Treating depression with Ketamine, Genetic Testing or Marijuana

November 21, 2016 12:46 PM

I have had lifelong depression and anxiety. I have tried meds, therapy and vitamin treatments. Nothing has worked. I am ready to try something new

I've had lifelong depression. You can read my previous threads for details. Basically OCD/anxiety/depression. I have racing thoughts, rumination and just can't ever relax. My mind is always going and analyzing and etc

I'd really like to try either ketamine or genetic testing for medication, but haven't had a lot of success with either. Ketamine isn't covered by my insurance and it will cost thousands and thousands of dollars a year and require a bit of travel from what I've read. I live about an hour north of NYC. I also wonder about the long term effects.

I've had genetic testing done through 23&me and know that I have a ton of snps (MTHFR, CBS, COMT, MAO etc). I wanted to get genetic testing done through a psych doc. Either genomind or genesite/genesight. I don't really know what the difference is. I called all of the docs in my area that do it (over 20) and no luck. Most of them were obnoxious (just an observation - horrible to treat depressed people that way). They don't take MVP or don't take new patients. I can't get testing done without a doctor. One doc does it but he charges 600 bucks a visit and would require monthly visits. No insurance accepted. I can't afford that.

This whole thing has been demoralizing as my health insurance is useless and I don't have enough money to get help. This system is so fucked up. I don't want to go down the road again of just throwing random pills at this.

I smoked pot the last two nights. It was the first time in 15 years. Sunday morning I felt great, but today, not so much. I probably won't continue since it isn't the healthiest thing. I also have a hard time getting up after it and overeat and drink too much.

THE POINT OF THIS POST: I was just wondering if anyone has tried ketamine or had success with genetic testing. What are people thoughts on vaping weed to help? What are the long term ramifications?

How can I get help when I'm not rich?

I'm so lost and scared, but I don't want to be a zombie again and have suicidal panic attacks from withdrawal

posted by kbbbo to Health & Fitness (19 answers total)

The first step is to at least be seen by a healthcare provider. This can be a primary care provider (especially if your insurance requires a referral to see a specialist) or a psychiatrist, though if your depression is very severe, it may make sense to try and see a psychiatrist. It would be helpful if you bring along your medical records and history of medication trials, if possible. After a thorough history is obtained, he or she can give you their thoughts on the role of genetic testing and candidacy for a trial of ketamine. I would not personally recommend marijuana as an antidepressant.

Ketamine is a hot area of research right now, so you might be able to try your luck with some large academic centers in NYC (think New York Presbyterian, either Columbia or Cornell campus, NYU, or Mount Sinai - links are to specific clinical trials; search clinicaltrials.gov for further trials in other locations) that may be recruiting patients who meet their criteria for a ketamine study.
posted by gemutlichkeit at 1:01 PM on November 21, 2016 [2 favorites]

This isn't going to be a popular opinion, but have you tried supplements (from reputable companies) based on your genetic testing results? One of the big pieces of the puzzle for me was supplementing methyl b12 based on those results. It's still too early to see how big the effect will be long term, but so far...pretty big.

I also used psychedelics, and that helped a whole bunch, too. If it were me I'd start with the supps, since you can research that and buy stuff on your own. I'd also start really, really slowly. Like buy veggie caps and take tiny fractional doses of everything and go up slowly.

Memail me if you want to talk more.
posted by schadenfrau at 1:05 PM on November 21, 2016 [2 favorites]

Everyone has lots of snps. I'm not sure this is your answer. Have you tried meditation? Excercise and meditation are consistently more effective when combined than medication.
posted by Kalmya at 1:05 PM on November 21, 2016

Response by poster: OP here:

Sorry to chime in so soon.

I exercise 6 days a week.

I have tried supplements. Tons for years. 5htp, methylfolate, B12, etc etc

I have a psychiatrist appointment tonight
posted by kbbbo at 1:11 PM on November 21, 2016

"Excercise and meditation are consistently more effective when combined than medication."

