What is Ketamine?
Ketamine is a medication that was first developed in 1962, and is on the World Health Organization’s list of essential medicines. Ketamine has been found to be effective in treating many conditions such as depression, chronic pain, and PTSD, but is most commonly used as a surgical anesthetic, and has only been approved by the FDA to be marketed as such. Ketamine’s use outside of that of an anesthetic is considered “off label,” and allowed when deemed medically appropriate by an attending physician. It is estimated that almost ¼ of all prescription medications sold in the United States, are prescribed off label.
How does ketamine work?
Ketamine has been shown to stimulate neuron growth in the brain in as quickly as one hour. Many scientists studying Ketamine are focusing on the neurotransmitter glutamate, which plays a key role in neural activation. Ketamine has also been found to be a strong anti-inflammatory, which is also being studied for its positive effects. While the studies of “how” continue, the life enhancing results are seen daily at KWC.
Will I be asleep?
You will be awake. The Ketamine infusion dosage is not high enough to cause you to fall asleep but you may feel a bit drowsy during, and shortly after the treatment.
Will ketamine infusions help me if I have treatment resistant depression?
We cannot guarantee any particular result as everyone is different. Many clinical trials have shown that Ketamine Infusions produce results for 70% – 87% of those involved. Our treatment is tailored, in terms of frequency and dosage, to each person. We believe it offers your best possible chance of success at over 80%.
How many ketamine infusions will I receive?
For our mood disorder patients, that will depend on your response. We begin with two (or, in some cases, three) infusions 48-96 hours apart 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 4 additional infusions over the next two weeks to maximize ketamine’s brain-repairing abilities. That is a total of 6 infusions for one full series. For our CRPS/RSD or other pain condition patients, we provide five 4-hour long infusions, generally done on five or more consecutive days. Because pain conditions require more substantial dosing, we cannot determine whether or not a patient is responding after their 2nd infusion. Results can be seen very quickly, in as little as one treatment, but are often not seen until after the full course of treatment is complete.
What happens after my series of ketamine infusions?
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. We offer Nuedexta, the only NMDA antagonist, FDA approved, oral agent, to those who are approved, to significantly extend the extraordinary benefits our patients are getting from IV Ketamine. Some patients are more receptive to conventional oral anti-depressants after treatment and most are encouraged to be involved in talking therapy with a trusted, licensed, mental health professional. We also work with patients on modifying their lifestyle choices to help maintain their good results. For pain patients, the aforementioned treatment plan applies as well. Physical therapy, exercise, and stretching are also beneficial in some cases, depending on what the cause of the pain is. Following the initial series of infusions, some patients begin an infusion maintenance program; returning for additional infusions as needed. In most cases, 1-2 boosters is all that is necessary to restore patients and significantly extend their results. The interval between maintenance infusions will vary from patient to patient. Some patients may have a booster once per month starting 3 months post treatment while others have gone over a year before needing to come back. There is no way to predict if or how often you will require booster infusions.
If ketamine therapy works for me, how soon will I begin to feel better?
For mood disorder 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 or more infusions before they see substantial and lasting relief.
Will I require ketamine therapy for the rest of my life?
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.
What should I expect during my ketamine treatments?
For mood disorder patients, ketamine is administered over a period of 40-60 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. For pain patients, ketamine is administered over a period of 4 hours. The amount given is significant and can increase side effects like dissociation. A number of adjuvants can be used to decrease or eliminate the negative side effects that are associated with higher doses of ketamine. Patients generally take 60-90 minutes of rest following the infusion before they feel comfortable leaving our clinic. There are no delayed “flashbacks” and aside from being tired or fatigued, most feel much like themselves. We require pain patients to be picked up inside our clinic by a responsible adult.
Are there any other side effects I should be concerned about?
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 before the infusion to help prevent it. Side effects usually dissipate within a few hours and are completely gone by the following day.
Do ketamine treatments cause bladder damage?
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 subanesthetic infusions of ketamine.
I am bi-polar, will ketamine make me hypomanic?
Although hypomania is possible, one clinic has not seen a single case in over 600+ patients.
Do I need to bring someone with me to my ketamine treatments?
Someone must bring you home, but they do not have to be present for the infusion. We advise you not to drive a car, operate heavy/dangerous machinery, sign any contracts, or partake in other potentially risky activities until the following morning.
Can I eat or drink before my appointment?
You cannot eat 4 hours prior to your scheduled appointment. You may have clear liquids up to two hours before your appointment.
Will my current psychiatric medications interfere with my ketamine infusions?
Anti-depressant medications (SSRIs, MAOIs, and tricyclics) do not interfere with ketamine, and there is no need to stop them. Patients taking large doses of benzodiazepines (Ativan, Xanax and Klonipin) will have a reduced response to ketamine, but taking these medicines does not mean that ketamine cannot help you. Lamictal in doses over 100mg/day will blunt the ketamine response. Important: You should not decrease or stop taking any prescribed medication without first consulting your prescribing physician.
Is there an age requirement to have IV ketamine infusions?
There are no formal age limitations.