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OfflineFlyOnTheWall
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The Ketamine Breakthrough for Suicidal Children * 2
    #24508803 - 07/26/17 05:39 AM (6 years, 9 months ago)

https://www.scientificamerican.com/article/the-ketamine-breakthrough-for-suicidal-children/

By Jack Turban on July 18, 2017

Fourteen-year-old Nicole, whose name I changed for her privacy, told her mother every day for years that she wanted to end her own life. Between suicide attempts were more psychiatric hospital visits than she or her mother could count. She refused to get out of bed, shower, or go to school, missing sixty school days in a single year. In one visit with her therapist, she admitted to praying every night that she would not wake up the next morning. After countless psychiatrists and psychotherapists were unable to improve her depression, her mother converted a bathroom cabinet into a locked safe, containing all of the sharp objects and pills in the house. Her parents were certain it was only a matter of time until Nicole killed herself.

Today, a now seventeen-year-old Nicole greets me with a big smile. Her blonde hair is pulled back into a ponytail to reveal her bright blue eyes. She tells me she hasn’t missed a day of school and is preparing for college. Blushing, she lets me know that her first date is coming up, a prom date to be precise. For the first time in years, she is happy and wants to live.

What happened to cause this dramatic change? In December, Nicole started infusions of a psychedelic drug called ketamine. Though she had failed to respond to endless medication trials for her depression (selective serotonin reuptake inhibitors, mirtazapine, topiramate, antipsychotics, and lithium to name just a few), ketamine cleared her depression within hours. The effect lasts about two weeks before she needs a new infusion.

Ketamine is a drug with many identities. For anesthesiologists, it’s a sedative for painful procedures. For partiers, it’s a fun way to hallucinate and have an out-of-body experience. For critics, it’s a dangerous addictive drug that can cause memory problems, bladder disease, and psychosis when abused. In the past few years, it has taken on a new identity: miracle psychiatric drug that works within hours. Its use as a psychiatric medication is relatively new, and it’s possible that regular infusions could cause significant long-term side effects. We currently lack the long-term data to know. Still, the National Institute of Mental Health has called it “the most important breakthrough in antidepressant treatment in decades.”

The ketamine for mental health story goes back as far as the 1980s, when neuroscientists examined the brains of people who had committed suicide. They found that suicide victims had structural abnormalities in a protein called NMDAR, a neurotransmitter receptor that is sprinkled throughout the brain. It also happens to be the receptor to which ketamine binds. Though some animal models suggested that ketamine improved depression in mice, it wasn’t until 2000 that researchers tried giving the drug to adults with depression. Surprisingly, many patients’ depression completely resolved within hours. The quick and dramatic result was unprecedented for an anti-depressant medication.

Since then, physicians have given the drug to thousands of depressed adults, including patients in eight successful clinical trials. But fewer have been willing to infuse the drug into the veins of minors. Yale School of Medicine is an exception, and I recently watched a few adolescents receive the infusions with Yale’s clinical trial team. It was less dramatic to watch than I expected, but the kids were definitely high. There was a lot of giggling involved, and they often said that they felt like time was changing and that their bodies felt ‘funny’ and sometimes numb. Nicole admitted, “I’m not gonna lie. I like the feeling of it.”

Perhaps more dramatic than the trips themselves, which happened in a carefully controlled procedure room with a psychiatrist and anesthesiologist ready to intervene if needed, were the interviews that came after. I could see the weight of depression lifted from these patients within hours. Adolescents who were previously ready to end their own lives became bright and hopeful. Psychiatry has never seen a drug intervention so powerful and fast acting. While most anti-depressants take weeks to work and offer modest improvement, ketamine offers dramatic improvement in less than a day.

Because of early success in adult patients, there has been explosion of ketamine clinical trails for adolescents. Frustrated by a lack of effective treatments for children experiencing severe, debilitating, psychiatric disease, doctors have new clinical trials underway for adolescents with depression, anxiety, obsessive-compulsive disorder, and even a rare autism-like condition called Rett’s syndrome. Dr. Gerard Sanacora at Yale School of Medicine explained it like this: “We know high blood pressure causes all kinds of things: heart attacks, strokes, vision problems, and kidney diseases. We treat all of those with blood pressure pills. Ketamine may be the blood pressure pill of psychiatry — altering basic physiology [of neuronal connections] and having a wide range of beneficial effects.”

