Ketamine

Physical Effects on taking Ketamine (20mg injected into thigh)

• Heart Rate is unaffected by Ketamine

• Blood Pressure goes up in the first 5-15 minutes after taking Ketamine from about 123/78 to 148/96 and then starts trending back down to normal by the 30 minute mark to normal by the one hour mark.

• Sensation of tightening at back of throat, or as if there is a post nasal drip. Inhaling through nose is harder

• Dissociation from body. Starts immediately and lasts for 20-25 minutes. Highest high around 15-20 minutes. dissipates very quickly withing one munte or so. Feeling as if I am leaving shadow / person trails behind when I walk.

• Medicinal taste in mouth

• Nausea in the first 10 minutes.

• Headache at about 20 minutes. Fades with time

• Corrdination is way off. Stagering around but effect minimised by sitting down. Slight medicinal taste in mouth. Slight sensation of numbness around mouth. Moving around causes a spinning sensation. Coordination mostly back to normal for walking around by 1 hours. Driving takea about 2 hours or more.

Slightly 5% manic for 3-4 days after taking Ketamine. Tend to notice it by quarrelling with people in my mind, but not actually breaking out into any arguments

Depression and taking Ketamine

I tried Ketamine yesterday.

I had been in a depression episode that lasted through all of September, which is a very long episode for me. This is problematical, because while many of the antidepressants have some effect in preventing me from getting depressed, none work to actually get me out of depression.

So there I was, with my parents getting ever more worried about me. I really was doing nothing - staying at home and sitting in front of the computer reading Fark.com and Cracked.com articles all day. That's all I did. All day. Literally.

Well, I fed the dogs too, but they were also upset because for the entire month I took them out walking perhaps three times. They are used to going for walks twice a day.

The Ketamine was a sort of a desperation measure, but there was a bit of method in the decision. Since regular antidepressants don't work while I am depressed, trying one that I had never yet used didn't make sense for me - I figured it would follow the same fairly useless pattern as all of the past ones.

That of course didn't stop my parents from encouraging me to do that - which led to some fairly heated arguments between us when I said no. Meanwhile, Ketamine has been making the news recently.

I did do my homework - Ketamine is not a magic drug, but it is claimed to have one feature that none of the previous drugs had - it alleviates depression within hours. So I figured - "hey look, if I can get a drug that gets me out of depression, I can probably sort the rest out."

Which gets me back to my parents. Amidst the arguments, I said if I was going to try a drug, I want it to be Ketamine. They helped me in my efforts to get some - which is important, since I was not in any position to initiate any action to do that (I was depressed, remember).

Here are the results.

I took 20 mg injected into my thigh. I got high within the first 5 minutes - did I mention that Ketamine is used as a recreational drug. After about an hour, the over the top effects dissipated and left me, well, not depressed. I'd say very slightly manic, but without any of the irritability or coordination issues or muscular tension that usually accompanies mania. So fairly close to normal. And, according to the people around me, I was acting normally.

More to the point, Ketamine is rapidly metabolised, so 12 hours later, the effects should have worn off. However, the depression hasn't returned - I am still feeling normal / functional / able to focus.

So apparently Ketamine does pull one out of depression. Though if I had to describe what happened, I wouldn't say that it alleviated depression - that sounds too smooth. For me, a closer description seems to be that it yanked me by the hair and dragged me out of depression. Yeah, it felt that rough. But hey, I'm currently not acting depressed.

I'm too cynical / weary to think this is a magic drug. Every drug I have used to date has worked to some degree, but not over any period of time. For me, to test Ketamine properly, I will see what happens over the next three months. This is early days.

But yes, although I don't know how long it lasts, Ketamine apparently does get you out of depression immediately.

A few warnings. The effect when you take it is fairly intense. Ketamine is what they call a disassociative - and if you take it for the first few hours you will feel as if you are not quite in your body. If you try it, have someone physically present to keep an eye on you, because the sensation can be unsettling. Set aside at least 4-6 hours of doing nothing when you try it. Do NOT try driving - you WILL get in an accident.