There may be some studies that show that, but I would be very shocked if it were true in comparison to Ketamine, which is showing revolutionary and near instantaneous improvement for severe, lifelong, intractable depression. Also, telling a depressed and anxious person to establish a consistent routine of exercise and meditation seems somewhat ableist (to me, at least), and possibly even dangerous in the case of meditation. (Edit: It seems OP does consistently exercise, but many other people in that situation would not find it possible.)
posted by thegreatfleecircus at 1:12 PM on November 21, 2016 [20 favorites]

I know two people on a ketamine regimen and it has had wondrous effects for both of them.

One receives it intravenously in NYC and yes, I believe he pays out of pocket and it's very expensive.

The other person (who has good insurance, but it's still not covered) was able to get liquid ketamine prescribed by a Boston psychiatrist. He uses a sort of vaporizer/inhaler thing to administer it nasally and it's much, much cheaper that way. My impression is that it's the intravenous administration, not necessarily the actual drug, that's pricey here.
posted by this, of course, alludes to sex at 1:20 PM on November 21, 2016 [3 favorites]

I don't know anything about ketamine, and what little I know about genetic testing for depression treatment suggests that it's not really at the widely-useful stage yet, but if you're in search of treatments for treatment-resistant depression have you considered ECT? It's obviously got a scary history and it's serious stuff even now, but it really does work for a lot of people, including at least one person I know.
posted by mskyle at 1:31 PM on November 21, 2016 [5 favorites]

Paying for genetic testing, as I understand it, is paying for the company to sequence some of your genes + use their library of results from other patients to predict what anti-depressants would be most effective - if you've already been through a lot of the treatment options, it may not be worth it. I think there's the most evidence for depression meds at this point, but it's new technology all around. I don't know how well it works with treating multiple conditions. Maybe worth asking your pdoc about.

The testing you've already had + research could be helpful and cheap. Sometimes universities will allow non-affiliated folks access to journals if they're on-site, public universities where I am allow state residents to get library cards with them with some restrictions. You can get a fair amount of info from just the abstracts on the PubMed site. It's a lot to do when you're dealing with illness, but it can pay off.
posted by momus_window at 2:15 PM on November 21, 2016

My neurologist, who treats headaches, was originally really excited about genetic testing for meds, because treating recalcitrant headaches is a long trial-and-error process. But he said that he and his colleagues have been finding that it didn't make that much difference: they still start carefully with low doses; they still start with the drugs that are known to help the most people and move onto the ones that tend to help fewer people from there; and so on. The genetics can tell you some things, he said, but not enough information to skip way ahead in the process.

Since anti-depressants are a common first-line headache treatment, this might be somewhat relevant to you. Though it is, of course, only one doctor's opinion.
posted by Orlop at 2:23 PM on November 21, 2016

If you live in a legal weed area then your local dispensary should be able to help you with some strains. I'd think a nice hybrid would ideally counterbalance the heady effects of a sativa and the couch-lock and munchies that an indica brings on. I'm probably a terrible person to weigh in on this because I exclusively self-medicate with weed and never see a doctor, BUT marijuana keeps me sane, truly. I had to quit for 45 days as I was on probation (for weed, prior to living in a legal state) and I was miserable for that entire time. Vaping is much, much better than smoking and here in WA I can go to the store and buy extracts which are even less damaging. Honestly the legality was a big reason I just moved thousands of miles across the country and I wouldn't call it an overreaction to do the same thing if you currently aren't able to access pot legally.
posted by masquesoporfavor at 2:35 PM on November 21, 2016

Pot can backfire on you, worsening anxiety and depression when you're not smoking (like, first thing in the morning). It's not a great long term solution (fun at the time tho!)
posted by annathea at 4:11 PM on November 21, 2016 [1 favorite]

What is your yearly out-of-pocket for out-of-network? Mine is 7600, and I've realized it's much better to just commit to that, than try and bounce through the underwhelming/overworked options that are in-network.

