Tag Archives: ketamine for suicidality

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703-844-0184 | Ketamine for depression | Alexandria, Va 22306 | Ketamine Treatment Center | Call for an appointment – Dr. Sendi

Is ketamine safe? What are some reasons I would not be eligible (contraindications)?

Ketamine is a unique among anesthetic medications in that it is extremely safe, having been used in various settings for more than fifty years, even in poorly monitored settings such as battlefield anesthesia and developing countries, “ketamine has a good safety profile and is easy to use, especially in under-resourced health systems and emergency settings where clinical conditions and medical equipment are generally not available” (World Health Organization).  Ketamine has an even higher margin of safety when used to treat depression because such doses are much lower than those used in surgery. Patients typically remain conscious the entire time, though may feel somewhat altered and experience perceptual changes.  When used in higher surgical and anesthetic doses, ketamine requires the presence of an anesthesiologist for full airway and cardiac monitoring, while the lower doses used in depression do not.  There are specific reasons you would not be eligible for ketamine, including recent myocardial infarction (heart attack), recent psychosis (hallucinations, delusions), or recent bladder inflammation (cystitis). Administration of ketamine and medical monitoring throughout the session is performed by Dr. Sendi, and not by nurses or personnel with less medical training.

Image result for intranasal ketamine | Ketamine Infusion Center | 703-844-0184 | Loudon, Va | Ketamine IV Treatment Center | Ketamine Doctor | Intranasal Ketamine |Alexandria, Va 22306 | Ketamine for Depression | Intranasal Ketamine | OCD| CBD Center | Medical CBD | Medical THC Center | THC Doctor | Ketamine for Alcoholism | Intranasal Ketamine | 22043 22046 22101 22102 22106 22107 22108 22109 20175 20176 20147 20148 20151 22030 22031 22032 22034 22038 | IV Vitamin Therapy
Ketamine Infusion Center | 703-844-0184 | Loudon, Va | Ketamine IV Treatment Center | Ketamine Doctor | Intranasal Ketamine |Alexandria, Va 22306 | Ketamine for Depression | Intranasal Ketamine | OCD| CBD Center | Medical CBD | Medical THC Center | THC Doctor | Ketamine for Alcoholism | Intranasal Ketamine | 22043 22046 22101 22102 22106 22107 22108 22109 20175 20176 20147 20148 20151 22030 22031 22032 22034 22038 | IV Vitamin Therapy

WHO Recommends against International Control of Ketamine

20160309_FactFile_Ketamine

What is the best route of administration for treatment of depression?

As noted above, ketamine can be administered in several different ways: by an intravenous infusion, an intramuscular injection, intranasally, sublingually, and orally. Intravenous ketamine infusions have been most studied because of their historical use and original FDA approval decades ago, though more and more studies are finding comparable efficacy with the other routes of administration.  It is not clear that intravenous ketamine infusions are more effective than other routes of administration, and further results in great patient discomfort, greater resource utilization, and ultimately result in a higher cost.  For this reason I typically offer ketamine via the intramuscular route, which appears to be non-inferior in terms of efficacy for depression.Here is a link to an article on Ketamine and depression:   the International Journal of Transpersonal Studies: Ketamine and depression: a review.

Am I a good candidate?  How are ketamine treatments structured?

Prior to initiating ketamine treatments, some  potential patients are scheduled for an initial psychiatric evaluation.  On this first meeting, we will determine a diagnosis, develop a treatment plan, and assess for any medical or psychiatric issues that may interfere with ketamine treatment. If we mutually agree that ketamine could be beneficial, then we can schedule a subsequent visit for the actual administration; with some planning, it is possible for both the intake and administration to be done on the same day.  The greatest benefit of ketamine is attained with multiple administrations over the first few weeks of treatment, which is then followed by periodic booster treatments to maintain freedom from depression.  I ask patients to commit to a series of 6 administrations over 3 weeks, and then return for periodic bimonthly to monthly booster treatments thereafter to prevent depression from returning. Please note, it is always your option to stop treatment at any time. Patients must have a friend or family member pick them up after the appointment, as ketamine temporarily impairs one’s ability to drive. Ketamine sessions are scheduled for 90 minutes in duration, and involve a brief medication management visit, the actual ketamine administration, followed by psychotherapy, all of which is integrated into one visit.

