IV Ketamine vs Clozaril

IV Ketamine vs Clozaril

I know I need another form of treatment, and my psychiatrist is respectful enough to give me a choice. However, as stated in my last post, making any decision is extremely difficult. This decision feels as if it’s nearly impossible.

At first thought, IV Ketamine terrifies me. I used to get high off of Ketamine, I’m now 11 years sober, but the possibility of dissociation is what scares me the most, it brings back traumatic memories which trigger my PTSD. I’ve already tried Clozaril once and ended up with a fever around 2 weeks. I had no other symptoms and my weekly blood work came back completely normal. Even though Clozaril is a very risky medication, it doesn’t scare me like the IV Ketamine does.

The information I found out about Clozaril after research and talking to my psychiatrist:

  • Giving Lithium with Clozaril can help prevent the low white blood cell count with a 94.5% success rate. I am already on Lithium, so this is beneficial to me.
  • The risks of this drug are increased for me because I’m Ashkenazi, which is Eastern European Jewish heritage.
  • Only 1-2% of patients that take Clozaril develop agranulocytosis, a blood disease that increases the susceptibility to infection. Only 1-5% of patients may have seizures, but that can be avoided by titrating the dose up slowly.
  • Clozaril is 60% effective for patients.
  • I would have to do weekly blood tests for 6 months, then do blood tests every 2 weeks for 6 months. I could then go to blood tests every 4 weeks if there were no problems. Blood tests are required to get medication.
  • From what I understand, my worst case scenario is: I start to get a fever or other symptoms, I call my psychiatrist, he would send me to the hospital where I would get blood work done and they would make sure my fever goes down. Then I stop the medication again and have to try something else. This is what happened last time.

The information I found out about IV Ketamine after research and talking to my psychiatrist:

  • The IV Ketamine trial consists of the first 2 treatments, which are done within 1 week. I would generally start to see some type of result within 24 hours. If I don’t see results after the first 2 treatments it would be considered ineffective for me.
  • This treatment is very effective, and patients don’t have to wait 6 weeks for medication to start working.
  • I would be monitored at all times by a doctor. If I had a panic attack during the infusion, he/she would be able to treat me.
  • I can take something for my anxiety before the treatment to help me stay calm.
  • Some patients experience dissociation during the infusion. Dissociation can cause a lack of control mentally and/or physically. This is the part that is a trigger for me. Just writing about it now is causing a massive anxiety attack.
  • Maintenance treatments are done anywhere from every 3 weeks to every 3 months. Every patient is different.

Now that I have all of this research, I should be able to make a decision, but my indecisiveness is always there. I’m leaning more towards the Clozaril rechallenge. I understand the risks and as long as I immediately tell my psychiatrist about any symptom I have, I should be okay. I know I could get a fever again and it won’t work, but then my options will be narrowed down for me. I also have several reasons not to do the IV Ketamine. First of all, it terrifies me. I’m having an anxiety attack right now just thinking about it, what will happen when it’s time for the actual treatment? It is very expensive and not covered by insurance. The first 2 treatments are $600 each, and every maintenance treatment is $400. The IV Ketamine is also new to me, and new things scare me. I’ve done the Clozaril before so I know what to be on the lookout for.

The only reason I’m considering either is because the psychiatric benefits outweigh the medical risks. Writing this post has helped me realize how scared I am of the IV Ketamine. I don’t think I could handle the treatment. I think my best option is to rechallenge the Clozaril.