[HN Gopher] Ketamine for the acute treatment of severe suicidal ...
       ___________________________________________________________________
        
       Ketamine for the acute treatment of severe suicidal ideation
        
       Author : hochmartinez
       Score  : 94 points
       Date   : 2022-03-14 18:12 UTC (4 hours ago)
        
 (HTM) web link (www.bmj.com)
 (TXT) w3m dump (www.bmj.com)
        
       | olliej wrote:
       | I've been getting intramuscular ketamine weekly for my severe &
       | treatment resistant depression while working on making progress
       | towards actual recovery. As with participants in this study I
       | wasn't one of the lucky "I did ketamine a few times and my
       | depression was cured" folk, but it has a huge reduction in
       | frequency and intensity of ideation, as well as pretty much
       | completely removing self harm.
       | 
       | That said it's not a long term solution (because honestly its
       | frustrating due to losing a few hours during the work week,
       | inability to drive, etc) so I'm working with Drs to actually
       | resolve things without regularly being stabbed :D
        
         | standardUser wrote:
         | I wish the gap between clinical treatment and recreational use
         | was bridged, and you could use a nasal spray on your own time a
         | couple evenings a week instead of a daytime injection.
        
       | intenex wrote:
       | The truly amazing thing here is how powerful the placebo control
       | was, even despite the fact that as someone who's done ketamine IV
       | treatment before, it's pretty obvious when you're on ketamine and
       | when you're not.
       | 
       | "At week 6, remission in the ketamine arm remained high, although
       | non-significantly versus placebo (69.5% v 56.3%; odds ratio 0.8
       | (95% confidence interval 0.3 to 2.5), P=0.7)."
        
       | oldstrangers wrote:
       | I did a full 6 week course of ketamine therapy. It was really
       | good, and I would recommend it if you're open minded. It's not
       | for everyone, and the lasting (a year+) benefits aren't really
       | measurable (maybe I'm different? maybe I'm not, maybe I've just
       | gotten older). I'd like to go again and see if it can help with
       | my obsessive existential dread.
        
         | aaaronic wrote:
         | There are treatments for that? I've never had anyone suggest
         | anything other than therapy for it.
        
         | agumonkey wrote:
         | what about how it felt early on / during the therapy ?
         | 
         | what about side effects also ?
        
           | bradly wrote:
           | There is the "trip" side affect which lasts about 30-45
           | minutes. Then there is some wobbly legs and slow speech for
           | an hour or two after. I had no side-affects besides those.
        
         | [deleted]
        
         | mrwaffle wrote:
         | Absolutely, I have a partner who has had severe PTSD and went
         | through a great month-long program, she's overcome many
         | longstanding fears and triggers and has made huge strides in
         | being able to feel that she is living her life once again.
        
           | jcims wrote:
           | I wonder what the age limit is on stuff like this. So many
           | young folks experiencing crippling anxieties that are
           | impacting their ability to navigate the world at an age where
           | it's going to have longstanding ramifications for
           | relationships and careers.
        
           | sshine wrote:
           | I have a close acquaintance who uses ketamine to manage
           | depression and Complex PTSD. My experience as a bystander is
           | that the depressive symptoms reoccur periodically regardless
           | of the use of ketamine. The depressive symptoms seem to be
           | caused by the PTSD, and ketamine does not seem to alleviate
           | the PTSD.
           | 
           | I'm saying this as a huge fan of the positive impact of
           | ketamine.
           | 
           | There are some symptoms that seem like they need more
           | rewiring.
        
           | jokowueu wrote:
           | May I recommend stellate gangelion block for PTSD .
           | 
           | https://youtu.be/nC2fBe6U7lg
        
         | hemloc_io wrote:
         | What's the process for this like? Been curious about the
         | current state of psych medicine.
        
           | ketamine wrote:
           | Not OP
           | 
           | I did 2 surveys and a phone consult then a baseline
           | depression survey before my first infusion.
           | 
           | I go to the clinic and go in my room and they give me my IV
           | then the doctor hangs the ketamine mix bag, hooks it up and
           | leaves. The rooms are dark and they have colored lights or a
           | dim light. I wear an eye mask.
           | 
           | I pay extra to receive talk therapy during the infusion so I
           | have a therapist with me the whole time. We do a ceremony to
           | start each infusion and set the intent just before the
           | effects start.
        
