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Ketamine Therapy for Depression?

1,729 Views | 21 Replies | Last: 17 hrs ago by KSBogey
Tree Hugger
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AG
I have a family member who has been doing a regular in-office Ketamine treatment. They initially said it was to wean them off of prescription medication for depression (and a litany of other meds) but they have been going twice a week since early this summer and have admitted they haven't stopped taking any of the other medications that they were supposed to be getting away from.

When asked about this by family members, the person in question admitted they are still on all of the other prior meds and that they are essentially just "getting high" twice a week and that they should ask "the doctor" about getting off the other meds. That question was asked of them a few weeks ago but I doubt they have had that conversation with their PCP.

My questions:

  • Shouldn't they have already had a plan to reduce/remove the medications in question?
  • Why are the treatments still going on this frequently after almost six months?
  • How dangerous is it to keep doing the ketamine treatments? just a quick Google search says it can be addictive, albeit they are referring to addiction potential happening in an unsupervised setting.

I'll turn it over to you for thoughts. I started to add a couple of other points but that was bordering on TMI for this conversation. I'm just looking for some insight if anyone has had experience with this.

I don't check this board terribly often these days but will try to chime in if anyone has questions for me.
bigtruckguy3500
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It's entirely possible that he's just getting high.

The questions I would want to know are
1) Is he under the care of a psychiatrist at all?
2) Is the psychiatrist affiliated with the ketamine clinic?
3) Is he currently undergoing cognitive behavioral therapy of some type?
4) Who owns the ketamine clinic, and how did he get approved for ketamine therapy?

To answer your questions
1) If that was the original plan, then yes they should have had a plan in place already. However no guarantee that was the original plan.
2) Depending on the type of clinic, the treatments are either going on because someone thinks there is still benefit, or someone is making money, or both.
3) Ketamine does have some addictive potential, but not as bad as other drugs. Like there is no withdrawal from ketamine like there is from opioids, heroin, alcohol, etc. Probably as addictive as marijuana. I think prolonged use can cause some bladder issues, but not sure if that's with the oral formulation given daily.
KSBogey
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AG
Please have them use this book for guidance as the medical community lacks knowledge on how to safely taper people off psychotropic medications.

https://www.amazon.com/Maudsley-Guidelines-prescribing-Prescribing/dp/111982298X

As for the depression depending on what the person is taking medication wise, might be the culprit. Many of the meds prescribed for anxiety and depression cause those exact same symptoms, whether long term use (benzos in particular cause depression when taken for a long time as they are nervous system depressants), withdrawal type symptoms experienced between doses if the med has a short half life (called interdose withdrawal) , etc.

I'm here if you'd like to discuss further. I have been thru five years of medication debacle bc of an initial misdiagnosis so have learned a lotttt. Mainly it all being a guessing game, and there is no such thing as a a 'chemical imbalance'. That term was developed by big pharma as a way to market the medications to keep patients for life. Hormone issues, thyroid problems, gut problems usually are the root cause, but root cause isn't usually sought out by conventional medical system. And even so, it's in addition to starting someone on a medication which doesn't silo in his it works…. The meds affect the entire body and systems which is also not discussed enough.

The fact there have been no established guidelines in place for people to come off medications has resulted in serious health complications and people dying as a result.
Thankfully this book has finally been written and should be in every drs office that prescribes. It has the 'Maudsley' accreditation which is the standard for the prescribing side, and now the deprescribing exists.

Again, happy to answer any questions as I've been thru 5 yrs of being started on meds, changed, rapidly improperly taken off (chemical brain injury as a result), misdiagnosed based on symptoms arising from medication rollercoaster seemed underlying issues, health diagnoses as a result of the medications themselves that disappeared once off the meds, etc etc.

Happy to discuss anything if it helps navigate the approach tapering off the meds, but please have them follow this book as it is the safest route to go. A further edition will be released in 2025 for additional med types.

combustion artist
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AG
Bogey
I've been on lexapro for over 10 years. I take it for anxiety and just moodiness. It helps me be less volatile in getting angry or upset and calms my reactions. Lately, over the last 9 plus months I have felt really good and have been considering cutting back. Currently on 20 mg. My thought was to drop to 15 for a month and then 10.

Thoughts on this as well as just slowly getting off it altogether? Any thoughts on micro dosing mushrooms?

