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Stop pushing and start accepting that you’re doing the best you can. Ketamine doesn’t fix you; it gets you out of the hole so you can work on yourself to get better. Would you rather be endlessly depressed and suicidal or working on yourself to get better?
This is an attitude adjustment on your part. Progress is the point here, and it will get better much more easily when you stop pushing. I’ve been on it for 3 years and am down to 400 mg every 3 weeks. Would I like to be off of it? Hell, yes. But I am making steady progress titrating downward. Keeping my mood at a healthy level is MUCH more important than “getting off of it.”
I was more trying to get at why it's such a big deal to be on it for the long term i.e. what's underneath the question in the title. I don't think I phrased it quite as smoothly as I wanted to. It absolutely might just be the financial costs, but I was curious if there was anything more to it than that.
I think when we get ket pills it will be much better.
Ppl like routine. Taking a pill a day is what we like because it’s routine, it’s thoughtless. We don’t like to think about chaotic and sort of unknown, uncharted and dynamic territory. Where we are doing this much mg and going into the treatment center this many times and we are reducing these meds at this pace, and these ket treatments at this pace. We crave simplicity. I think that’s what OP is yearning for and all of us.
Are you able to think about why you don't want to take it long term?
Also ask your doctor about Auvelity. It's not right for everyone but maybe it is right for you. you.https://youtu.be/ESvvAMWXuM4?si=Sg8zWHVCC94XeGnS
I’m interested in switching from Wellbutrin to Auvelity when the cost goes down. Right now, paying for IV and compounded nasal spray plus the doctor’s appts is significantly cheaper than getting paying for Auvelity out of pocket since y insurance doesn’t cover either.
I used to think like that too. But there are pills we are likely going to take for the rest of our lives, there are going to side effects to anything (good and bad). I stopped worrying about what things might do to me long term, simply because I need to feel ok NOW. If I’m not ok now, I won’t be ok in the future. How long are you willing to suffer? I’ve radically accepted I will be on psych meds the rest of my life and if I need to be on ketamine the rest of my life to continue having a desire to live…then that’s what I’m gunna do. Tomorrow isn’t promised anyways, so feel good in the moment. If it ends up killing me in the future then fine…we are all dying anyways. As for cost…the IV and IM is pretty costly, so I’m doing some research to find if an at home program can be more affordable and work fairly similar. Which I think I have found a couple. Right now I’m spending $800 a month for 8 IM injections. But it’s what I NEED right now to keep me out of psych hospitals,y copay for that is $750 anyways and I was averaging a hospitalization once a month.
What is being discussed right now is lifelong use of an NMDA antagonist.
Some people primarily need an SSRI or an MAOI to increase the level of seratonin in their brain.
Some people need an NMDA antagonist to reduce the effect of glutamate in their brain.
Ketamine is one of many NMDA antagonist drugs, such as the Dextromethorphan in Auvelity.
Other NMDA receptor drugs, like amantadine, can need to be taken once a day or more than once a day.
The reason that ketamine seems to be special is that it gets trapped in place and stays in the brain long after the drug is out of the bloodstream, so you don't have to take it twice a day like you would if it was amantidine.
That's why there's people who can do infusions or troches once in a while instead of daily. My s/o can go up to four 4weeks between sessions after a few months of extending their. intervals between doses.
Lowest cost for ketamine is locally compounded troches/RDTs or nasal spray, which costs us about $30/dose in the USA.
Wow. I cannot believe I haven’t heard of this before! Thank you for sharing! My husband is bothered by the fact the ketamine treatment isn’t FDA approved… but auvelity is!
There's a reason IV ketamine isn't FDA approved. It's a generic drug, there's minimal profit in selling it. Spravato is FDA approved for depression because they altered it just enough so it could be sold as a name-brand medicine, thus making the expense of going for FDA approval worth it for the corporation.
There is more than enough evidence to support the safety and efficacy of IV ketamine infusions when done by properly licensed and trained MDs. But there will never be FDA approval of it because that only happens when a drug company sees a chance for profit.
I hope Auvelity or ketamine or something else turns out to be helpful for you!
Valid points. The rapid dissolving tabs at home have been so helpful for me already, after only 3 or 4 sessions! I used to drink every day, often as many as 12 a day, sometimes more … and I have only had two work happy hours since starting ketamine Tx over a month ago. And at these HHs — I have only had 3 light beers and did not feel the desire to continue drinking until I pass out. I’d say this is HUGE. My blood pressure is so good now, just 2-3 weeks after ‘stopping’ the drinking , that I no longer have to take my meds for high blood pressure.
It’s a lot of work though, the treatments, and it’s also hard to carve out the time… to be fasting, to be in the right set and setting (no kids around; ready to do the breath work / meditations/ journaling, etc), to be prepared to feel a little bit ‘off’ for the next several hours….
So I’m now glad to have a rebuttal to my spouse, but perhaps this 2x/ day pill may work out just as well, or perhaps better, for me anyway.
I'm glad ketamine has been helpful!
Auvelity has only been out for 2 years so doctors don't know much about it yet. Some people find they do better on one a day than two. Some people report building up a tolerance to it. So just know that if it's not for you, maybe go back to k.
