While this study involved using Ketamine as a IV infusion with pts that state they are suicidial. I know at least one pt that is using Ketamine that is being prescribed by a Psycharitist and a compounding pharmacy is making Ketamine Troche. A Troche is like a cough drop and is designed to be put in the buccal area (between cheek and gums) and let it dissolve. Doing this, the medication is aborbed by the body in a similar methodology like a pt getting a Sub-Q or IM injection. The medication misses first pass of the liver metabolism and goes directly to the receptor site(s), also avoids the stomach acid which could be rather destructive on the Ketamine. The pt that I am aware of is getting a Troche that is FOUR TIMES what the pt is suppose to take – but the pt breaks the troche into quarters. Studies have demonstrated that when a pt breaks a tablet in HALF that each HALF will be +/- 20% of what would be otherwise expected. When a pt starts breaking a tablet into QUARTERS – 4 pieces – the dose the pt is taking could be highly variable. There is no better way to get a very inconsistent therapy outcome from taking a particular medication.
What I would suggest is that a prescriber give the pt the Ketamine injectable and use a mini-nebulizer and enough normal saline to make a total volume of 2.5 to 3 ml in the nebulizer cup. Taking Ketamine this way, the dose that the pt is getting is pretty accurate, the onset of the medication would be fairly rapid, and the duration of the therapy should be in the 15 minute range.
The pt working with the prescriber, the Ketamine dose could be easily adjusted up or down, only thing that the pt should keep consistant is the total volume in the nebulizer should be around 15 minues. Less Ketamine would mean more Normal Saline. More Ketamine would mean less Normal Saline.
Ketamine Linked to Reduced Suicidal Thoughts, Depression, Anxiety
https://www.medscape.com/viewarticle/980814
Ketamine infusions can help reduce symptoms of suicidal ideation, depression, and anxiety in patients with treatment-resistant depression (TRD), new research suggests.
Results from a retrospective chart review analysis, which included more than 400 participants with TRD, illustrate that ketamine is a safe and rapid treatment in a real-world patient population, lead author Patrick A. Oliver, MD, founder and medical director, MindPeace Clinics, Richmond, Virginia, told Medscape Medical News.
The effect was perhaps most notable for reducing suicidal ideation, he said.
“In 2 weeks, we can take somebody from being suicidal to non-suicidal. It’s a total game changer,” Oliver added.
Every year in the United States, about 12 million individuals think about suicide, 3.2 million make a plan to kill themselves, and more than 46,000 succeed, the investigators note.
The findings were published online September 12 in The Journal of Clinical Psychiatry.
Molecule Mixture
Primarily used as an anesthetic in hospitals, ketamine is also taken illegally as a recreational drug. Users may aim for an intense high or feeling of dissociation, or an out-of-body–type experience.
Ketamine is a mixture of two mirror-image molecules. An intranasal version of one of these molecules (esketamine) is approved by the US Food and Drug Administration for TRD. Both esketamine and ketamine are believed to increase neurotrophic signalling that affects synaptic function.
The study included 424 patients (mean age, 41.7 years) with major depressive disorder or another mood disorder and who received at least one ketamine infusion at a specialty clinic. Most participants had failed prior medication trials.
Patients in the study were typically started on 0.5 mg/kg of ketamine, with the dose titrated to achieve symptoms of partial dissociation. The median dose administered after titration was 0.93 mg/kg over 40 minutes.
The main treatment course of at least six infusions within 21 days was completed by 70% of the patients.
At each clinic visit, all participants completed the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7).
The primary outcome was PHQ-9 total scores, for which researchers looked at seven time periods: 1 week, 2-3 weeks, 4-6 weeks, 7-12 weeks, 13-24 weeks, 25-51 weeks, and 52+ weeks.
“Blows It Out of the Water”
Results showed PHQ-9 total scores declined by 50% throughout the course of treatment, with much of the improvement gained within 4-6 weeks. There was a significant difference between week 1 and all later time periods (all P values < .001) and between weeks 2 and 3 and all later periods (all P values < .001).
Other measures included treatment response, defined as at least a 50% improvement on the PHQ-9, and depression remission, defined as a PHQ-9 score of less than 5. After three infusions, 14% of the patients responded and 7% were in remission. After 10 infusions, 72% responded and 38% were in remission.
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