Thanks in advance
KSBogey
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Hi there…. I have three copies of the book mentioned above. Would it be ok to send you a copy? I've given out about 30 copies to friends and doctors and would love to send you one.
Or at least let me take pictures of the lexapro section and send you.
From what I've learned that is way too fast (usually 6 months for every year you've been on anti depressants, but I know this seems outrageous for people, yet it is the harm reduction and safest route).

Majority of people are rushed off within 6 months by drs and then told it's their underlying condition coming back when they start having symptoms that are withdrawal type (which can be extreme anxiety and mood stuff which feeds into the thoughts, oh ok, I must stay on these and can't come off).

So let me send you the book or we chat over direct message and send you the lexapro info.
Since drug manufacturers don't make pills in smaller doses which obviously doesn't help the weaning off process, marketing ploy (the typical cut in half, in half again and go to zero 'strategy' told by prescribers, is again very dangerous and zero scientific backing…..they just don't know what else to do).

People get scales to shave and weigh their tablets to make reductions( especially important getting to lower doses by a hyperbolic method is the more safe approach than stairs telling with same dose reduction each time. With hyperbolic you make 5-15% reductions of the current dose all the way down not original dose.

I use a compound Pharmacy up in Arlington, Texas, Pharmacy solutions, Nick Miller is the lead pharmacist and does an incredible job (and we've talked through the book and he's trying his staff with it now).
This enables me to make small reductions with syringes for my medication because I need very small reductions to maintain functionality.

They also are usually options to make your own suspension vehicle… I need to see if this is an option for Lexapro itself, but I know a lot of the medication's a suspension vehicle of maple syrup and water mixed together provide a way to keep the cost down and still be able to use a syringe and taper and small reductions. This is usually favored by people more than trying to shave and weigh their pills and then weigh it on a scale, which is more cumbersome(but it becomes a routine and you get used to it if this is what people want to try).
The scales that are used are on Amazon… Here's a link if people are wanting to try this route. (so we all understand, I get zero kickback from the link.)

https://www.amazon.com/Gemini-Digital-Weighing-Silver-GEMINI-20/dp/B0012TDNAM?tag=hydsma-20&source=dsa&hvcampaign=beautym&gbraid=0AAAAA-byXLqAASP0XYFbigK-FDCaiKHjb&gclid=CjwKCAiApY-7BhBjEiwAQMrrEcovZcScT0xaGVuTmy6rDxZRajENiXrQUdC2IucDfXQmVkQU8kAE8BoC_1IQAvD_BwE

It explains hyperbolic in the book (and I get zero kickback from this book, it has saved my life and peoples that I know after a failure of the typical approach by med professionals in the beginning for my ordeal).

Specific medication Facebook groups offer a lot of support and most of all they've done all the research and understand what can and cannot be done when it comes to tapering each medication type. The moderators understand the hyperbolic approach for most of the main support groups as well as the tapering style types,… There are a lot of other small smaller support groups for each medication, that might not have the knowledge and background to understand the tapering options. This is where the maudsley deprescribing book comes in handy now because it's got all the relevant, credible research backed info in one place.

Surviving in antidepressants website is also a very good resource. However, it can be a bit overwhelming for people at times to navigate. But it has all of the relevant info to keep people safe tapering off these medication's.
It also is where the Doctor Who wrote the deep prescribing guidelines, Dr. Mark Horowitz, who went through all of this after being negligently tapered to quickly off his Lexapro, he took for 20 years, where he first gained support and learned all the information that people had gathered over the years. This combine with his background in microbiology, and he's a psychiatrist himself, provided all the framework for the book.

Again these guidelines are to mitigate some of the more severe symptoms and keep people functional in their lives, while tapering and successfully getting off and staying off. Too many people come off quickly and then have rebound symptoms and again as mentioned before, I told this is your underlining condition and they get back on. This yo-yo of on off can also be problematic and it's not talked about enough. More and more coming out and being shared and with all the support groups created, the medical industry is finally starting to realize a lot of what has been done up till now has been very dangerous.

I'm in no way anti-med, but when you start to understand the background, and how these things are marketed, (to keep people taking them), and the lack of guidelines to take people off of them… It's been quite the overwhelming learning experience, with many repercussions affecting my health. Now I'm getting a lot better and sharing all that I've learned along the way the last five years.

