Ketamine and "off label" medications

[Beetlebum]

I'm just wondering if anybody has been prescribed ketamine for their depression. I know it is not officially licensed for this purpose but it does appear that the nasal spray, Esketamine, will be approved in the UK next year (as it has been in the US).

I was on Pregabalin for about three months a few years ago as I had heard it was good for treating anxiety in particular. However I just found that it mostly made me tired so I stopped taking it.

I asked my psychiatrist a couple of years ago if I could try Bupropion (Wellbutrin) which is approved as an antidepressant in many countries but in this country is used only as an aid to help people quit smoking. However he told me that it would not be prescribed (I forget why exactly).

I have tried all the major SSRIS, SNRIS and none of them really helped. I would be grateful to know if anybody else is on either of the aforementioned medications as GPS do appear to be somewhat inconsistent in the way that they apply the rules (perhaps even to the extent of bending them in some cases).

Thanks,
Rob.

[Suzi]

Hi Rob and welcome to DWD.
Are you sure you've tried all of them? There are so many and there are different combinations etc which work for different people. Have you ever seen a psychiatrist of had talking therapy?

[Paula]

Hi Rob and welcome. I’m on 2 antidepressants, a mood stabiliser and pregabalin (for pain but also works on anxiety). It took time to find the right combination to help me but we got there. Personally, I would make sure I’d tried all those routes before looking elsewhere

[Angie]

Hi and welcome Rob

[OldMike]

Hi Rob, I'd explore every avenue before trying off piste medications.

[Beetlebum]

Hi Suzi, thanks for the reply. I had CBT a few years ago but I did not find it helpful. I was told that no other talking therapies were available on the NHS (a sign of these enlightened times we live in). I can't afford to pay for counselling so that is not an option.

I failed to mention that I am diagnosed with ADD for which I am diagnosed Elvanse (Lisdexamfetamine). This does slightly improve my mood but only for a few hours.

I do believe my depression is at least partly due to a chemical imbalance so no amount of talking is ever going to alter that. And I have taken just about every major antidepressant on the market over a period of 30 years so I am reluctant try more of the same again.

Hi Paula and thank you for the reply. There are those of us who are believed to be resistant to conventional antidepressants. It is these people who were selected on recent trials for Ketamine as this was the main criteria for inclusion . I was declined because apparently I had not a full psychiatric assessment (whatever that is) prior to being seen.

Thank you Angie.

Thanks Mike. I think I have pretty much explored every avenue which is why I am looking at alternatives.

[Suzi]

I'm surprised you were told that there was only CBT, there are loads of different talking therapies available.. Have you told your Dr/consultant that the meds are only helping for a few hours? What did they suggest?
Have you asked your Dr about getting an assessment done if that's what needs to happen?

[Paula]

There are those of us who are believed to be resistant to conventional antidepressants.

I am one of those who are resistant, hence why I’m on such a combination (at very high doses). But these combinations could only be originally prescribed by a psychiatrist. Perhaps it’s worth getting a second opinion?

Hunni, I’ve had a ketamine treatment before for chronic pain. It was the single worst medication experience of my life - I would never consent to that again - please understand what you might be getting into before going down that route ......

[Suzi]

I was hoping you'd reply about your infusion Paula as I remember talking to you after it.... I remember how you described it and it certainly isn't something I'd consider lightly after what you had to say about it...

[Beetlebum]

Thanks Paula and Suzi. I have heard some bad things about the Ketamine infusion and this is why during the trials people are often treated in hospital or have a responsible adult to supervise them in between visits. This did frighten me slightly but this has to be balanced against the number of people who have had no serious adverse effects and have reacted positively to the treatment when all other treatments appeared to have failed in the past.

I guess it's just a case of weighing up the pros and cons and making a calculated risk. All medication involves a certain amount of risk, let's face it.

[Suzi]

All you can do is talk through all the options with your medical team and see what they say... Whatever you decide will you let us know how you get on?

[Beetlebum]

Thanks Suzi. I'm not sure what my options are but I don't have a medical team, just a medical practice which is like something out of Kafka.... that's how hard it is just to get an appointment and see the doctor of your choice. I am so disillusioned it is almost two years since I stepped foot inside the place.
I will give it one more go and see if I can book an appointment on Monday.

[Suzi]

If you don't see a dr then what are your other options?

[Paula]

So does that mean no doctor has recommended you for this treatment? I know how hard it is to get to see your GP but unfortunately you’re not going to get any further until you do get that appointment .....