Have You Tried Ketamine or Esketamine for Major Depression?

I am currently in my 3rd or 4th week of screening and will most likely be accepted into a clinical trial of an esketamine nasal spray. I believe that they will start me on it in 1-2 weeks.

I have read a great deal about the potentially life changing benefits and I'm very excited at the prospect of finally finding a medication that works for me. On the flip side, I'm dreading the thought that this highly promising treatment won't help me.

I would very much like to hear from anyone who has tried either ketamine or esketamine. I'm talking medically supervised use, not self medication. I have no desire to get high.

I read a little bit about it.

For anyone who might be interested in the Esketamine clinical trial:

The study is targeted at those who have dealt with drug resistant Major Depression for an extended period of time. The qualification parameters are quite narrow and the study requires a large time commitment. Each visit is 3-5 hours. Participants cannot have diagnoses such as BiPolar or psychoses. I believe that cardiac issues, high blood pressure and nasal/sinus problems are also disqualifying factors.

The screening portion of the trial lasts 4 weeks, consisting of twice weekly visits. Participants answer questionnaires (many, many questions) about mood and lifestyle. Participants must conduct a phone interview with a psychiatrist once per week, lasting 30-40 minutes. Blood draws and urine samples are taken regularly.

If accepted, participants begin the drug phase of the study, beginning with coming off current meds. They are then given a new antidepressant that they have not taken in the past. Once off old meds, Esketamine is self administered 3 times, in the form of a pre-measured nasal spray. The sprays are taken at 5 minute intervals. Blood is drawn 4 minutes after the 3rd spray and again 1 hour later. The participant is asked a series of questions immediately before and 1 hour after the full dose. Participants are 'discharged' at the discretion of the attending psychiatrist and are not allowed to leave alone. This routine is also twice per week. Participants conduct phone interviews with a psychiatrist several times per week during this phase.

This is a paid study. Normally $100 per visit. The amount can vary depending on the length of each visit. On one visit the Dr was running behind. I was there for at least 5 hours and was paid $200. Payment is in the form of a prepaid MasterCard supplied to the participant on the first visit. Money is added to the card at the end of each visit and is immediately available.

I have thus far had 2 doses of Esketamine. Because of the effects, I am certain that I am not receiving the placebo. Within seconds of a inhalation I get a feeling similar to gas at the dentist's office although far milder. In my case, this feeling completely dissipates after 2-3 minutes. (I got the impression from the psychiatrist that in others it lasts up to an hour.) There's an unpleasant post nasal drip taste but again, it is short lived. Slight sniffles; also short lived.

I'm extremely pleased to report that there was a noticeable difference in my mood immediately after the first dose. I felt far less 'trapped in my head.' At one point on the following day, I realized that I was grinning to myself. Completely out of character. The daily 'I wish I was dead' thoughts have disappeared. Anxiety has decreased. Increased appetite. More sleep. I feel a sense of hope for the first time in forever. Very, very encouraging.

I apologize for babbling but sincerely hope that someone finds this information helpful.

I'm in the same or similar trial. I get my first dose on 9/30. I'd love to hear how you're feeling a few months out. I really hope this works for me. I'd love to feel normal again.

tiffany978 wrote:I'm in the same or similar trial. I get my first dose on 9/30. I'd love to hear how you're feeling a few months out. I really hope this works for me. I'd love to feel normal again.

Congratulations, Tiffany! This is such a difficult study to qualify for. The clinic I go to only has 1 other person who qualified.

I completed the main study and signed on for the follow-up phase. Dosing drops from twice a week to once a week to every other week. I haven't had a dose in 13 days and I can feel myself sliding backwards some. Isolating mostly, which has been my M.O. for almost 2 decades. Thankfully, the 'wish I was dead' thoughts haven't returned. (knock on wood)

It's my understanding that this drug is having positive results on the majority so, assuming that you don't get the placebo, (you'll know if you get the drug) I think it's safe to say that you'll feel at least some relief.

Keep in touch and let us know how it works out for you. Best of luck!!

Update - 1 Year Later

Sunk fast after the end of the study. Got new scripts for my former meds but after the resounding success of the esketamine, I didn't bother filling the scripts. They're basically useless on me. Pre-study, I was taking lamotragine and something else. Possibly Prozac. Can't remember. Prior to that, I'd been on everything from Prozac to lithium. The only meds that ever helped were diazepam and seroquel, both taken for sleep. Upon moving, the new clinic decided not to prescribe them. No idea why. Anyway, nothing lifted the depression and now my sleep is so fkd up it's ridiculous.

For the past year I've been a sedentary hermit. Only get out of bed when I have to. Quit smoking for 7 months (during the study) and then started again after it ended. Gained 40lbs. Feel and look terrible. Every day I tell myself that I'm going to exercise, eat right and lose weight. I never do it.

I'm just marking time and wondering if I can wait out the 5 or more years it will take for esketamine to be reviewed and hopefully approved by the FDA. I attend weekly group therapy, not because it helps the depression but because it gets me up and out. I dread it every week but so far I'm still going.

I guess my point is that the differences between the Before/During/After of the drug study are dramatic. On a visual chart it would look like an upside down V. Not good at all.

I had Ketamine infusions,it worked while I was receiving it but I too "plunged" after the treatments ended. My Pdoc tells me I need maintenance treatments, but at $500 per infusion it's just not realistic.

Witchy wrote:I had Ketamine infusions,it worked while I was receiving it but I too "plunged" after the treatments ended. My Pdoc tells me I need maintenance treatments, but at $500 per infusion it's just not realistic.

Hi Witchy. I'm sorry to hear that you had a similar experience after coming off Ketamine. I did a lot of research into infusions and was floored by what I found. Aside from it's intended use as an anesthetic, Ketamine is used as a boutique drug by unscrupulous doctors who charge insane fees. It's disgraceful. Any doctor whose bottom line is 'I'll help you ... if you can afford me,' is the scum of the earth in my book.

On Sept 4, 2018, Janssen Pharmaceuticals announced that they filed a New Drug Approval application for intranasal esketamine with the FDA. Average time for FDA approval of a new drug is 7-12 yrs. That includes trials, etc. It could conceivably take a minimum of 2 yrs before esketamine is approved. The upside is that Esketamine has been placed on the Compassionate Use list.

FDA on Compassionate Use
https://www.fda.gov/NewsEvents/PublicHe ... ndedAccess

Janssen Compassionate Use Request
https://www.janssen.com/compassionate-u ... e-requests

Janssen Policies and Principles
https://www.janssen.com/compassionate-u ... principles

If you have treatment resistant Major Depressive Disorder, look for an esketamine clinical trial in your area. Otherwise, you can talk to your doctor about the possibility of applying for early access to the drug.

Update on Intranasal Esketamine:

It was reported on February 12, 2019 that the FDA Psychopharmacologic Drug Advisory Committee recommended Spravato (intranasal esketamine) for approval.

It has been reported in a number of medical journals that the new drug is expected to receive final FDA approval on or by March 4, 2019.

Estimates on when newly approved drugs reach the market range from 6 months to a year. The process could take less time. It all depends on how much advance work Janssen did on marketing and insurance.

Downside is that the Advisory Committee doesn't trust patients to self-administer at home. Users will have to go to a healthcare provider's office, receive a dose and then remain for 1-2 hours to ensure that disassociative and sedation side effects have subsided.