I'm giving a lot of details so that if anyone else is reading this thread, it can be helpful!!

Please, if anybody else needs to reach out, I'm always available over direct message.

On the ketamine side, yes, it can be addictive, and just remember that all the stuff doesn't work in isolation of the rest of the body. Too often people think oh it's just affecting what it needs to in my brain and don't understand that there's far reaching implications for anything ingested. And the lack of informed consent and quick dismissal of the info on the drug label… It just leads people to believe these things are a lot safer than they are. So do your research ahead of time if possible and work through all possible options, with the medication, your last resort(which should be how the standard approaches, but we all know that's not the case!!).
KSBogey
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AG
Here are the lexapro pages… I have no idea if this will work bc never posted pics on here before!

The book has all ADs, benzos, gabapentinoids and z drugs (ambien, lunesta etc).






KSBogey
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Here are the lexapro pages… I have no idea if this will work bc never posted pics on here before!

The book has all ADs, benzos, gabapentinoids and z drugs (ambien, lunesta etc).
Page 1
KSBogey
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Page 2 and 3- lexapro deprescribing guidelines (maudsley)


KSBogey
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Pages 4-6 lexapro deprescribing guidelines (maudsley)



KSBogey
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Page 7- lexapro deprescribing guidelines (maudsley)

Tree Hugger
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Thanks for all the feedback, I'm not sure what meds they are on, but based on their history they will take most anything until specifically told not to. They even have a history of getting a scrip for one issue from their PCP and then seeing a "specialist" for the same issue and getting a different scrip and then will proceed to take both, since they were prescribed by a doctor and all that.
BadMoonRisin
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combustion artist said:

Bogey
I've been on lexapro for over 10 years. I take it for anxiety and just moodiness. It helps me be less volatile in getting angry or upset and calms my reactions. Lately, over the last 9 plus months I have felt really good and have been considering cutting back. Currently on 20 mg. My thought was to drop to 15 for a month and then 10.

Thoughts on this as well as just slowly getting off it altogether? Any thoughts on micro dosing mushrooms?

Thanks in advance

lexapro is bad. After a few days of withdrawl if you taper too quickly, you will start to notice what is referred to as "brain zaps" where you feel slight dizziness or tingly feeling when you turn your head too quickly. it sucks ass and it lasts for days...weeks...months. 6 months for me, and I was only on 10mg/day. Definitely go slow when you taper. If they get too bad, just smash the **** out of a pill and take as little as you can for relief so you can continue going on.

The poster above that said that doctors have no idea how to deal with the taper is 100% on the money. These are not safe drugs to be on long-term or get off.

Microdosing mushrooms is pretty good. Not sure if it helps with the withdrawl, but I stopped using my anxiety meds about 2 years ago and do it occasionally. It does not get you high at all, so dont worry about that. for me it just kind of takes the edge off. I can take it before work and it helps me concentrate a little and relax.

https://www.schedule35.co/us/

there's some research into it that suggests that it can rewire your brain neuroplasticity to treat things like PTSD, anxiety, OCD, depression, addiction, etc.
BadMoonRisin
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AG
OP, here's some more info on Ketamine therapy when I asked about it a few months ago. I never ended up pursuing it, but there is good info here:

https://texags.com/forums/48/topics/3446695
Aggie Therapist
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AG
I wouldn't say lexapro is bad for everyone. Works great for me and many people.

I also know that a lot of people who don't like it either. Plus the side effects are too much for some.

Ketamine is great. I work with the Veteran population and have seen it do great things for people.

Once I retire from the Army, I may experiment more with psychedelic and mushrooms hehe
OasisMan
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AG
I am guessing it is the intranasal ketamine??
(rather than oral or IV)
IV ketamine is significantly more effective, but it is usually not covered by insurance


The addictive potential is very low,
The side effect potential is very low,
Goal would be to come off other meds (slowly), but this is not always doable

Just like other meds, ketamine is not a 100% certainty

I think there is a very bright future for Ketamine in the behavioral medicine territory,
From a population standpoint, it is way more effective than SSRIs/others and has fewer side effects


For your family member, y'all could consider pharmacogenomic testing to see if they are on appropriate oral agents
texasaggie2015
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AG
I never did Ketamine- but I will say. I had someone recommend I try magnesium glycinate before trying anything else a while back when I was struggling big time with depression. I take about 480mg per day and my life has completely changed.

