Ketamine and VNS, the ugly details

Likely part 1 of many

Some logistical updates. I have a feeling this will be a regular type of post, as there are so many moving parts to the two main therapies.

Still no word on what’s between Ketamine and VNS. The notes on my visit mention the possibilities of an Emsam patch, which is an MAOI in, well, patch form.


So apparently BlueCross/BlueShield, who have been quite helpful and payful thus far, will not pay for Ketamine. I feel like if you had a party and refused to pay for the drugs people wouldn’t respect you. Just saying. It’s not like Brad from down the block is asking for the Ketamine, it’s an actual doctor who is going to apply it in a healthful way to try and make people not want to die.

So we’ll be paying out of pocket for the Ketamine. We may have to sell one of the cars, as it is going to cost $24 every month. I’m thinking Brad down the block can’t get it for that cheap! And no, you can’t pay $48 and get extra. Sorry.

Here’s the order of operations, not delayed by any insurance approval:

I’ll get the first Nasal dose in the mail, and the care team is going to trust me not to sell it on Lake street or just snuffle it down as soon as it arrives. Which is fine, since doing either of those things would likely invalidate my discount Ketamine. And $25 doesn’t buy much these days, beyond 3 poorly-thought-out domain names or almost a lightning cable for an iPhone.

My first appointment is before the end of this month. So it’s not tomorrow but not December, I suppose. I’ll bring the nasal dose in and they’ll administer it. After that, they check vitals every 15 minutes and ask me how my trip is going. I’m leaning towards listening to Moby or the Chemical Brothers. Or Crystal Method! As long as I don’t jump out a window and start self harming with the window glass, like Helen Hunt did in the 1982 made for TV movie about the dangers of drug use, “Desperate Lives” – don’t worry, her brother Doug McKeon is there to tackle her back into the broken glass.

Yes, the one with Dr Joyce Brothers. Duh.

If that goes well I come back every Monday, Wednesday and Friday for a period of time that eludes me. I think it’s a couple weeks then down to maintenance once a week or something. Each appointment will be an hour “in the chair,” a polite way of saying show up on time. Can’t drive until the next day, or “a good night’s sleep” – so you literally have to sleep it off. Just like the old days! (I wouldn’t know, actually.) So the dear wife will have to be my chauffeur again. Not as bad as the ECT though. For some people, there are no real effects, for others it’s a bit of a disassociation. I think I already mentioned that though. They keep you around for that hour to make sure you’re good to go and not sue them for falling over later.

So it sounds like October could be a fun month for me.


The ease and cheapness of the Ketamine will be offset by the process and time frame of the VNS. I was told Livanova, the vendor, would be calling me to coordinate. They’re the makers of Symmetry™, which has been shown to significantly improve lives. (Direct quote from their web site.) I’m not really mocking them (much), as they have some great information on the site, as well as a picture of what I might start calling the “peacemaker” – because it’s like a pacemaker but brings you peace. I should maybe market that to them and see if we can get a campaign going.

Imagine two quarters next to each other

If you watch the video, fully the last third of the video is a legal text scroll — read it though, it has some fun side effects. They seem to stress that the most common side effect is infection, so yeah. Awesome!

What’s that? It all seems way too easy? Well..

Later that day…

Had a call with a representative from Livanova, the makers of Symmetry™, which has been shown to significantly improve lives. She was very nice and had a ton of information for me. Things like:

  • The device was FDA Approved in 2005
  • It’s about the size of two quarters next to each other, and as thick as two quarters
  • 7 out of 10 users significantly improve their depression (I think she meant it would get lesser, not better)
  • 4 out of 10 users have complete remission (so those odds are actually better than initially expected, though could be vendor padded.)
  • I will continue my depression meds while on the device
  • Installation is done under general anesthesia, takes about an hour, and is an outpatient procedure
  • It can take anywhere from 1-6 months to really get all of this going on, if there are no delays in insurance approval (see below)

From there, it’s just a matter of waiting. For some people it’s immediately useful, others it can take up to a year to really show benefit. But who cares, I’ll be a cyborg!

More Later that day..

I got the first email from my friendly representative at Livanova, the makers of Symmetry™, which has been shown to significantly improve lives. She sent me some bureaucracy to work on, and let me know that usually BlueCross/Blue Shield denies VNS. (sad clown noise) But they’re used to going through all levels of appeal and eventually go to external review. Approvals have not been 100%. Which will delay the timeframe, of course, but I am ?? [*] by the knowledge that it’s the vendor driving the approval. Since they get money if it’s approved, they’re the best capitalists for the job!

* Another word I couldn’t find. Not even going to come up with something funny. Deal with it.

So one is going to happen, the other not sure. And BCBS apparently isn’t in the business of making sad people not want to die. Yay money and USA and stuff. Pretty sure if I was in Denmark I would have a professional assigned to live with me and make me better 24×7, or allow for the “care team euthanasia” concept. Oh well.

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