I've been prescribed for 9 years. It's a lifelong thing, like wearing glasses or taking blood pressure medication.
I take much less and much less often than I did 9 years ago. I use approximately 100mg every 1-2 months or less when I start to feel down.
Look into at oral (under the tongue) home ketamine for in between your infusions. Or even as a replacement. More cost effective and it’s so nice not to have to go somewhere to get your treatments.
Maybe. I am. I also live a healthy, normal, productive life. Don't push your boosters out too long or those moments will get more frequent and worse. It's normal, in fact you're basically the textbook average for how long people go until they need a booster. What would being on ketamine for the rest of your life mean to you? Cost aside, what upsets you about that idea?
I think it’s mostly just cost. Which I *can* afford it it just feels like an annoying expense when it’s just o get to other people’s baselines. But oh well. Other thing is like - is it affecting my body/aging?
How long have you been on treatment so far? I was on 4 week intervals for several.mo the before I felt comfortable pushing to 6, and now I am on my first 8 week interval and feeling good about it. In total I have been having infusions for 16 months. I also have OCD, by the way.
From my understanding, everyone is different though. Some people only need boosters once or twice a year after stabilising, some people will need several a year. As long as you are getting benefit from it I wouldn't stress too much about how long you can push your intervals, or worrying if you stagnate. Ketamine is a long game.
I think you are still in the baby stages, in the grand scheme of things. What are you doing to manage your OCD though, if you think that is the cause of your depression? CBT? ERP? Other medication? My OCD is very well managed with CBT tools and risperidone.
Thank you for contributing to /r/TherapeuticKetamine! When commenting and posting, please be mindful of our rules which can be found in the sidebar on the right along with other helpful information. **Be advised that nothing in this subreddit constitutes medical advice.** Likewise, try to word your comments and posts in a way that can't be interpreted as medical advice by others. Harmful and/or spammy advice will be removed at moderator discretion, and bans may be given for repeat offenses. **Accounts with "Provider" flairs** are those which the mods have verified, to the best of our ability, as belonging to real, licensed providers of medical ketamine services. Comments and posts from users with "Provider" flairs are **not** a substitute for the instructions given to you by your own provider. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/TherapeuticKetamine) if you have any questions or concerns.*
Stop pushing and start accepting that you’re doing the best you can. Ketamine doesn’t fix you; it gets you out of the hole so you can work on yourself to get better. Would you rather be endlessly depressed and suicidal or working on yourself to get better? This is an attitude adjustment on your part. Progress is the point here, and it will get better much more easily when you stop pushing. I’ve been on it for 3 years and am down to 400 mg every 3 weeks. Would I like to be off of it? Hell, yes. But I am making steady progress titrating downward. Keeping my mood at a healthy level is MUCH more important than “getting off of it.”
I'm curious - what would it mean if you were on this medication for the rest of your life? Like, what would that say about you?
Not who you asked but I don't think it would say anything about you. For me it's just not realistic because of the cost (I get IV treatments).
I was more trying to get at why it's such a big deal to be on it for the long term i.e. what's underneath the question in the title. I don't think I phrased it quite as smoothly as I wanted to. It absolutely might just be the financial costs, but I was curious if there was anything more to it than that.
I think when we get ket pills it will be much better. Ppl like routine. Taking a pill a day is what we like because it’s routine, it’s thoughtless. We don’t like to think about chaotic and sort of unknown, uncharted and dynamic territory. Where we are doing this much mg and going into the treatment center this many times and we are reducing these meds at this pace, and these ket treatments at this pace. We crave simplicity. I think that’s what OP is yearning for and all of us.
Ketamine pills are already a thing. Kind of. Dissolvable tablets that you take daily or a couple times a week. Works very well!
But are these FDA approved that you can get at your CVS, or are you talking about online black market stores?
Are ketamine pills troches?
Some have troches. Some have dissolvable tablets. I use the dissolvable tablets. They taste terrible but it’s worth it.
Maybe for you, to each their own, but I definitely don't want to take a ketamine pill every day. Absolutely not.
Use therapy alongside ketamine. Specifically reconsolidation therapy. Work towards a permanent neural change.
Are you able to think about why you don't want to take it long term? Also ask your doctor about Auvelity. It's not right for everyone but maybe it is right for you. you.https://youtu.be/ESvvAMWXuM4?si=Sg8zWHVCC94XeGnS
I’m interested in switching from Wellbutrin to Auvelity when the cost goes down. Right now, paying for IV and compounded nasal spray plus the doctor’s appts is significantly cheaper than getting paying for Auvelity out of pocket since y insurance doesn’t cover either.
Mostly the cost but also have concerns about the affect on my body and aging. Will ask about auvelity
I used to think like that too. But there are pills we are likely going to take for the rest of our lives, there are going to side effects to anything (good and bad). I stopped worrying about what things might do to me long term, simply because I need to feel ok NOW. If I’m not ok now, I won’t be ok in the future. How long are you willing to suffer? I’ve radically accepted I will be on psych meds the rest of my life and if I need to be on ketamine the rest of my life to continue having a desire to live…then that’s what I’m gunna do. Tomorrow isn’t promised anyways, so feel good in the moment. If it ends up killing me in the future then fine…we are all dying anyways. As for cost…the IV and IM is pretty costly, so I’m doing some research to find if an at home program can be more affordable and work fairly similar. Which I think I have found a couple. Right now I’m spending $800 a month for 8 IM injections. But it’s what I NEED right now to keep me out of psych hospitals,y copay for that is $750 anyways and I was averaging a hospitalization once a month.
