What is Ketamine?
Ketamine was first, and still is, an important human general anesthetic agent. It has been used in hospitals for the past five decades and has a proven record of safety. More recently it is being used to treat neuropathic pain and the symptoms of PTSD. The small doses and methods of administration used to treat psychiatric patients differ greatly from those used in hospitals.
Ketamine is on the World Health Organizations’s list of “Top 10 Essential Drugs”.
Not yet. Over the past two decades dozens of studies in prestigious medical centers and The National Institute of Mental Health have proven ketamine’s safety and efficacy in treating major depressive disorders, anxiety, obsessive compulsive disorders and suicide ideation. Yet, without very large controlled studies generally required by the FDA to get approval for any psychiatric drug, approval has been delayed. Since ketamine is a generic drug, no pharmaceutical company will spent the hundreds of millions of dollars required for such a study. Efforts are being made to create a national registry of the outcomes of the thousands of patients treated by ketamine providers across the country to date. This data will be used to expedite FDA approval. In the meantime, ketamine is being used “off label”, as is true with many other medications prescribed by physicians.
Yes, ketamine infusions for depression are outpatient procedures requiring no hospital admission.
No, while referrals from any mental health care provider are welcome and encouraged, an initial phone interview with one of our doctors can determine if you are a good candidate for ketamine therapy.
No, mild to moderate depression is successfully treated by mental health professionals with drugs and psychotherapy. The treatment of severe depression is more difficult and requires a higher level of care, such as ECT, TMS, and now ketamine therapy. Ketamine infusion therapy is reserved for those patients with severe depression that is considered otherwise treatment resistant.
The patients we see are all considered treatment resistant. That is, they have not responded to available antidepressant medications and in many cases have not responded to ECT or TMS. We cannot predict who will respond to ketamine, but statistically 2 out of 3 patients do show a dramatic improvement in their mood and 3 out of 4 will cease to have suicide ideation. We will know within two treatments if ketamine infusions will help you.
If you have a favorable response to the first two infusions, a total of six is recommended within a twenty one day period. That will maximize the ketamine effect on new dendrite and synapse growth. Thereafter, patients are placed a maintenance program where they return when they feel it necessary for a single infusion booster. During the maintenance period, the duration of relief following the initial infusions and the first booster, and between subsequent single booster infusions varies between patients. The average duration of relief between booster infusions is 3 to 4 weeks. There is no way to predict what your needs will be.
No, right now ketamine infusion therapy is, perhaps, the most exciting and successful new treatment for severe depression. But, there are large pharmaceutical companies developing ketamine like drugs for more convenient nasal and oral administration. It may be a few years, but those drugs will become available. In the meantime, ketamine has been proven effective in most cases, and is available to you or your loved ones. Patients with debilitating severe depression with constant thoughts of self harm can not afford to wait.
About an hour, with an additional half hour before discharge.
No. The dose of ketamine you will receive does not cause any loss of consciousness.
Most patients experience a mild dissociation or inner reflective experience that is generally well tolerated. If you find it unpleasant we can treat it. Within 15 minutes of ending the infusion your thinking will be clear. There are no delayed “flashbacks.”
Yes. The benzodiazepines, such as Klonopin, Xanax, and Ativan do interfere with ketamine if used daily and at higher doses. Lamictal (lamotrigine) in doses above 100mg/day also can block ketamine efficacy.
No, other antidepressant medications do not interfere with ketamine’s mechanism of action.
Almost none. Uncontrolled high blood pressure or heart failure need to be corrected.
No, ketamine has been proven safe in humans over five decades in and out of hosptials and battle fields for surgical anesthesia and trauma management. Those patients experience longer exposures and at much higher doses than those used to treat severe depression. Although it has been abused recreationally in high doses as a club drug, there is no evidence that ketamine is addictive.
True emergencies, with a psychiatric referral, can be seen within a day. But, in general, five to seven days are required to get you onto the schedule. Since we are here seven days a week we can meet most patient’s scheduling needs.
The fee for each infusion is $475. We do not accept any private insurance or Medicare, but will provide you with the forms to submit for reimbursement. As of now about 35-40% of patients are receiving some reimbursement, but we cannot predict if your insurance plan will reimburse you.
Financing options are available through Advance Care, a medical funding company. For details please call them directly at 800-432-9470, or visit their website advancecarecard.com.