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Dr. Bob is Robert Hsiung, MD,
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Posted by alchemy on February 6, 2013, at 14:55:35
In reply to Re: Ketamine: it's working » brynb, posted by Emme_V2 on February 6, 2013, at 5:54:31
Are infusions more likely to have a more effective response than injections? I know they are suppose to over the nose sprays.
Also, is the agitation and lethargy after the treatment common?
Posted by brynb on February 6, 2013, at 15:22:13
In reply to Re: Ketamine: injections vs infusions, posted by alchemy on February 6, 2013, at 14:55:35
> Are infusions more likely to have a more effective response than injections? I know they are suppose to over the nose sprays.
> Also, is the agitation and lethargy after the treatment common?Hi Alchemy,
My pdoc said that infusions and injections are equally as successful, and that the injections may be even better (he thinks they're better controlled). Both are stronger than the nose sprays.
I'm not sure if agitation is necessarily common, but jrbecker, a poster on this thread, read that it is a likely side effect of ketamine in patients with bipolar. The assistant who monitors me during the treatment told me fatigue afterwards was pretty common.
I don't feel as great today as I had been feeling, but I think I need to remind myself that everyone, even non-depressives, have dips in mood and energy. I just get really nervous as I worry that it's a sign that I'm slipping into the abyss again. As much and as long as I've suffered, I've become more fearful of depressive episodes occurring.
Hope you're doing well. I read you're trying minocycline. Good luck!
-b
Posted by Phillipa on February 6, 2013, at 20:52:43
In reply to Re: Ketamine: injections vs infusions » alchemy, posted by brynb on February 6, 2013, at 15:22:13
Bryn how are you this evening. As you wrote a dip this afternoon? Phillipa
Posted by brynb on February 7, 2013, at 6:50:29
In reply to Re: Ketamine: injections vs infusions » brynb, posted by Phillipa on February 6, 2013, at 20:52:43
> Bryn how are you this evening. As you wrote a dip this afternoon? Phillipa
Thanks for asking, Phillipa. I bounced back and felt better later on. I get nervous if I have a dip in mood as I fear I'm going into a depressive episode again. I think I need to remind myself to live in the moment...
-b
Posted by Phillipa on February 7, 2013, at 20:46:24
In reply to Re: Ketamine: injections vs infusions » Phillipa, posted by brynb on February 7, 2013, at 6:50:29
Bryn more today IM's? Phillipa
Posted by brynb on February 8, 2013, at 5:30:39
In reply to Re: Ketamine: injections vs infusions » brynb, posted by Phillipa on February 7, 2013, at 20:46:24
> Bryn more today IM's? Phillipa
p, yes. followed my the usual fatigue. otherwise, it went well. thanks for asking :).
b
Posted by brynb on February 8, 2013, at 5:43:30
In reply to My Ketamine trial + new pdoc, posted by brynb on January 31, 2013, at 9:48:34
I went for another IM (3 shots) of Ketamine yesterday. Again, it went well. So far, the only side effect I feel immediately is fatigue afterwards. It's really helped my mood. (It lifted me out of a bad depressive episode.)
I still suffer from irritability and cognitive difficulties, but the pdoc told me last night that Ketamine should help irritability, as they've had great success with it in bipolar patients as well as in those with MDD. Hopefully that symptom will resolve, but we'll reevaluate each time.
The plan is to get 2 more rounds of treatment next week, then 1 Ketamine treatment a week for the following 2 weeks, followed by 1 treatment a month thereafter as maintenance.
I've got my fingers and toes crossed. So far, so good,
I'm happy to answer any questions if you're interested in knowing more.
Hope you're all faring well.
-b
Current regimen:
-Ketamine IM injections
-Lexapro 20mg
-Tramadol 50 mg
-Valium 30 mg (20 @ night, 10 during the day)
-Deplin 15mg
Posted by jrbecker76 on February 8, 2013, at 14:52:14
In reply to Moving Forward with Ketamine, posted by brynb on February 8, 2013, at 5:43:30
B-
I'm surprised they plan on stepping you down to a ketamine injection just 1x a month as an eventual maintenance schedule. Is this part of a protocol that they've formulated with their experience with past patients? I assumed they'd at least wait for you to stabilize more on a week to week basis before making that determination. From what I've read, most patients receiving maintenance treatment on a weekly to biweekly schedule. Curious what there experience is with maintenance dosing.
Also, what is the dosage per injection?
