Once CS became the hot thing to get a degree in, the impact was almost immediate. And based on my experience, it happened a decade earlier than you think.
In the early 90s, universities threw students straight into data structures and algorithms in LISP and expected fully half of them to drop out first year. By the early 2000s, the market was already full of useless grads. I was always on the east coast, but near as I could tell from the refugees I interviewed after the dot bomb, SV had been hiring anyone who could type as a senior developer, and the market just kept going downhill from then on. The schools must already have been complicit in it, because I had employees with degrees who didn’t even recognize the names of basic algorithms and data structures when the need for them arose. Now I see intro curriculum from serious schools that’s just a few loops in python or even visual programming in a browser. Less serious CS schools seem to be little more than job training programs. And of course, like this post shows, tens of thousands of coders who really have just completed a job training program are flooding the market.
When I started working, every programmer I worked with was at least competent. If they weren’t, they just didn’t have a job. There wasn’t such a desperate need for people and it wasn’t hard to find someone competent. Now I assume that someone’s code can’t be trusted until I see evidence to the contrary. I used to bring people straight in for in-person interviews or do a really quick phone screen. Then I started doing much deeper questions on phone screens. Now I have to start with a coding test, because 95+% of candidates cannot write simple programs in their language of choice, even though they’ve got a fancy degree and they sound like an expert on the phone, because they’ve been trained for that... but apparently they have not been trained to actually create software from scratch. One company I worked for had a well researched candidate screening program and was talking about spinning it off as a service by the mid-2000s. Now extensive screening is universal and there are multiple companies that you can outsource it to.
There’s no shortage of developers on the market, but there’s a real shortage of good ones. If you’re right and that shortage ends at some point, there’s going to be a sea of unemployed, unqualified coders who need job retraining or something. But I don’t see the shortage ending unless the pipeline starts spitting out more well qualified people.
Exactly. Street ketamine powder is often heavily cut. If I had to buy illegally for some reason, I would only consider buying sealed vials, and I'd probably still have them tested. My ketamine doctor has worked with patients who used to buy on the street, and they brought in "ketamine" that was the wrong color, had flecks of different colors in it, etc.
The negative side effects of ECT can be dramatic and life-changing. I've known people who lost significant chunks of their memory (and that's with modern ECT), and they said it was worth it for them... but I have zero interest in risking that. If the alternative is killing yourself, it might be worth it, but for TRD without attempted or planned suicide, I have never even considered ECT seriously.
In a situation like that where you're in pain and anxious to start with, and are not prepared for what's going to happen, I can imagine it would be pretty horrible. I was in a comfortable situation and well-prepared when I got my first IV, and there were still a couple of brief, scary moments in the experience. And as someone else said, you probably got a much bigger dose, putting you deep into k-hole territory, if not actually knocking you out. When used for therapy, that kind of dose is usually reserved for those with chronic pain or other conditions, not depression or suicidal ideation.
You don't need to start your own IV to do it at home. I've been getting IV ketamine occasionally for around 8 years. I've also been using a prescription ketamine nasal spray for most of that time. For me, the effects of the two are nearly the same. Intranasal only has about 20% of the bioavailability of IV, supposedly, although in my experience it's closer to 10%. It takes quite a few sprays to achieve the same level of the drug as the IV treatment provides, but it works.
$130 gets me 3000mg in a spray every month. That's enough for about 4 IV-equivalent treatments even with the low bioavailability. The biggest difference is that the intranasal (of course) absorbs more slowly than an IV, so some of the effects last for 2-3 hours after I stop administering the spray, whereas once the IV runs out, I'm ready to leave the clinic in about 15 minutes. (Taking an uber or the subway rather than driving, obviously.)
The therapeutic index for ketamine is ridiculous and I know I don't have adverse reactions to it, so I'm not at all concerned about harming myself with it accidentally. I wouldn't recommend it for anyone who hasn't had some IV treatments, partly because a small number of people do have strong negative reactions to it, and partly because it would be really difficult to know what kind of effect you need to achieve. It's pretty easy for me to tell how high the levels in my blood are because I'm so familiar with how it feels as the IV dose escalates.
While I wouldn't recommend it for an initial treatment, I would recommend it to anyone who has been successfully treated with ketamine. Unfortunately, I think that it's harder to get now. I know my doctor has stopped prescribing it to patients because too many people were selling or abusing it.
I agree. I think people would be far more likely to try it out if you could kick off a dev server from the CLI without having to fire up any extra processes.
