Ketamine is a medicine developed more than 50 years ago for anesthesia during surgery, and has been used for that purpose since that time in children, adults, and animals. More recently, ketamine has been found to be a valuable and highly effective treatment for depression, anxiety, and certain pain disorders.
Depression, anxiety, pain, and other forms of stress damage the communication system between areas of the brain responsible for memory, learning, and higher-order thinking. Ketamine is able to promote the materials necessary to make repairs to this damage within hours.
There are several. First is that it is an N-Methyl D-Aspartate (NMDA) receptor antagonist. Another is that it effects levels of the neurotransmitter glutamate. Third, is that ketamine enhances neuroplasticity with the neurons in the central nervous system.
Major depression, the depressed phase of bipolar disorder (bipolar depression), postpartum depression, anxiety, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), pain syndromes such as fibromyalgia and complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD), and addiction.
Uncontrolled blood pressure, unstable heart disease, untreated thyroid disease, active substance abuse, current manic phase of bipolar disorder, or active psychotic (hallucinations or delusions) symptoms.
At this time, the majority of insurance companies do not pay for ketamine treatments for either pain or psychiatric conditions. Insurance companies view ketamine for these purposes as investigational or experimental.
Yes, you may have heard of “Special K”, “Kit Kat”, or “K”, and yes, they are referring to ketamine. However, ketamine IV therapy is not used at the dose, duration, and method which individuals abuse on the street.
No, however, you will need to provide documentation from your primary care, pain specialist, psychiatrist, or therapist related to your diagnosis and past treatment. You will be required to continue regular ongoing contact with them during and after your ketamine infusions. We will contact them to confirm your diagnosis. Then we will contact you and schedule your appointment.
• comfort of administering the medication
• awareness of this treatment
• acceptance of this treatment
• Outside of emergency room doctors, anesthesiologists, few other medical specialists are comfortable with administering this treatment. Many doctors are not educated on the latest research about ketamine, and only recognize it as an anesthetic or street drug use.
• While there are some doctors who don’t know about this treatment, there are others who are used to the current traditional model of treatment and not ready to accept this novel treatment.
We begin with two (or, in some cases, just one infusion) infusions back to back to see if Ketamine Infusions are effective for you. Most of our patients who respond see some improvement the day of or after their 2nd infusion. If not, we may attempt a longer and/or higher dose infusion. If there is still no response, we generally stop further treatment. If ketamine does improve your mood, outlook, and functionality, we suggest that you receive 2-4 additional infusions over the next 4 weeks (1-2 infusions every 2 weeks) to maximize ketamine’s brain-repairing abilities. That is a total of 6 infusions for one full series.
Our commitment to you and your recovery remains long after your last infusion. We know how vital it is that ketamine therapy be part of a bigger treatment plan for our patients, and that’s why we combine it with an extensive aftercare plan at no additional cost to our patients.
Some will begin to feel better within 1 hour of their first infusion. Patients with thoughts of self-harm or suicidal ideation often notice those thoughts and feelings dissipate first, and almost immediately. There is often a dramatic relief of dread and hopelessness. Other patients may not notice any improvement in mood until the day after their 2nd infusion. Some patients will require a third infusion before feeling significantly better. It is important to note that the results of ketamine can be sudden and dramatic, but they are not always. It is more common for patients to see gradual, subtle improvement. Sometimes function improves before mood does. For pain patients, it is uncommon to see substantial relief after 1-2 infusions. It is possible, and we do have patients leave the clinic pain free after one infusion, but that is uncommon. Most of the time, pain patients need to complete the full series of five infusions before they see substantial and lasting relief.
No. Some patients achieve long-term relief after one series of infusions. Others will find that infusions enhance the impact of antidepressants or provide initial relief that is then sustained by oral medicines, other therapies, and lifestyle choices. If ketamine therapy is the only solution for you, you may be able to space your infusions apart by 3-6 months. After the initial series of infusions restores the brain to a healthy balance, it is generally easier to maintain that balance than it was to attain it in the first place. Follow-up or “booster” infusions are provided on an as-needed basis for maintenance.
Ketamine is administered over a period of 45 minutes to 60 minutes. The amount given will not cause you to lose consciousness. During the infusion, most patients have a mild dissociative experience, with an increased sensitivity to light and sound and an altered perception of time and color. Most patients tolerate these experiences without discomfort and many people find them to be pleasant. In the rare case these side effects are considered unpleasant, other rapid acting medications can be used to relieve or eliminate this discomfort. Once the infusion is complete, the dissociative effects of the drug rapidly dissipate and are often mostly gone within 20-30 minutes. There are no delayed “flashbacks” and patients generally leave our clinic within 30 minutes following the infusion and aside from mild fatigue, feel much like themselves.