I have a psychiatrist who also does psychotherapy. Currently I go twice a week. Since I'm past my out-of-pocket cap, it's not any more expensive than once a week. I find that the combination works better than either alone, and research backs me up. I try to remember that because there is a genetic component, that means my parents behavior was partially symptomatic of the same disease. So unpacking that socialization can't be easily separated from treating the illness.

I also recently started using medical marijuana (sparingly!). My doctor has basically taken the approach that he wouldn't want to deprive me of anything that was giving me relief from my symptoms. But that I should feel comfortable telling him about my use, and the symptoms that I'm trying to relieve. I only use it for rumination-fueled insomnia. I've found that I can only tolerate high CBD strains (20:1 ration between CBD and THC) maybe a few times a week. Any more, and I get rebound anxiety from the resulting brain-fog and psychoactive effects of THC. Not pleasant.
posted by politikitty at 4:45 PM on November 21, 2016 [1 favorite]

Talk to your psychiatrist about ECT. It has side effects but for the right patient can be life-changing.
posted by pintapicasso at 5:07 PM on November 21, 2016

I want to third the ECT recommendation. Also you might be eligible to participate in a research trial of transcranial magnetic stimulation
posted by Waiting for Pierce Inverarity at 5:20 PM on November 21, 2016 [3 favorites]

TMS is commercially available and as of last summer, was beginning to be covered by insurance for treatment resistant depression. The side effects are much less severe than ECT and you don't have to be anesthetized- you can drive and function normally afterward. You just need to find a center or doctor with a machine and the ability to calibrate it and set it up for sessions.
posted by MadamM at 5:43 PM on November 21, 2016 [5 favorites]

There is a new alternative to ECT called TMS. It's non-invasive and has way fewer side effects than ECT, and from personal experience it was 1000% better than anything else I have ever tried. Like, "can't get out of bed" to "normal" better. It was pretty miraculous.

on preview, it's FDA approved for depression and anxiety and insurance often covers it for people with treatment-resistant depression. So you don't need to do a trial or anything.
posted by zug at 7:07 PM on November 21, 2016 [3 favorites]

Have you tried p5p/ zinc supplements? It treats an actual condition called pyroluria. I had some severe digestive issues a few years ago and wasn't absorbing anything. I became quite anxious and my gastro suggested this, it was a miracle cure for me until we got the gastro stuff sorted out. It used to be prescription but now it's available anywhere. It's a form of b6 but safer than the regular type. It isstrongly suggested that you work with a doctor though as too much b6 long term can cause nerve damage. They do a urine test to see if you're deficient.

As far as genetic testing a friend had it done and didn't find it useful, her doctor now recommends against it as it hasn't helped many of her patients. She went for ECT eventually and it's helped a lot.
posted by fshgrl at 7:28 PM on November 21, 2016

Which meds have you tried? A lot of psychiatrists are reluctant to prescribe drugs beyond the usual SSRI/SNRI families, or move quickly to atypical antipsychotics for treatment-resistant depression. But many patients are finding that some of the older drugs, like tricyclics and MAOIs (which were abandoned because they have more side effects and, for the latter, because they have a high rate of adverse interactions with common medications and foods). But if you haven't exhausted the available drug treatments, press your doctor to consider less commonly prescribed drugs, especially some of the older drugs that were breakthroughs at the time. And they're often dirt cheap. Different things work for different people.

Mental health is a weird beast, and I hope you find an effective way to tame it.
posted by decathecting at 11:03 PM on November 21, 2016 [1 favorite]

Hi kbbbo. I'm sorry nothing has been working to treat your depression.

I am a scientist in the area of mental health research. Just recently I heard a bit about the state of research related to ketamine. From what I could tell (and this isn't my specific area of research), it appeared that the effects of ketamine don't last as long as other therapies, like ECT. My understanding of genetic testing is similar to mskyle's, the practical utility for individuals is not proven (like aspirin for preventing strokes, the effect is significant on a population-wide scale, but medicine only reduces an individual's risk by a fraction of a percent). The evidence is stronger for ECT or TMS, so maybe ask your doctor about those options?
posted by MrBobinski at 11:52 AM on November 26, 2016