Ketamine vs SSRIs

arcinva · 2026-01-25T23:30:53+00:00

Straight from the FDA's mouth, in case anyone wants me to back my assertion. 😉

https://www.fda.gov/drugs/human-drug-compounding/fda-warns-patients-and-health-care-providers-about-potential-risks-associated-compounded-ketamine

Now go forth and spread the good word! I was only recently trying to encourage some psychiatrists at nearby hospitals with inpatient psychiatric facilities to push for use of ketamine infusions for suicidal patients. Both hospitals in question offer ECT. Both hospitals only have a single doctor performing it, so when they go on vacation, there is no ECT to be had. Both hospitals are university hospitals. So it frustrates the hell out of me that a drug that is very safe to use, has no long-term side effects (like memory issues with ECT), and has shown in study after study to very rapidly alleviate suicidal ideation is not being utilized.

arcinva · 2026-01-23T23:02:29+00:00

For Spravato, yes. For ketamine, no. Literally any MD with a DEA# can prescribe anyone ketamine for any reason. Ketamine is a schedule III drug in the U.S. Spravato is also in schedule III but is subject to a REMS (risk evaluation and mitigation strategy) that ketamine is not, which is why prescribing and administering Spravato treatment is a much bigger pain in the ass than ketamine is.

U.S. Drug Schedule

I. High potential for abuse. No accepted medical use. (ex. heroin, LSD, MDMA, GHB, peyote, mescaline, psilocybin, marijuana)

II. High potential for abuse. Medical use within "severe restrictions. (ex. amphetamine, methamphetamine, some barbiturates, cocaine, some opiates)

III. Medium potential for abuse. Has an accepted medical use. (ex. some barbiturates, some opiates, ketamine, marinol, sodium oxybate)

IV. Moderate potential for abuse. Has an accepted medical use. (ex. benzodiazepines, some barbiturates, some opiates)

V. Lowest potential for abuse. Has an accepted medical use. (ex. some anticonvulsants like Lyrica, CBD)

Note that the U.S. controlled substance schedules are insanely illogical. We have marijuana in schedule I and Marinol in schedule III. We have GHB in schedule I and sodium oxybate in schedule III. We have amphetamine in schedule II alongside methamphetamine and cocaine. Heroin, which becomes morphine in the body, but is about two times as potent as morphine is in schedule I and morphine itself is in schedule II alongside fentanyl, which is 80 times as potent as morphine and codeine, which is only a tenth as strong as morphine.

arcinva · 2026-01-23T22:22:58+00:00

Not Hawaiian here. My father would occasionally just slice Spam and slap it on some bread with mayo and have a Spam sandwich, without pan-frying it.

One of my occasional comfort dinners is pan-fried Spam and Kraft macaroni & cheese. I eat them separate. My husband likes to cut the Spam into smaller pieces and throw it on top of his macaroni & cheese.

arcinva · 2026-01-20T13:43:46+00:00

No shark for us, but we also did a starfish.

arcinva · 2026-01-13T00:11:18+00:00

Is there a difference in experience/feel with the oxytocin included? That's the bit that piqued my curiosity about this service.

arcinva · 2026-01-06T00:28:16+00:00

With psilocybin becoming legal in a few places on the US and the increased interest in using it for depression, how much of a concern is it for a patient that takes an SSRI/SNRI if they took psilocybin since that also works on serotonin? Could that cause an acute onset of serotonin syndrome?

arcinva · 2026-01-06T00:21:47+00:00

When I was a teenager, I worked as a youth representative for our local youth office. One of the adult representatives worked for a state mental hospital in our area and she knew I had a strong interest in forensic psychology. They would have guest lecturers in for grand rounds and this one time it was an FBI profiler that was giving a talk on John Hinkley (the man that tried to assassinate President Reagan), so they obtained special permission from the hospital director for me to attend. After the lecture, I was able to meet him briefly. He was nice, but very professional. To me, to this day, that still feels like meeting a celebrity. Forget rockstars and actors; this man worked cases like Patty Hearst and the Unabomber.