Will follow up on this as it evolves over the next month or two. Meanwhile, got to restart my life. Again. Sigh.

UPDATE: It appears that Ketamine may be pushing my blood pressure way high. I'm currently keeping an eye on this. Meanwhile, I recommend that you check your blood pressure before injecting the Ketamine, checking your blood pressure an hour after taking it, and then every two hours after that.

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Still Not Depressed after taking Ketamine

It's been 11 days since I took the 20 mg of Ketamine. I still haven't gotten depressed yet.

This is exceptional because according to my experiences from the last 15 years, I should have gotten depressed already. More to the point, I've taken no other medication since I took the Ketamine.

Quite frankly, I'm quietly celebrating. If I can take one dose of a medication once every 10-15 days and then have no mood swings for the intervening period, I'd be happy.

The caveat - this is very early days. I won't know until probably February or March 2013 what the deal is.

My blood pressure is back to normal (120/85 or so), so that's good. I will be meeting with my cardiologist next Monday and hopefully I'll get the monitored test done next week so I'll know if the Ketamine is indeed affecting my blood pressure or heart rate negatively. Stay tuned.

With regards to the Ketamine making me manic, my experience to date has been

15 Oct 12: Monday afternoon

I was depressed before taking the Ketamine. For the first hour after taking Ketamine, I was in the dissociative / high state. It's odd, but I did not behave wildly. I was aware and coherent and perhaps a bit talkative. Possibly very mildly manic. When the dissociative effect dissipated after about one hour, I had no depression. The depression wasn't masked or so; all the mood states, attitudes, and behaviours I associate with depression simply were gone.

15 Oct 12: Monday afternoon continued

For the next five hours until I went to sleep for then night, I was perhaps a bit hyper. I'm not sure if I was mildly manic or just plain excited to suddenly not be depressed. All actions were controllable and I did not present as being manic to my parents or brother.

16-18 Oct 12: Tue - Thur afternoon

For the next 3 days, there were no symptoms at all. Not manic or depressed, simply the absence of any mood swings. By Thursday afternoon, I was feeling a bit manic, but to a very low level - perhaps at 5% mania - enough to notice, but low enough not to even bother about.

19-20 Oct 12: Friday - Saturday

The next 2 days, I exhibited the same low level of mania as on Thursday afternoon. I did have to not be irritable, but this was easy to control without medication.

21 Oct 12: Sunday

This one day I got up late. To me that was a depression concern, but I did pretty much everything I wanted to do. So a high function day.

22 Oct 12: Monday

Back to showing no symptoms of either mania or depression. High function, productive day.

23 Oct 12: Tuesday

Had to carry dog to vet, which broke up my schedule and left me very out of sorts and falling into some very depression like habits like eating a good bit of junk food. Bah humbug. But objectively the day itself was productive at a high level.

24-26 Oct 12: Wednesday - Friday

For the last three days I have been getting up a bit late and not feeling like doing much. But once I start moving, the entire day goes well without any mania or depression symptoms.

Today, I was mentioning how I felt on waking up to my housemate and saying how I am worried that it might be the onset of depression. She looked at me and said dryly 'What you describe sounds exactly like how normal people feel on mornings.'

So. Now I know that I describe normal in terms of depression and mania. Geez. I wonder what it might be like to think about life from that viewpoint instead of worrying all the time that I may be about to become a victim of my mood swings.

More to the point, it's been 11 days and I'm still essentially symptomless. It's unheard of for me. Am waiting to see how long it will last.

Also something I wonder about. Ketamine flushes from one's system rapidly. So rapidly that two days after I took it, there should have been essentially none in my body. So if there is no drug within my system, what exactly is keeping me stable?

Curious.

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Ketamine is Complicated

Here's an update about Ketamine.

The good news is that the Ketamine works brilliantly to pull me out of depression - it happens within about an hour if I take the Ketamine in injectable form. The bad news is that my doctor (general practitioner / GP, not psychiatrist) believes that the Ketamine dose I took is causing high blood pressure.

