Below are commonly asked questions about IV Ketamine Therapy.
What is Ketamine?
Ketamine is an anesthetic developed in the early 1960s. It is one of the most widely used drugs in modern medicine. It has a variety of medical uses, and is FDA-approved as an anesthetic and hypnotic drug. Ketamine has a remarkably safe track record in both adults and children. It is also commonly used to treat painful conditions such as CRPS/RSD.
Is Ketamine safe?
Yes. Ketamine has been proven safe in humans of all ages for decades. Although it has been abused for non-medicinal purposes, there is no evidence that ketamine is harmful or addictive when used in a controlled environment and administered by medical specialists.
How does Ketamine work?
Ketamine acts differently on our brains and neurological system when compared to traditional anti-depressant and anti-anxiety medications such as SSRI’s, TCA’s, MAOI’s, and benzodiazepines. The mechanism of how exactly ketamine is able to remarkably reduce depression as it does in so many candidates is still unclear. What is known, however, is that when ketamine is administered in a very precise manner it triggers a cascading sequence of events in the brain, which leads to the regeneration of previously healthy neurons that had been damaged. The entire process is complex and still under investigation, but the outcome is clear – significant increase in the physical and emotional status of an individual.
How does Ketamine actually work?
Depression, anxiety, pain, and other forms of stress harm the communication system between sections of the brain responsible for memory, learning, and higher-order thinking. Ketamine is able to stimulate and reinvigorate those affected areas of the brain and promote the regeneration of damaged neurons and their connections within hours
What are the success rates?
Approximately 75% of people respond to ketamine infusions.
Is there an age requirement for Ketamine therapy?
How quickly can I be seen?
Generally, within a day or two of your initial call or email request.
Do I need a physician referral for treatment?
No. Under most circumstances, patients may refer themselves, but it would be ideal if your psychiatrist or family physician is at least familiar with your condition and aware of your plans of seeking treatment from the outset.
Why isn’t my Psychiatrist offering this treatment?
Most psychiatrists do not perform “procedures” and do not have the necessary equipment in their offices in order to use ketamine. The process of establishing a program similar to ours in a hospital or outpatient center is arduous and difficult. In addition, because there is no profit potential, pharmaceutical companies do not market ketamine. Therefore, there will be no conferences or sales representatives promoting, educating, or providing our medical community with useful information about the extraordinary benefits of ketamine infusion for depression and painful disorders.
Is Ketamine used to treat all types of depression?
No. Mild-to-moderate depression is usually treated effectively with conventional antidepressants. The assistance of a behavioral specialist enhances one’s response to medication therapy. In contrast, the treatment of severe depression is complex and usually requires a higher level of interventions. IV Ketamine infusion therapy is reserved for patients with treatment-resistant depression with or without suicidal thoughts.
Will my severe depression respond to IV Ketamine infusion therapy?
We cannot predict who will respond to ketamine, but statistically 66% of patients will notice a dramatic improvement in their mood and 75% will stop having suicidal thoughts or intentions. We will know within two treatments if IV ketamine infusion is right for you
Can Ketamine help with the treatment of chronic pain?
Yes. Individuals with neuropathic-related pain seem to do well with ketamine infusions. Examples of the types of painful disorders are:
•Trigeminal Neuralgia (TN)
•Complex Regional Pain Syndrome (CRPS, RSD)
•Phantom Limb Pain
•Post-herpetic neuralgia (PHN)
•Diabetic Neuropathy (DN)
•Failed Back Surgery Syndrome (FBSS)
What are the risks of undergoing ketamine infusion therapy?
The dose used for ketamine infusion is low and safe.
Are there any conditions that may make ketamine therapy dangerous or ineffective?
Yes, and these conditions are:
•Active Substance Abuse (e.g. cocaine, amphetamine, opiates)
•Manic Phase of bipolar disorder
How many infusions will I need?
If you have a favorable response to the first two infusions, a total of seven is recommended within a fourteen-day period. That will maximize the ketamine effect on new dendrite and synaptic nerve growth. Thereafter, patients are placed on a maintenance program where they return when they feel it is necessary for a one or two day infusion booster. During the maintenance period, the duration of relief following the initial infusions and booster, and between subsequent 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.
Will I be asleep during the ketamine infusion?
No. The dose of IV Ketamine given will not cause any loss of consciousness, but napping has been observed in individuals who are already sleepy or tired from the previous day.
What will the procedure be like?
The ketamine infusion takes place in a private office setting. Patients sit in a reclining chair or lie comfortably on an examination table during the intravenous infusion. The infusion takes about an hour, and one can expect to stay about 15-30 minutes afterwards. There should be no major side effects that will cause us to stop the procedure. Following the procedure you may be a bit lightheaded or dizzy for an hour. A responsible adult driver is required for our patients before being released to home.
What will I feel during the infusion?
