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New Psychedelic Anti-Depressant Esketamine: What the Patients Have to Say

esketamine patients say
Written by Sarah Friedman
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Psychedelic-assisted therapy, and the legalization pf psychedelic drugs, is most definitely a thing. We know this, because the psychedelic drug esketamine is already legal for use, with MDMA and psilocybin on the way, and being pushed by the FDA. Is esketamine an effective treatment, here’s what the patients have to say.

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What is esketamine?

Before getting into esketamine treatment and what patients say about it, let’s cover what it is. If the name ‘esketamine’ sounds incredibly similar to a popular party drug, that’s because it is. The drug ketamine has been a staple of the party circuit since the 80’s and 90’s, and esketamine is its close cousin. Ketamine was discovered in 1962 by scientists at Parke-Davis. They were in search of a strong anesthetic, and after creating, testing, and ultimately rejecting PCP, and other closely related compounds, ketamine was discovered. It was described as a compound with “cataleptic, analgesic and anesthetic action but without hypnotic properties.”

It became known as a dissociative anesthetic, because of how it seemed to disconnect parts of the brain. This was subsequently described as “electrophysiological and functional dissociation between thalamocortical and limbic systems.” Since that time, ketamine has been used as an anesthetic in both animals and humans, as well as being used as a recreational party drug. Essentially it doe three things, provides pain relief, anesthetic affect, and sedation. The chemical formula for ketamine is C13H16ClNO.

Of course, we’re not talking about ketamine, we’re talking about esketamine. Esketamine hasn’t been around as long, making its first appearances in Germany in 1997 as an anesthetic. While it was being used as an anesthetic, it was noticed that the compound had very fast-acting antidepressant effects, and began being investigated for this purpose. In 2017 the drug finished trials in the US for treatment-resistant depression, and in 2018, Johnson & Johnson filed an application with the FDA for a new medication – Spravato. It was approved on March 5th, 2019.

It was technically approved in conjunction with standard antidepressants for the treatment of depression in adults. In 2020, this was updated to include prescription for suicidal thoughts on account of how fast-acting it works. It is already being prescribed for use in psychedelic-assisted therapy.

Esketamine

Esketamine therapy, what the patients say

Pharmaceutical companies put out all kinds of medications, and they promote them all like they’ll save your life, even when going through litigation because of lies. Though psychedelics do seem to have good efficacy for helping people, this does not mean that any psychedelic medication will be okay. So, it suffices to say that hearing directly about esketamine from patients, and what they have to say, is the best thing for understanding the current situation. In the first few years of something being out, it can be hard to find the stories. These are the stories around right now.

One test subject, Amelia D., started receiving esketamine in 2017 at the Rochester Center for Behavioral Medicine. As she explains, she began taking anti-depressants shortly after she finished college, and had been given a range of diagnoses ranging from dysthymia to ADHD to anxiety to major depressive disorder. She explained how after the intake for the study, she was required to take the drug twice a week for at least a month, each time under supervision in the doctor’s office.

She explained how those taking part were not allowed to drive for 24 hours following administration. She says it started with four hours of supervision, but was brought down to between one and two hours over time. This makes sense for shorter acting drugs like ketamine.

By the time a Time article was written about her in 2019, she was going every two weeks for treatment, in which she was administered three nasal doses at five minute intervals, and then watched for an hour or two. She also stated fears of not being able to continue the medication when the trials were over due to insurance not covering it, and not being able to find a therapist. Though she had plenty good to say about the treatment, she highlighted the fact that she had gone from being unemployed for quite some time, to holding a job steadily, and being generally okay. She said she always knows when she’s ready for another dose.

It doesn’t seem like this particular trial included the therapy aspect of it, and was likely more to establish effects of the drug. She did not mention negative side effects, and spoke generally of an improvement in her life.

Esketamine, what more patients have to say

patients say

Esketamine therapy has begun to find its way into the mainstream, and has been spoken about openly by American comedian Theo Von. Von, known for his stand up and podcast work, among other projects, runs a podcast called This Past Weekend with Theo Von. In Episode 341, called Ketamine Therapy, Von talks about his own experiences with depression and ketamine therapy, as well as interviews with founder and medical director of the Chattanooga Ketamine Center, Dr. Jason Pooler.

Von talks about the hallucinations he had while taking esketamine (it is often called ketamine by users, but the drug they are prescribed is esketamine). Theo’s father died when he was young, and through the ketamine therapy, he was able to deal with the subconscious pain of not having his father, and he said that using esketamine allowed him to complete the grieving process.

Yet another public personality, albeit on a smaller scale, is podcaster Ariel Kashanchi who runs the show Mad Genius. In her June 16th episode ‘Ketamine Touchup’, she goes into specifics about getting ketamine therapy. She starts by talking about her 7th infusion. She did six consecutively, followed by the 7th touch-up. She explains how touch-ups can be done per person needs, and that for her it’s every eight weeks or so.