Actually, it's worse than even that. We both are worried that the Ketamine didn't just raise my blood pressure, but it is keeping it in a possibly long term elevated state - even after the drug should have flushed from my body. There is a fear that each time I take the Ketamine again, my blood pressure will ratchet up to an even higher value. Obviously not a good thing.

(My blood pressure figures were 125/89 on 25 Sep 12. I took 20 mg Ketamine injected at 3.50 pm on 15 Oct 12. Blood pressure was 165/112 at 10.30 am on 16 Oct 12, about 20 hours after taking Ketamine. At about 3 pm on 16 Oct 12, my blood pressure was 137/102 and has remained around 137/95 since then to date. Basically it's up and it's not coming down.)

And it's not just the blood pressure that my doctor is worried about. Ketamine potentially causes tachycardia (fast heart rate), so when I take it, I may be putting myself at risk for heart related damage. Between the spiking high blood pressure and the tachycardia, there is some possibility I may give myself a stroke or a heart attack when I take Ketamine.

This is also the additional small detail that men in my family have a well established history of dying from heart attacks. Some in their forties. You know, around my age.

As you can imagine, my doctor has understandably not been keen on me ever taking the Ketamine again.

I, on the other hand, think that Ketamine is the most promising drug I have ever tried for depression. In fact, it's the only drug I have ever tried that has been able to pull me out of depression. So I'm understandably not keen on abandoning Ketamine.

I leave you to imagine the discussion that then ensued between me and my doctor.

We finally hammered out a compromise. My doctor (GP) has said that I have to get an okay from my psychiatrist that I should be allowed to try the Ketamine. And that the next time I take Ketamine, I have to do it under monitored conditions - in a hospital with a doctor supervising. We also agreed that I should get a heart Stress Test check done and to also get our plan of action greenlighted by my cardiologist as well. I also had to agree not to take any more Ketamine until the test was done (grumble).

Setting up meeting with my psychiatrist and my cardiologist is going to take some time. And of course we have to schedule the monitored test as well. I'm not expecting this to be all organised until mid-November.

It might sound as if I am jumping through lots of hoops that my doctor has demanded. But it's not so straightforward. For all my fascination with Ketamine's action on my depression, I'm not at all keen on the increase in my blood pressure. And I think it would be thoroughly ironic if I managed to finally sort out my depression only to have a stroke or something. Checking to see what happens in detail when I take the Ketamine sounds really good to me too.

So both my doctor and myself agree that being safe is the best next step.

Right.

My story so far are the facts, not the thinking behind the facts. My experience with the Ketamine has reminded me how complicated dealing with depression and drugs are, and how difficult it can be to make the best choice on what to do next. In my next post I'll talk more about the dilemma and complications that Ketamine is posing for me, or for anyone taking medications for depression.

Meanwhile, we'll see what happens in mid-November.

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Ketamine and Being High

Ok, the damned stuff is used as a recreational drug too.

What is the high like?

Well, it didn't seem very impressive to me.

Ketamine does create the dissociative state that you will read about. It is hard to describe - my best description is that it is like standing about 6 inches outside your body and inhabiting your body at the same time. You don't lose your ability to perceive things or to think, but it feels as if the world outside is at a remove, as if your body is a marionette you are getting information from and manipulating. You might be slower to interpret what your senses are telling you (so no driving) and your actual response time and coordination might be slow.

It is a curious experience, but if I had to describe it, I'd use the words unsettling or interesting rather than enjoyable.

In fact, if I wanted an enjoyable high, I'd choose a pint of Belgian Chocolate ice cream over the Ketamine.

Or one or two Vodka and Cranberry Juices instead.

In the wider scope, I'd usually shrug my shoulders and say 'The experience wasn't my thing, but hey, if you want to try it...'. However, given the problems I'm having with Ketamine to date, it seems to me that there must be other ways to have fun with less risk.

Jumping Through Hoops / Ketamine

Still trying to get a medically supervised test of Ketamine scheduled. Yeah, in a hospital and all that. Hopefully this will happen in the next two weeks.