Sorry for the unsolicited advice, but I recommend they give it a shot and see if it helps. It really did wonders for me.
BadMoonRisin
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AG
Sorry, i mean the withdrawl from lexapro, not the drug itself.
ZigZagWanderer
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combustion artist said:

Bogey
I've been on lexapro for over 10 years. I take it for anxiety and just moodiness. It helps me be less volatile in getting angry or upset and calms my reactions. Lately, over the last 9 plus months I have felt really good and have been considering cutting back. Currently on 20 mg. My thought was to drop to 15 for a month and then 10.

Thoughts on this as well as just slowly getting off it altogether? Any thoughts on micro dosing mushrooms?

Thanks in advance

I'd certainly recommend that you bring this up with your psychiatrist and do this under their supervision. While some people are more sensitive to discontinuation syndrome from SSRIs, I find that it's pretty rare for people to have a difficult time with a slow taper over a few months. I own the Maudsley's book shown below (primarily for benzo tapers) but feel like the tapering schedule for SSRIs is overly conservative for the vast majority of patients. If people end up having difficulty decreasing doses, a common method is to switch to fluoxetine given its pretty long half life that makes tapering easier. Please don't let the information about people having a hard time coming off scare you if you and your psychiatrist decide tapering is wise; the nocebo effect is a real thing.
KSBogey
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AG
Actually switching to fluoxetine is not recommended these days by knowledgeable medical professionals. The Maudsley Deprescribing manual was developed by a psychiatrist who also has a background in microbiology and one of the top researchers in the world for psychotropic medications.
Many people have a difficult time going at the recommended taper pace by their medical prescribers and are told the problems they encounter months later that it is their 'underlying condition' and they need to go back on the medication.

Surviving antidepressants catalogues the many who have difficulties as does all the groups on Facebook who have encountered hell after being tapered off incorrectly by negligent prescribers.

The medication doesn't care if you think it's too long to taper….. the receptor occupancy is still significant for most of these mediations at lower doses. So slowing down at lower doses is the safest way to prevent more severe issues. Ie not jumping off at the smallest tablet dose bc that still Has very high receptor occupancies, yet most med prescribers don't realize you can go lower than tablet values. It just requires getting a liquid compound or making own suspensions as detailed out in the Maudsley book.

Where most medication injuries happen is from jumping off too high and negligent advising of taper speed….. and once that happens , you can't just go back and try again.
It's better to be cautious on the speed and stay highly functional than to come off in a couple months and risk being debilitated for months to years.

And no this isn't a fear thing, it's a studied researched back guidelines for a reason. And how I know- had to become an expert in this navigating hell the last 5 years with this stuff bc none of 30+, drs understood it.

If you were on them and came off in a few months, you're very lucky. (If you were only on a few months then maybe the short use helped).

The more you know, ie informed consent which very few people get these days, is critical.
Max Power
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Tree Hugger said:

My questions:

  • Shouldn't they have already had a plan to reduce/remove the medications in question?
  • Why are the treatments still going on this frequently after almost six months?
  • How dangerous is it to keep doing the ketamine treatments? just a quick Google search says it can be addictive, albeit they are referring to addiction potential happening in an unsupervised setting.

I'll turn it over to you for thoughts. I started to add a couple of other points but that was bordering on TMI for this conversation. I'm just looking for some insight if anyone has had experience with this.

I don't check this board terribly often these days but will try to chime in if anyone has questions for me.
So I recently posted on another Ketamine thread as I had my first session recently and my second session was just two days ago. I don't know about the first question. In terms of going six months that appears to be excessive based on my research, but I'm no doctor. Though if they're going into a doctor's office that's as legitimate as it can be. In terms of danger the only medications they've told me to stay away from on the days of treatment were things like cannabis and benzodiazepines, amongst others, but they said my antidepressant and anti-anxiety medication was fine to take. I haven't experienced what I would call any addictive side effects, but everyone is different in terms of what their brain can be addictive toward and I've never had addiction issues with drugs or alcohol.

