What is Ketamine?
Ketamine was discovered in 1956 and approved by the FDA in 1970. It is widely used as an anesthetic in children, adults, and the elderly. Ketamine is a safe, effective anesthetic and has been listed on the World Health Organization’s Essential Medicines list since 1985. Multiple studies and trials at Mt. Sinai in New York, Yale, and other prestigious universities and hospitals since 1990 have shown that ketamine is exceptionally effective in treating treatment-resistant depression, PTSD, anxiety, suicidal ideation, neuropathic pain, and other related mood disorders. Unlike standard antidepressants like SSRIs and SNRIs, which generally take 6-8 weeks to work (if they work), ketamine is fast-acting. It can sometimes show immediate efficacy after a single intravenous dose. Because of its fast-acting nature, ketamine can be an essential tool in preventing suicide and immediately alleviating the suffering caused by major depressive disorder.
Who is a candidate for Ketamine infusions?
Ketamine is recommended for anyone with treatment-resistant depression, meaning tried and failed at two or more antidepressant therapies and those with PTSD.
What are the chances of responding to ketamine treatment?
While we cannot predict who will respond to ketamine, a meta-analysis by the American Psychiatric Association using data from multiple ketamine trials reported that over 70% of treatment-resistant patients responded positively after receiving the initial round of low-dose infusions. There’s no way to predict what someone’s response will be or at what point they will react. Some patients respond to the first infusion, while others take 4-6 infusions. The degree and duration of response are also highly dependent on the individual. Unfortunately, not everyone responds to ketamine treatment. Those who have not improved after six infusions are unlikely to benefit from further ketamine treatments.
How many treatments are needed?
An initial series of six ketamine infusions are recommended for optimal results over 2-3 weeks. After that, patients are placed on a maintenance program and are asked to return when they feel it necessary for single infusion boosters. During the maintenance period, the duration of relief varies by patient. The average time of relief between booster infusions is 4-6 weeks. There is no way to predict what your needs will be. Some patients find that the time between boosters lengthens as they go through this process, prompting them to come in every other month, every three months, or even less frequently. In our experience, patients find ketamine boosters effective for as long as needed with no long-term side effects.
Is ketamine an FDA approved medication?
Ketamine is FDA approved for use in the United States as an anesthetic during surgical procedures. Ketamine is not approved for the treatment of psychiatric conditions. Therefore, its use as a psychiatric treatment is considered “off-label.” “Off-label” does not mean it is experimental, ineffective, or illegal. Physicians routinely and legitimately prescribe many other medications for unapproved indications based on additional scientific research completed after a drug’s approval. The rationale for this- is money. It takes large sums of money for the FDA approval process, which is why the majority of drugs being used “off label” will never be approved.
Is ketamine safe?
Despite its dramatic effect, ketamine is an extraordinarily safe medication. It has been used for over 50 years as an FDA-approved general anesthetic agent. It has wide application in operation rooms, ICUs, emergency departments, pain centers, burn units, and pediatric anesthesia and is non-addictive with few significant side effects. It is also listed on the World Health Organization’s “essential medicines” list due to its efficacy and safety record.
What are the possible side effects?
Ketamine is rapidly removed from the body. Any side effects typically resolve within a short time after completion of the treatment. Patients often feel unsteady, clumsy, mildly intoxicated, or dizzy during and after the treatment. Some patients may experience drowsiness, anxiety, dreams, or other unusual feelings. Nausea or vomiting may occur rarely.
Ketamine infusion causes a brief, usually mild, increase in blood pressure and heart rate. These are monitored and resolved quickly after the treatment is stopped. The rate of treatment and dose may be adjusted if necessary.
Ketamine does not interfere with breathing or respiratory drive, especially at low doses and without other sedatives or narcotics. Allergies to ketamine are rare.
How do I prepare for a ketamine treatment?
A designated driver must accompany all patients, or treatment will not be provided. You may eat or drink without concern, but try not to eat a heavy meal directly before your infusion.
Please bring these with you if you wish to listen to music during your treatment and prefer your headphones/music.
What happens during an actual ketamine treatment?
You will be asked to complete a survey of your current mental state, and your current vital signs will be obtained. An IV is started while you are seated in a comfortable recliner. Evidence shows that sensory deprivation lends to the most effective experience, and we provide an eye mask, noise cancellation earphones, and a weighted blanket for you to use if you choose to do so. The medication is given slowly, over about 40 minutes. During the treatment, your vital signs are continuously monitored, and a provider is always in the room.
What is Ketamine Assisted Psychotherapy?
Ketamine Assisted Psychotherapy is an intensive psychotherapeutic experience that can result in rapid improvement in depression, anxiety, suicidality and other psychiatric conditions. Ketamine can help to enhance and deepen the therapeutic process. It can provide an opportunity for the temporary softening of defenses to allow for deeper processing through psychotherapy. We have partnered with severeal therapists offering this service, which can be done either during or following infusions.
Is there anyone who should not receive ketamine treatment?
Ketamine is not used to treat schizophrenia because it may worsen the condition.
Ketamine has not been adequately studied as an initial treatment for depression or anxiety. Other treatments should almost always be tried before ketamine.
Persons abusing alcohol or other drugs are unlikely to respond to ketamine and may be at greater risk of adverse effects. These persons should seek appropriate assistance to achieve a period of abstinence before ketamine treatment.
Persons with severe and uncontrolled high blood pressure should not receive ketamine until the blood pressure is under control since ketamine can cause a very transient rise in blood pressure.
Recent evidence that the use of benzodiazepines, such as Xanax (alprazolam), Valium (diazepam), Klonopin (clonazepam), and others, may reduce the efficacy of ketamine for depression. For those who already take these medications regularly, we will be happy to offer assistance to wean off these prior.
Ketamine therapy is not usually recommended during pregnancy because the possible risks of harm to the fetus are unknown. Breastfeeding should be avoided for 12 hours after ketamine treatment.
Will any medications interfere with ketamine infusion effectiveness?
Yes. Benzodiazepines, such as Klonopin, Xanax, and Ativan, interfere with ketamine if used daily and at higher doses. Lamictal (lamotrigine) in doses above 150mg/day also can block ketamine efficacy. During our intake exam, we will discuss if and how to modify your medication regimen to maximize ketamine’s effectiveness.
What is esketamine or Spravato?
Esketamine is the S(+) enantiomer of racemic ketamine and is already used as an anesthetic in Europe. The FDA has recently approved esketamine specifically for use in treatment-resistant depression. It is available in a nasal spray, marketed as Spravato. However, because it still has the same potential psychotropic effects and changes in blood pressure and heart rate as racemic ketamine, it is restricted for use in certified centers. We are currently not offering Spravato nasal esketamine therapy. We have seen better results with intravenous ketamine.