Meanwhile I have...

(A) Got Blood Tests done.

My blood sugar is normal, and my lipid profile is ok and in the safe regions, although my LDL levels are too high. My thyroid indicators are non-standard, so my doctor (GP) has asked me to bring in any records that I have.

(B) Meanwhile, at the Psychiatrist

My psychiatrist has been unwilling to approve a prescription for the Ketamine because it has not been cleared by the FDA for use in depression. In fact, since it has not really been used for mood related disorders, my psych has not much experience with the Ketamine and is unwilling even to prescribe it as an 'off label' use.

(C) Got Stress Test done to test Heart function

Yup, I stayed 13 minutes on the treadmill (into stage 4) - not too shabby. Got signed off as no obvious heart condition to worry about.

(D) Then To an Anesthesiologist

Got referred to an anesthesiologist to ask if the Ketamine would be safe. Was told at the dosage I am suggesting, there should be no obvious issues.

(E) Been checking my Blood Pressure at home

Have been testing my blood pressure using a home machine. Blood pressure a bit on the high side (122/84).

(F) Been monitoring my Weight

Am overweight. Need to lose about 18-20 pounds to be at my desired or healthy weight. It has been coming down fairly swiftly over the last 3 weeks.

So reasonably healthy given that I have been more or less sedentary for the last 12 months since about October 2011. But my health could indeed be better and I am taking the correct actions to bring my health indicators in line.

Except for the thyroid function stuff, none of the doctors are particularly concerned about the current status of my health (except the usual lose weight, get more exercise, eat healthy stuff). BUT, none of them have exactly been forward in getting me along the track to getting Ketamine either. I have been the one pushing to have it prescribed for me.

I do understand the doctors' concerns. Since Ketamine really isn't prescribed typically for anything, and on humans is most used an an anesthetic, my doctors don't have much experience with it, and consequently are taking the cautious route. I agree with them and the safety issues are certainly there, but hell... it's a damned nuisance to have to do so much stuff in order to get access to a drug that may work better than anything else I have ever tried for my depression.

Meanwhile, if you are thinking of trying this, expect that you will have to visit your GP, various specialists, psychiatrist, and probably others. Expect that the doctors will be very nice and but cautious about actually prescribing the Ketamine. Expect to do lots of physical tests. Expect this process to last from a few weeks to a few months before you actually get your hands on the Ketamine.

It's a pain in the nennen to do all this, but it's the safe thing. I'm chafing at the slow pace, but I do approve the doctors' caution. I wouldn't ordinarily bother with all this hassle, but Ketamine still is the only drug to ever pull me out of depression. That's worth jumping though all the hoops for.

Ketamine currently Good, but Useless.

So. The Ketamine works very well as an antidepressant for me so far. But my doctors and psychiatrists are unwilling prescribe it to me because it has not been approved for depression, and in fact its ability as an antidepressant is so far from its approved use as an anesthetic that they are not even keen to take a chance and prescribe it as an 'off label' drug.

I understand their position and I really have no wish to possibly get them in trouble. But with no doctor's prescription, I'm stuck.

This is not going as swimmingly as I would like. Not quite sure what my next step will be yet.

Drugs, Quality of Life, and Dilemmas

I'm still kinda gru00mpy about not being able to take the Ketamine. Here's why.

I'm not disagreeing with my doctors - their points on why they aren't keen on my taking it are very good. Ketamine apparently can push up blood pressure and is associated with tachycardia (rapid heart rate). And long term heavy use is associated with bladder infections and damage and possibly liver damage. And it may be addictive.

It should be noted though, that since Ketamine is used primarily as an anesthetic, most people would never be exposed to it more than once or twice in their life. The only long term users are those taking it recreationally. So there's not really a heck of a lot of information on how toxic it might be if taken as a prescribed drug.

I will grant that not knowing the long term effects of a drug is a pretty darned good reason for a doctor to not want to suggest or recommend it it.