I was also wondering about your experience with the benzodiazepines. You mentioned issues with anergia and being reclusive. For me, the benzos made these issues worse. But I found that Valium and Klonopin were bigger offenders when it came to this than Ativan was. Not sure if you have any experience with it but just wanted to throw it out there.
JB
Posted by brynb on February 8, 2013, at 15:10:26
In reply to Re: Moving Forward with Ketamine » brynb, posted by jrbecker76 on February 8, 2013, at 14:52:14
> B-
>
> I'm surprised they plan on stepping you down to a ketamine injection just 1x a month as an eventual maintenance schedule. Is this part of a protocol that they've formulated with their experience with past patients? I assumed they'd at least wait for you to stabilize more on a week to week basis before making that determination. From what I've read, most patients receiving maintenance treatment on a weekly to biweekly schedule. Curious what there experience is with maintenance dosing.
>
> Also, what is the dosage per injection?
>
> I was also wondering about your experience with the benzodiazepines. You mentioned issues with anergia and being reclusive. For me, the benzos made these issues worse. But I found that Valium and Klonopin were bigger offenders when it came to this than Ativan was. Not sure if you have any experience with it but just wanted to throw it out there.
>
> JBHi JB-
I'm not really sure, but I think their protocol has been once the patient is stabilized via Ketamine, maintenance is once or twice a month or every 3 weeks. I'll speak to my doctor more about this next week (I'm going in again on Tuesday). I've reacted positively fairly quickly. It seems I have a high tolerance for it, too. Dosages are based on weight, but at my session yesterday, I had an initial 30 mg, then a 2nd round of 30 mg, and lastly, a 10 mg injection for a total of 70 mg IM. I titrated up to this dose over the past 2 weeks. I'll let you know what they decide to do in terms of number of injections, etc. going forward.
It's costly. At $250 a treatment, it's been $500 a week, but I will say that the pdoc is there to talk to me and answer questions and I'm not charged separately for his time. He doesn't rush me and he listens. My family is paying for it; without them I don't know where I'd be.
As far as anergia, I'm pretty tolerant to benzos, and found Valium to be the best for me; I get a lot of muscular aches and pains and it helps with that, too. The Ketamine treatments render me exhausted afterwards. I'm still having difficulty with cognitive functions and irritability, but I was told to give that time, so I'll reassess in the upcoming weeks. Actually, I wonder if Lexapro is contributing to these symptoms, too. I don't doubt it.
Hope you're doing well,
b
Posted by Starsly on February 8, 2013, at 15:18:37
In reply to Ketamine: it's working, posted by brynb on February 5, 2013, at 18:08:31
Hi Bryn, I'm very glad it's working for you. It's very hard for it not to work especially at first. I'm just hoping that it's able to work for you long term.
I have been on Ketamine for a while & you must be responding if you feel better for more than a few hours after the injections. Sometimes ketamine tolerance does happen so you may need it more often(in my case, I still got about 2 years where it was pretty effective), but I really hope that it doesn't happen for you.
Posted by brynb on February 8, 2013, at 16:54:51
In reply to Re: Ketamine: it's working, posted by Starsly on February 8, 2013, at 15:18:37
> Hi Bryn, I'm very glad it's working for you. It's very hard for it not to work especially at first. I'm just hoping that it's able to work for you long term.
>
> I have been on Ketamine for a while & you must be responding if you feel better for more than a few hours after the injections. Sometimes ketamine tolerance does happen so you may need it more often(in my case, I still got about 2 years where it was pretty effective), but I really hope that it doesn't happen for you.Hi Starsly,
thanks! I sure hope it doesn't wear off or that I build a tolerance to it.Do you still do Ketamine treatments? are they injections, or do you use the nasal spray? if you use the nasal spray, do you find it effective?
thanks,
b
Posted by Starsly on February 8, 2013, at 22:52:22
In reply to Re: Ketamine: it's working » Starsly, posted by brynb on February 8, 2013, at 16:54:51
Hi, the name is actually meant to be Starskly but I may as well get used to it.
I have used Ketamine for 2-3 years. I still do it & when I first started I used either the spray or the syrup I don't remember. It never completely treated the depression, but it kept me from getting in too bad of shape.
I did infusions after having started the spray, as part of a study, these were very effective but only while I was hooked up to the IV. They used so much of a dose that could cause some people to lose their mind temporarily, but I was kinda prepared.
Anyways, 2-3 years the depression is still bad & it gets worse slowly, but the Ketamine is what is essentially keeping me alive. The problem has been that the tolerance has slowly crept up & it's not enough to treat it anymore. Outwardly, I look pretty good so most people don't even get the depression thing. The doctor I'm going to says Im the highest dose of I think 30+ patients on it, so I may be an exception.
