The WebMD article is referencing esketamine, also known as Spravato, which is an FDA authorized form of ketamine. It's generally indicated for longer-term use in patients with Treatment Resistant Depression (TRD), and has really good results on par with ketamine (IV or intramuscular).
At Lumin Health, we treat about 80% of our patients with esketamine, and the rest with ketamine (generally only if they don't meet esketamine criteria). After the initial course, patients tend to find a good balance of ongoing care that helps treat their particular depression / depressive symptoms. This happens less with ketamine since it tends to be prohibitively expensive to continue care (upwards of $1k/month).
Do appreciate informed commentary; thank you. I work in a research lab studying depression and the brain, but am not a clinician (which is why I threw in a lot of caveats).
In general, esketamine has been shown to have about the same efficacy as ketamine for Treatment Resistant Depression (TRD) and MDD. There seem to be some minor differences in bioavailability between esketamine and ketamine, but from experience, if one work, the other will, and if one doesn't, the other won't. Anecdotally, we've seen great results in a matter of weeks with patients who have had no success through numerous antidepressants, TMS, ECT, and other treatments.
There is a long-term trial now in its 4th year with esketamine (https://clinicaltrials.gov/ct2/show/NCT02782104). I'm not sure how much has been published yet, but early data I saw supported immediate relief and long term benefit over the 4 years.
In terms of it being a sinister ploy by pharma, it's definitely priced higher than its ketamine generic counterpart, but for the vast majority of our patients, ketamine treatment out of pocket (since its not covered by insurance) is absolutely unaffordable, and pursuing the insurer-covered version of treatment is a high-value option.
For those who don't want to read the article, the highlights for me were: 1) esketamine may not work as well as ketamine and 2) esketsmine was invented to make pharm companies money because they couldn't do it with ketamine.
After dealing with depression myself, I dove deeply into this world, and actually ended up founding a ketamine and esketamine treatment startup in the Boston area (lumin.health). We've seen pretty amazing results with patients who have otherwise failed antidepressants and/or ECT and TMS (Transcranial Magnetic Stimulation). The reality is that ketamine/esketamine are much more accessible from a patient perspective, and while considered "new" by many in the medical community, offer faster results and carry less stigma for patients than ECT in particular. If ketamine/esketamine don't work, patients typically know within 2-3 sessions, and can walk away with no long term side effects. With ECT, patients generally have to complete a whole course before they see effect, and then are stuck with some of the potential mid/long-term side effects.
The space is also at the precipice of a whole new class of psychedelics coming online - MDMA, psilocybin, and more are all 1-5 years out (working through FDA drug trials), and hold promise of both faster results (versus 6-8 months of trialing traditional antidepressants) and fewer downside risks (versus weight gain, sex drive, etc. issues with antidepressants and memory loss, headaches, etc. with ECT and TMS).
Bottom line, if you're suffering and considering those treatments, I highly recommend finding a local center and at least learning more about options available to you.
Edit: If anyone wants to talk, advice, etc., email is in my profile.
One rumination I have had about the medical application of psychedelics is to wonder how lasting the effects of all these initial studies will be over the long term.
The effects of psychedelics are profound to a person who hasn't experienced them, which is the vast majority of people today. I think, when a person goes through a powerful experience they've never had, it makes them a lot more suggestive, which in turn makes therapies more effective. Will this still be the case if psychedelics usage is normalized? When a person knows what to expect out of the drug will they still remain as suggestible to therapy?
My own experience with psychedelics tells me no: once you become familiar with the effects the "high" loses some of it's properties that make it a useful tool for introspection.
I haven't done psychedelics in a purely therapeutic setting so there may be something to my observation that I'm missing completely.
Ketamine’s effects on depression are not caused by the hallucinations or psychedelic effects.
I can’t speak to other hallucinogens but I would imagine the situation is the same there. The day after an acid trip isn’t a new neurochemical environment because of the powerful hallucinations the day before, it is something else.
> My own experience with psychedelics tells me no: once you become familiar with the effects the "high" loses some of it's properties that make it a useful tool for introspection.
My own experiences run directly counter to this assertion.
> The day after an acid trip isn’t a new neurochemical environment because of the powerful hallucinations the day before, it is something else
What is a "new neurochemical environment" exactly? I've had many acid comedowns, and they have all been affected by how the high was - emotionally, mentally, and physically. What do you mean by "its something else"?
I’m far from an expert here, but as I understand it there is no repeated, or daily dose of the psilocybin. Instead it physically changes your brain. Here’s one study:
IMO I think it is still a new neurochemical environment, much like how the body is different after intense exercise for the next few days, as it recovers. It gets sore, weaker, etc. There is definitely a training & depletion effect for the brain.
As I understand ECT is basically just having a seizure while under some heavy-duty muscle relaxants and/or general anaesthetic (?), so you don't flail around and hurt yourself.
(This is not medical advice and I am not a doctor)
I don't think ketamine is directly indicated overeating, and I know esketamine isn't for insomnia or overeating. That said, There do seem to be a handful of papers studying the use of ketamine in things that affect sleep, like circadian rhythm [0][1]. In general, ketamine causes sedation in about 70% of those treated with it. Though that is short acting (hours) it may help set an individual for a good sleep, and to the extent that insomnia or overeating are caused by or co-occurrent with depression, ketamine could likely help.
Overeating might be helped by knowing your own body's blood sugar response to carbs. Take a browse through Tim Spectors ZOE. Hope you get some progress.
If you're struggling with sleep and "turning the lights off" around bed time - we made a custom natural sleep product for high performers focused on quality, restful sleep - https://impossible.co/products/sleep
Shoot me a DM if you want to try it out - happy to send one your way.
