Ketamine Infusion Therapy

Depression

Depression affects 300 million people a year and is the leading cause of disability worldwide. Ketamine is thought to be 70-80% effective in treating the most difficult cases of treatment-resistant depression.

Why Ketamine for Depression?

Ketamine improves the cell signaling in the brain and helps reverse brain atrophy (shrinking) that is seen in depression patients. Many find relief of symptoms after just one infusion and lasting effects for weeks to months after completing the initial series. Boosters can be required after the initial series depending on your results and to continue to control symptoms. There are several steps we will go over to help you determine if boosters are needed for your case. Ketamine just like any drug is not a cure, but a treatment meant to aid in reducing symptoms.

Ketamine is the worlds fastest acting antidepressant and is highly effective.

However, there are still those patients that do not respond or are unable to tolerate the treatments. Some patients also take longer to respond than others. Do not expect overnight complete recovery. In the beginning, expect small improvements. They can even be day to day, some do not notice benefits till one to two weeks after final treatment in their series. Continued evaluation of symptoms daily is key to keep track of progress. Many patients feel journaling really helps them see their overall changes and progress. How much faster does intravenous Ketamine work versus oral antidepressants? Typically oral antidepressants take effect 6 to 8 weeks to start working. Patients that have received intravenous Ketamine have reported relief in symptoms as early as the first 24hrs after their first infusion. Intravenous Ketamine is absorbed immediately, allowing for faster relief of symptoms.

Is Ketamine right for you?

Ketamine can treat a wide range of mental health and pain conditions. With the help of your referring physician, we can determine if Ketamine is right for you and the appropriate protocol for your specific needs.  This is not a one protocol fits all type of treatment plan. Each patient is different and needs their treatment plan tailored to how they respond. Our team will evaluate your personal condition and history to increase the chances of your success. Working along with your referring physician to help you gain mobility, start enjoying life again and reducing your pain is our goal. Your physician will continue to work with you and decide how to adjust any medications you are currently taking. Most medications need to be weaned off of. You can cause yourself serious harm if you abruptly stop any medication. Please consult your physician prior to making any changes in your medications.

Pain

Chronic pain causes over sensitive neurons, a persistent state of hyperactivity and inflammation.

 

Ketamine is an NMDA receptor blocker.

It reduces the increased sensitivity to pain, hyperactivity, inflammation and reduces allodynia.  Allodynia can lead to the triggering of pain response from stimulation which does not normally cause pain. The most important benefits are the ability to reduce opioid intake, possible long term pain reduction, and a large number of treatable conditions.

Depression in Veterans

The United States has a veteran population of 20 million. The estimated diagnosis rate of depression is 14% – up to 2.8 million veterans.

Between 1/3 to 1/2 of those veterans may be considered treatment-resistant. We are determined to help as many of our veterans as possible. It is time for our veterans to be our countries top priority, they have served to protect our future. The current system requires VA patients to pick up records in person or can potentially wait up to 6 months for records to be sent. The other option is to come into our clinic and log into your patient portal so we can download them from there.

What should you expect during the infusion?