But there is also reason to be concerned. Before now, ketamine has only been used as a one-time injection for anesthesia. The FDA approved the drug based on trials where the drug was given just once. For depression, however, it is given every few weeks with an unclear end point. Will repeated administration reveal new risks? Studies in adolescent mice show that ketamine can cause long-term cognitive problems. Ketamine-treated mice can also develop a schizophrenia-like illness, with a pattern of neuron loss in the brain that is similar to schizophrenia. However, it’s important to note that the majority of these studies use mice given ketamine doses equivalent to 10 times that which is given to patients.

Dr. Michael Bloch, Yale child psychiatrist and principal investigator of several controlled trials for ketamine for adolescents, points out that the drug is only used for select patients who have severe mental health problems that have not responded to other medications. The infusions are provided in a clinical trial setting, where doctors collect efficacy data and carefully watch for side effects. For each of his patients, the theoretical risks of ketamine are carefully weighed against the risk of suicide. For Nicole, who seemed likely to die from suicide, the calculus was not difficult.

But not all physicians are treading as cautiously as Dr. Bloch. Doctors of questionable ethics are giving patients large doses to inject themselves at home. Pharmacies are making child-friendly ketamine lollipops and nasal sprays. Will this revolutionary drug be the new thalidomide, creating a new generation of children who experience devastating side effects because doctors get too excited too quickly? Ketamine can be addictive, and its abuse can cause devastating memory problems and a bladder disease that can lead to removal of the bladder. Will we create child addicts, addicted to ketamine candy? Will some of these patients taking ketamine at home suffer from laryngospasm, a rare but potentially lethal complication of ketamine administration that makes it impossible to breathe through the vocal cords?

When I spoke to Dr. Jennifer Dwyer, another researcher on the Yale clinical trial team, her reaction to what is happening outside of academic medicine was strong: “the nightmare is happening already. Ketamine should only be given under careful physician supervision with appropriate monitoring.”

Though Dwyer and Bloch stress that doctors need to be careful, they are also quick to point out the potential promise of this research. Dr. Bloch explains, “Suicide is the second leading cause of death in adolescents. 40% of depressed adolescents don’t respond to first-line treatments. Another half of those don’t respond to multiple trials of medication paired with psychotherapy. Other than electroconvulsive therapy, which carries its own risk of memory problems, doctors have almost no other choice.” Suicidal patients are also at a high risk for suicide after leaving the hospital. Existing anti-depressants like Prozac take weeks to work, while ketamine can take effect in less than 24 hours. This could decrease deaths from suicide after patients leave the hospital.

For Nicole, one of those suicidal teens, everyone involved seems convinced that ketamine saved her life. According to her, her family, and her doctors, the theoretical risk of long-term side effects was less frightening than what might happen in the face of chronic hopelessness and suicidality.

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Offlinefractalgod
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Re: The Ketamine Breakthrough for Suicidal Children [Re: FlyOnTheWall]
    #24509883 - 07/26/17 04:31 PM (6 years, 9 months ago)

Now they're trying to ban all research chemicals, scientists need to be able to study and research. who knows how many different cures and treatments could happen in the next 50 years if scientists are allowed to do trials, I think full legalization is the best choice with common sense regulation not government monopolies.

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Invisibletrvptamine
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Re: The Ketamine Breakthrough for Suicidal Children [Re: fractalgod]
    #24510260 - 07/26/17 07:08 PM (6 years, 9 months ago)

Yes ketamine is the ultimate antidepressant!


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OfflinePsilosopherr
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Re: The Ketamine Breakthrough for Suicidal Children [Re: trvptamine]
    #24510328 - 07/26/17 07:46 PM (6 years, 9 months ago)

very interesting. So they're not getting the healing effects of a profound trip from the sound of it, its strictly a long term shift in brain chemistry?

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InvisibleCookieCrumbsM
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Re: The Ketamine Breakthrough for Suicidal Children [Re: Psilosopherr]
    #24510562 - 07/26/17 09:27 PM (6 years, 9 months ago)

Yeah it's not like LSD or psilocybin trials from what I understand. I suppose it could still be a trip, but it's a relatively light one. And that's probably for the best if that's what works.

I am concerned with doctors getting too excited about it too, it's exactly how miracle drugs get pushed for years and the serious risks are downplayed. Especially when, when doctors get excited, they tend to prescribe recklessly and at high doses.


Little girl with bladder disease and environmental depression? ketamine! old woman developing dementia and kidney disease? ketamine!