         | ketamine wrote:
         | It immediately relieved my existential dread. I fear the next
         | infusion will be intense, however.
        
       | ketamine wrote:
       | Hello! Throwaway account for obvious reasons.
       | 
       | I just started IV ketamine infusions at .5 mg/kg for depressions.
       | 
       | I am not finished with my treatment yet.
       | 
       | Ask me anything if you would like.
        
         | glerk wrote:
         | Any issues with your bladder? Have doctors mentioned anything
         | about the potential damage to the urinary system? This seems to
         | be the scariest side effect.
        
           | rootw0rm wrote:
           | This is part of the reason MXE was developed. Love me some
           | MXE.
        
           | chimeracoder wrote:
           | I'm not OP, but I have some relevant professional (clinical)
           | experience here.
           | 
           | > Any issues with your bladder? Have doctors mentioned
           | anything about the potential damage to the urinary system?
           | This seems to be the scariest side effect.
           | 
           | We're lucky because ketamine has been used for decades in
           | inpatient settings at much, much higher doses than what is
           | being used now for psychiatric purposes, so we have a good
           | sense of its safety profile already.
           | 
           | Urinary tract and bladder issues are noted for long-term and
           | frequent recreational users of ketamine, but not really for
           | anesthetic use. The dosing schedule for psychiatric use is
           | closer to anesthetic use than it is for recreational use.
           | 
           | The effects also are reversible if detected early and use is
           | ceased, so periodic but infrequent treatment is unlikely to
           | result in long-term damage, both because it's not frequent
           | enough to accumulate, and because you can stop if it becomes
           | a problem.
        
         | VyperCard wrote:
         | Good luck to you. It helped me a lot. I refresh it every three
         | to four month with a single session and a 2 day of vacation
         | away from everything in another town.
        
       | [deleted]
        
       | after_care wrote:
       | > Then, patients received a first 40 minute intravenous infusion
       | of ketamine (0.5 mg/kg) or placebo 0.9% (saline solution) in
       | addition to their current treatment.
       | 
       | This really shouldn't be labeled as double blind.
       | 
       | 1.The nurse administering knew if it was placebo or active (for
       | safety reasons).
       | 
       | 2. It would immediately become obvious to the subject if they
       | were injected with salt water or ketamine.
       | 
       | 3. Within minutes it would become obvious to everyone in the room
       | if the patient was injected with salt water or ketamine.
       | 
       | Some trails are impossible to be double blind. That's okay, there
       | are other ways to address concerns of internal validity.
       | Pretending like this trail is double blind does not address any
       | internal validity concerns, and only raises concerns about the
       | researchers understanding of experimental design.
        
         | BurningFrog wrote:
         | Injecting some other psychoactive drug should work, at least
         | for patients who have never used ketamine before.
         | 
         | But I suspect that would take many years to get through the
         | permitting apparatus, if it was at all possible.
        
           | after_care wrote:
           | Injecting someone with another psychoactive drug would not be
           | a placebo. We would be comparing the efficacy of {other
           | psychoactive drug} and ketamine. That's not to say this
           | experiment has no value, it's one of the many experiments we
           | should run to help build the case for ketamine.
           | 
           | The classic gold standard is to randomly assign subjects to
           | groups. Then give one group a sugar pill, give the other
           | group the treatment pill. Neither to patient, the person
           | administering, or the person recording the results know who
           | got the treatment who got the placebo. This is not possible
           | with ketamine, psilocybin, MDMA, LSD, etc. That's fine, we
           | can still build a strong body of experimental evidence of
           | their efficacy. It bothers me when clearly non-blind non-mask
           | experiments are labeled as double-blinded, which we see often
           | in this body of research, this study included.
        
             | phren0logy wrote:
             | There is precedent for this; it's called "active placebo."
             | For example, I think some of the psilocybin trials used
             | methylphenidate as an active placebo comparison condition.
        
