Ketamine & Mental Health: What We Know Already

A very good friend sent me a landmark study surrounding Ketamine a little while ago.  In drug research, big effects and powerful findings are usually accompanied by tiny sample sizes and weird statistics magic to rig the findings. So when I read the meta-analysis and systematic review published in The American Journal of Psychiatry, I was heartened. This is serious science and serious stats, with 167 patients evaluated across multiple studies. Also, the reporting scales (MADRS, HAM-D, QIDS-SR & the BDI) are well understood, robust and respected in the field. All of this adds up to this results abstract being very, VERY important:

Ketamine rapidly (within 1 day) reduced suicidal ideation significantly on both the clinician-administered and self-report outcome measures. Effect sizes were moderate to large (Cohen’s d=0.48–0.85) at all time points after dosing. A sensitivity analysis demonstrated that compared with control treatments, ketamine had significant benefits on the individual suicide items of the MADRS, the HAM-D, and the QIDS-SR but not the BDI. Ketamine’s effect on suicidal ideation remained significant after adjusting for concurrent changes in severity of depressive symptoms.
~The Effect of a Single Dose of Intravenous Ketamine on Suicidal Ideation: A Systematic Review & Individual Participant Data Meta-Analysis (Wilkinson et al)

That’s a dense couple of sentences, so let me explain why it’s so earth shattering. Suicidal thoughts, (known as suicidal ideation in clinical psychology) and depressed feelings are very difficult to get rid of, especially for depressed people. Treatment-resistant depression is a term associated with someone who has attempted multiple types of treatment for their Axis I disorder, but it hasn’t gotten better. After trying multiple types of interventions with no success, people slide quickly into hopelessness and thoughts of self harm. Up until now, depression treatments like SSRI drugs and Cognitive Behavioral therapy take time to work, sometimes more than a month. If you’re not in a good place right now, these things can’t help you. Ketamine infusions help immediately, and the change is apparent both to the patient and to the interviewing physician afterwards. This bit is huge, as most drug research relies heavily on self-report, which leads to bias and distorted findings. But, people are already talking to the press swearing by it, and it’s getting quite a lot of press, so here’s what they’re talking about.

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Benzodiazepines : Socially Acceptable Drowning

As many people reading this have been with their families long enough at this point to start taking sedatives or hypnotics to cope, I figured that Black Friday’s harm reduction post should focus on benzodiazepines. They were developed early in the history of pharmaceuticals, with the first going on sale in 1960, becoming the most prescribed medication in 1977, with numbers dropping since.Benzos have a long  history. Which I have no part in, so I won’t be taking time to explain it here. As some of the people reading this have giant chunks of those memories voided by said benzos. Continue reading

Ketamine: Destroyer of Scenes, Savior of the Depressed

This week, I want to discuss a substance that has developed a huge global following and staunch defenders on both sides of the Atlantic. Ketamine has become one of the most used substances in the Burner, rave & dance music communities. Whether you’re in London, New York City, Hong Kong, Cairo or Seattle, you’ve seen it diffuse into your scene. A dissociative anesthetic that’s never actually been used on horses, the crystalline powder took many dance floors by storm. In recent years, it’s not just become tethered to dance parties, but to treatment-resistant depression as well, with Ketamine infusion centers popping up at a surprising pace. But first, a little bit of local history.
I can’t speak for how the Ketamine may have filtered into your personal scene, but I can speak about the parties that I cut my teeth on, back during the era that people still thought we’d be greeted as liberators in Iraq. My friends and I first saw the issue when people in the psytrance scene couldn’t find LSD here in the city. While some chose to do 2C-I or roll, others began using this psychedelic powder that seemed to only last 40-60min. The utility of having a powder that only lasted 40min vs. a tab that could last 6-8hrs seemed to be immediately apparent and it started being THE thing.

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Post-Playa Depression: How to Come Down From Burning Man

by Whatsblem the Pro

Do you feel lucky, burner? Well, do you? Photo: Rory Wales

Do you feel lucky, burner? Well, do you? Photo: Rory Wales

Coming back from Burning Man was hard for me this year. Home seemed drab and too quiet; it was depressing and I missed the total sensory overload of Black Rock City. I was suffering from the dreaded Booty Drop Syndrome, aka Bop Loss.

I think a lot of burners – maybe even most burners – feel that way to some degree when they get home from the playa, and I wondered how they cope. . . so I conducted a poll in the Burning Man group on Facebook. I didn’t define any answers, just allowed people to write their own and/or vote for the answers other people had written:

  • I start planning for next year.
  • I don’t decompress. . . I leave the volume set at eleven.
  • I go to a regional Decompression.
  • Lay tarps all over my house, and have a party with a five-gallon bucket of Wesson oil.
  • I take two weeks off afterwards.
  • I just writhe and cry at my house with my cats.
  • I keep partying and continue to go to burner events, plus look for ways to stay involved with the community throughout the year. Oh, and I drink and cry.
  • Start a journal and relive it.
  • Get kicked out of a bar. Paint something. Clean your fucking stuff with vinegar. Inhale the dust. Listen to your music really really fucking loud. Go to bed with ear plugs in even if you don’t need them.
  • Get rid of everything that doesn’t have a need in your house. If its not useful, donate, purge. Get the clutter out.
  • All of the above.