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          :dancingbear: Free time is the only time :dancingbear:                    :thatsinteresting:

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InvisibleMush 4 Brains
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Re: The Ketamine Breakthrough for Suicidal Children [Re: CookieCrumbs]
    #24511578 - 07/27/17 11:34 AM (6 years, 9 months ago)

Quote:

Yale School of Medicine is an exception, and I recently watched a few adolescents receive the infusions with Yale’s clinical trial team. It was less dramatic to watch than I expected, but the kids were definitely high. There was a lot of giggling involved, and they often said that they felt like time was changing and that their bodies felt ‘funny’ and sometimes numb. Nicole admitted, “I’m not gonna lie. I like the feeling of it.”




It's funny, god forbid you enjoy the effects of a (controlled/scheduled) medication you're prescribed. You have to hide it otherwise be labeled this or that.

Quote:

CookieCrumbs said:
Yeah it's not like LSD or psilocybin trials from what I understand. I suppose it could still be a trip, but it's a relatively light one. And that's probably for the best if that's what works.

I am concerned with doctors getting too excited about it too, it's exactly how miracle drugs get pushed for years and the serious risks are downplayed. Especially when, when doctors get excited, they tend to prescribe recklessly and at high doses.


Little girl with bladder disease and environmental depression? ketamine! old woman developing dementia and kidney disease? ketamine!



Doctors tend to get excited about medications when they're receiving financial incentives. Then it's the new miracle drug.

I understand your concern however there's a few things to consider. The medical community is scared shitless of prescribing scheduled/controlled substances to patients, especially children. Another thing to consider is that the possible negatives and future medical complications from extended use of ketamine might be worth the risk in severely depressed people.

I mean if you think of depression like a disease such as cancer, something agonizingly painful and deadly, what I'm saying makes sense. Quality of life is often considered more important than quantity. I mean depression that's otherwise untreatable can kill. I'd roll the dice personally and try the treatment if I was in such a position

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OfflineAztecDeathWhistle
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Re: The Ketamine Breakthrough for Suicidal Children [Re: Mush 4 Brains]
    #24512110 - 07/27/17 03:51 PM (6 years, 9 months ago)

I also hope they don't jump too quickly into this. I've met a few people who were permanently fucked up as kids from the Ritalin fad.

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InvisibleCookieCrumbsM
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Re: The Ketamine Breakthrough for Suicidal Children [Re: Mush 4 Brains]
    #24512497 - 07/27/17 06:37 PM (6 years, 9 months ago)

Don't get me wrong, I'm excited about it. I've battled suicidal depression for 20 years. My current partner has as well.

I've just seen doctors fuck up too often to not be wary.


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Offlinethe_way
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Re: The Ketamine Breakthrough for Suicidal Children [Re: CookieCrumbs]
    #24512752 - 07/27/17 08:23 PM (6 years, 9 months ago)

20-40 mg sessions are tight with cannabis but thats not what they doing tho. It wouldnt be enjoyable for me personally or my future tolerance. let me just get it pill form or trust me to have more competence than an insulin user


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They were dead before the ship sank!

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Offlinethirtygoats
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Re: The Ketamine Breakthrough for Suicidal Children [Re: FlyOnTheWall]
    #24513135 - 07/28/17 12:20 AM (6 years, 9 months ago)

"For critics, it’s a dangerous addictive drug that can cause memory problems, bladder disease, and psychosis when abused."

I hate when they say stupid ass bullshit like this about drugs. The people that are abusing these drugs to the point of memory problems, bladder disease, psychosis, and other problems are the absolute lowest of the low. They neglect their diet, have no morals, probably on a bad path in life already, unfriendly towards people, never exercise, constantly using tobacco, alcohol, coffee, stealing, lying, etc. The people that abuse drugs to this point are the worst people and should never be compared to somebody who is not a complete dumbass like those people.

Edited by thirtygoats (07/28/17 12:21 AM)

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InvisibleMush 4 Brains
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Re: The Ketamine Breakthrough for Suicidal Children [Re: thirtygoats]
    #24513430 - 07/28/17 06:38 AM (6 years, 9 months ago)

Yeah I'd imagine that knowing (the docs that is) What they know about the risks, they're constantly monitoring patients health/doing tests to check for any complications.