               | after_care wrote:
               | Sure, but as a scientist conducting an experiment I will
               | be able to determine who is dosed with psilocybin and who
               | is doses with methylphenidate >90% of the time, thus
               | removing the observer mask. I think the average patient
               | would be able to tell if they were dosed with psilocybin
               | or methylphenidate, even if they were drug naive, thus
               | removing the patient mask.
               | 
               | I'm not saying it's impossible to conduct good
               | experiments on these substances. I'm saying that they
               | require special considerations of internal validity and
               | it's incorrect to call this study (iv ketamine vs iv
               | saline water) double blind.
        
               | phren0logy wrote:
               | The person assessing the depression response in the
               | psilocybin studies is not in the room with the person
               | while they are under the influence of the substance. The
               | ratings are done on a different day. It's two different
               | people to preserve blinding.
        
         | PragmaticPulp wrote:
         | 0.5mg/kg spread out over 40 minutes wouldn't be as dramatic as
         | you're suggesting.
         | 
         | > 3. Within minutes it would become obvious to everyone in the
         | room if the patient was injected with salt water or ketamine.
         | 
         | I think you're mistaking IV infusion for injection. The dose is
         | given slowly over 40 minutes, not as a rapid injection. The
         | patient would barely have any of the drug in their system in
         | the first few minutes. Given the short duration of action, it
         | wouldn't produce peak levels anywhere near what recreational
         | users experience.
        
         | [deleted]
        
         | hadmatter wrote:
         | I'm sorry but you are strongly over exaggerating the (side)
         | effects of i.v. ketamine. It's not a dose that sends you in a K
         | hole. It's way less than that. Some get sedation and some do
         | get dissociative symptoms which can unmask the study arm of the
         | patient. Approximately one out of ten got at least one of those
         | side effects. Sedation can be mimicked with midazolam, so if
         | you use that as placebo, you get 90 % of the patients that are
         | not obvious, which medicine they got. I do agree that a better
         | "placebo" would be good to use.
         | 
         | The problem with ketamine and suicidality studies is that
         | suicides - thankfully don't happen very often - so we have no
         | direct evidence that ketamine prevents suicides. Of course if
         | it would only alleviate suffering and wouldn't increase the
         | rate of suicides, that would be a win too.
        
           | dataisfun wrote:
           | Umm...ketamine IV at these doses is most certainly a unique
           | and insane experience, speaking as someone who's done it
           | about a dozen times for anxiety.
        
             | black_puppydog wrote:
             | Can't reply so sibling but _WTF_ the username  "ketamine"
             | was still available... On HN ?
        
             | bragr wrote:
             | Are you getting it all at once or as an infusion?
             | Considering this is given as an infusion over 40 minutes,
             | this seems to be a pretty mild dose consistent with mild
             | analgesia and well bellow the recreation and dissociative
             | doses based on all the charts I just pulled up, but I'm not
             | personally experienced with K ;)
        
             | ketamine wrote:
             | How often do you need maintenance?
             | 
             | How numb does it make you. My mouth and throat being numb
             | was very surprising.
        
           | chimeracoder wrote:
           | > I'm sorry but you are strongly over exaggerating the (side)
           | effects of i.v. ketamine. It's not a dose that sends you in a
           | K hole. It's way less than that.
           | 
           | 0.5 mg/kg intravenous. For frame of reference, a small
           | recreational dose is between 5-25 mg (insufflated[0]), and a
           | larger recreational dose (for people targeting a "k-hole") is
           | more like 50-100mg. For clinical depression (ie, not this
           | study, but for a similar purpose), the fixed dose is 84mg
           | (not weight-based).
           | 
           | So assuming a 75kg individual, that would be a 37.5mg
           | intravenous dose, which is definitely going to provide a
           | noticeable effect for any ketamine-naive user (ie, someone
           | who does not already have a tolerance for the drug from
           | recent prior use).
           | 
           | > The problem with ketamine and suicidality studies is that
           | suicides - thankfully don't happen very often - so we have no
           | direct evidence that ketamine prevents suicides.
           | 
           | That's not really a problem - suicidal ideation is a strong
           | enough predictor for suicidality and mental health that it's
           | common to use as a biomarker. In other words, nearly anything
           | that reduces suicidal ideation is presumed to reduce
           | suicidality (on a large scale) - it's not necessary to wait
           | months or years to see what happens (and in fact, depending
           | on the specifics of the study, it can be considered unethical
           | to do so).
           | 
           | Source: former clinical researcher and drug counselor
           | 
           | [0] bioavailability when insufflated is significantly less
           | than other means of ingestion
        
