Ketamine infusion therapy

joeylittle

Administrator
Well....I'm trying ketamine infusion, for depression. Specifically, treatment-resistant (refractory) Major Depressive Disorder with dysthymia.

About...two years ago, now - my psych prescribed me a ketamine intranasal spray, to give it a go and see if it helped with suicidal ideation and overall mood. It did help some with the former, but not the latter. And, at that time it wasn't practical for me to pursue intravenous ketamine. So - I retained an as-needed option for a ketamine spray when my suicidal thinking got particularly difficult, and that was that.

I went back to TMS, which always helps a bit - but it doesn't really make a big enough dent.

With the pandemic still keeping me rooted to one city - normally I'd travel for work - I've got some time where my local job is a little less intense, and I'm just here in one place....so, psych and I decided it was worth a try.

The protocol is for two infusions per week, three to four weeks. I have them done at a clinic where they can check blood pressure, monitor heart rate, and be there in case I have a bad reaction.

Today was my first day. The doctor administering it was pretty clear about what the goal was, in terms of level of dissociated state - and also, that she would start today by underusing me slightly, to see how it hit me and adjust up from there.

The infusion itself lasts 45 minutes; then, this clinic has you stay in the prone position still running saline for another 10 minutes before you can start getting up again. That apparently helps with the re-connecting to reality part of it. They kept me for another 30 minutes after that, just to watch me and make sure all was well.

Something I didn't know - they do want the patient to get to the point where they are lightly hallucinating and feeling out-of-body. It was interesting...I don't have a lot of experience with hallucinogenics in general. Today, I definitely went out-of-body, lost all sense of time and location, and had the strange feeling that there was some brightness just around the corner of my mostly black with some purple field of vision (this is all done with an eye mask on, so we're talking mental field of vision)...so it was slightly trippy, but not as trippy as it needs to be, so says the Dr.

I wasn't sure how PTSD-me would react, but so far, so good. I did a lot of advance prep, just to get into a leveled out, relaxed frame of mind.

I'll report back on the experience overall...if this ends up even doing a little bit of good, I'll benefit a lot. And once we've gotten through the basic mood disorder protocol, there's a good chance I'll carry on with it for a few more sessions of guided psychotherapy, to work on some of the more difficult parts of that. But - one thing at a time....

Happy to answer questions.
 

siniang

MyPTSD Pro
I'm following someone on social media who recently (as in: a few months ago) had started Ketamine treatment for severe depression and cPTSD and from what I gathered they reporded promising results.

Keeping my fingers crossed for you @joeylittle and interested in the journey (I'm not in need of it, but always very interested in learning and improving my personal knowledge database)
 

Friday

Moderator
It’s amazing how much windows of relief contribute to overall stability.

If I’m understanding correctly the nasal spray is similar to taking a benzo during a panic attack, but the infusion treatment is a regular thing (ie not crisis management) that works on building a foundation / sort of staircase up? Biweekly treatments over a fairly short period of time, to create those windows of relief / to allow someone to move up in their own life onto more secure ground? Or have I got that totally wrong?
 

Mach123

MyPTSD Pro
Hi thanks for posting. Yes I hope you feel better. I feel out of the loop with these new medications and drugs because is am not doing any psychopharmacology.

Suicidal ideation and depression are my biggest fears along with my freeze response which brings it on. So I really hope it works because anything that helps with that is good.

I read magic mushrooms have held some promise also perhaps with medication resistant depression. Maybe that’s something else to consider . I love mushrooms.

Good luck, I’ll be looking forward to hearing more and I hope you get some relief .
 

joeylittle

Administrator
I've been meaning to update this thread for quite some time.

It's hard to know how it's been going for me (with ketamine) because it's still ongoing. And if I've learned anything over the last...10? 12? years of formally accepting and attacking my depression...it's that no-one's journey is ever quite the same. What we're always looking for are the similarities in how things (treatment options) work, while simultaneously trying to be brave enough to acknowledge that everything - every single f*cking medical or mechanical intervention for depression - has the potential to make things worse than they were to start with. Some of them have the potential to truly break a person. Whether it happens directly or indirectly, doesn't matter - you're broken, just the same.