I would imagine it would work well for you maybe as maintenance between infusions. But if you don't need it just keep doing the shots/infusions. I don't want to scare ya! I'm happy that your doing well, but even if it does wear off you should get at least 2 or 3 years out of it because I usually require way more of a drug than the average person.
Posted by brynb on February 9, 2013, at 13:01:01
In reply to Re: Ketamine: it's working, posted by Starsly on February 8, 2013, at 22:52:22
> Hi, the name is actually meant to be Starskly but I may as well get used to it.
Hi Starskly,
> I have used Ketamine for 2-3 years. I still do it & when I first started I used either the spray or the syrup I don't remember. It never completely treated the depression, but it kept me from getting in too bad of shape.
>
> I did infusions after having started the spray, as part of a study, these were very effective but only while I was hooked up to the IV. They used so much of a dose that could cause some people to lose their mind temporarily, but I was kinda prepared.
>I do the IM injections; my current dose is 70 mg per treatment--powerful! They told me it's more controllable than IV. We haven't breached the topic of the nasal spray yet, but I know it's not nearly as strong.
> Anyways, 2-3 years the depression is still bad & it gets worse slowly, but the Ketamine is what is essentially keeping me alive. The problem has been that the tolerance has slowly crept up & it's not enough to treat it anymore. Outwardly, I look pretty good so most people don't even get the depression thing. The doctor I'm going to says Im the highest dose of I think 30+ patients on it, so I may be an exception.
>
> I would imagine it would work well for you maybe as maintenance between infusions. But if you don't need it just keep doing the shots/infusions. I don't want to scare ya! I'm happy that your doing well, but even if it does wear off you should get at least 2 or 3 years out of it because I usually require way more of a drug than the average person.Thanks for your feedback. I'm glad to hear it lasted a few years; that's longer than anything's ever worked for me.
How are you doing these days? Hope you're well,
-b
Posted by jrbecker76 on February 9, 2013, at 15:16:30
In reply to Re: Ketamine: it's working, posted by Starsly on February 8, 2013, at 22:52:22
> Hi, the name is actually meant to be Starskly but I may as well get used to it.
>
> I have used Ketamine for 2-3 years. I still do it & when I first started I used either the spray or the syrup I don't remember. It never completely treated the depression, but it kept me from getting in too bad of shape.
>
> I did infusions after having started the spray, as part of a study, these were very effective but only while I was hooked up to the IV. They used so much of a dose that could cause some people to lose their mind temporarily, but I was kinda prepared.
>
> Anyways, 2-3 years the depression is still bad & it gets worse slowly, but the Ketamine is what is essentially keeping me alive. The problem has been that the tolerance has slowly crept up & it's not enough to treat it anymore. Outwardly, I look pretty good so most people don't even get the depression thing. The doctor I'm going to says Im the highest dose of I think 30+ patients on it, so I may be an exception.
>
> I would imagine it would work well for you maybe as maintenance between infusions. But if you don't need it just keep doing the shots/infusions. I don't want to scare ya! I'm happy that your doing well, but even if it does wear off you should get at least 2 or 3 years out of it because I usually require way more of a drug than the average person.Hi Starksly,
Thanks for the insight. I'd be interested in knowing more about the infusion trial you participated in. How many infusions over what period of time did you get administered?
I'm assuming the AD effect was rather fleeting given that you said that you only felt relief when the IV was in. Should we interpret that each infusion only provided a few hours of relief for you in most instances? Would be eager to hear more.
In regards to your nasal spray. How often do you dose (e.g., 1-2 x daily)?
What is your out-of-pocket costs for the spray, if you don't mind me asking?
Apart from it antidepressant properties, how would you say that ketamine performs as a anxiolytic?
Did you experience side effects from the infusions (beyond the acute infusion period) and from the spray?
If you had to give a rough ratio of how effective the spray is in comparison to the infusions, can you say how they stacked up for you?
Many thanks for your input.JB
Posted by Starsly on February 13, 2013, at 7:28:35
In reply to Re: Ketamine: it's working » Starsly, posted by jrbecker76 on February 9, 2013, at 15:16:30
Hi Becker, I'll be happy to answer your questions, to the best of my ability. Also, thanks Byrnn for the comment
I cannot believe I misspelled it again, it's actually Starsky.