Unfortunately, that's not true. Corporate networks got rid of plain old proxies that just passed anything SSL on 443 many years ago. In order to meet regulatory requirements to record employee communications, pretty much every US company of any decent size uses a proxy (blue coat, zscaler, palo alto, etc.) that executes MiTM attacks on all SSL traffic. If it's something other than HTTP over SSL, or if it's to a blocked hostname, it won't go through.
I generally leave my clinic about half an hour after my infusion ends, but I'm taking the subway. If I were going to drive I'd probably hang out for 60-90 minutes. The dissociative and psychotomimetic effects wear off pretty quickly. But this depends on dose... my doc used to use higher doses before there was as much research around what works, and back then it would sometimes take a few hours before I felt back to normal in terms of cognitive and motor skills.
$400 is a fairly typical price. The ketamine itself is cheap, but operating a clinic doing off-label infusions that take an hour or two each is expensive. And nope... no insurance in the US that I know of covers it.
It's a huge problem for recreational use. Some individuals have trouble with it even with prescription ketamine, but it's not nearly as common. Last time I asked him, my doctor hasn't had any patients who were forced to discontinue treatment because of it.
n=1, but I've been receiving ketamine therapy for about 6 years and have not developed ketamine cystitis.
A low baseline is common in bipolar disorder, too. It was (and to a lesser but unfortunate degree, still is) very commonly misdiagnosed as depression because of this. It reacts quite differently to drugs than depression; many anti-depressants pose a high suicide risk when taken by bipolar individuals. While the overall effect during depressive periods (which can last years) in bipolar seems the same, it seems to have a different underlying cause. Normally you wouldn’t get cycling that fast, but AFAIK, there is even less research so far about how psilocybin affects bipolar disorder. I’m not trying to diagnose anyone... just something to think about for anyone who thinks they might be suffering from depression. I think I was misdiagnosed for many years, leading to decades of ineffective treatments.
The full dose isn't pushed. It's on a drip IV over half an hour or more. But I fully agree that you should have a competent, experienced doctor doing it, preferably an anesthesiologist.
Oh, and for the record, the crazy-ass geometric animations on the article are not that far off what I get when receiving IV ketamine and I close my eyes--although the real ones are far more complex and change constantly. However, the fear-and-loathing melty and color changing stuff is not something ketamine induces. What the page does not capture at all is horrible effects it has on sound. The visual stuff is pretty tolerable, but a simple fan ends up sounding like a helicopter, and most other sounds get very harsh. For me, having music is absolutely critical to getting through the whole process. I listen to a mix of various Bach performances, which gives the whole crazy trip some structure and narrative and keeps it familiar enough that I feel like I still have a handle on and am still grounded in reality, despite the strong dissociative side effects.
In the early 90s, universities threw students straight into data structures and algorithms in LISP and expected fully half of them to drop out first year. By the early 2000s, the market was already full of useless grads. I was always on the east coast, but near as I could tell from the refugees I interviewed after the dot bomb, SV had been hiring anyone who could type as a senior developer, and the market just kept going downhill from then on. The schools must already have been complicit in it, because I had employees with degrees who didn’t even recognize the names of basic algorithms and data structures when the need for them arose. Now I see intro curriculum from serious schools that’s just a few loops in python or even visual programming in a browser. Less serious CS schools seem to be little more than job training programs. And of course, like this post shows, tens of thousands of coders who really have just completed a job training program are flooding the market.
When I started working, every programmer I worked with was at least competent. If they weren’t, they just didn’t have a job. There wasn’t such a desperate need for people and it wasn’t hard to find someone competent. Now I assume that someone’s code can’t be trusted until I see evidence to the contrary. I used to bring people straight in for in-person interviews or do a really quick phone screen. Then I started doing much deeper questions on phone screens. Now I have to start with a coding test, because 95+% of candidates cannot write simple programs in their language of choice, even though they’ve got a fancy degree and they sound like an expert on the phone, because they’ve been trained for that... but apparently they have not been trained to actually create software from scratch. One company I worked for had a well researched candidate screening program and was talking about spinning it off as a service by the mid-2000s. Now extensive screening is universal and there are multiple companies that you can outsource it to.
There’s no shortage of developers on the market, but there’s a real shortage of good ones. If you’re right and that shortage ends at some point, there’s going to be a sea of unemployed, unqualified coders who need job retraining or something. But I don’t see the shortage ending unless the pipeline starts spitting out more well qualified people.