So much for why I shouldn't take it. Here's why I should. Ketamine stops my depression in its tracks and my quality of life goes up dramatically. And I'm not talking about the 'poor self image' type issues either - though those are critically important. I'm talking about productivity and health related gains that are unambiguous and easy to measure.

Let's focus on weight. It is generally a good idea to keep one's weight at a healthy figure. My healthy weight is about 150 lbs (68 kg). However, whenever I am depressed, I eat incredible amounts of junk food - sugary stuff and any ready-to-eat food that can be purchased in a bag. In general, whenever I am depressed, my weight goes up and the quality of the food I eat goes down.

If the depression episodes are very close to each other, as they have been for the last year or so, then I don't have time to lose the weight, so I keep on getting heavier and heavier (I can't bring myself to say 'fatter and fatter'). And the weight gain can be impressively fast.

Let's put some information and numbers on that. I was mostly depressed / non-functional for most of September 2012. I also had a major depression episode from the 27 Sep 12 to the 15 Oct 12 during which I did not leave the house except for when I went to buy food. And the food was generally junk food - KFC or Burger King or large pasta dinners from the local pizza shop. Alternatively, dinner could be a party bag of Chex Mix and 2 Sprites. And a family box of Cocoa Krispies could be my breakfast and be finished for lunch. Or, my favourite, a meal could be two bags of microwave popcorn and a Coke or two. During this period, I also ate bags of biscuits and pints of chocolate ice cream. You might notice there is no mention of fruits - that's because there was none. No fresh vegetables either. In short, I was on an extremely high sugar, high salt, low everything else diet, with absolutely no exercise and spending between 12-18 hours a day sitting in front of the computer. For two and a half weeks non-stop.

My weight on the 22 Sep 12 was 168.6 lbs (76.6 kg)

My weight on the 15 Oct 12 was 175.6 lbs (79.8 kg).

That's an increase of 7 lbs in 23 days.

In summary - Being depressed keeps me overweight and unhealthy.

Then, I took the Ketamine on the afternoon of the 15 October 12. My moods stabilised immediately and from the next morning I started eating the way I wanted to instead of being driven by depression related cravings and the depression related inability to focus and control my actions.

When I am not depressed, I eat the way I want to, and how I eat is extremely healthy. The results are equally dramatic...

My weight on the 15 Oct 12 was 175.6 lbs (79.8 kg).

My weight on the 11 Nov 12 was 165.6 lbs (75.3 kg).

That's an decrease of 10 lbs in 27 days.

It gets better. As long as I stay with Ketamine, my depression will stay at bay and my weight would keep decreasing towards my recommended 150 lb weight. And I will lose many of the health risks associated with being nearly 30 pounds (14 kg) overweight.

That's just weight. I haven't started back exercising yet - one thing at a time - but I plan to in early December when my weight drops below 160 lbs. Once this happens, and I stay stable, by the end of December I'll be able to comfortably run 10 miles. My cardiovascular fitness becomes substantially better. So does my flexibility and my strength.

In summary - NOT being depressed keeps me at a healthy weight and in good cardiovascular and general fitness.

That's just one indicator. Since stabilising with Ketamine on the 15 Oct 12, my cholesterol reading has dropped from 182 to 106 and my lipid profile risk factor has dropped from 3.37 to 2.21.

My productivity - and I'm not exhibiting manic signs either - is also doing well. I'm also less tense and more laid back about getting things done generally. Basically, all the indicators of having a satisfied, healthy lifestyle are going up.

So.

Well.

This is a real problem.

I have a drug that apparently works for my depression, but I can't tell if it is dangerous to use it again. How do I decide? Suppose I play it safe and not take it. That's a good decision, right?

Is it? Not taking the drug for depression means that I will still be getting depression episodes. That will also mean that I will be frequently functionally useless and having the poor diet and exercise habits I describe above. So I'm likely to be overweight and unfit and exposed to the health risks of obesity. And since I don't take any of my meds when I am depressed, including the Crestor for cholesterol, not taking the drug for depression increases my risk of heart disease too.