Anyways, the infusions took place at least a year after I had already started the spray. It took place over a weekend of 3 days. Each day the dose was increased. The first day I believe was 50mg, the 2nd: 100mg & the 3rd, 200mg.It provided relief within minutes of the IV(which was done with a drip bag, not an IV injection). It wasn't as much of a high, as just a complete absense of pain & the cloud of depression. Then, it got pretty intense(like, out of body, liquid-energy watching the creation of the universe type stuff). I'm not some hippy or anything, just what I experienced.
Anyways, the spray is kind of interesting. The actually part of the Ketamine that I can feel affecting me lasts only maybe 90 minutes. Then of course their are residual effects otherwise the depression would be...bad. It takes me about 250-300mg to have a significant boost in mood now. I get refills once a week & they are roughly $54.00, & they are about 3 grams.
I have no desire to ask the Dr. for more, because my tolerance would just raise in a few months & it would have the exact same effect(but this is my body, it takes massive amounts of anything(except stimulans) to feel any medication or drug). There is a side that wants to, but I know better.
In terms of how effective they are, I would say the infusions are infinitely more effective *if* you can get them frequently enough. However, the problem is, you can't be hooked up to an IV all the time. If they continue to keep peoples mood elevated for days afterwards, I would do the infusions. But given that the spray is cheaper than the infusions, I would try it afterwards & compare(if the option is possible), if the infusions aren't quite doing it.
Hopefully, that answers everything. But more questions are fine
Posted by brynb on February 13, 2013, at 9:17:07
In reply to Re: Ketamine: it's working, posted by Starsly on February 13, 2013, at 7:28:35
Hi-
In response to your email Starsky (lol), my experience was totally different.
I started with my first session being 1 hour of Ketamine IM injections (about 1/2 hour apart). They based my dose on my body weight (110 pounds). I've had a total of about 5-6 treatments within 3 weeks so far and they've increased my dosage each time, as well the number of injections (I'm at 3 shots per treatment now for a total of about 1.5 hours). I have another session tomorrow (they will increase the dose), 2 more next week, and then I have an appointment w/my pdoc 2 weeks from today where we will assess how I'm doing and how to proceed. It's been intense and I've been really motivated to get well.
S, I totally agree w/you about the trippy, euphoric, philosophical experience that it brings on. I'm carefree and happier than ever while in the moment (I pondered my own existence at one point). This "high" is fleeting and I'm fine when I leave the office. The AD effects seem to last for days if not longer, perhaps because I'm getting treated so often, but I admit to becoming really grouchy/irritable and drained *initially* after treatment. I'll need to discuss this with my pdoc, and I'd be interested in the nasal spray in between maintenance treatments, but no word on that yet. If this turns out to not be the right long-term treatment for me, I think TMS is my next step.
I believe you need a decent amount of K treatments in order for it to remain effective. That's been my experience so far.
Hoe you're both well.
-b
Posted by jrbecker76 on February 13, 2013, at 22:11:17
In reply to Re: Ketamine: it's working, posted by Starsly on February 13, 2013, at 7:28:35
> Hi Becker, I'll be happy to answer your questions, to the best of my ability. Also, thanks Byrnn for the comment
>
> I cannot believe I misspelled it again, it's actually Starsky.
>
>
> Anyways, the infusions took place at least a year after I had already started the spray. It took place over a weekend of 3 days. Each day the dose was increased. The first day I believe was 50mg, the 2nd: 100mg & the 3rd, 200mg.
>
> It provided relief within minutes of the IV(which was done with a drip bag, not an IV injection). It wasn't as much of a high, as just a complete absense of pain & the cloud of depression. Then, it got pretty intense(like, out of body, liquid-energy watching the creation of the universe type stuff). I'm not some hippy or anything, just what I experienced.
>
> Anyways, the spray is kind of interesting. The actually part of the Ketamine that I can feel affecting me lasts only maybe 90 minutes. Then of course their are residual effects otherwise the depression would be...bad. It takes me about 250-300mg to have a significant boost in mood now. I get refills once a week & they are roughly $54.00, & they are about 3 grams.
>
> I have no desire to ask the Dr. for more, because my tolerance would just raise in a few months & it would have the exact same effect(but this is my body, it takes massive amounts of anything(except stimulans) to feel any medication or drug). There is a side that wants to, but I know better.
>
> In terms of how effective they are, I would say the infusions are infinitely more effective *if* you can get them frequently enough. However, the problem is, you can't be hooked up to an IV all the time. If they continue to keep peoples mood elevated for days afterwards, I would do the infusions. But given that the spray is cheaper than the infusions, I would try it afterwards & compare(if the option is possible), if the infusions aren't quite doing it.