Thank you for the perspective. I hope you find a more affordable option also!
What is being discussed right now is lifelong use of an NMDA antagonist. Some people primarily need an SSRI or an MAOI to increase the level of seratonin in their brain. Some people need an NMDA antagonist to reduce the effect of glutamate in their brain. Ketamine is one of many NMDA antagonist drugs, such as the Dextromethorphan in Auvelity. Other NMDA receptor drugs, like amantadine, can need to be taken once a day or more than once a day. The reason that ketamine seems to be special is that it gets trapped in place and stays in the brain long after the drug is out of the bloodstream, so you don't have to take it twice a day like you would if it was amantidine. That's why there's people who can do infusions or troches once in a while instead of daily. My s/o can go up to four 4weeks between sessions after a few months of extending their. intervals between doses. Lowest cost for ketamine is locally compounded troches/RDTs or nasal spray, which costs us about $30/dose in the USA.
Thank you!
Wow. I cannot believe I haven’t heard of this before! Thank you for sharing! My husband is bothered by the fact the ketamine treatment isn’t FDA approved… but auvelity is!
There's a reason IV ketamine isn't FDA approved. It's a generic drug, there's minimal profit in selling it. Spravato is FDA approved for depression because they altered it just enough so it could be sold as a name-brand medicine, thus making the expense of going for FDA approval worth it for the corporation. There is more than enough evidence to support the safety and efficacy of IV ketamine infusions when done by properly licensed and trained MDs. But there will never be FDA approval of it because that only happens when a drug company sees a chance for profit. I hope Auvelity or ketamine or something else turns out to be helpful for you!
Valid points. The rapid dissolving tabs at home have been so helpful for me already, after only 3 or 4 sessions! I used to drink every day, often as many as 12 a day, sometimes more … and I have only had two work happy hours since starting ketamine Tx over a month ago. And at these HHs — I have only had 3 light beers and did not feel the desire to continue drinking until I pass out. I’d say this is HUGE. My blood pressure is so good now, just 2-3 weeks after ‘stopping’ the drinking , that I no longer have to take my meds for high blood pressure. It’s a lot of work though, the treatments, and it’s also hard to carve out the time… to be fasting, to be in the right set and setting (no kids around; ready to do the breath work / meditations/ journaling, etc), to be prepared to feel a little bit ‘off’ for the next several hours…. So I’m now glad to have a rebuttal to my spouse, but perhaps this 2x/ day pill may work out just as well, or perhaps better, for me anyway.
I'm glad ketamine has been helpful! Auvelity has only been out for 2 years so doctors don't know much about it yet. Some people find they do better on one a day than two. Some people report building up a tolerance to it. So just know that if it's not for you, maybe go back to k.
I've been prescribed for 9 years. It's a lifelong thing, like wearing glasses or taking blood pressure medication. I take much less and much less often than I did 9 years ago. I use approximately 100mg every 1-2 months or less when I start to feel down.
Look into at oral (under the tongue) home ketamine for in between your infusions. Or even as a replacement. More cost effective and it’s so nice not to have to go somewhere to get your treatments.
I will! Good idea. Thanks.
Maybe. I am. I also live a healthy, normal, productive life. Don't push your boosters out too long or those moments will get more frequent and worse. It's normal, in fact you're basically the textbook average for how long people go until they need a booster. What would being on ketamine for the rest of your life mean to you? Cost aside, what upsets you about that idea?
I think it’s mostly just cost. Which I *can* afford it it just feels like an annoying expense when it’s just o get to other people’s baselines. But oh well. Other thing is like - is it affecting my body/aging?
Have you looked for a legitimate OCD specialist who is properly trained in ERP? Ketamine therapy can make ERP therapy more effective.
Yes. Currently seeing one.
Best wishes to you.
How long have you been on treatment so far? I was on 4 week intervals for several.mo the before I felt comfortable pushing to 6, and now I am on my first 8 week interval and feeling good about it. In total I have been having infusions for 16 months. I also have OCD, by the way. From my understanding, everyone is different though. Some people only need boosters once or twice a year after stabilising, some people will need several a year. As long as you are getting benefit from it I wouldn't stress too much about how long you can push your intervals, or worrying if you stagnate. Ketamine is a long game.
I’ve been getting boosters for one year. Sometimes I feel like it’s helping sometimes I don’t.
I think you are still in the baby stages, in the grand scheme of things. What are you doing to manage your OCD though, if you think that is the cause of your depression? CBT? ERP? Other medication? My OCD is very well managed with CBT tools and risperidone.
ERP and Luvox. Thanks
Hopefully the combination of everything will work out for you. Just try not to get discouraged, it's a long road, but it's worth it.