For individuals interested in ketamine treatments, please print out the informed consent  and bring it with you to our appointment.  I will have you sign it after an in depth discussion about the risks, benefits, and alternatives available to you.

Are there any precautions?

Individuals receiving ketamine should abstain from any food or drink for the 6 hours prior to receiving the medication, and furthermore, should not drive for the remainder of the day. This is a necessary precaution because the subtle after effects of ketamine can linger for hours after the treatment and impair the ability to drive.  Effects typically resolve by the following day, at which time driving is allowed. Typically patients arrange a ride home with a friend or family member, and once tolerability is established can later use a taxi or ride sharing service to return home.

What is the cost of ketamine treatments? Do insurance companies cover it?

I do not directly contract with insurance companies, but instead collect the full fee at time of the visit and provide patients with a superbill that can be submitted to their insurance provider for reimbursement.  Current fees can be found on the new patient intake form, available here.

Visits may be partially covered depending on your insurance plan.  The ketamine administration itself is generally not covered by insurance, however the typical 90 minute long ketamine treatment session involves several other components which may be reimbursed for: the brief medication management (99213, 99214, or 99215) and psychotherapy visit (90833 or 90834) are typically covered by insurance, though this cannot be guaranteed.  In addition, the initial psychiatric evaluation visit (99205) is also typically covered.  I suggest potential patients check with their insurance provider to see what their out-of-network coverage benefits are for the above procedures/CPT codes.  PPO type insurances usually allow for out-of-network benefits, while HMO plans do not.

What can you tell me about the use of ketamine for treatment of addiction or substance use disorders?

Ketamine has been studied for treatment of addiction, specifically to the opiate and street drug, heroin.  Findings suggest that ketamine, as part of a structured therapy program, is effective for the treatment of addiction, perhaps due to biochemical properties as an NMDA receptor antagonist. While studies examining this particular application of ketamine are more limited than those examining treatment of depression, work with compounds that create similar states of consciousness–such as the “classical hallucinogens”: LSD, psilocybin, mescaline, DMT, and ayahuasca–suggest a role for altered states independent of the biochemical effects of ketamine.  Such compounds seem to work to treat addiction via their ability to produce spiritual or mystical experiences. While such “classical hallucinogens” are not currently available for clinical use, there exists a growing literature detailing successful and robust treatment of tobacco and alcohol addiction. Use of the aforementioned compounds outside of a research setting is however illegal, except for ketamine which has been FDA approved for other indications and is consequently available for off-label use to treat such diagnoses as depression, post-traumatic stress disorder, and addiction / substance use disorders.

What other psychiatric conditions has ketamine been used for?

Treatment resistant depression is, by far, the most extensively studied psychiatric application of ketamine, and has a wealth of data to support its use.  Other indications (or reasons to use ketamine) include drug or alcohol use disorders (specifically for opioid or cocaine use disorders),  Post-Traumatic Stress Disorder (PTSD), and eating disorders such as anorexia or bulimia.  On the other hand, data suggests ketamine is less effective for treatment of Obsessive-Compulsive Disorder (OCD), but may be worth pursuing on a case by case basis.

Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder a randomized clinical trial.

Where can I learn more?

You are invited to read a review article on ketamine for depression.  The full text is available free of charge from the California Institute of Integral Studies [ full text ].  Ketamine and Depression_ A Review An updated version of this review is available as a book chapter in a larger publication on ketamine.  The book, entitled The Ketamine Papers–Science, Therapy and Transformation, is published by the non-profit Multidisciplinary Association for Psychedelic Studies (MAPS) and available for purchase through their website and amazon [ order the book via MAPS, or via amazon ].  Also available is a video recording of a presentation on ketamine that I gave for the Aware Project [ YouTube video ].

 

 

 

The Ketamine Papers

 

 2007 Mar;39(1):13-9.

Single versus repeated sessions of ketamine-assisted psychotherapy for people with heroin dependence.