Yes - they're both great compounds for helping improve sleep performance - (which unlike knockout pills you can improve over time). Most of our customers tracking their sleep with an Oura ring, Whoop band, or Eight sleep see improvements in both their scores and energy levels when adding our product to their nightly routine.
This is an area I have experience and expertise in. Look at Master License Agreements in Houston, Dallas, San Antonio, Charlotte. Some states also have uniform legislation snaking its way through the various bodies, including Virginia, Ohio, Washington, Minnesota, Colorado, Florida, and California. Some is driven by ALEC and/or the wireless carriers, so it may be aggressively pro-deployment (to the detriment of local cities), but it's at least somewhere to look. If you're interested, PM me and I can share some materials on this, or at least discuss further.
I built and run DocketDaily (http://www.docketdaily.com). We mine and process litigation data which is used for a number of law-related purposes. As others have mentioned, Thomson and LexisNexis have the law firm market nearly locked down (for the time being, at least, as even this is changing), so we decided to target a slightly different space. We focus on legal vendors -- those selling into law firms and in-house counsel -- and provide them with very useful data and information for their sales/marketing efforts.
This strategy -- not targeting the law market head on -- has proved beneficial, and has allowed us to establish a base from which to expand to adjacent verticals (law firms, in-house counsel, legal recruiters, etc.)
We have a few competitors (Lex Machina, DocketNavigator, LawProspector, others) but they each tend to carve out a niche. In the case of Lex Machina and DocketNavigator, both are entirely focused on 1) law firms, and 2) patent litigation. It's a big world out there, and data in law is relatively young and nascent.
In any case, if anyone wants to discuss further, I'd be very happy to share learnings. I'm gene@ the website I mentioned earlier. If anyone is Cambridge/Boston based and interested in the law sector, I'd love to get together!
Travel. Extensively. You will never regret it, you will always remember it, and you will always have a story or 10 to tell people when socializing. Parts of the developing world (India, Thailand, parts of South and Central America) are still cheap enough, and interesting enough, that you can get by on $1,000 or so a month while still living relatively well. I spent several months traveling >4 years ago while transitioning between both job and countries, and still talk and think about it often.
Thanks for the suggestion. I've never felt compelled to travel although I've been to Japan and would like to go again. I feel like going abroad to do something might be more up my street. Do what? Is the question.
RECAP hasn't been nearly as active as its initiators had hoped. The data there is pretty good however, and for a handful of key cases, I would say it's very good. The biggest issue with the data is that it's spotty. Since it relies on individuals to pull info on each case, some cases may only have partial information (not all the parties, attorneys, etc. represented), or not have the full docket available (and rarely, if ever, all of the documents associated with a case).
PACER is definitely interesting, a bit antiquated, and to date, the data has mostly resided in the hands of the big information companies (Lexis, Westlaw, etc.).
I've been building a system/website to access, search and develop intelligent analytics from PACER court information. We're tracking cases, attorneys, parties, judges, as well as the actual case dockets. The data is a treasure trove of information, and if anyone's interested, I'd be very happy to chat more about it.
The site (a signup for now as I'm working out the kinks in the system) is www.docketleads.com. Email me there or ping me here for more info.
I worked on a similar project a decade ago written mostly in Perl with the frontend in PHP (hey, it was 2004, folks!). Just checked and I still even have the old courtbot.com domain I registered for the project.
I suspect you'll find pretty quickly that there's a limit to how far regular expressions or similar techniques can take you if you want to normalize and reference precedents and make sense of cases. That's why Lexis and Westlaw pay actual attorneys considerable sums to summarize cases, and why they can still command such princely subscription fees even in 2014. But analytics might be interesting. A family member is a judge, and her judicial office keeps track of how many cases she decides per month, how many reversals she receives, etc. I don't know if those are made public -- certainly I'm not aware of any project to do it across a large data set, and I wish you luck with it.
You're definitely right about case/precedent information, but what we've found is that there's a whole other world of info that can be neatly organized with a lot of crunching, and a small bit of manual manipulation.
The big guys chasing this are highly focused almost entirely on lawyers, in the context of providing them case analysis tools. We've found a bit of a different niche which doesn't need as much fidelity/granularity to the information, but needs it nonetheless.
In any case, I'd love to chat about your experience, even if a decade old. Can I PM you?
Sure, happy to chat! What you're doing seems interesting, especially if you're not targeting the lawyer/case research market. My email address is in my HN profile. Though I am working nonstop on http://recent.io/ right now. :)
Looking for a data scientist / developer to help in analyzing, and building some visuals around a pretty interesting dataset (65,000+ court cases and their associated data -- judges, parties, attorneys, dockets, etc.). This is early stage, experimental, a bit greenfield, and so far a lot of fun. There's a decent amount of statistical correlation to figure out, and also potential for some textual analysis to be done.
The intent is to eventually convert some of the more interesting analyses into visuals for presentation online.
Dataset currently resides in Postgres and the language of choice is Python (so Pandas, NumPy, NLTK (maybe?),etc.)
I'd prefer someone local (Cambridge) so we can do some work in tandem, but if remote is the only possibility and there's a good case for it, willing to try.
At Lumin Health, we treat about 80% of our patients with esketamine, and the rest with ketamine (generally only if they don't meet esketamine criteria). After the initial course, patients tend to find a good balance of ongoing care that helps treat their particular depression / depressive symptoms. This happens less with ketamine since it tends to be prohibitively expensive to continue care (upwards of $1k/month).