             | hadmatter wrote:
             | I agree about you second point. I was too quick to make my
             | comment and I was conflating stuff I've read about nasal
             | esketamine, which didn't have as robust evidence behind it
             | as i.v. ketamine. I should not write comments while holding
             | a baby that is trying to sleep and failing at it.
             | 
             | About the first point, I still disagree with the parent
             | comment. The standard 0,5mg/kg ketamine is given under 40
             | minutes. I've seen two patients receive it. The room was
             | dimly lit, silent and peaceful, as to not induce or
             | exacerbate any possible dissociative or hallucinative side
             | effects. The patients didn't report any side effects at
             | first and later reported a little sedation. I wouldn't be a
             | able to tell with certainty if they had received a placebo
             | or ketamine, and certainly not within minutes.
             | 
             | Source: psychiatrist in training
             | 
             | Edit: I still think we need hard data about anti-suicide
             | effect and not just surrogate markers. Variability in
             | suicidal ideation is suggested to be a predictor of suicide
             | attempts [1]. If ketamine first gets someone better and
             | later on they relapse, they could, in theory, be at
             | increased risk for suicide. More long term data is also
             | needed about it's long term effects. Note that I do think
             | it's a good thing that ketamine is becoming more available!
             | I will continue to suggest it for e.g. patients with
             | treatment resistant and severe depression.
             | 
             | [1] https://www.sciencedirect.com/science/article/abs/pii/S
             | 01650...
        
               | ketamine wrote:
               | Source: patient taking infusions.
               | 
               | .5 mg/kg
               | 
               | I was numb all over, my lips tongue and throat were numb.
               | 
               | I melted in to the chair and felt like I was up down and
               | sideways at the same time.
               | 
               | You would not be able to tell immediately but I put on my
               | blindfold within 7 minutes due to effects starting.
        
               | hadmatter wrote:
               | Thanks, I appreciate your comment and experience. I agree
               | that if one was to get those effects, one would be quite
               | unlikely to suspect placebo. I hope you got the help you
               | needed from ketamine.
        
               | Forbo wrote:
               | I've had to vouch for four of your comments now. Looks
               | like you account was shadow banned. Maybe contact @dang
               | to see if they'll fix it?
        
           | VyperCard wrote:
           | I get the used dosage every three month and I can assure you,
           | it is very noticeable.
           | 
           | However, I have no idea how other sedations feel, so who
           | knows if they are a good placebo. Could be.
        
           | after_care wrote:
           | I don't think I am exaggerating the noticeable effects of
           | i.v. ketamine. Patients given i.v. ketamine are advised not
           | to operating an automobile hours after administration. This
           | level of impairment would be noticeable to the patient and
           | the staff administering the treatment.
        
             | hadmatter wrote:
             | Advice not to operate an automobile is for minimizing
             | risks. It doesn't mean that most would be unable to handle
             | a car, although it could mean that their reaction times
             | would be slower. The standard way to administer ketamine is
             | to give 0,5 mg/kg under 40 minutes. It would in no way be
             | immediately obvious to everyone in, if someone began to
             | receive ketamine or not. At least I couldn't differentiate
             | them at that point.
        
               | after_care wrote:
               | Maybe you have more experience with patients at this
               | specific dose range than I do. I remain skeptical this
               | could be double blind, but do have less certainty than I
               | originally started with.
        
           | encoderer wrote:
           | Have you had it?
           | 
           | A friend of mine did it last week and he described it as the
           | most intense experience of his life. He's 40 and he has
           | experience with other drugs.
           | 
           | I think possibly you don't know what you're talking about?
        
             | stimpson_j_cat wrote:
             | Right it varies greatly depending on dose. If you don't
             | know the exact dose your friend took (they don't sound like
             | an anesthesiologist) then you're insulting someone you
             | likely know much less than.
        
               | ketamine wrote:
               | Clinics in the US seem to all use .5 mg/kg as a baseline
        
               | Forbo wrote:
               | I vouched for your comment since it is relevant. I assume
               | it was dead because you're new.
        
