration of effects after a session is shorter, sometimes MUCH shorter. As far as I know, few if any insurance plans will cover sublingual, due to it also being prescribed off-label. A sublingual session is shorter, less intense, and MUCH less consistent than IV infusion.

A third option that IS covered by many insurance plans (including Medicaid) is a nasally-administered, patented “version” of Ketamine , Brand-named “Spravato” (esketamine). This is JUST different enough from the very old drug Ketamine to be patentable, making it worth the while for the maker to have gone through the very expensive clinical trial process, resulting in FDA approval to prescribe “on-label” for depression and other psychiatric issues. Spravato is VERY expensive, thousands of dollars PER session, but because this is hidden behind the insurance wall, most patients care little or nothing about this.

I have not yet tried this method, but I have learned that the clinic in Reno that I went to for IV infusions regained their ability to successfully bill Medicaaid for Spravato, so I may try it at some point, if I can figure out the travel issues.

Spravato is administered in a clinical setting ONLY, as far as I know. The patient inhales the spray dose through the nose, then settles in to “experience” (or talk to a therapist), often with an eye mask on and headphones playing soothing, non-vocal music. Onset is fairly rapid, apparently, but short-lived, so many Ketamine clinics (including the one I went to for IV) will administer a no-fee “booster” dose of ACTUAL Ketamine, intramuscularly, to extend and intensify the session. The clinic openly admits that Spravato sessions, even with the IM “booster”, are not as good as an IV session with real Ketamine.

I don’t think many patients would choose Spravato at all, except for the cost issues.

An IV infusion session goes like this:

You are given a local anesthetic injection around the IV site, to quell any pain from the IV during the session, so you’re not distracted by that.

The IV is placed in a vein, and you settle in for the session, on a comfy chair or couch. You are in a room by yourself, at least in the case of the clinic I went to.
I consented to be monitored on camera, so they can avoid coming into the room as often to monitor me.

The automated machine that provides the flow of the measured dose of Ketamine (heavily diluted in a saline solution) is programmed with the desired feed rate for your body weight and desired intensity of the experience.

At the patient’s option, a “Bolus” of the drug can be provided. In my case, I always do this, so I get 30mg of the total 150mg dose all at once, when the flow is first started. This means that I feel the effects within seconds, smoothing and speeding the entry into session. It takes maybe 10-15 minutes to REALLY “get there”, mentally, then the very precise feed rate keeps the drug level in my blood very stable until the dose is fed. When the end of the feed occurs, “exit” from the experience is almost always pretty smooth, and I am able to walk (carefully) maybe 20 minutes after the feed ends. You feel back to “yourself” maybe three hours after the end of the session. Driving is recommended against for 24 hours after a session.

I can ATTEMPT to describe the actual “in-session-experience” here, if desired, but know that “if ya ain’t been there, ya don’t know!”, and also, individual experiences apparently vary a lot…

I've never heard of Ketamine.

"Ketamine is a dissociative anesthetic used medically for induction and maintenance of anesthesia. It is also used as a treatment for depression, a pain management tool, and as a recreational drug.

Ketamine is a novel compound that was derived from phencyclidine in 1962, in pursuit of a safer anesthetic with fewer hallucinogenic effects."

https://en.wikipedia.org/wiki/Ketamine

I'd love to try ketamine, and I've looked into it, but the availability of a doctor who actually can be arsed and the price of said doctor to be arsed make it difficult.

The speaker in this video is Autistic.

I'm not a fan of hallucinogens.

I voted no, never...but I have heard ketamine is a dissociative, and I don't want that at all. I just think that would freak me out psychedelics I can handle but I have specifically avoided ketamine as I am not interested in dissociative drugs and do not think I would find that thereputic. Like weed and psychedelics for sure like some LSD would be nice, but no
ketamine does not really sound like a drug i'd like to take.

I’d do it.

I've had a psychiatrist suggest it to me, but I declined.

My understanding of Ketamine and other psychedelics is that they allow you to see more clearly, almost a kind of awakening to things you were unaware of but that seem obvious now, to better see and understand yourself and your surroundings, and the larger world. Given that I am going through a personal tragedy and am trying to cope day to day without having it overwhelm me all the time (if I'm lucky only some of the time), the last thing I feel I need is to see my situation more clearly.

It would make sense perhaps for someone whose depression is causing them to have distorted perceptions, since it might clear them up. But I don't think I would want it then either. I don't want to feel open and vulnerable, which would hurt me more than help me. And there isn't anyone I would trust to be with me for the experience, certainly not my psychiatrist, whom I don't trust in the slightest. (And I'm not currently seeing her anymore.)

Also anything with needles is out of the question.

(Sorry, I'm not going to watch the videos.)