Question: I just started getting ketamine IV infusions two weeks ago, after I heard about the Spravato nasal spray. After a few days, I’m a person again!

I haven’t really laughed or enjoyed anything at all for more than 20 years. That’s my entire adult life. I just got a life given back to me, and all I feel now is hope and gratitude. Nothing has been even close to how ketamine has transformed me.

I’ve been on more than a dozen antidepressants over that time, prescribed by half a dozen psychiatrists. Some things helped, but nothing like this. This isn’t a placebo. No way.

I’ve suffered long enough and have grappled with suicide for years. That’s all gone now. This medication saved my life. It should be accessible to everyone who needs it. All I can think now is this: It’s sure exciting to be alive!

Answer: Over the past several years, psychiatrists have been reporting that ketamine infusions can act quickly to alleviate treatment-resistant depression (American Journal of Psychiatry, March 29, 2019; Handbook of Experimental Pharmacology, Nov. 27, 2018).

Such pilot studies probably touched off the research leading to the esketamine (Spravato) nasal spray that the Food and Drug Administration recently approved for hard-to-treat depression. We are delighted that you have achieved such a good response.

Treatment for cluster headaches

Question: I have suffered from repeated cycles of cluster headaches. They’ve come every three to five years since the early 1990s. Each cycle lasts four to six weeks, with multiple headaches daily.

The neurologist I saw came up with a solution: prednisone and verapamil as preventive medicine and Zomig as an emergency measure. After I started on this regimen, I experienced a headache from eating an excessive amount of chocolate. (I knew alcohol could trigger a cluster headache, but the chocolate was a surprise.)

I took one Zomig tablet without relief. I took a second one 45 minutes later and the headache was gone in seven minutes. This has worked for me, so I have never needed to use the oxygen treatment.

Answer: Cluster headaches are incredibly painful, and they can be difficult to treat. High-flow oxygen is a first-line therapy (Headache, July 2016). So are sumatriptan shots or zolmitriptan nasal spray (Zomig). Verapamil is a blood pressure pill that is sometimes used off-label as a preventative approach for cluster headaches.

If you would like to learn more about oxygen or alternatives such as melatonin for cluster headache, you may wish to read our Guide to Headaches and Migraines. To order a copy, please send $3 in check or money order with a long (No. 10), stamped (70 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. M-98, P.O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from our website: www.peoplespharmacy.com.

Unlike migraines, cluster headaches aren’t usually linked to triggers. However, you may not be the only one who reacts badly to alcohol or chocolate.

Open nasal passages for nighttime breathing

Question: Sometimes people write to you about nasal congestion at night. This happened frequently to me until I started using SnoreCare nasal vents. These really open my nasal passages, and I no longer feel congested. I hope you will pass this hint along.

Answer: It comes as no surprise that nasal congestion could interfere with nighttime breathing (European Archives of Oto-Rhino-Laryngology, September 2011). Doctors generally prescribe steroid nasal sprays such as Flonase or a continuous positive airway pressure (CPAP) machine for such problems. However, nasal vents or nasal strips such as Breathe Right can improve nasal breathing (Pulmonary Medicine, Dec. 13, 2016).

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