               | ketamine wrote:
               | Email sent. Thank you, stranger :)
        
             | skissane wrote:
             | You generally can't compare recreational and prescribed
             | drug use, even for the same substance, because the doses
             | tend to be widely different.
             | 
             | A lot of people take amphetamines as a medically prescribed
             | treatment for ADHD (and other conditions such as narcolepsy
             | too). A lot of people take amphetamines recreationally.
             | Studies done on the negative heath consequences for
             | recreational users are largely irrelevant to medically
             | prescribed users, because your average recreational dose is
             | an order of magnitude (or more) higher than the average
             | prescribed dose. Increase the dose ten-told, it acts like a
             | different drug altogether.
             | 
             | Plus, the irregular dosing schedule of recreational users
             | probably isn't helping either. And many recreational users
             | try to get the drug into their bloodstream as fast as
             | possible (injection, snorting, smoking), while most
             | prescription drugs aim to be released more gradually (oral
             | route, sometimes even extended release or an inactive
             | prodrug such as Vyvanse/lisdexamfetamine)
        
               | chimeracoder wrote:
               | > Studies done on the negative heath consequences for
               | recreational users are largely irrelevant to medically
               | prescribed users, because your average recreational dose
               | is an order of magnitude (or more) higher than the
               | average prescribed dose. Increase the dose ten-told, it
               | acts like a different drug altogether.
               | 
               | What you're saying applies in other cases, but in the
               | case of ketamine, the recreational dose is one or two
               | orders of magnitude _lower_ than the clinical dose.
        
               | netizen-936824 wrote:
               | The person you're replying to, from my interpretation, is
               | saying that their friend had a ketamine infusion at a
               | clinic. Nowhere do they mention recreational use
        
             | prophesi wrote:
             | You can look at the study yourself to see what dosage was
             | administered, then compare that to user-reported
             | experiences on erowid if you're curious. And the study
             | itself lists out the side effects they experienced.
        
             | adwi wrote:
             | I think possibly commercial "infusion clinics" and medical
             | trials use different doses.
        
               | officeplant wrote:
               | Going by a friends experience, infusion clinics need to
               | be investigated more regularly by medical professionals.
               | Co-worker went to one for treatment and from her
               | recollection of the event they left her in a dark room
               | with a white noise generator while she went down the
               | k-hole. Terrified the living shit out of her.
        
               | hadmatter wrote:
               | That's awful. I've also read about shady clinics in the
               | US that don't really screen their patients but just give
               | the drug to anyone who pays. E.g.
               | https://www.scientificamerican.com/article/is-the-
               | ketamine-b...
        
               | bradly wrote:
               | IM and IV are going to be very similar. Smaller
               | independent psychologist will do IM while bigger clinics
               | with nursing staff will typically use IV.
               | 
               | At home treatments with sublingual trockies have much
               | less side affects, but differently still noticeable.
               | Nasal spray is the weakest with just some minor body
               | numbing.
        
               | ketamine wrote:
               | Same dose for me. .5 mg/kg
               | 
               | It was more intense and less intense at the same time
               | because I did not know what to expect.
        
           | bradly wrote:
           | Inter muscular ketamine treatments were the only thing that
           | helped my severe treatment resistant depression that included
           | suicidal thoughts. They definitely had strong side affects.
           | Complete disconnection, loss of the concept of humanism, I've
           | gone inside a rainbow, held hands with my brain, etc..
        
         | AdamH12113 wrote:
         | My psychiatrist administers IV ketamine treatments for
         | depression. (I don't use those; regular antidepressants work
         | for me.) I'm not sure what dosage she uses, but from what she's
         | told me, it's not a drug trip, and a lot of people don't feel
         | any different during the treatment.
         | 
         | [Edited to clarify.]
        
           | sandworm101 wrote:
           | You might be in her placebo group.
        
             | AdamH12113 wrote:
             | Sorry, poor wording. I meant that my psychiatrist runs a
             | ketamine clinic and administers IV ketamine treatments to
             | patients.
        
             | TaylorAlexander wrote:
             | The person is saying their doctor administers this
             | treatment to other people, but not to them. And that the
             | doctor has said the patients receiving the treatment do not
             | experience a drug trip.
        
             | aaaaaaaaata wrote:
             | I read it as their doctor receiving the treatment, not
             | them.
        
