What is Ketamine?
Ketamine is a medication that has been used in general anesthesia for decades.
Ketamine can lead to a dramatic improvement in symptoms of depression, even in patients who have severe, chronic, treatment-refractory mood disorders.
Ketamine is an FDA-approved anesthetic agent. Use of Ketamine outside of the
anesthesia application is considered an “off label” use. At subanesthetic doses (doses below the amount necessary for anesthesia), Ketamine may be useful in the treatment of bipolar and unipolar depression, anxiety disorders, post-traumatic stress disorders, chronic migraine, fibromyalgia, addiction and pain.
HOW DOES IT WORK?
Ketamine infusion works by providing medication directly into the bloodstream where it immediately begins to repair the stress-induced damage in the brain’s communication system. Ketamine is able to increase BDNF, the substance responsible for synaptic plasticity and neurogenesis.
According to the literature, Ketamine is effective in about 70% of patients, with the effects of a single treatment lasting 1 week. Longer or shorter duration of action is possible. The initiation protocol includes 6 infusions over a 3-week period. Maintenance treatment is required to sustain the effects.
Potential side effects from ketamine include dizziness, bad dreams, perceptual disturbances, confusion, elevation in blood pressure, euphoria, dizziness, increased libido and nausea. These side effects mostly disappear 20 minutes after completion of the infusion, ketamine treatment is well tolerated. Patients may not leave our office until deemed stable by our staff members.
Reasons you might not be a good candidate for
- Uncontrolled hypertension or unstable health disease
- Raised intracranial or intraocular pressure
- Psychosis, schizophrenia, current mania
- History of brain bleed or aneurysm
- Active or recent substance abuse
- Pregnancy or breastfeeding
- IV access difficulty
- Prior adverse reaction to Ketamine
Ketamine can be effective in treating:
- Major Depressive Disorder
- Suicidal Ideation
Ketamine is currently being studied for the treatment of:
- Bipolar Depression
- Generalized Anxiety Disorder
- Obsessive-Compulsive Disorder
- Post-traumatic Stress Disorder
- Substance Abuse
Things to Consider:
- Patients are instructed to continue to take all medications unless instructed otherwise.
- Our clinic requires a full list of medication prior to first visit.
- Patients must have a driver to take them home following treatment, driving is not allowed the rest of the day.
- Patients must have a Photo ID for treatment to be administered.
- To achieve best results, Ketamine is administered for 6 infusions over a 3 week period, no consecutive days.
- After the initial 3 weeks of treatment, maintenance is required. Remission periods vary from one patient to another; can be anywhere from 28-168 days. Average treatment frequency is 1-2 times a month.
Most insurance companies will cover the majority of charges for ketamine infusion. We are in-network with most major insurance companies and are happy to verify your benefits and provide an estimate of your out-of-pocket cost for treatment. Patients are responsible for any amount not covered by insurance.
Is there a potential for addiction?
Some may have heard that ketamine is used as a “party drug” and worry about addiction potential. Studies and clinical experience have found that in the very low doses used, medical setting, lack of access at home, and infrequent dosing, there is virtually no potential for addiction or abuse.
Do I have to stop my other medications?
There are very few medicines that cannot be taken in combination with Ketamine. For treatment planning purposes, please contact us with any questions regarding interactions between your current medications and Ketamine.
How do I know it worked/what should I expect?
You will fill out depression and anxiety scales prior to the first treatment and approximately 24 hours following your second infusion. This will help determine response. For Ketamine infusions, the nurse will place your IV and the 40-minute infusion will begin. It is possible to notice effects as soon as 40 min after the infusion, most typically starting 2-4 hours later, but sometimes taking up to 24 hours.
Patients may begin to feel better within the first few hours following the first treatment. Those with thoughts of suicide and self-harm often notice those thoughts dissipating first. Many experience dramatic relief of dread and hopelessness. Ketamine treatment is provided in a safe, nurturing and healing environment. Patients are treated in private, comfortable treatment rooms with space to accommodate a family member or friend. All treatments are supervised by a physician.
