[ketathrowaway]

> I would just buy some online and insufflate it. Safer than a needle and just as effective.

Insufflation is only "just as effective" if your goal is to get an intense psychedelic high.

If your goal is a strong antidepressant effect, insufflation is extremely less effective than IV-drip-over-40min. This isn't just my opinion, it's the consensus opinion of ketamine docs across the world.

Insufflation helps you for a few minutes to a few days, IV drip method works for 3-6 weeks.

[mruts]

What biological mechanism would make this the case? Are you saying it has to do with bio-availability? Half-life? Onset? Duration?

What about IM? What about rectal administration? How about sublingual? Are there any papers suggesting that IV is somehow quantitatively different from the aforementioned methods?

My personal experience is that IM, IV, and snorted all made me feel better for maybe a period of 2 weeks. I wasn't necessarily doing a "clinical" dose, whatever that means (maybe 25-75mg of IM or IV and 100-250mg snorted), but the anti-depressant effects all seemed comparable.

A drug crossing the blood-brain barrier is a drug crossing the blood-brain barrier. There should be no difference in administration if we are talking about weeks to months later.

[ketathrowaway]

The effectiveness of ketamine for depression is all about the state it puts your mind in. This is obvious because the drug itself has totally left your body shortly after administration, but the effects can last much longer. In this respect you can think of it as your mind actually healing itself, by being induced to by the ketamine, rather than the ketamine itself impacting your brain's structure. This is different from most conventional psychiatric medicine where the drugs need to build up and remain in your system over very long periods of time to be effective.

Optimizing the dose & duration to get your mind into that state, and for the right amount of time, makes a huge difference in how long the effects last. This is why I prefer using an actual doctor with ketamine depression treatment experience, because they have experience figuring out the right dose & duration for you.

[atomical]

Ketamine is an off label treatment. Many of the practitioners aren't even psychiatrists. There are nurses, anesthesiologists, and pain specialists that do this as a side gig to make money. Your statement reads like we should put a lot of trust in these people when it's actually the opposite. One of the biggest clinics just hired a CEO to expand their business.

The time that the effect lasts is variable. A patient may need an infusion every week. That's $26,000 a year in some cases.

I actually had a doctor tell me that the infusions last 6 months.

[ketathrowaway]

Yes, I am indeed saying you should trust the opinions of people with medical training and experience. Especially doctors that have been treating depression with ketamine for years. Whether or not they're an anesthesiologist or one of the handful of people in the entire world that are both an anesthesiologist and a psychiatrist. (All of my ketamine docs require you to also see a psychiatrist, so that profession is still completely involved for me.)

My previous doctor runs a monthly group meeting where patients get together to discuss their experiences. The vast majority of attendees had positive experiences. So even if you don't trust the doctor, you can trust the living proof of positive outcomes. Sure, you could say that the group self-selects for positive outcomes, but no one claims this treatment is 100% effective, either.

[atomical]

My doctor has been treating ketamine for years and he says that these doctors you are talking about are screwing patients. My doctor is more reputable: A) he has clinical research experience and B) he isn't making any more money than he would on other treatments for depression.

Yes, ketamine docs want you to see a psychiatrist because they don't want to deal with you. It's about the money and having as little responsibility as possible.

A support group to discuss experiences? That sounds like it would encourage a placebo effect.

[ketathrowaway]

Which doctors, exactly, are you referring to when you say "these doctors you are talking about"?

What makes you think both my doctors don't have clinical experience? (I never stated, you never asked. As it turns out, they both do.) You've turned this conversation into a pissing match about whose doctor is best, which is too petty for me, so this will be my last post in response to you.

> Many of the practitioners aren't even psychiatrists

> ketamine docs want you to see a psychiatrist because they don't want to deal with you

So a ketamine doc that isn't a psychiatrist is bad, in your opinion. And also any ketamine doc who realizes that the situation he's treating requires psychiatry for optimum outcome, recognizes they lack said experience, and makes you go to someone with that experience, is also bad? I'm sorry, but your posts reek more of an anecdotal agenda rather than... science. So, I'm done.

[ultraluminous]

I don't have an opinion on the subject in either direction, but I was struck by this sentence -

"ketamine doc who realizes that the situation he's treating requires psychiatry for optimum outcome, recognizes they lack said experience, and makes you go to someone with that experience, is also bad?"

The "ketamine doc" you're advocating people should see to treat their persistent psychological conditions such as PTSD or Depression, has no experience or background in treating any psychiatric/psychological conditions at all (and they get credit for recognizing that!).

Given the above, what service does the "ketamine doc" provide other than selling the ketamine? Like, what difference does it make that they are a doc? The access to an IV drip? The ability to google dosage? I can do renal function work ups with my family physician.

I'm genuinely confused on what value they add beyond a street dealer (assuming identical substance quality, home tests do exist).

Which is to say, a doctor is generally understood to be something beyond a prescription pad and should actually be involved in the treatment he's supposedly providing. Also, I feel like this "treatment" model is highly likely to incentivize profit-maximizing-pill-pushing clinics rather than compassionate therapists.

[ketathrowaway]

The value the ketamine doc (in my case, both docs have been anesthesiologists) provides, that a psychiatrist doesn't, are:

(1) Safely starting an IV on you

(2) Monitor your heart rate, O2, bp levels during the infusion - sometimes people have problems during infusions, I've never had one, but I feel safer having these treatments knowing my vitals are being monitored

(3) Training to know how to solve emergency health issues you may have during the treatment. I personally value this on-the-spot emergency medical knowledge very highly, but if you don't then I can understand why you might question the value. I am completely and utterly helpless during an infusion, if anything bad happens to me, I will be utterly unable to help myself, even a tiny bit.

(3) Access to pure/safe ketamine

I've never known, or heard of, a psychiatrist that will do all this. They very well may exist but not in my area.