               | sandworm101 wrote:
               | "she uses" is an odd phrase for a patient. Patients
               | normally "receive" or "are given". Drug addicts and
               | doctors "use" a drug.
        
               | [deleted]
        
           | chimeracoder wrote:
           | > My psychiatrist does IV ketamine treatments for depression.
           | I'm not sure what dosage she uses, but from what she's told
           | me, it's not a drug trip, and a lot of people don't feel any
           | different during the treatment.
           | 
           | At 0.5mg/kg intravenous, there's no way that people wouldn't
           | feel anything. It's not necessarily a "drug trip", but pretty
           | much anybody can tell the difference between that large of a
           | dose of ketamine vs. a saline solution.
           | 
           | For trials in cases like this, it's common to use a group
           | which receives either a smaller dose of the drug or a drug
           | that is intended to mimic some of the subjectively observable
           | side effects.
        
             | ketamine wrote:
             | That is the dose I receive and it is very noticeable.
             | 
             | I do not know what a trip is or is not supposed to be like
             | but it was a very wild sensation.
        
           | bradly wrote:
           | Does is dependent on weight (and gender?) if I remember
           | correctly.
        
         | boomboomsubban wrote:
         | >1.The nurse administering knew if it was placebo or active
         | (for safety reasons).
         | 
         | I read it as the nurse preparing the IV's knew if it was a
         | placebo, it doesn't really say that the same nurse administered
         | the IV's.
        
           | btach wrote:
           | The nurse administering it is most certainly liable for what
           | s/he administers. It is a very big no-no to blindly
           | administer a medication of which you cannot reasonably verify
           | what it is. To push a syringe or start a pump of something
           | that "could be ketamine, or could be NS" is walking an
           | uncomfortable line for your license to practice nursing.
           | Right patient, right medication, right dose, right route,
           | right time. If you as a nurse cannot attest to all of the
           | above when you push something, it is in error to push it.
        
             | throwaway81523 wrote:
             | How does it work in other clinical trials where you take a
             | pill instead of getting an injection? Those are double
             | blind all the time. They watch you take the pill, but they
             | don't know whether it is active or placebo.
             | 
             | For that matter, a quick web search shows that at least
             | some of the (injected) coronavirus vaccine trials were
             | double blind. Seems like enough for someone in the next
             | room to know if the maybe-ketamine injection is placebo, so
             | they can unblind immediately in case of a bad reaction.
        
             | boomboomsubban wrote:
             | >Right patient, right medication, right dose, right route,
             | right time
             | 
             | Can't you achieve all of those by having someone else
             | create the bag and then label it for the patient. The
             | "right medication" is the one they're receiving as part of
             | the study.
             | 
             | It's not like what they need to do is different if it's
             | ketamine or saline.
        
       | mabbo wrote:
       | > The primary outcome was the rate of patients in full suicidal
       | remission at day 3, according to the scale for suicidal ideation
       | total score <=3. Analyses were conducted on an intention-to-treat
       | basis.
       | 
       | Question: does reducing suicidal ideation reduce suicide? I mean,
       | it sounds like it obviously should, but we've been wrong about
       | this before. Many heart medications to reduce cholesterol worked
       | great at reducing cholesterol without reducing heart disease!
       | 
       | All that said, reducing suicidal ideation is a worthy goal
       | itself, even if it doesn't reduce suicide. I'm a full supporter
       | of seeing this treatment move more mainstream.
        
       | aarontait wrote:
       | FYI: Johnson & Johnson patented the S(+) enantiomer of ketamine
       | and sells it as a nasal spray called Spavato. It's been FDA
       | approved for depression since 2019. Although Spravato costs more
       | on paper than regular ketamine, it's often less expensive for
       | patients since it is covered by insurance (regular ketamine
       | treatments are considered an off-label use and are usually not
       | covered).
        
       | archhn wrote:
       | Christianity without tears?
        
       | sshine wrote:
       | This suggests that ketamine is beneficial for people who are
       | suicidal to prevent them from killing themselves. The claim that
       | is generally made about ketamine and depression is that it can
       | have a short-term resetting effect of someone's depressive
       | symptoms (not necessarily at a suicidal level), making it
       | possible to escape the black hole that otherwise can take weeks,
       | months, years to come out of.
       | 
       | https://www.nih.gov/news-events/nih-research-matters/how-ket...
        