>
> Hopefully, that answers everything. But more questions are fineStarsky,
Your feedback is really interesting. I do have a few more questions if you don't mind responding.
-So how often do you dose the nasal spray (1x, 2x per day?). The spray bottle you get per week lasts you just the week, correct? As you mentioned, you say you have a high tolerance so perhaps other peoples' mileage will vary, but I am just curious about your own dosing. As an aside, in reading past posts for people who have tried intranasal ketamine, they find it's tough to find the right dose.
-Do you believe you experience any side effects from the ongoing ketamine treatment (aside from acute effects that might occur immediately after administering a dose)? For instance, have you experienced any ongoing cognitive dysfunction, irritability, lethargy as possible SEs?
-Does the ketamine help with anxiety or just with your mood?
-Do you take any other meds as adjunctive treatment?
Thanks for any further input.
JB
Posted by Teresa167 on February 14, 2013, at 21:47:12
In reply to Ketamine: it's working, posted by brynb on February 5, 2013, at 18:08:31
Hi Brynb,
Just a question. Where do you get your injections,
and what's the name of the doctor?teresa
Posted by brynb on February 15, 2013, at 21:22:16
In reply to Re: Ketamine: it's working, posted by Teresa167 on February 14, 2013, at 21:47:12
> Hi Brynb,
>
> Just a question. Where do you get your injections,
> and what's the name of the doctor?
>
> teresaHi Teresa. I get them done wit Dr. Ed Fruitman in New York City.
B
Posted by Phillipa on February 15, 2013, at 21:53:09
In reply to Re: Ketamine: it's working » Teresa167, posted by brynb on February 15, 2013, at 21:22:16
How did yesterday go? Any plans? Phillipa
Posted by brynb on February 16, 2013, at 10:02:26
In reply to Re: Ketamine: it's working » brynb, posted by Phillipa on February 15, 2013, at 21:53:09
> How did yesterday go? Any plans? Phillipa
Hi Phillipa-
The last treatment was good, thanks. I feel very "blah" today, though, which scares me a bit. I'll see how the weekend goes...
Thanks for following up, P.
-b
Posted by Teresa167 on February 16, 2013, at 11:35:09
In reply to Re: Ketamine: it's working » Teresa167, posted by brynb on February 15, 2013, at 21:22:16
> > Hi Brynb,
> >
> > Just a question. Where do you get your injections,
> > and what's the name of the doctor?
> >
> > teresa
>
> Hi Teresa. I get them done wit Dr. Ed Fruitman in New York City.
>
> BHi Brynb,
Thank you so much for that info.
Would you mind to provide the address of the doctor? Is he in private practice?
I'm just too depressed right now to find out how to turn the babble-mail to e-mail you.
How much are the shots, and how many is required?
What is the difference between shots and IV infusion?
I'm doing very bad right now and I have horrible anergic depression.
Ketamine treatment may be the only option for me.
Thank you for your help.Teresa
Posted by brynb on February 16, 2013, at 14:26:28
In reply to Re: Ketamine: it's working/brynb, posted by Teresa167 on February 16, 2013, at 11:35:09
> Hi Brynb,
>
> Thank you so much for that info.
> Would you mind to provide the address of the doctor? Is he in private practice?
> I'm just too depressed right now to find out how to turn the babble-mail to e-mail you.
> How much are the shots, and how many is required?
> What is the difference between shots and IV infusion?
> I'm doing very bad right now and I have horrible anergic depression.
> Ketamine treatment may be the only option for me.
> Thank you for your help.
>
> TeresaNo problem. Sorry you're struggling, it's the worst.
Here's his website: www.trifectahealthnyc.com
Dr. Fruitman is located in Manhattan, but he also has an office in Long Island, NY (Hewlett, I think).
He does TMS as well.
The shots are $250 a session. The requirements vary per individual, but usually, I think it's two sessions per week for a month, then you assess how to proceed.
Good luck and don't give up--hang in there.
-b
Posted by Phillipa on February 16, 2013, at 20:47:19
In reply to Re: Ketamine: it's working » Phillipa, posted by brynb on February 16, 2013, at 10:02:26
Brynn I hope you feel better now? Will you start on any medications now or is it too soon? Did you get out today? P
Posted by Teresa167 on February 17, 2013, at 20:51:35
In reply to Re: Ketamine: it's working/brynb » Teresa167, posted by brynb on February 16, 2013, at 14:26:28
Thank you brynb for the info and the kind words,
Teresa
This is the end of the thread.
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