Well, I hope this wall of text helps at least one person. For you or anyone else who needs this and happens to find it: yes. There are many treatments beyond traditional antidepressants that are only a last resort because insurance is a pain in the dick. All of them are different methods of increasing neuroplasticity, making it easier to form new neural pathways instead of staying stuck in the same “comfortable” depression. It’s like depressive thoughts are a paved sidewalk and happy, healthy thoughts are overgrown, covered with branches and weeds. With enough persistent effort you might be able to clear out that other path, but it’s a hell of a lot easier if someone clears out all the weeds first and gives you a machete. That’s neuroplasticity with appropriate therapy.
The main treatments available are ketamine (IV), Spravato (ketamine nasal spray), ketamine troches, TMS (transcranial magnetic stimulation), and psilocybin (still illegal in most places). I can give details on each, but specifics will likely vary a bit by treatment center.
- IV ketamine therapy
is guided therapy while under the influence of IV ketamine. It’s the most helpful form of ketamine. Both the dosing and therapy are more targeted. The therapy part may be covered by insurance, but the ketamine rarely is and that runs roughly $400 a dose. Sessions are once a month.
- Spravato
is well covered by insurance because they were able to patent it. That also means it’s slightly different: it’s only the S-ketamine enantiomer as opposed to racemic ketamine, which is a racemic mixture of both S- and R-ketamine enantiomers. Studies funded by the drug company say that’s better. Other studies are less clear. But really, there’s just far less data in general because it’s new. Treatment centers may vary, but mine just put me in a room with no guidance or therapy and had me do drugs.
I knew how to make the most of it anyway, but I felt really bad for the people who expect it to work like other medications they can just take and they feel better. You need to actually form the new pathways during the state of increased neuroplasticity. If you go this route, make sure you have a therapist appointment the day after treatment, preferably with a therapist who is familiar with it. Treatments are twice a week for the first month and once a week after. Each one lasts about two hours and must be done at the clinic.
- Oral ketamine troches
are not usually covered by insurance, but they are relatively affordable at $50-75 a month. You may have to shop around to find a compounding pharmacy that can ship to your state (if US) at that price. Ketamine is poorly absorbed when taken sublingually so the dosage is much higher and the side effects may be worse. However, in my case I had fewer side effects once I found a good routine. Even though the troches are affordable, you still need to check in with the doctor every month. If insurance won’t cover that it will probably be almost as much as IV therapy. Some therapists are willing to do telehealth therapy with you during treatment so you can have guided therapy.
In the interest of being as informative as possible for anyone that finds this: studies show similar rates of absorption between oral troches and suppositories, but anecdotally some patients report a greater effect from melting their oral troches and boofing them. You can find instructions for doing this with opiates and the process is similar. The troche just needs a bit of heat to melt it. A hair dryer or holding the (capped) syringe under hot water will work. Anecdotally, this does seem more effective and was a lot easier than trying to hold the troche under my tongue.
- TMS
is well studied, non-invasive, has a high rate of success, and is usually covered by insurance. Treatments are only a few minutes, but you need to go in four times a week. It’s like Spravato in that you will get the most benefit if you’re actively working with a therapist to take advantage of the increased neuroplasticity.
- Psilocybin
is probably illegal where you live. Studies are extremely limited because drug laws make it difficult, but the data we do have is extremely promising - moreso than ketamine. The only reason we do ketamine instead is it’s already used as an anesthetic, so using it for depression is just off-label, which doctors do all the time. There is a push to legalize psilocybin for treating depression, but it’ll still be a while. Until then, you have to either obtain it illegally or grow your own mushrooms (illegally).
When using mushrooms, state of mind and a comfortable setting are most important. If possible, be with someone who knows you and can keep you calm if you get anxious. Some people - especially those with severe mental illness and/or a genetic predisposition to one, such as schizophrenia - may have a bad reaction, sorta like how any medication has rare side effects and some people just get the fun of being especially unique. But for most people, the experience can be profound and life changing. Some may snap out of depression after a single dose, others may need regular treatments every couple months. Unfortunately, drug laws limit both the data and the accessibility of this treatment. However, it has the potential to be the most effective and the most affordable.
There is hope. Your depression can be cured. You can feel alive and content and so many other emotions again.
If there are questions, feel free to ask, but I don’t know if I get notifications so I may not see it. I have not personally done IV ketamine or TMS, but I have read up on them and gone over the details with a doctor when discussing treatment options.