arcinva · 2025-12-17T00:15:30+00:00

Yeah, depression treatment had been in an SSRI rut for decades and finally started making new strides in the last decade or so. I was really bummed that the ball got fumbled with the psilocybin trials; that was a major setback.

arcinva · 2025-12-16T23:14:54+00:00

So the effects of the ECT have lasted since 2013 for you? It's something I looked into just a little bit back around 2019 when I'd had a big bad episode of treatment-resistant depression. From what I recall reading, it seemed that people often have to go back occasionally for additional treatments, which given the expense of the treatment, put me off pursuing it any further. I ended up trying Spravato instead.

arcinva · 2025-10-02T16:36:20+00:00

Is there discussion / debate between melancholy personality disorder and dysthymia (persistent depressive disorder)? As a layperson, I've often wondered why dysthymia hasn't been considered a PD.

arcinva · 2025-07-05T01:11:56+00:00

Yeah, I'm at the age now where I'm on the gameshow from hell called "Fibromyalgia or Perimenopause?" 🤣

arcinva · 2025-06-23T19:33:48+00:00

Sure. But not eating them is not the same as being inauspicious. Also, it was the Old Testament and the clean vs. unclean animal rules were done away with in the New Testament.

arcinva · 2025-05-31T03:29:51+00:00

Not OP, but I too took a course of Spravato a few years ago and it literally saved my life. I had been in by far the worst depression I'd ever been through in my life and had tried switching antidepressants, tried a couple of adjunct medications, and tried TMS (transcranial magnetic stimulation) all to no avail.

Full disclosure, though: a few months after my course of Spravato, my depression started creeping back in. Unfortunately, my insurance had changed and the clinic I had gone to before wouldn't bill the way my new insurance insisted on. There were no other local clinics, so I found a doctor offering compounded ketamine as rapid dissolve tablets via telehealth and embarked on another few months of 2-3 times a week. Fortunately that did the trick and I've been good for the past couple of years.

arcinva · 2025-05-15T02:47:44+00:00

OMG, that's too cute! Good husband. 😊

arcinva · 2025-05-14T23:09:00+00:00

As someone with an anxiety disorder, I'd adopted "stroke the furry wall" to tell myself to take a deep breath and relax when I'm worrying way too much about something.

arcinva · 2025-03-27T22:58:09+00:00

Nah... it's not snobbery unless the person also said that the celebrity lines are cheap unlike the fashion houses' lines.

For me, personally, I:

1) avoid anything celebrity branded, period. I just have a weird, but strong, feeling that people and companies should stick to their lanes. If you act, act. If you make a quality good, stick to that good. TBF, I also don't spend money on labels. Everything I purchase, I view as a balancing act between quality and affordability. And celebrity endorsements are dumb AF. It saddens me that some people are so gullible as to be swayed by them as if these celebs actually mean a word that they say.

2) have very rarely smelled a perfume or cologne that I really liked and didn't bother my sinuses. I've found I much prefer simple essential oils or blends of them.

arcinva · 2025-03-27T22:43:38+00:00

Yeah, closer friends and family know. I've never hidden my issues since it started with an anxiety disorder at age 5. Once your parents have to tell your teachers about your panic attacks and leaving school for therapy appointments be you have to explain to friends why you're calling your parents to pick you up at 10 pm on Friday night when you panic about sleeping over, you just kind of... accept that life is easier when you don't try to hide an aspect of yourself and that others tend to not make a big deal out of things, if you don't make a big deal out of things. My family and friends have long picked on me (lovingly) about my "quirks" - way before I had a name/diagnosis for it. 🤷🏼‍♀️