What to Expect During Treatment
You should not expect to wake up feeling “perfect and overjoyed”, but rather there should be a noticeable difference in feeling more hopeful, less sad, decreased thoughts of suicide, increased calmness, “weight” of depression lifted, or more inclined to engage with people. Further improvements are often seen over the course of treatment. Most people can expect to be with us for about 90 minutes from the time you walk in the door to when you leave, with no side effects at that point and none between treatments. You will be provided with post-procedure instructions and will receive a call the day following your first infusion to see how you are feeling.
How long will the results last?
A single infusion typically lasts anywhere from a couple of days up to 1-2 weeks. A series of 6 infusions may last anywhere from weeks to months, and often a single booster infusion when effects are wearing off can restore response. For those who have not had long-standing chronic depression, it may last much longer than that. The number of treatments needed for a positive response is highly dependent on each individual’s unique circumstances. For Ketamine infusions, it is recommended to have 6 within the first 2-3 weeks. After that, maintenance (booster) infusions may be scheduled to maintain response.
Do I continue with my current psychiatrist, therapist, or primary care physician?
Yes. Our clinicians are serving in a consulting capacity to provide this procedure. In some cases, patients may choose to see one of our doctors in his/her private practice. But in most cases, people will continue with either their primary psychiatrist or primary care doctor and are highly encouraged to either begin or continue talking with a therapist.
What are the success rates?
Approximately 70-80% of patients respond to Ketamine infusions. Certain genetic factors and patient characteristics may increase the likelihood of success. Factors associated with successful treatment include: exposure to chronic stress, family history of alcoholism, suicidal ideation, increased BMI, anxious depression, cognitive dysfunction, and a Val/Val BDNF gene.
Is it more expensive than taking an oral medication?
An infusion of Ketamine is more expensive than a typical doctor’s visit and medication copay. However, when also considering the financial toll of ongoing depression symptoms affecting work and social function, as well as multiple office visits and ongoing medication costs, quickly being restored to life by Ketamine is an excellent value.
Are there any conditions that may make ketamine dangerous or ineffective
Uncontrolled high blood pressure, unstable heart disease, increased intracranial orintraocular pressure, interstitial cystitis, active substance abuse, current manic phase of bipolar disorder, active psychotic (hallucinations or delusions) symptoms.
What are the risks?
The dose used for the treatment of mood and anxiety disorders is very low and safe. For a few minutes during the infusion itself, blood pressure and heart rate may increase. This is monitored to ensure safety and medications administered as necessary to manage problematic increases in blood pressure, episodes of nausea or anxiety.
How do I maximize the benefits?
It is common to get advice when depressed that makes sense intellectually but is impossible to follow through on because of the depressive symptoms. This includes things like, “eat well, exercise, engage in talk therapy, find social support, stay busy, etc”. Ketamine rapidly enables you to be able to act on these important activities, and those who have the best results support the medicine’s effect in these ways. In addition, ketamine likely “primes” the brain for learning and making new connections. Talk therapy can be an ideal way to “lock in” therapeutic learning and capitalize on this unique window of time.
How does Ketamine compare to alternatives?
Typical antidepressants take weeks to months to work. There are many to choose from and no reliable way at this point to know which we will be effective and well-tolerated. Therefore, one may wait weeks and find that the medicine does not even work. These medications have common side effects of weight gain, sexual dysfunction, gastrointestinal disturbances, sleep disturbance, fatigue, and emotional blunting. Some newer “add-on” antidepressants also have risks of causing diabetes. Unfortunately, not everyone will respond to ketamine, but you will know that almost immediately and not have to waste time or money unnecessarily. Side effects are limited to the time of the infusion, with no side effects in between. In this way, outside of the infusion time, you are not “medicated”.