My method, since I live in Reno: go drink at a casino. The local casinos have become accustomed to hordes of dusty burners descending on them post-playa; most of them welcome us with open arms, and go out of their way to accommodate us and our collective frenzy. Room parties abound in the two weeks after Exodus, and the flashing lights and noise provide a happy medium between BRC and a quiet home. Even better: the air’s typically got oxygen added, and if you do it right, the drinks are free.

If you do it really right, the drinks, the food, the rooms, and all the other amenities are free as well; along with the comforting hub-bub and surreal blinkenlights soothing my nerves during this last week I’ve spent in casinos, I’ve enjoyed a whole raft of deluxe style-outs to help ease my transition back to daily life. On Tuesday, I dined on a half-dozen Blue Point oysters, followed by a perfectly-cooked lobster tail the size of a human brain, then went upstairs to enjoy the jacuzzi in my room and have some party time with friends. The next morning when I didn’t feel like getting out of bed, I didn’t; I ordered room service instead, then went for a relaxing swim and had a massage. The casino paid for it all.

Naturally, you have to gamble. Hopefully you’ll break even at the very least. . . but for god’s sake, don’t count on it.

There are different approaches to gambling that are more or less oriented toward making money, scoring ‘comps’ (the free perks that casinos give to gamblers to keep them coming back), or both.

If all you want is free drinks, your best bet might be to slip a twenty into one of the video poker machines built into the bar in front of you when you sit down. You can play as slowly as you like; the bartender will keep serving you free drinks as long as you’ve got money in the machine. This may not be a good strategy if you don’t intend to consume at least twenty dollars worth of drinks, however.

If you want comps, play for hours on end. Slot machines are a good way to do this, and many casinos actually give more comps to slot players than to table game players. If you prefer to be sociable, though, the table games are where it’s at. Regardless, the first thing you should do when you walk into a casino for the first time is get a comp card. Just ask any pit boss, or look for a sign that says something like “Guest Services.”

The card game Pai Gow is one decent way to play cards for a good long while; the game moves a bit slowly when the table’s full of people, and there are a lot of ‘pushes’ in the game, which are hands in which neither you nor the dealer win. Making the minimum bet in Pai Gow can easily kill an hour or two and find you with still about the same amount of money as when you started (but with a card full of comps).

Blackjack is a game that everyone is familiar with and that offers the second-best odds in the house, if you’re looking to make money and willing to work for it. Entire books have been written about the best ways to play blackjack; if you use a sound strategy and count cards, you stand a decent chance of leaving with some of the casino’s money. . . but only if you have the good sense to get up and walk away while you’re ahead.

In a nutshell, counting cards means to keep track of how many cards worth ten points have been dealt, and how many cards worth less than ten points have been dealt. When there’s a disproportionately large number of tens left in the deck, your odds are better and you might want to make a larger bet than usual. There’s nothing illegal about it, but casinos hate card counters and will ask you to leave if they are convinced that you’re doing it. . . but if they just suspect you, they’ll try to make you screw up your count by throwing distractions at you. The dealer will get very chatty with you; the waitress will start bringing you drinks more frequently, and might get a bit chatty as well. If you’re a man, you might find yourself approached by an attractive woman with an inordinate interest in you. Playing blackjack properly and counting cards is a lot of work, and not very relaxing.

For the best odds in the house, the craps table is the place to be (and it’s where I’ve been all week, instead of at home writing articles for you to read). Playing craps correctly gives you the same odds as the house enjoys on some of your bets; the house retains a slight advantage over you on other bets.

I play what’s known as “the dark side” when I roll the bones. This involves doing something that is horribly counter-intuitive for most people: betting against yourself. We’re taught our entire lives to believe in ourselves and never give up hope. . . but that’s just foolishness in the face of statistics, and anyway, there’s no reason to consider rolling your point before you roll a seven some kind of personal achievement. It’s really no different from rolling the dice the other way ’round, which is what you want to do when you’re playing the dark side. Once you get used to the workflow of playing craps on the dark side, you can happily, mindlessly while away a lot of hours, assuming your bankroll holds up.

In any case, you should never gamble more money than you can afford to throw away; no system is perfect and nothing is ever guaranteed. If casinos are evil dens of sin, it’s only because the odds are always with the house. . . so be careful, don’t take undue risks, and pay attention to what’s going on around you. With the right approach and the tiniest bit of luck, you can decompress in style. I know it works for me; tonight I’ll be very happy to sleep at home in my own bed, having weaned myself off the sensory overload and made an easy landing of it instead of a horrendous, depressing crash. I even came home with a fat wad of cash in my pocket.

As a bonus, the casino will now be sending me coupons in the mail from time to time, good for a free hotel stay. . . which is a really nice thing when you live in Reno and don’t have to travel to use the freebies. They want me back because they know the more time I spend gambling, the more likely I am to lose. I don’t have to gamble to use the free room stays, though, and with winter approaching it’s going to be really nice to take them up on their offers and spend some more time in the indoor pool and the hot tub.

Good luck!