New tool, new hope
The use of ketamine for treatment of depression is one of the major breakthroughs in psychiatry. Racemic ketamine, a mixture of two mirror-image molecules, 'R' and 'S' ketamine, is administered intravenously in to the patient's bloodstream. This is often called intravenous or IV ketamine. In research studies, IV ketamine was well tolerated and showed greater antidepressant efficacy compared to placebo or control treatment. IV ketamine is shown to shown to take effect right away, and typically effects last long after the drug is cleared from the body, anywhere from days to weeks. Given these clinically beneficial effects, doctors are now using it off-label for managing treatment-resistant depression; rather than being a first-line treatment, ketamine is given when other antidepressants don't work
The treatment course consists of a total of six infusions given over two to three weeks. This is sometimes referred to as an induction phase. After that, your doctor may recommend maintenance ketamine infusions every three to four weeks.
IV ketamine is also being used for the treatment of suicidal ideations, post-traumatic stress disorder (PTSD) or other psychiatric disorders. However, doctors do not prescribe it for children or those patients experiencing mania, active psychosis, or unstable cardiovascular disease.
Ketamine, which has a similar chemical structure to phencyclidine, is an anesthetic drug that was first tested in humans in 1964 and found to produce a unique effect termed 'dissociative anesthesia'. It was approved for medical use by the United States Food and Drug Administration (FDA) in 1970. In spite of the potential abuse liability, ketamine remains on the World Health Organization (WHO) Model List of Essential Medicines. At lower or subanesthetic doses, it helps ease pain. At anesthetic doses it results in a complete loss of consciousness while preserving certain protective reflexes. When administered in proper doses by a trained medical professional, IV ketamine infusion therapy is relatively safe and effective for treating depression.
The network of neurons in brain, communicate with each other via neurotransmitters: chemicals that act as messengers between neurons. One of the brain's key neurotransmitters is glutamate. It plays a particularly important role in neuroplasticity (the brain's ability to form new synapses and neural connections over a lifetime), learning, and forming memories. Altered concentrations of glutamate and dysregulation of its binding to N-methyl-D-aspartate (NMDA) receptor have been implicated in development of depression, anxiety and other moor disorders.
Our present understanding of ketamine's mode of action is that it produces antidepressant effects by acting as an antagonist to the NMDA receptor. The NMDA receptor has an important role in controlling synaptic plasticity, or the ability of synapses to increase or decrease in activity. This is why the NMDA receptor is considered to be heavily involved in excitotoxicity, a phenomenon in which nerve cells become dysfunctional due to excessive stimulation. The glutamate-mediated excitotoxicity and neuronal damage has been linked to depression and other psychiatric illnesses. Ketamine, by blocking the glutamate and NMDA receptor interaction can stop the over-excitation of synapses, and thereby aid in treating depression in a rapid and sustained way.
However, it's not entirely clear how ketamine works. Scientists continue to research, and explore other formulations to improve delivery, efficacy, and durability of the response.
During the evaluation session, one of our specialists with expertise in treatment-resistant depression, will review your current and past symptoms, previous treatments, and other relevant medical history. We will determine if ketamine is the best treatment for you and answer any questions you may have about ketamine to enable you to make an informed decision.
In most cases, the treatment course consists of six intravenous infusions of ketamine, given 2 to 3 times per week over 2 to 3 weeks. Depending on your unique needs, you may receive additional infusions after this initial treatment period.
On the day of your ketamine infusion treatment, please follow directions given by our medical staff regarding food and medication intake and arrange for someone to drive you home after the session.
Ketamine infusion treatment will be performed in an outpatient office setting. Once in the safe private infusion room, you will be seated in a comfortable reclining chair and the medical staff will take your vital signs.
When you're ready, an IV cannula is placed in your arm or hand, and the infusion is slowly administered over 40 to 60 minutes. You will also be connected to a cardiac monitor for monitoring your heart rate, breathing, oxygen levels in the blood and blood pressure before, during and after treatment. This monitoring does not cause any pain or discomfort. One of our medical staff will frequently check on you to ensure that you are not having any side effects and answer any questions you may have. You'll be conscious and awake the entire time and likely experience mild dissociative effects, which are often regarded as relaxing or pleasant. In rare cases, if the patient finds the feeling of dissociation uncomfortable, the infusion procedure can be immediately stopped, and/or medications can be given to end the thoughts quickly. Once your infusion is complete you will be monitored for at least 20-30 minutes prior to your discharge.
Patients are advised to take it easy for the remainder of the day; no driving, no operating heavy machinery, and no strenuous activity. A healthy meal, lots of water, and rest are recommended.
Our commitment to your recovery continues well after you have completed your initial course of IV Ketamine therapy. Post-treatment, you can either continue to follow up with our providers or return to your primary care physician or psychiatrist to assess your progress. If necessary, our team will work with you to determine if additional IV Ketamine infusions are right for you.
We will also review the resources that can help you maintain your benefit, and what signs to look out for so you can recognize when you may need additional intervention. We remain available to all of our patients by phone and email and respond to all questions and inquiries in a timely manner.
Like any medical treatment, ketamine infusion has risks and potential side effects. Each individual may respond to ketamine differently. To reduce the risks, medical evaluation is necessary before starting IV ketamine infusions.
During the ketamine treatment you may experience;
At present, ketamine infusion treatment is NOT covered by any insurance plan because it is still an off-label medication for the treatment of mental health. However, your insurance may cover office visit and initial consultation charges. Contacting your insurance company concerning benefits is always advisable prior to any medical procedure to verify.
When administered in proper doses by a doctor, ketamine infusion treatment is relatively safe and side effects tend to be minor.
Ketamine infusions can help individuals diagnosed with a number of mental health issues - depression, suicidal thoughts or behaviors, anxiety, PTSD, stress, OCD, bipolar disorder, and more. Patients with treatment-resistant disorders benefit greatly from ketamine infusion.
No, ketamine infusions are just like any other IV infusion. There is a slight pinching sensation when the needle is inserted into the skin, but otherwise, there is no pain or invasive procedure involved in this treatment.
Ketamine belongs to a class of drugs called dissociative anesthetics. There is no evidence that ketamine can lead to addiction, however, there have not been many widespread studies on this. Administered at small doses in a medical setting, there is no evidence that ketamine is addictive.
Ketamine side effects are limited, and if present, normally resolve within a short time after completion of the treatment. Ketamine infusion usually causes a brief, mild increase in blood pressure and heart rate. These are monitored, and resolve quickly after the treatment is completed. Patients may feel clumsy, unsteady, mildly intoxicated, or dizzy during and after the treatment. Some patients may experience nausea, drowsiness, anxiety, dreams, or other unusual feelings.
Some patients experience relief only hours after treatment. But, for others, it may take a few days to start feeling better.
Yes, ketamine is safe to administer with most antidepressants medications. However, some medications may interfere with ketamine infusion treatments. But, before begining ketamine infusion treatment, here at Holistic psychiatry, each person will undergo a medical assessment. This will help to identify if any medications you may be taking may interfere with ketamine infusion treatment and ensure your safety before beginning treatment.
Studies show that approximately 3 out of 4 patients will have a positive response to ketamine treatment for depression.
No, you do not need a referral for ketamine treatment.