Ketamine is a non-narcotic medication most commonly used for sedation in anesthesia. It has been used safely for decades in the operating and emergency rooms. Ketamine for depression has not YET been approved by the FDA; However, it has been shown to be highly effective and safe in multiple studies.
Ketamine works in a few ways. It works directly on glutamate receptors to help balance this important neurotransmitter in the brain. It also helps turn on neurotropic growth factor which may allow the brain to make new healthy connections. We also believe that the Ketamine experience can be quite therapeutic and allow processing and transformative change.
Ketamine is indicated for the treatment of severe, treatment-resistant, depression. While there is no guarantee of success, the literature suggests 70-80% of clients see a greater than 50% reduction in their depression symptoms after the series of 6 treatments. In our clinic, we have an 80% success rate. We should know whether this will work for you within two hours of your first infusion. Occasionally, a second treatment trial, at higher dosing, may be indicated if you do not respond to the first.
Once we know Ketamine is working for you we will perform a total of 6 treatments over 6 to 8 weeks. Most often, they are once weekly until week 5, when we space out treatments by 10-14 days. Of those that respond to treatment about 50% will remain improved for the long run and not require any significant booster schedule. The other 50% does quite well with an occasional booster infusion performed once a month or every few months. These can likely be spaced out over time.
This varies from patient to patient. It is important to remember that it will take time to heal what took years to develop. Many clients report seeing subtle improvement after the first session and we usually see that continue to build after each treatment. This is a journey, so we can expect ups and downs during recovery. In research studies, 70% of people responded to ketamine therapy with a significant decrease in your symptoms. In our practice, we have seen 80% respond.
For the first infusion, we will spend 45min-1hr getting to know you and settling you into the room, and preparing you for the infusion and experience. On future visits this will be about 30 min of checking in, discussing dosing and progress, and settling in for the infusion.
We will then turn off your cell phone and settle in for the treatment by putting on your eyeshades and noise-canceling headphones. The infusion will run over 40 min to 1 hour. After the infusion, you will continue to relax for 10-15 min and we will then remove the headphones and being to check in and start to process and recover with you. Slowly returning and processing the experience and any important moments from it. We recommend spending at least 45 min to 1 hour after the infusion recovering and processing before leaving.
The dose of Ketamine used in the infusions is small and will not cause you to go to sleep. It is infused over 40 minutes-1hr. Dosing is calculated based on your weight and will be customized based on your case. During the infusion, you may have a mild dissociative experience where you have increased sensitivity to light and sound and may notice alteration in colors and time perception. Most tolerate this well and some even enjoy the sensation.
We utilize noise-canceling headphones, therapeutic music, and eye shades to minimize distractions and allow the brain to focus on healing. There are no prolonged side-effects and the dissociative effect will fade in 30-35 minutes after the drip. There are no flashbacks or other prolonged symptoms. Rarely patients may develop anxiety or nausea. These can be treated if they develop and this will not interfere with the Ketamine. Ketamine infusions are not addictive.
Do not take Lamictal for 6 hours before or after infusion. Hold any sedatives such as benzodiazepines for 12 hours before and 4 hours after. Do not eat for 2 hours before the infusion. Drinking water, tea, or coffee is ok. You will need a ride home and can not drive, sign contracts or make significant financial decisions for 12 hours after infusion.
Take time before your treatment to relax, meditate and calm your body and mind. You may also want to set an intention for the treatment ahead. This can be something you want to specifically work on or focus on. Schedule time for yourself the evening after or the day after your treatment to meditate, journal and speak with your therapist.
Plan for 2.5 hours total time for your first treatment and 2 hours for each additional infusion. This allows time for you to settle in, receive the infusion, and process/recover after the infusion. We will support you through this entire time making sure you get the most out of each infusion.
Your IV Ketamine will be administered by a team including a highly skilled and trained emergency medicine MD, ACNP, and RN. You and your vital signs will be monitored closely throughout the infusion. We will continue to monitor you for one hour after the first infusion and then thirty minutes after each future infusion.
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