Still: it's impossible to live with this much depression. So, we try.

(To be clear - I'm coming from the perspective of having a co-morbid condition of depression, not depression as a facet of PTSD. I'm certain that's my situation - rather, as certain as one can be, given that there's little hard evidence to go off of, ever. So, of course I could be wrong. God I hate it, I hate it so much that there's not a way to know.)

Anyway. Ketamine.

The clinic I've been going to started with a six-to-eight session protocol, with sessions happening twice a week. Apparently, if you've experienced no benefit whatsoever by the fifth infusion, the recommendation is to discontinue treatment, because if nothing has really changed in an observable way by three weeks in/five treatments, then that sixth one will just be a waste of money for the patient/client.

Ketamine is dosed by weight. There's a slight ramping up period that's recommended, and there's a target 'zone' for the dosage that has been observed as effective.

Where I went, they put a fair amount of energy into making sure you've got the right mindset going into an infusion session, since you're basically dealing with a psychedelic-type drug. You can have a bad trip or a good trip.

Or, as happened to me for the first three infusions - no trip to speak of. It wasn't until the fourth session (and some adjustment to how I was being dosed) that I actually experienced t he level of disassociation that is where a person should get to, in order to be receiving a therapeutic dose. It's interesting to note that so far, research is showing that whether or not the individual has a vivid, out-of-body experience, the re-organizing that is happening on a neurological level will still happen. BUT, there is an observable positive side effect from having a hallucinatory experience, in that those are often going to create some feelings of being at one with the universe, or profound relief or peacefulness or insight.

So, for me - the first three sessions weren't really anything at all. Heart monitor showed I was having some level of reaction, but I wasn't having the kind of dissociative experience that I should have been having.

The third session was when the doc tried giving part of it as a bolus, about five minutes in. I was aware that having that 'push' made a slight bit of difference.

Fourth session, bolus+a more aggressive increase in the dose, and it was definitely a trip. I became very emotional during it, and I was feeling totally OK about that - I remember, it felt like releasing a huge weight from my self, it was very cathartic - but the doc was concerned, I guess, (b/c I have trauma history? not sure). She stopped the infusion and the nurse worked on talking me down. It left me in a not-great place mentally, like I had started some kind of grieving process that was abruptly paused. I still had those feelings that I wanted to let out, but no way to access them. Not sure if that makes sense, that's just what it felt like.

But, in the days following that session, I noticed a definite change in my functionality. I wouldn't describe it as a shift in mood, so much as a shift in outlook. Things - tasks - seemed more possible. It wasn't constant, and I couldn't tell what was making it turn on and off.

Fifth session, repeated the dosing protocol from the fourth session, the experience was medium-vivid, no emotional connection established. Sixth, I think I was in a better headspace, was more relaxed and had a similar experience to the fourth session. I was tired afterwards, but a good kind of tired.

Then we started spacing them out - to figure out how long I was getting the (still positive, but intermittent) effects for. Going from the 6th to the 7th was 10 days, but I felt the positive effects drop around day 6 of that time. And same again for the time following the 8th session.

Since I wasn't getting lasting effects, and the dip back down into depression was pretty distinct (and if I'm being honest, a severe drop; not really what I'd call 'safe') - at the encouragement of my psych, the ketamine doc started prescribing a dose of rapamycin to take before the infusion. There hasn't been much formal research into it yet, but the one study that generated results showed that for people who were partial responders, and who were finding that the effects weren't lasting the way they should - so, people like me - a dose of this immunosuppressant (rapamycin) taken before the infusion would...enhance the ketamine somehow, and make the benefits stronger and more long-lasting.

Next post, I can update about the adventures with rapamycin. It's been interesting. Overall, better. But also a little hard to tell.
 

Movingforward10

MyPTSD Pro
Really interesting to hear @joeylittle.
And how controlled they are with the doses and the support you have (whether it helped or not, if you felt it ended abruptly) through each infusion.

I used ketamine as a street drug to get as wasted as possible. The opposite of theraputic value. Inside I scream when I hear it's used as treatment, given my abuse of it. But, working through that: I am intrigued by your experience. Both in how you felt it accessed feelings for you, and also the dip after.
 
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