However, before this, she had an April 8th, segment called Ketamine, TMS & My New Brain in which she describes more about the actual process. At the time of the recording she was one week into her esketamine and TMS (Transcranial magnetic stimulation) therapies, having had two ketamine sessions at that time. She talks about her longstanding issues with depression, PTSD and childhood trauma. She said more than once in the episode that she feels like a different person since treatment began.

She explains that in her case its administered via IV. She talks about being in a comfortable setting, with a comfortable chair and blankets, eye mask, and noise canceling headphones. She talks about being hooked to the IV for about 40 minutes, with a doctor checking on her every so often (not the standard format for psychedelic-assisted therapy). She was told she had to have an intention the fist time she went in, and hers was to feel valuable and lovable. She said the experience felt a bit like virtual reality…but her overall sentiment was that prior to this she didn’t think she’d ever feel okay, and now she does. She also – like Von, spoke about hallucinations of dead loved ones, and how it created a positive situation to experience them like that.

What is psychedelic-assisted therapy?

When we talk about the new rise in medical psychedelics, it’s not about a doctor blindly giving out a prescription for a drug and saying ‘go take a trip’. In fact, quite the opposite. Perhaps in the future this will be less restrictive, but for now, the only legalization for psychedelics is for medical use, and this goes for Oregon, the first state to legalize for use in this way (although that state, and others like Denver do have decriminalization policies for drugs like psilocybin from magic mushrooms).

magic mushrooms

If you’ll notice, esketamine only has an approval at the moment for use in conjunction with other antidepressants. I don’t expect this will last forever, but this is the first one to get a legalization like this, so it’s not shocking that there are several caveats attached that don’t make a lot of sense. If this stuff works better than standard antidepressants, which actually come with a lot of warnings, why not just use it? In the future, this stipulation will probably be cleared, but for now, that’s the way it’s been legalized.

So, if standard treatments are not working, the doctor can prescribe esketamine to be taken under the supervision of the doctor. There are a few different steps in the process of psychedelic-assisted therapy, and it goes something like this, though the process could certainly be tweaked as the industry progresses. This model may also be more relevant for psychedelic trips on drugs like ayahuasca, LSD, or psilocybin, which create much longer experiences.

  • Preparation – These are initial sessions in which the psychiatrist gets to know the patient, and the issues the patient has. In this phase it’s important to build repour between the two in order to facilitate a meaningful psychedelic session. In this phase, the doctor provides instructions for the psychedelic phase, that include things like not running away from something scary, but approaching it and asking a question instead, or opening a door if one is there. These instructions are meant to help the patient face their issues when they encounter them in the next phase.
  • Psychedelic session – This phase is done in a comfortable setting, which is important, because the setting can affect the patient’s mindset. Two doctors are generally present, likely as safety since the patient is being put in an altered state. The drug is given to the patient, and the doctor guides them through the experience, but does not perform any analysis at this time.
  • Integration – This phase takes place soon after the psychedelic phase, and is meant to help the patient make sense of their experience. This is where the doctor can help the patient analyze their experience to gain meaning out of it.

To be clear, it does not sound like the esketamine therapy model matches this one exactly, but that could be on account of it being very short acting.

Into the future

mdma

Esketamine might be the only legalized psychedelic at the moment, but that should change soon. In 2017 the FDA granted a ‘breakthrough drug’ designation for MDMA for the treatment of PTSD, and in 2019, the FDA granted not one, but two ‘breakthrough drug’ designations for psilocybin from magic mushrooms, also for the treatment of severe depression.

These designations are granted when a drug company finds in testing that a new compound might work better than existing alternatives, and is meant to quicken research and production to get products to market. In this way, the FDA is outwardly pushing for the approvals of these two psychedelic compounds.

To give an idea of how much the FDA seems to want this to happen… the organization running the MDMA studies, MAPS (Multidisciplinary Association for Psychedelic Studies), actually planned its third MDMA trials in conjunction with the FDA to ensure that the results would fall in line with existing regulation. I’m not sure there’s a better indication of what’s to come, than an actual government agency helping to design drug trials. With all this going on, it becomes that much more important to get first hand descriptions of esketamine from patients, who are right now the only people who can say anything about it.

Conclusion

Psychedelic-assisted therapy is a real thing, and esketamine in the first drug to get approval. In understanding how esketamine works, it helps to hear what patients themselves have to say. It should never be assumed that every medication will be an answer for everyone, but the information trickling in shows esketamine to be a very promising drug.

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DisclaimerHi, I’m a researcher and writer. I’m not a doctor, lawyer, or businessperson. All information in my articles is sourced and referenced, and all opinions stated are mine. I am not giving anyone advise, and though I am more than happy to discuss topics, should someone have a further question or concern, they should seek guidance from a relevant professional.

About the author

Sarah Friedman

I am a US born writer, travelling the world and doing the digital nomad thing.

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