What is Ketamine?
Ketamine is a medication that has been used in general anesthesia for decades. The exciting news for both men and women about Ketamine recently is that a single dose 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 sub anesthetic 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 treat depression, anxiety, and suicidal ideation by repairing 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.
Ketamine can be effective in treating:
- Major Depressive Disorder
- Post-partum Depression
- Suicidal Ideation
- Bipolar Disorder
- Generalized Anxiety Disorder
- Obsessive Compulsive Disorder
- Post-traumatic Stress Disorder
- Substance Abuse (very early evidence)
Reasons you might not be a good candidate for Ketamine:
- 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
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 may be required. Remission periods vary from one patient to another; can be anywhere from 28-168 days. Average treatment frequency is every 1-2 months.
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. We do not accept Medicare or Medicaid. Patients are responsible for any amount not covered by insurance.
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How does Ketamine work for pain?
It is well known that when pain persists for a long period of time the brain begins to perceive pain as more severe. In certain types of chronic pain even non-painful stimuli such as wind blowing over the skin can solicit and intensely painful response. This phenomenon is referred to as the “windup”, we believe that Ketamine works by preventing the windup that occurs and some pain disorders. It also seems to decrease the amount of pain medication patients need to treat their pain symptoms.
Does Ketamine treat Fibromyalgia?
Authors of a study of Ketamine infusion for the treatment of Fibromyalgia found that hyper analgesia and muscle pain at rest were reduced by Ketamine infusion and found statistically significant differences in pressure pain threshold and pain tolerance at tender points, control points and muscle endurance with no statistically significant differences in muscle strength after Ketamine.
Can Ketamine treat Post-partum Depression?
Postpartum depression is the most common postpartum complication with more than 20% of postpartum moms meeting criteria for a depressive and/or anxiety disorder. Breastfeeding mothers with postpartum depression often agonize about whether or not to use antidepressants to treat their symptoms because they often don’t want to expose the baby to medication and don’t want to stop nursing in order to take a daily medication. All moms, breastfeeding or not, need rapid and effective relief–for their own health and the health and development of their babies. Multiple studies show that untreated postpartum depression affects mother-baby interactions and is associated with lower cognitive functioning and adverse emotional development in the baby.
If you have postpartum depression or know someone who does, IV Ketamine can treat it within hours without requiring a patient to stop breastfeeding. IV Ketamine is an extremely rapid, effective treatment for depression and 75-80% of patients respond quickly and dramatically to very low dose IV infusions. This makes IV Ketamine therapy an exciting treatment option for postpartum depression, where getting better quickly is what every mom hopes for, and where restoring the health of the mother positively impacts the whole family. Mood, negativity, hopelessness, anxiety and distractibility can improve within hours, and hopelessness and suicidal thoughts can evaporate. A series of low dose infusions over about 2 weeks can result in dramatic and complete remission of symptoms.
We make it a priority to see postpartum moms. We offer flexible scheduling in the late afternoon so that a breastfeeding mom can come in for her treatment and resume breastfeeding when the medication has cleared from her system, usually within 7-8 hours following infusion, so that her baby is not exposed to it.
Do you treat patients with Spravato (esketamine)?
Mind Mood Pain is a provider of the Ketamine nasal spray Spravato (esketamine). A consultation with your physician will help determine the Ketamine treatment right for you and your symptoms.
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.
Many find it helpful and relaxing to listen to music and to wear an eyeshade or sunglasses. It can be difficult to carry on a conversation during the procedure, so you are encouraged to sit back and relax and pay attention to what you are feeling. Expectations coming into the treatment do affect the experience, so it is helpful to decide ahead of time that you will be safe, will feel “weird” for a little while, and that is okay. These feelings will quickly pass and you will be left feeling much better.
The first 5 minutes are uneventful with no noticeable effects. At around the 10-minute point, people tend to notice some blurring of vision or double vision, a feeling of “lightness”, “floating”, or intoxication, and sometimes some numbness in the toes or area around the mouth. Over the course of this 20 minute period, these feelings tend to build, so that the medicine is at the peak of its intensity at the very end. Other common feelings include euphoria, talkativeness, a feeling of being “disconnected” or in a dream, heightened perceptions (background noise may seem louder, colors or lights are more intense), and a feeling that people often describe as “weird, odd, different, or interesting”. Less commonly, people may experience some anxiety and headache, nausea, or sweating (typically toward the end). These feelings start to subside approximately 10-15 minutes after the medicine is done and last for a total of 45-50 minutes.
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. Mind Mood Pain physicians 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.
Why aren’t other doctors doing this?
Most psychiatrists do not perform “procedures” and do not have the staff and equipment within their offices to use this medicine. The process of establishing a program like this in an outpatient clinic is a long and difficult one. In addition, because Ketamine is not marketed by a pharmaceutical company, there are no conferences or sales representatives teaching doctors about this and giving them samples. Dr. Dalthorp was one of the first to make Ketamine treatment available in Oklahoma.
Are there any conditions that may make ketamine dangerous or ineffective?
Uncontrolled high blood pressure, unstable heart disease, increased intracranial or intraocular pressure, interstitial cystitis, active substance abuse, current manic phase of bipolar disorder, active psychotic (hallucinations or delusions) symptoms. In addition, Ketamine treatment is not compatible with MAOI medication treatment and the effectiveness of infusion treatment may be decreased with higher doses of Lamictal, opiate pain medications and Benzodiazepines.
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”.
Are there support networks available?
Yes. Please visit ketamineadvocacynetwork.org