I will also say that though I've only had 2 sessions they were both very different experiences. When you have a Ketamine session you're supposed to go into it with a level of mental intention, not just take a ride and see where it goes. The first time it was very abstract and emotional as I went in searching for joyful experiences in my life. The second time was much different and more of an analytical experience because I was thinking about sources of my anxiety. I felt more "high" the first time even though the second time I was on a higher dose of medication. Your brain is receptive to the pre-work you put into the experience, at least it has been for me. The best way to put it is your brain and body are having different experiences and it's not a purely euphoric experience either, so that might be why I'm not experiencing it in a way that makes me want to go back the next day.

My gut feeling is that your family member is using the drug as an escape and that's not how you get the most out of it...but I'm not trying to be judgemental of a person I know nothing about. I have very limited experience only having done this twice over the last week, and in speaking with the physician, the way to get the most out of it is to go in with intention, but not expectations. If your family member goes in to get "high" that's all they'll likely get out of it until they change that mindset.
ZigZagWanderer
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KSBogey said:

Actually switching to fluoxetine is not recommended these days by knowledgeable medical professionals. The Maudsley Deprescribing manual was developed by a psychiatrist who also has a background in microbiology and one of the top researchers in the world for psychotropic medications.
Many people have a difficult time going at the recommended taper pace by their medical prescribers and are told the problems they encounter months later that it is their 'underlying condition' and they need to go back on the medication.

Surviving antidepressants catalogues the many who have difficulties as does all the groups on Facebook who have encountered hell after being tapered off incorrectly by negligent prescribers.

The medication doesn't care if you think it's too long to taper….. the receptor occupancy is still significant for most of these mediations at lower doses. So slowing down at lower doses is the safest way to prevent more severe issues. Ie not jumping off at the smallest tablet dose bc that still Has very high receptor occupancies, yet most med prescribers don't realize you can go lower than tablet values. It just requires getting a liquid compound or making own suspensions as detailed out in the Maudsley book.

Where most medication injuries happen is from jumping off too high and negligent advising of taper speed….. and once that happens , you can't just go back and try again.
It's better to be cautious on the speed and stay highly functional than to come off in a couple months and risk being debilitated for months to years.

And no this isn't a fear thing, it's a studied researched back guidelines for a reason. And how I know- had to become an expert in this navigating hell the last 5 years with this stuff bc none of 30+, drs understood it.

If you were on them and came off in a few months, you're very lucky. (If you were only on a few months then maybe the short use helped).

The more you know, ie informed consent which very few people get these days, is critical.
I'm speaking from both personal experience from being on/stopping an antidepressant as well as being an ivy league trained psychiatrist who has started and stopped these medications on many, many patients. These taper schedules for SRIs have a use in very specific situations but are unnecessary for the great majority of people on these medications. I'm sorry that you had a difficult time coming off of an SRI, but it's not the typical experience of people.
KSBogey
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AG
You can have all the experience you want, it doesn't change someone not reacting well to being tapered too quickly. And once that's happened there isn't a switch you can flip to say oh wait.
I got severe life threatening akathisia bc my psychiatrist tapered me too quickly off of 3 months of Zoloft and she's one of the top psychiatrists in Texas.

You can have all the education in the world and been on the meds on and off yourself….. no single person can predict what will be too fast for someone's body. There is no way to know and once you've induced akathisia which is a hell no one should ever have to experience, it's a hell of a road and more likely to develop it again with further medications.

Again, no amount of training, experience, or brilliance can make you knowledgeable to predict how someone will do coming off a medication bc it's all individualized and a guessing game, which you should know given your background.

I'd be curious how you taper off your patients especially when the lowest available manufactured dose tablets are way too high to come off of CT (cold turkey). What do you recommend your patients do?

Also swapping to Prozac can induce akathisia any single time you have a patient crossover- also would be curious what steps you take to
crossover or do you direct swap over?

Do you use compounded (PCAA accredited) meds? My psych too in houston didn't even know compounding psychotropic meds could be done…. Again one of the top in Tx with 30yrs 'experience.'

I just ask you consider that starting a taper off slower and like what's recommend in the Maudsley guidelines, not CT people off the smallest available dose and realizing you have zero way of knowing how someone will respond getting on or off the meds you prescribe, is critical in not harming patients. (And there are way more out there that even know that's why they are sickly or can't get off the meds thinking it is underlying issue why they were put on).

Thanks.
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