  • Your initial infusion will be started at a low dose to see how you tolerate the medication. As long as you adjust well to the infusion we will continue to make adjustments at each infusion to bring you to the dose that gives you the most symptom relief. We use a set of questions before and after each infusion to help guide how we make adjustments. You will also have access to site call Mood Monitor, which you can access from home to help keep track of your progress. Always keep in contact with your referring physician and our Clinic should you have any changes that you find concerning. If any thoughts of suicide you should contact your physician, our facility or go immediately to the ER. There is help, never think you are alone. (National Suicide Prevention Lifeline 1-800-273-8255, suicidepreventionlifeline.org)
  • Generally, we try to avoid benzodiazepines for anxiety prior to infusions, because some studies have suggested they can reduce the effectiveness of Ketamine. However, we will determine their use on a case by case basis. There are other alternatives we can use first should you need something extra to help you be relaxed and calm.
  • The “dissociation phase” is thought to be a key phase in the Ketamine treatment protocol. For some patients, this is a pleasant experience where others find it scary. We are here to help. Whether that means we sit with you and help guide back to more positive thoughts or adjust the infusion.
  • The mental health infusions generally last about 40 minutes with a short recovery period after.
  • Pain infusions go over 4 hours and have a longer recovery time of about 30 to 40 minutes. We will also provide intravenous fluids while you receive this infusion to help with the after-effects and give you a bump in your body’s hydration.
  • All patients receiving Ketamine must have a person to drive them home. This can not be any type of public transportation unless another friend or family member is with you.
  • All Ketamine patients will receive anti-nausea medications prior to their infusion. Our goal is to prevent it rather than fight it after the fact.
  • Most patients during their infusion are not able to walk, because of the effects of the Ketamine, so going to the bathroom is a challenge. We will have you use the restroom right before we start and as soon as you are able to ambulate. Some patients feel their not able to control holding it so they wear a Depends for their infusions. We recommend you do whatever makes you feel the most comfortable. Most of the fluid we will be giving will be at the end of the infusion while your recovering, to try to avoid having any issues.

Typical Effects of Ketamine Infusions

  • Dissociation (disconnection with thoughts, memories, surroundings, and actions)
  • Profound analgesia (reduction in pain)
  • Vivid dreams (normal side effect)
  • Hallucinations (normal side effect)
Precautions
  • Patients with severe coronary artery disease (All heart disease patients will require cardiac clearance prior to any Ketamine infusions. Ketamine does increase heart rate, blood pressure, and other cardiac functions during the infusion. Some patient’s heart health can not handle these changes and it is safer to not undertake these treatments in those cases.)
  • Glaucoma patients (would require clearance by your ophthalmologist)
  • Patients with elevated intracranial pressure
  • Patients taking beta blockers with a history of congestive heart failure
  • Patients with Wolff-Parkinson White (WPW) Syndrome
Side Effects
  • Nausea and vomiting (medications can be given to counteract these effects). This is also part of the reason we require nothing by mouth for 6 to 8 hrs prior to infusions. (That includes: food, non-clear drinks, candy, chewing gum, or chewing tobacco). It is recommended to help reduce nausea to have a high clear carbohydrate drink prior to infusion. We will provide options and instructions for you. Diabetic patients, please let us know what diabetic medications you are taking so we can give you instructions on how to adjust your medications. The nausea can last during and several hours after infusion.
  • Lightheadedness and dizziness can last a few hours to a few days after depending on the dose and number of infusions received.
  • Increase in cerebral blood flow (not an issue with patients that have no issues with intracranial pressure)
  • For high dose infusions, blurry vision or double vision can occur, which may last for several hours after.
  • Mood swings and mild anxiety on and off for the first few days post-infusion, until the ketamine has a chance to work fully in the brain.
  • Increase in heart rate and blood pressure during infusion (Usually resolves once infusion is complete. If you tend to have this occur medications can be given to prevent this from happening).
  • Increase in saliva
  • Nystagmus (involuntary movement of the eye)
  • Hypertonus (muscle overactivity)
Rare and Very Rare Side Effects
  • Patients that have used ketamine daily over a long period of time have reported getting Interstitial Cystitis. This is usually not seen with short term IV treatment plans. Always consult a urologist if these symptoms develop.
  • Worsening anxiety or Bipolar symptoms (most common in those with Bipolar Disorder). Can cause worsening of mania symptoms in someone with mania. Ketamine should not be given to people with Schizophrenia or severe Bipolar Disorder that are prone to breaks from reality or hallucinations as there is a rare possibility that Ketamine can cause worsening of psychosis in those patients.
  • Elevated liver enzymes can occur. (More likely to occur in patients who take Opiates, drink alcohol, use a lot of Tylenol, or have a fatty liver)