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Comment by opwieurposiu | Hacker News Reader

If you want to avoid SSRIs, you can try ketamine treatment. Should be able to find it in most major cities now. In my city the cash price is about $400/a session and you probably need 2-3 sessions. Pros: if it works you will start to feel better in just a few days, and you only have to get a few 2-4 hour treatments a year. Cons: hard to get insurance to pay for it, SSRI are cheaper.

https://www.health.harvard.edu/blog/ketamine-for-major-depre...

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Ketamine is good and it's nice to see the recommendation but you are wayyyyyyy low on your numbers haha.

Minimum induction that basically every clinic follows is the 6 session schedule.

From there the standard is to slowly taper down to once every 4-6 weeks. Some patients cannot taper and so need more constant.

For example, I'm more "Ketamine resistant" so I was on 2 weeks for a while, then 3, then about a year in I made it to 4, 5, then 6 with the help of doctor prescribed at home dosing.

About $10,000-$12,000 out of pocket for a year's worth of infusions for me. Saved my life and turned it around, so totally worth it.

Also...the spiritual benefits. I think that alone, having that seed planted is invaluable. To me.

But for nearly everyone the effect wears off after 4 weeks (hence the need for a response w/ Ketamine). So it's what one does over a few years to shift their brain superstructure that I think weans them off. And all that BDNF + everything else flying around in there haha.

Fortunately there are compounded racemic ketamine options in a lot of places, whether troches (lozenges) or nasal spray (that's the one I use).

I pay out of pocket fully, and it's $60/month.

Clearly YMMV, but worth looking into if the infusions are prohibitively expensive.

Yes, Esketamine (what they're calling S-ketamine) can be a good one. Just be careful if there's any history of psychosis.

It nearly got me stabbed and had to be discontinued. It really can work on depression, though, in a way the other drugs just don't.

Makes me wonder how much the others are doing, honestly, though missing a dose causes misery. I truly wonder sometimes what just slowly getting off them all would do to her.

A hybrid approach is occasional infusions plus at home. I was infusion exclusive for a while and am at home exclusive now (extremely disciplined about it). But my Ket admin doctor and I both I think have the opinion that the occasional IV treatments.... It's hard to beat.

It just does something different. But then at home can help maintain in a more muted way. I think it's because a mainline infusion has no top end limit for drip speed, whereas buccal/nasal membranes can only transport so much at a time. There's a few dose charts that basically flatline at the beginning as transport/transporter stuff saturates vs the line which goes sky-high. Also the bioavailability is phenomenal, and it's easier with IV to avoid the dose creep/tolerance/psychological addiction aspects.

That said, IV Ketamine is hella expensive. :'( An $80 Ketamine nasal spray (not even with insurance, just that), can last me for 6 months with weekly lower dose solid session topup treatments. So, ~$12 a month. Less than HBO Max w/o ads. Hell yeah. That's a good price for an effective treatment haha. Both seem to have unique benefits too that I haven't easily gotten wjfb the other.

Just a few thoughts but am sure you're on a similar wavelength too so mostly just sharing! Curious to hear what your thoughts experiences were/are/have been.

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