At least in this story the kid is only getting injections once every couple weeks if i read correctly. Risk is probably minimal

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OfflinePsilosopherr
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Re: The Ketamine Breakthrough for Suicidal Children [Re: thirtygoats] * 1
    #24513527 - 07/28/17 07:59 AM (6 years, 9 months ago)

Yeah I hate it when they state facts that don't line up with my world view too :smirk:

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OfflineKryptos
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Re: The Ketamine Breakthrough for Suicidal Children [Re: CookieCrumbs]
    #24513993 - 07/28/17 01:05 PM (6 years, 9 months ago)

Quote:

CookieCrumbs said:
I am concerned with doctors getting too excited about it too, it's exactly how miracle drugs get pushed for years and the serious risks are downplayed. Especially when, when doctors get excited, they tend to prescribe recklessly and at high doses.


Little girl with bladder disease and environmental depression? ketamine! old woman developing dementia and kidney disease? ketamine!




While I understand and agree with the sentiment, I disagree in this particular case. Drugs regulate themselves fairly well, even illegal ones. Why do you think your friendly street pharmacist doesn't carry, say, MPPP, or MPTP, but has cocaine/heroin/LSD/amphetamines? Because MPTP is incredibly neurotoxic, and MPPP generally has MPTP as an impuity. There is no business logic to selling *actual* poison, because you prevent repeat customers.

I think ketamine is generally safe. Not necessarily safe as water or something, but I'm not particularly worried about suddenly discovered long-term effects. At one point we were worried about Olney's Lesions caused by ketamine, now those seem to not be directly linked. Years and years of illicit use have given us plenty of data to do a safety meta analysis. It's not like every other user is staggering into an ER mid-OD, nor does it seem like there is a huge epidemic of ketamine-induced [insert syndrome here].

So, overall, while I agree with the sentiment that we shouldn't jump on the new drug bandwagon whenever we come up with a new drug, I don't think that ketamine can be treated as a "new drug" in this scenario. It's not like it was first synthesized two years ago, we've been putting this shit into our noses, veins, and stomachs for over 50 years without any terrifying side effects.

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InvisibleCookieCrumbsM
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Re: The Ketamine Breakthrough for Suicidal Children [Re: Kryptos]
    #24514098 - 07/28/17 02:03 PM (6 years, 9 months ago)

Eh. Ketamine can cause bladder damage over time. At least at recreational doses.

My main concern would be for people already susceptible for such disease. Or, like with benzos, allow people access to far more of the drug than they would ever need.


Dissociatives aren't quite like other psychedelics. It's far easier to abuse them.


Of course I believe the primary problem with all drug abuse, especially medical drug abuse, is ignorance of the user. And since ketamine is pretty much totally unknown for those who don't seek such things it poses a serious risk of doctors not appropriately taking the situation into account and giving it to a person who is vulnerable to illnesses it may contribute to or already on medications that ketamine may interact with. Since the people don't have any idea there is no failsafe to what doctors do all the time to this day.


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Invisibletrvptamine
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Re: The Ketamine Breakthrough for Suicidal Children [Re: AztecDeathWhistle]
    #24514313 - 07/28/17 04:14 PM (6 years, 9 months ago)

Quote:

AztecDeathWhistle said:
I also hope they don't jump too quickly into this. I've met a few people who were permanently fucked up as kids from the Ritalin fad.



I don't see how this could be compared to Ritalin at all. Getting an IV infusion of a sub-recreational dose over a period of time with ketamine seems to be extremely safe. Shit you have to abuse the fuck out of ketamine for long periods of time to bring on the bladder problems.

Ketamine is both less damaging to the mind and body than stims in general.


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InvisibleCookieCrumbsM
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Re: The Ketamine Breakthrough for Suicidal Children [Re: trvptamine]
    #24515750 - 07/29/17 09:15 AM (6 years, 9 months ago)

If you read the article you'd see they've already developed lollipops and nasal sprays for kids.


Giving kids drugs like candy... well now they give it to them in candy form too :cookiemonster:


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OfflineWoodRabbit
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Re: The Ketamine Breakthrough for Suicidal Children [Re: CookieCrumbs]
    #24515807 - 07/29/17 09:54 AM (6 years, 9 months ago)

Reading these give me hope and drive me crazy at the same time. On the one hand it's great to see controlled trials that will potentially help a population that really needs new alternatives to SSRIs SNRIs and Benzos, but at the same time its so pathetic that the U.S. is so backwards with "drugs". The medical community has no problem doling out opiates, but even discussing a Ketamine they have to play CYA. One would think that in 2017 the FDA and DEA would get their act together. But one would be wrong. So sad. But by all means allow the industry known as Big Pharma "convince" doctors to prescribe the pills that are most profitable. Kudos to Yale Med for standing up for science and patients.


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