Most patients experience a mild ‘out of body’ or inner reflective experience that is generally well tolerated. Within 20 minutes of ending the infusion your thinking will become clearer.
Will I be treated on an outpatient basis?
Yes. You will be released to a responsible driver to be taken home. No hospital admission is required.*
What should I do during the infusion?
Many find it helpful and relaxing to listen to soothing music while wearing a pair of sunglasses. It’s encouraged to bring in your smartphone and a pair of headsets.
How long does an IV Ketamine infusion take?
About an hour, with an additional 30 minutes before being discharged to a responsible driver. *
What is the usual course of treatment?
Typically, it will take just 2 infusions to know if ketamine will help you. If you are having positive results, it is recommended to have 7 total infusions within the first 7-14 days. After that, maintenance (booster) infusions may be scheduled to maintain response. The total length of treatment is highly dependent on each individual’s unique circumstances.
Can I eat or drink before my appointment?
You cannot eat 6 hours prior to your scheduled appointment. You may have clear liquids up to 2 hours, however.
Do I need to bring someone with me?
You do not need to have someone bring you or remain with you during the infusion, but someone must bring you home. 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.
Do I have to stop my other medications?
There are very few medicines that cannot be taken in combination with ketamine. Amphetamine-based stimulants, such as Adderall or Ritalin should not be taken on the day of treatment. MAOI (monoamine oxidase inhibitors), especially, can pose difficulties. Therefore, please inform us of any medication you are taking regardless of how inconsequential you believe them to be.
Will my current medications interfere with my Ketamine Infusion?
Please inform us of any and all medications you are taking. We are particularly interested in learning if you are taking:
1.Lamictal (generic name, lamotrigine). Patients should allow 12 hours between taking Lamictal and the start of their infusion. You should wait at least 6 hours after your infusion before resuming the use of Lamictal.
2.MAOI’s (monoamine oxidase inhibitors). Some common brand names are Isocarboxazid (Marplan), Phenelzine (Nardil), Selegiline (Emsam), and Tranylcypromine (Parnate). Patients cannot take any MAOIs within 2 weeks of an infusion.
3.SSRI’s or TCA’s (tricyclic antidepressant) medications do not interfere with ketamine. There is no requirement to discontinue there use.
4.There is no need to discontinue or reduce taking narcotics, muscle relaxants, or anti-inflammatory medications.
* You should not adjust your dose or frequency of use of any prescribed medication without first consulting with your prescribing physician.
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, the physician 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. There are zero long-term or permanent side effects of IV Ketamine Infusion Therapy.
How do I know if it worked/what should I expect?
You will fill-out rapid depression survey and anxiety scales prior to the first treatment and approximately 18-24 hours later. This will help determine response. It is possible to notice effects as soon as 45 minutes after the start of the infusion. 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.
How long does the relief last?
This can vary greatly between patients. Most patients who respond to ketamine find that a single infusion will provide at least several days of symptomatic relief. This means relief of the physical symptoms that make depression/bipolar/PTSD so unbearable: anxiety, fatigue, dysphoria, cognitive impairment, insomnia, etc. Patients who undergo a series of multiple infusions over 1-2 weeks often get symptomatic relief that lasts weeks and months (~2 weeks – 3 months). When physical symptoms are improved it triggers a myriad of favorable changes that dramatically improves mood and behavior. This subsequently helps you feel better, more energetic, less sense of self-negativity, and improved sleep hygiene, sometimes for the first time in as long as one can remember. Even if some of the physical symptoms return, most patients can withstand it and react more positively against it instead of regressing back to a dark place with each new stress that arises. The reason, improvement in mood and behavior seem to endure much longer than the physical symptoms themselves.
How many ketamine infusions will I receive?
For patients with mood disorders, it will depend on your initial response. We begin with two, or in some cases, three infusions over two to three days to determine if Ketamine treatment will be effective for you. Most of our patients who do respond, do after their 2nd infusion. If not, we generally will discontinue further treatment. If ketamine does improve your mood and other symptoms, we strongly suggest that you receive the remaining 5 infusions over the next 7–10 days to maximize ketamine’s neuron-repairing abilities. For patients with CRPS, FBSS, Fibromyalgia or other painful ailments, we provide three infusions, generally done over three consecutive days.
Should I continue with my treating psychiatrist, counselor therapist, or primary care physician?
Yes. Patients will need to continue with their primary psychiatrist and/or primary care doctor, and are highly encouraged to start or begin talking with their therapist about their results.
Are there support networks available?
Yes. Please visit the following site by clicking on the link – www.mipmpc.com
Is the treatment considered expensive?
Some individuals feel that the cost of ketamine infusion is relatively expensive than a typical doctor’s visit and medication copay, but consider the financial toll of ongoing depression symptoms affecting work and social function if you don’t consider trying ketamine therapy.
How soon can I be seen?
Our patients are typically seen within 2-3 days after the initial phone call or email.