The Struggle to be Heard

It’s easy to sometimes feel as though we are being ignored. It’s even more true when you’ve got a mental illness. Depression fogs every emotion, not merely the “Good” ones.

It grows, with very little help, from sadness and fatigue, until you don’t know how anyone gets through the day. And the anxieties kick in. It reaches a panicked pitch of loneliness and isolation. By choice or by force.

When every time you start a new, “better” medication, you receive a warning from the doctor you’ve had memorized for years,

Now, remember, it could take two or three months before you notice a change…”

This is somehow seen as an acceptable way to treat people within an inch of suicide. It’s hard to imagine how we ended up here. Surely this wasn’t the goal when the first MAOIs were made available for prescription.

MAOIs were developed in the 1950s, accidentally. The action was noticed in tests by the patients have a slight increase in energy, motivation, and activity than those on placebo.

Tricyclics antidepressants were discovered in a similar manner in 1957 while attempting to create antipsychotic. It’s effects were thought to be almost entirely placebo at first. Imipramine was prescribed for years without any understanding of how it worked. It was hypothesized to work on norepinephrine, then later, serotonin.

For 30 years, little changed. MAOIs had weird interactions with even common foods. Tricyclics are still considered among the most effective medications for depression, but they seem to have little effect on suicidal ideation, and can cause major issues in the case of overdose

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In 1988, this all changed, when the first of a “novel class of antidepressants,” fluoxetine(commonly known by brand name Prozac) was released in the US. It was the first majorly successful SSRI, the class of medication that would hold America for thirty years to come.

SSRIs are the most prescribed antidepressants ever. Dozens of slightly different SSRIs, and SNRIs have come and gone on the market. a few atypical medications have seen popularity in this time as well. Substituted amphetamines, GABA Inhibitors, Dopamine agonists, anticonvulsants, steroids, hormones, antipsychotics, stimulants, all have been used for depression, some in combination with an SSRI.

Yet, even with secondary medications supplementing SSRIs, the success rate has been incredibly low. Around 30% of people have no reduction of symptoms, or only experience a partial relief.

That’s right. Seventy percent of people who see a doctor for depression will find no help there. If we’re real for just a moment, that’s barely outside of placebo-range.

In 2000, the first tests were done on depressed patients with the common anesthetic, ketamine. Another test was published in 2006. In 2011, Harvard Medical School published a study that brought ketamine to the forefront of research in medications for depression and anxiety.

Over the last decade, countless tests have shown results too similar to be ignored. Ketamine consistently provides rapid, relief. From taking SSRIs for months with no idea if they were working, to waiting an hour.

In 20 years, ketamine has brought us further than the 100 years of therapy and psychiatry prior. With a dose far below what is used in anesthesia, ketamine can remove suicidal ideation the same day as administered. Because the patent on ketamine ran out in the 1980s, however, it was not a profitable route for pharmaceutical companies, and thusly, still not FDA approved.

Researchers worked at break-neck speed to split the ketamine molecule down to it’s s-enantiomer, esketamine, which was ran through very unpromising testing, and approved by the FDA earlier this year. However, it doesn’t take much to see that it does not cut the mustard in data or results. Now available as a nasal spray in controlled clinics, where you must take it, under observation, it can cost a patient over $2000 for a single dosing.

That’s nearly completely markup. Compounding pharmacies make a nasal spray for ketamine use at home, with a prescription, for about $50. Nasal sprays actually, are a terrible way to measure such a small amount of medicine. The mucus membrane doesn’t absorb ketamine or esketamine evenly, which means you have no idea exactly what dose you are receiving.

Absorption is most accurately rated via intravenous infusion, followed by sublingual. Only a certified anesthesiologist should try to provide ketamine by infusion. Needles and IV bags belong away from the suicidal patient’s home. I think that’s easy enough to see.

However, with such a dramatic increase in the time for effects to be felt, with most studies reporting near 90% success rate, it’s time we have to take this into our hands as patients.

Psychiatrists who haven’t read the studies on ketamine, are living in a closet. If they prefer to say, “I disagree,” than accept the evidence, they are a danger to themselves and their patients. And if they’ll only help you get the inferior byproduct, they only care about money.

Is your doctor doing what’s best for you, and his or her patients? Or are they terrified by something new? Afraid that they might not be needed every month anymore?

Some say it’s because it is sometimes abused. While true that ketamine is abused in very high dosages, and can even be addictive, it’s exceedingly rare. If received from an anesthesiologist, in their presence, then these worries have no face value at all.

In fact, the ever popular amphetamine mixture, Adderall, has a far higher abuse potential. So much so, that it’s more restricted and monitored by the DEA. Amphetamines consistently rank among the most abused drugs in the world. You won’t find a psychiatrist so adverse to prescribing Adderall.

So, 30% or 90%? Either choice is an all or nothing bet. If you’re among the 70% of depressed patients with TRD, you’ve likely already wasted a chunk of your adulthood hopping back and forth between one ineffective medication and another. I wasted away for 15 years, and I’d love to punch a few jackasses that never suggested ketamine treatment. How about you?

Personally, I couldn’t afford to risk it. I could only see another 15 years without change ahead. I’d rather be dead in a gutter.

– Jack

as always, real.

07.16.19

One Reply to “The Struggle to be Heard”

  1. @jack My journey with ADs is pretty similar. The first one I took nearly killed me, so you can imagine how I felt about trying more after that. 2nd one was unending nausea and nerves, 3rd same thing, 4th killed my sex drive, stopping it brought it back immediately, 5th is the one I'm on now, and it's alright as long as I don't forget to take it. There is no science here, it's all guessing games. I think it's ridiculous this is as far as we've gotten with mental health pharmacology in 2019.

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