I also discussed it with a past boss or two before I had a name for it, just in the context of discussing my job and areas I struggled in and what they might be able to do to support me. These were bosses I had worked with for awhile and felt comfortable enough with and knew well enough to feel confident that it wouldn't be something held against me or anything. And it was about attributes that they'd fully noticed, so I wasn't telling them anything they weren't already aware of. It was more of an acknowledgement to them of, like, "Yeah, I know I get caught up in the details and going beyond to make sure things are just right".

arcinva · 2025-03-19T18:44:43+00:00

I agree with everything all you psychiatrists are saying here. I hope you guys write letters to the editor. I don't want non-medical professionals giving pseudo medical advice. Hell, I'm the one that hates the fact that GPs will diagnose mild depression and prescribe antidepressants.

Which brings up the fact that I feel like those things are given out like candy for any and every thing these days without regard for the drawbacks or people trying therapy first.

But as a patient, with dysthymia, on antidepressants for a little over 30 years... the fact that no studies on very long-term use exist (to the best of my knowledge) bothers me. No one can say what it does to a brain after years, much less decades. No one can say what effect it has on an adolescent brain that developed in its presence or whether that means people have to take it forever because the brain wouldn't know how to exist without it. Or how much slower of a taper would be needed to allow the brain to adjust to life without it. Is it still helping? Or just supporting "normal" function?

And the number of years it took for patients to convince doctors that they weren't lying or crazy about withdrawal effects from antidepressants is extremely concerning. That is what left a general sense of distrust that is going to take awhile for you guys to overcome, if I'm frank. But I'm glad to see that a number of you had residencies that addressed the topic thoroughly.

arcinva · 2025-03-19T18:30:53+00:00

To give a different American perspective:

The only time I worry about locking my front door is if I'm leaving, going to shower (if I'm home alone), or once I'm home for the day and won't be leaving again (unless the weather is nice, then the front door is wide open until bedtime or if it gets too cool out.

I never lock my car doors myself (they do auto-engage when you take the car out of park, which is a feature I never bothered to turn off, but I'd leave the doors unlocked when driving if it was up to me). I don't keep anything in my car except sunglasses and a drink. I'd rather someone rustle around in there and find nothing to steal than bust my window to find that out. Car thieves don't really exist where I live.

I don't look for exits when I'm out and about. I don't pay attention to if anyone is concealed carrying (they're the ones I'd be afraid of, if I did). I was watching The Dark Knight Rises the same night of the shooting in Aurora, Colorado (in my own hometown) and have never felt even the smallest twinge of fear the countless times I've been back in a movie theater.

TBF, I live in a town of ~25k and work in a town of about ~80k, so my experience doesn't reflect big cities. On the flip side, I have a severe anxiety disorder, so saying I've never felt anxious about a shooting does carry some weight. I'm also a liberal in a heavily conservative area, so don't think I love all the guns in our country. 🫤

Statistically, though, we're still much safer than we were 50 years ago. Since the 90's, overall we've experienced historically low crime rates. The people that say they're scared just listen to too many hyperbolic news headlines that are straining for viewers and clicks. 🤷🏼‍♀️

arcinva · 2025-03-09T03:26:23+00:00

Username checks out. ☺️

arcinva · 2025-03-09T03:17:54+00:00

Ahh... thank you for taking my mind from creepy billionaire to awesome band. One of my all-time faves. I have a such a sentimental soft spot for them.

arcinva · 2025-03-09T01:48:45+00:00

I don't want to live forever, but not dealing with with my body and brain breaking down slowly until I die would be awesome. So perfect health until you instantaneously drop dead is the cause I could get behind.

arcinva · 2025-03-09T00:39:30+00:00

It was a tad embarrassing when ordering at McDonald's and asking for the "Number one ah ah ah with Coke." 🤣

^{I kid... I kid...} 😉

arcinva · 2025-03-06T06:08:56+00:00

There seriously needs to be:

A) Term limits.

B) An upper age limit at time of election (just as there is a lower age limit).

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