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Ketamine vs. Esketamine for Depression New Hope for Treatment Resistant Depression
    #25923966 -

https://www.psychologytoday.com/us/blog/two-takes-depression/201904/ketamine-vs-esketamine-depression

Ketamine vs. Esketamine for Depression
New Hope for Treatment Resistant Depression
Posted Apr 07, 2019





Pixabay
Source: Pixabay
Ketamine has a long and varied past as a pharmaceutical.

It was developed in 1962, tested on subjects in 1964 and approved as an anesthetic in 1970 in the United States. Ketamine was used in the Vietnam War as the field anesthetic of choice for soldiers, particularly those with PTSD. And ketamine became a staple in the field of Veterinary Medicine.

In the late 1960s and early 1970s, ketamine grabbed the interest of psychedelic researchers like Humphry Osmond, John C. Lilly, Marcia Moore, and Stanislav Grof due to its calming, dissociative and trancelike effects. Loosening repressed traumas and gaining higher consciousness were the goals of using ketamine with psychotherapy.

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In the 1980s, Ketamine’s popularity shifted to the club culture. It was widely known by its street name "MDMA" or "Special K." The fast-acting, floaty, dreamy and sensation deepening effects made it a popular drug at raves, night clubs and parties. 

Ketamine evolved again over the decades. Most notably in 2006, when researchers began studying its use as an application for Treatment Resistant Repression (TRD). Studies found Ketamine was better at getting across the blood brain barrier, unlike SSRIs, SSNIs and other widely available antidepressants - and highly successful at reducing symptoms of depression.

With such positive outcomes,  Ketamine clinics began opening around the globe around 2012.  Adults with unbearable depressive symptoms were able to receive ketamine treatment via intravenous, nasal, sublingual, orally or intramuscularly infusions.

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Data collected over the next few years showed relief of treatment resistant depressive symptoms in about 80% of people who were prescribed Ketamine. The depression treatment benefits discovered placed Ketamine in the World Health Organization's List of Essential Medicines, which encourages its use far and wide.

6 Things to Do

On March 16th 2019, the FDA approved the first Esketamine nasal spray for Treatment Resistant Depression, called Spravato.  Esketamine is different than Ketamine, and the confusion begins there for many. Here are some things to know.

1. Molecular differences: Understand that Ketamine and Esketamine are similar but they’re not the same. Simply stated, they have the same molecular makeup but Esketamine is more potent than Ketamine. Both can be used to treat resistant depression. For a scientific understanding read more here.

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2. Who is the right candidate for Ketamine or Esketamine treatment? Studies suggest these medications should be limited to adults with treatment resistant depression, without a history of substance or alcohol abuse disorders and without significant other medical conditions.

3. Ketamine and Esketamine are NOT first-line treatments for depression. It's vital to know these medications are pharmacological treatments for difficult depression cases. Treatment Resistant Depression occurs when an individual has not clinically responded to two or more rounds of antidepressant medications. Read more about Treatment Resistant Depression

4. This is a treatment, not a recreational drug. Another fact to keep in mind is that dosages of Ketamine and Esketamine are significantly lower than any dose that's used as an anesthetic or a club drug. These medications have been carefully synthesized and studies to address symptoms of depression.

5. Educate yourself. Read as much as you can about Ketamine and Esketamine. There will be more mental health professionals familiar with Ketamine than Esketamine - at least right now. Ask to visit Ketamine Clinics or arrange for a consult with a specialist. The more you learn, the better informed you'll be about which medication (Ketamine or Esketamine) and which modality (IV, Sublingual, Nasal Spray, etc) is best suited to your needs.

6. Get a genetic test. I always recommend patients get a psychiatric panel genetic test to aid in their depression treatment. It can speed up recovery from depression when target-specific medications are identified. Furthermore, if you're  a non-responder to SSRIs, SSNIs, MAOs or other medications -  or you carry genetic alleles for treatment resistant depression - it may help get your insurance to cover other kinds of depression treatments.

7. Insurance may or may not cover your treatment. If you're interested in exploring Ketamine or Esketamine to reduce your Treatment Resistant Depression, call your insurer to find out about your coverage. Many Ketamine clinics and prescribing doctors, NPs and PAs will also help you navigate the financial path to this promising treatment.

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Re: Ketamine vs. Esketamine for Depression New Hope for Treatment Resistant Depression [Re: sycodelix]
    #25923971 -

???


In the 1980s, Ketamine’s popularity shifted to the club culture. It was widely known by its street name "MDMA" or "Special K."

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Re: Ketamine vs. Esketamine for Depression New Hope for Treatment Resistant Depression [Re: sycodelix]
    #25923985 -

They're both fucking ketamine wtf....

Edit: both are probably usually provided as S isomer as I don't think they perceive racedemic K.... Seriously wtf?