Abstract

A prior study found that one ketamine-assisted psychotherapy session was significantly more effective than active placebo in promoting abstinence (Krupitsky et al. 2002). In this study of the efficacy of single versus repeated sessions of ketamine-assisted psychotherapy in promoting abstinence in people with heroin dependence, 59 detoxified inpatients with heroin dependence received a ketamine-assisted psychotherapy (KPT) session prior to their discharge from an addiction treatment hospital, and were then randomized into two treatment groups. Participants in the first group received two addiction counseling sessions followed by two KPT sessions, with sessions scheduled on a monthly interval (multiple KPT group). Participants in the second group received two addiction counseling sessions on a monthly interval, but no additional ketamine therapy sessions (single KPT group). At one-year follow-up, survival analysis demonstrated a significantly higher rate of abstinence in the multiple KPT group. Thirteen out of 26 subjects (50%) in the multiple KPT group remained abstinent, compared to 6 out of 27 subjects (22.2%) in the single KPT group (p < 0.05). No differences between groups were found in depression, anxiety, craving for heroin, or their understanding of the meaning of their lives. It was concluded that three sessions of ketamine-assisted psychotherapy are more effective than a single session for the treatment of heroin addiction.

How to use psychedelics

How to Take Ketamine to Treat Depression, Anxiety and PTSD

Ketamine is a legal prescription medication used for a variety of purposes– as a pain killer, sedative, anesthetic, and anti-depressant. It’s one of the safest anesthetics in the world and is available in every hospital. Ketamine’s use as an anti-depressant and PTSD treament is growing very quickly and research studies are expanding. Here’s a directory of US doctors offering ketamine treatment for depression, bipolar, PTSD, and other mood disorders.

As the BBC wrote in a 2014 article about ketamine, “Some patients who have faced incurable depression for decades have had symptoms disappear within hours of taking low doses of the drug.”

What makes Ketamine so remarkable for treating depression is that its positive effects begin almost immediately, within 1 – 12 hours, compared to SSRIs that may take weeks to start working, if they work at all. Ketamine also seems to have much fewer side effects than SSRIs (though it hasn’t been studied much for long term use) and is incredibly effective as a treatment for people who don’t respond well to SSRIs and other anti-depressants. If you’ve had limited success with other treatment methods you may respond very well to ketamine.

Before you begin, be sure to read our safety section and ensure that you aren’t taking any medication or supplements that interact with Ketamine.

Dosage

Dosage for ketamine varies depending on whether it’s taken intranasally, intravenously (IV), orally, or sublingually. We recommend taking ketamine orally or sublingually because it’s safe and easy. Many doctors and treatment centers will give ketamine in an IV. Treatment with a doctor / center can be quite expensive but you may be able to find a doctor or center in your area if you google around.

The anti-depressant effect of ketamine typically wears off after a while (a few days to a month), though the relief that is felt while it is active can often lead to lasting improvements. There are various protocols for using ketamine to treat depression– some people take small amounts daily, others weekly, and others monthly. We recommend starting with a moderate dose once a week and adjusting based on how it feels.

How to Take Ketamine Sublingually (Under the Tongue)

Sublingual ketamine seems much more potent than oral ketamine. We suggest starting with a very small “microdose” and trying a little more each session until you find the minimum amount that works for you. You should almost certainly see results using .3mg of ketamine per pound of body weight (or .75mg per kg of body weight). This works out to about 50mg for someone who weighs 160lbs (72kg). But start far below that.