         | kuhewa wrote:
         | For bipolar or other disorders, not much of a discernible
         | effect for depressives
        
       | datavirtue wrote:
       | Doctor prescribed anti-inflammatory for a pinched nerve I
       | have...cured mine.
        
       | Terry_Roll wrote:
       | Some vets use Ketamine as part of a multi stage protocol for
       | euthanising animals, other vets just use a single drug protocol
       | but I havent established what that drug is, but it just seems all
       | a bit refined butchery to me!
       | 
       | Ketamine is supposed to be a disassociate drug, which I'm
       | guessing is perhaps like an out of body experience or something.
       | But I cant see how that can help with depression when people dont
       | understand depression can actually be lots of things, but it has
       | one overriding common element which is people remembering.
       | 
       | So unless people get something like dementia where recent
       | memories seem to fade first and the earliest memories come back,
       | I fail to see how K can help treat depression.
       | 
       | As for suicide ideation, well look around at what constitutes 1st
       | world medical care! If you dont buy into the smiley faces because
       | you might have grown up around medical professionals and heard
       | the back office chats you might think twice about the
       | authenticity of so called medical professionals! Not only that,
       | its just a job for most, leave it at the door when your shift
       | finishes, which is easier said than done especially if a dying
       | patient seemed nice and innocent compared to an unpleasant angry
       | dying patient.
       | 
       | I really dont know why we dont have legal euthanasia because
       | being experimented on in the name of science is not something I'd
       | let others do to me if I can help it, I am aware that some argue
       | it would be a direction towards eugenics, but that goes on
       | already in stealth with some medical procedures.
        
         | amelius wrote:
         | Isn't morphine overdose the best (friendliest) possible
         | euthanizing method?
        
           | Terry_Roll wrote:
           | Morphine/Heroin is supposed to physically cause respiratory
           | depression so you stop breathing and I guess the CO2 builds
           | up past the 30% blood saturation point by which stage it
           | takes about 2 mins for the body to shut down. As the CO2
           | levels reach that 30% blood saturation point, the body
           | becomes increasingly stimulated which is why you see people
           | thrashing around when drowning or asphyxiating. Having done
           | sea rescue to stop someone drowning in rough sea's, you can
           | say goodbye to all the training water rescue people get
           | taught and just hope the panicking person isnt as strong as
           | you and hope your lungs are better than theirs, because they
           | will force you under and you will ingest lots of water so you
           | have CO2 build up which spurs you on to shore ironically.
           | 
           | Obviously (going off things like trainspotting and peoples
           | accounts), opiates are supposed to give you a warm fuzzy
           | feeling as you slip into a deep sleep or unconsciousness I
           | guess but not to sure, never done it not even in an operating
           | theatre.
           | 
           | MAOI's the old style anti depressants are quite sudden in
           | that they are like an on off switch for the brain, you dont
           | remember or feel nothing and I think they were popular with
           | people who wanted to end it, but SSRI's have replaced them as
           | the new anti depressant treatment but their problem is you
           | dont sleep properly on them so they introduce their own
           | problems, but I'm not aware of any end of life properties in
           | SSRI's other than they ruin your sleep and send you off the
           | rails slowly.
           | 
           | But all the while, these chemicals still dont address the
           | fundamental problem with depression which is remembering
           | stuff that causes depression. Maybe depression should be
           | treated more like PTSD, because depression seems to be an ego
           | thing, where as talking to other people, PTSD seems to be
           | more like what people associate as depression.
           | 
           | For bloke's I think the bio mechanical properties of
           | testosterone would help many with PTSD, cant comment for
           | women though, but the risk the police and medical lot dont
           | want is some hulk losing it so the idea isnt entertained
           | AFAIK.
           | 
           | Self preservation of institutions comes before everything
           | else!
           | 
           | Edit: I should add, once CO2 blood saturation exceeds 30% it
           | has a noble gas effect on the body, so anyone who remembers
           | the periodic table should remember what noble gasses are and
           | its why compressed gas companies go to great lengths to not
           | enable pure noble gases getting into the hands of the public.
           | 
           | Biology and chemistry is just the mammalian equivalent of
           | computer hacking.
        
         | [deleted]
        
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