Many patients recover 20-30 minutes after the infusion. You may feel a little tired, notice a mild difficulty in walking, or even “cloudy thinking” for a few hours after. We advise you to take it easy, and have a relaxing day following the infusion. We will make sure you are ready and safe after your infusion, before we let you go home!
A single infusion typically lasts anywhere from a few days to a month. A series of 4 – 6 infusions may last anywhere from weeks to months, and often a single booster infusion when effects are wearing off can restore and extend response. Every patient responds differently, and some patients get several months of relief with just a few infusions.
Patients commonly feel tired following an infusion. On rare occasion, some patients experience nausea after an infusion. If so, we have medication that will relieve this. If you are prone to nausea, we can administer a prophylactic medication before the infusion to help prevent it. Side effects usually dissipate within a few hours and are completely gone by the following day. There are zero long-term or permanent side effects of IV Ketamine Infusion Therapy.
No. There has been zero link between therapeutic ketamine use and bladder damage, also known as cystitis. The only known reports of bladder damage caused by ketamine are based on the abuse of street ketamine at doses 10-20 times the amount we administer, taken daily, over the course of years. There has been a study on this topic, but bladder cells were exposed to ketamine for 72 hours at concentrations several thousand times greater than the peak serum levels achieved in patients undergoing sub anesthetic infusions of ketamine.
Ketamine can impair your thinking 24 to 48 hours after the infusion. So it is mandatory a trusted friend or family member drives you to and from your appointments. We also recommend refraining from operating heavy machinery, avoid watching small children, participating in strenuous activities, or signing or entering into any legal contracts for at least 24 hours after your infusion.
You cannot eat 6 hours prior to your scheduled appointment. You may have clear liquids up to two hours before your appointment. Patients in the morning session must have no food or liquids after midnight the night before. A sip of water with medications is OK. Afternoon patients may have clear liquids until 8:00 am, then nothing other than medication with a sip of water.
You do not need a referral from a psychiatrist or therapist but we do require pre and post treatment evaluations by a mental health professional in order to verify the efficacy of the treatment for you, monitor your progress, and ensure a successful treatment plan.
Please inform us of any and all medications you are taking.
We are particularly interested in learning if you are taking:
• Lamictal (generic name Lamotrigine). Patients should allow 6 hours between taking Lamictal and the start of their infusion. They should wait 6 hours after their infusion before resuming Lamictal
• Patients taking large doses of benzodiazepines may have a reduced response to ketamine. This does not mean you can’t receive ketamine treatment while taking benzodiazepines. It is perfectly safe. We want to ensure the best possible chances for your success though, so we may ask you to skip a dose 12 hours before the start of your infusion and wait until 6 hours after before resuming your benzodiazepine. Some common brand names are Xanax (Alprazolam), Ativan (Lorazepam), Valium (Diazepam), and Klonopin (Clonazepam).
• SSRIs and tricyclics do not interfere with ketamine. There is no need to stop them.
• If you are taking opiates, muscle relaxants, or anti-inflammatories, there is no need to adjust your dose.
• We can assist you in reducing or tapering off of any medications that are contraindicated, cause a reduced response to ketamine, or that you would like to stop taking due to negative side effects, ineffectiveness, or price. You should not adjust your dose or frequency of use of any prescribed medication without first consulting with your prescribing physician.
While treating some types of chronic pain with Ketamine Infusions have been more studied and found more effective than treating others, there is no guarantee that Ketamine Infusions will help your pain.
If given alone, Ketamine can cause hallucinations. To limit the occurrence of this side effect we administer midazolam, a benzodiazepine that is very effective. Only rarely will a patient have to stop treatment because of any of Ketamine’s side effects.
Your thinking may be a bit cloudy and your walk unsteady for an hour or two after treatment. There will be a few more hours of tiredness. But, hopefully there will be a noticeable improvement in the pre-treatment level of your pain as well.
What we want to achieve is a significant improvement in the level of your pain or mood disorder. With a decrease in your symptoms you can expect to increase your activity level and improve your overall quality of life.
Following a series of infusions we want to see a prolonged period of significant pain relief measured in weeks to months. Most patients will need to return from time to time for a booster infusion to maintain that level of relief.