  • STEP ONE
    Prepare your ketamine solution. You’ll want to use one of those little bottles that has an eyedropper in the lid. Maybe you have one around the house with some sort of herbal tincture. Boil some water, then let it cool. Using the eyedropper, wash out the dropper and the bottle with the water, just to get rid of any residue. Put a known amount of ketamine into the bottle. Then add water to the bottle using the eyedropper, carefully counting the drops. You want to use as few drops as possible to dissolve all the ketamine. In a lab you should be able to dissolve 5mg ketamine per drop. If you add this much water and you still see some undissolved ketamine in there, add just enough water to dissolve it all. Carefully swirl it around to speed things up. Now you can give yourself microdoses of ketamine. Just divide the amount of ketamine by the number of drops. If you had 1000mg of ketamine, and added 200 drops of water, you’d know there was 5mg ketamine per drop.
  • TWO
    Find a place where you can sit or lie down comfortably for an hour. Unlike traditional psychedelics like mushrooms, LSD, and even MDMA, the benefits of ketamine do not seem to derive from an exploratory experience while taking the medicine. In addition, the experience at an effective dose is much more gentle. You can read a book, watch TV, etc.
  • THREE
    Looking at yourself in a mirror, put one or two drops under your tongue. This is probably at most 5-10mg. Don’t swallow it, just leave it under your tongue. After 5 minutes or so, you can swallow.
  • FOUR
    The effects will be very subtle but you might feel a slight mellow or sleepy feeling in about 5-15 minutes.
  • FIVE
    The anti-depressant effects of the ketamine generally start to appear about two hours after taking the first dose. In some people the anti-depressant effect is strong right away and in some people it gradually grows over 1-4 days– so you might feel the most relief 4 days after taking the dose.
  • SIX
    See how you feel the next day. If you are less depressed, great! If not, the next time try the previous dose plus one more drop. Don’t take ketamine two days in a row. Once you find a dose that seems to work, see how many days you can wait between doses. Ideally, you would take a dose once a week or once a month. Worst-case, you’d take it every other day. If you get up to 50mg sublingually and it still doesn’t work, it might just not work for you in general.

How to Take Ketamine Orally

We suggest using .6mg of ketamine per pound of body weight (or 1.5mg per kg of body weight). This works out to about 100mg for someone who weighs 160lbs (72kg).

Remember these are oral doses– usually mixed with warm water and swallowed. If you are taking ketamine in an IV the doses should be much, much lower.

  • STEP ONE
    Find a place where you can sit or lie down comfortably for an hour. Unlike traditional psychedelics like mushrooms, LSD, and even MDMA, the benefits of ketamine do not seem to derive from an exploratory experience while taking the medicine. In addition, the experience at an effective dose is much more gentle. You can read a book, watch TV, etc.
  • TWO
    Make sure you have the right dose measured and ready. If you don’t have a mg scale, you can order them cheaply anywhere, including Amazon. They are about $20-$30.
  • THREE
    If it’s your first time, mix about 1/5th of the dose with about an inch of warm water in a mug. If you are taking about 100mg, that would be roughly 20mg. Once you mix it, drink it.
  • FOUR
    A 1/5th dose will be very subtle but you should be able to feel a nice mellow or sleepy feeling in about 5-15 minutes. After 15 minutes, if you feel comfortable with that test dose (and it’s fine if you don’t feel anything at all), then you can mix the rest of the dose with warm water and drink it.
  • FIVE
    As you feel the effects of the dose, again after 5-15 minutes, you will likely feel sleepy or mellow. You can rest, read, watch tv, etc. After about 45 minutes to an hour, the effects will be mostly gone, though you may still feel very relaxed or sleepy for a couple more hours.
  • SIX
    The anti-depressant effects of the ketamine generally start to appear about two hours after taking the first dose. In some people the anti-depressant effect is strong right away and in some people it gradually grows over 1-4 days– so you might feel the most relief 4 days after taking the dose.

Afterwards

The anti-depressant effects of ketamine last for days and sometimes weeks or even a month. We suggest starting with weekly re-dosing, using the same dose, and seeing how it goes. If you find that you don’t need to redose after a week, then wait longer and see how things go. It’s always good to err on the side of taking too little rather than too much. Some people need to redose more often, every few days. You’ll probably get a sense pretty quickly of what works for you.

Special Safety Considerations

Always research any supplements or other medicines that you may be taking to avoid interactions. Here’s a Medscape list of potential interactions. (Note that the dosing levels listed on that site are for inducing anesthesia, which is way way more than what is use for anti-depressant effects.)

Articles and Research on Ketamine for Anxiety and Depression

Research on ketamine is growing quickly and some drug companies are trying to create new versions of ketamine that they can patent.