Edited by tacodude (04/08/19 10:04 PM)

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Re: Ketamine vs. Esketamine for Depression New Hope for Treatment Resistant Depression [Re: tacodude]
    #25924512 -

Esketamine is the only one being used for depression...but research was done with racemic ketamine, estketamine is "smoother" and less jarring use in depression, even recreational racemic ketamine is a little more "chaotic", imo, if that makes sense

BUT I would LOVE to see a side by side study of the two, although I know it wont happen, theyve moved on to estketamine and aren't going back, esketamine is viewed as less recreational...and to a point thats true, you can go deeper with racemic if supply is not a problem, but esketamine is less overwhelming, clearer, and better for lower doses and not holing. And if you are holing esketamine is easier to hold onto reality with as you emerge, and not lose yourself, and go insane

The reason I would love to see one is they found a metabolite of racemic ketamine, which is not produced from esketamine, was responsible for some of the rapid antidepressant effect, and this metabolite was effective as a rapid antdepressant in its own right and has a mechanism of action that is not found in esketamine

I have a feeling racemic could actually be better for depression if deployed correctly, but because of fearmonger and ketamines history, fear of all recreational drug use and the mistaken belief that esketamine is less recreational, they had to fine a way to distance the treatment from recreational ketamine, for both public perception and especially FDA approval, even if in name only

This article is RIDICULOUS though, calling ketamine "MDMA" WTF??

Its basically propaganda trying to distance esketamine from "special k", even though you can get fucked up on it just as easy, its pointless because no one receives racemic ketamine for depression outside of research, which isn't being done with racemic anymore

Edited by Holybullshit (04/09/19 08:09 AM)

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Re: Ketamine vs. Esketamine for Depression New Hope for Treatment Resistant Depression [Re: Holybullshit]
    #25925491 -

I know about stereoisomers, but the point was do the clinics actually use anything besides S+?

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Re: Ketamine vs. Esketamine for Depression New Hope for Treatment Resistant Depression [Re: tacodude]
    #25925667 -

tacodude said:
I know about stereoisomers, but the point was do the clinics actually use anything besides S+?



No.

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Re: Ketamine vs. Esketamine for Depression New Hope for Treatment Resistant Depression [Re: Holybullshit]
    #25925967 -

Exactly so saying ketamine and esket is like saying oxycodone and oxycotin. It's misleading

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Re: Ketamine vs. Esketamine for Depression New Hope for Treatment Resistant Depression [Re: tacodude]
    #25926100 -

it's a nasal spray too
sounds like they didn't even mention that

funny how close they hold it and yet it's this "new" drug


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Re: Ketamine vs. Esketamine for Depression New Hope for Treatment Resistant Depression [Re: tacodude]
    #25926650 -

tacodude said:
Exactly so saying ketamine and esket is like saying oxycodone and oxycotin. It's misleading


At least those contain the same active ingredient. It's more like comparing dexedrine to adderall, or l-methamphetamine, the OTC nasal decongestant, to racemic methampetamine.

As for the article, it is pointless at this point to talk about racemic ketamine for depression treatment, since no one has really worked with racemic ketamine for depression outside of early research.

https://www.ncbi.nlm.nih.gov/pubmed/19224412

"Abstract

Recent studies with intravenous infusion of the NMDA receptor antagonist ketamine showed robust and rapid antidepressant effects within hours after treatment. Ketamine is a racemic mixture consisting of two enantiomers, R- and S-ketamine. In contrast to ketamine, S-ketamine is reported to be less prone to psychomimetic side effects, such as derealisation and hallucinations. In this report we describe the effect of ketamine and S-ketamine infusion therapy, respectively, in two patients with treatment-resistant major depression. Severity of depression was rated using the Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI). While one patient did not respond to either treatment, in the other patient intravenous administration of ketamine as well as S-ketamine showed an antidepressant effect as assessed by a decrease in HAMD-21 and BDI at days 1 and 3 after infusion which faded until day 6. Both patients experienced psychomimetic side effects during ketamine infusion which were absent during treatment with S-ketamine. We conclude that S-ketamine might exert similar antidepressant effects as ketamine in drug-resistant depression but may be better tolerated by the patients."[emphasis added]

I theorize that racemic ketamine may have the ability to be more effective than esketamine, although the difference(if it exists) would probably be small, but once they found out it wasn't necessary that was the end of that, they mostly abandoned research into racemic in favor of esketamine, because of less psychomimetic effect. Although I promise you can still get fucked on esketamine, it isn't as intense as racemic, and racemic is better for holing, but I think many(not all) would say esketamine is more "enjoyable" and much smoother unless an anesthetic state is your goal.

But I was wrong when I said no earlier, I had FDA approval for depression in mind, which is esketamine, in the form of a nasal spray. Racemic ketamine is not approved for depression, like esketamine is, BUT racemic ketamine is what had been previously FDA approved and is the one being used off label at ketamine infusion clinics, they use the same ketamine that is used for anesthesia, racemic, in fact I'm not sure of the legality of using esketamine before its FDA approval, since it was the racemic that was previously approved allowing it to be used off label.

Edited by Holybullshit (04/10/19 10:33 AM)

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Re: Ketamine vs. Esketamine for Depression New Hope for Treatment Resistant Depression [Re: Holybullshit]
    #25926821 -

Yeah I get your point, but my point is when this article states "ketamine vs esketamine" they are still referring to s+ k... I am really not trying to argue semantics here I know the difference.

Edit: I think the difference is more in the metabolism difference between the two. S metabolizes cleaner and has more standard effect that wear off.... I haven't obtained R isomer yet, but I've done racedemic and it just feels more so in the body and wears off slower. Much better for a hole experience, but felt dirty with more "hangover." I'm speculating a lot on the why, but I did look into it a while ago.

Edited by tacodude (04/10/19 12:12 PM)

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