Not taking a somewhat unsafe drug can actually be more unhealthy for me. But I am not certain. While I can recognise what the risks of being depressed are, I don't have accurate information on the potential dangers of Ketamine to assign risk adequately. So I'm not sure what to do next.

By the way, if anyone has useful links on Ketamine risks, please add them in the comments.

Bottom line - Looking at the dangers of the drug in isolation doesn't capture the whole picture. It is necessary to look at how much the drug improves both general health and the overall quality of life too.

note: The dates for gaining weight during depression don't quite match up. My major depression episode was from 27 Sep 12 to the 15 Oct 12. However I was sufficiently unstable before the episode started that the closest weight reading was on the 22 Sep 12.

Well, it's instructive that for the last year, I've been worrying that my trend has been downwards. The standard meds don't work for me. I'll obviously try other stuff, but if the Ketamine doesn't work, I'll probably be trending downward for a few months again.

More that that, as the depression episodes get longer, my expectation is that my weight will continue tracking upwards. I used to average closer to 160 a few years ago - for the last 2 years the average has been closer to 170 with high weights getting to 177.

I can exercise any less because I'm currently not exercising. With depression, my diet will be pretty awful. So, I may have a choice of taking Ketamine and getting high blood pressure or not taking Ketamine and being overweight, high risk for heart attack, and possibly diabetes as well (runs in the family too). And maybe high blood pressure as well, since that might be what is causing the current problem. Do I may be damned if I do and damned if I don't.

If I guessed wrong and my problem is with diet/exercise, then not taking the drug will actually make my blood pressure and general health worse. OK, so I will do the test with the drug in mid-November. That's no so far away, right? But it's far enough away - given my mood cycles, I am definitely going to get depressed during between now and then. But I have things to do between then and now - go to my psychiatrist, get a stress test done, talk with my cardiologist. If I am depressed, I may not be able to leave the house to do these things, in which case I won't be able to have my mid-November test, in which case determining the risk for Ketamine won't happen in which case I won't know whether it's safe to take it.

And it's a bit worse than that. My visit to my psych is to persuade him to give me a prescription for Ketamine. If I am depressed, I won't have the capability to mount a reasoned or passionate reason why this should happen. I am physically less capable when I am depressed, so the Stress Test may not show my normal fitness. I have to persuade my cardiologist to admit me for a monitored test of Ketamine. Same problem with as with psychiatrist in terms of persuasion.

I'm actually having to do this incredible setup where I am asking my father and brother to do backup for me to make sure I arrive at the doctors appointments AND to argue the case why I should have the trial done if I can't do it. That's a hell of request to ask people who don't necessary really understand what is going on. Just by setting it up makes me feel as if I am losing control of my own life.

And it feels like a patch job. And I have a rule that if something becomes too complicated, I'm doing it wrong. This is nearly at that stage. So I have a plan to get me to my mid-November trial. It's not ideal, but it could work. So.., good enough. At least, good enough to last for the next month. But in the meanwhile, I still have blood pressure readings of 135/97 and I'm carrying about 25 pounds too much.

I don't want to take any blood pressure medicine because I'm already on statins for my cholesterol (family related issues) if I am to take Ketamine in the future, then I feel I will be on too many drugs. See note about being too complicated. Meanwhile my blood pressure is borderline too high, so the best way to deal with it is with diet and exercise.

My doctor will tell me so, and in fact I do know how to eat a proper diet and I can set up a proper exercise plan. Fifteen years of this will give you surprisingly good information. But...there is the little problem. If I'm depressed, I won't follow the exercise plan or the exercise plan. I don't care how good it is - it won't happen.

Since I will get depressed from now to mid-Nov, I won't be able to do anything to get my blood pressure under control. But that's only for one month, not to long. Now suppose I have the test in Nov and we find out that the Ketamine IS increasing my blood pressure.

What then? Should I stop taking it? There is a good chance that any differences in physical health indicators was caused by extremely poor diet and exercise habits rather than the Ketamine. But I can't tell for sure. Is the problem the Ketamine or my poor diet/exercise. I don't know. and because of that, it's hard to decide how to move forward.