What is Ketamine?
Ketamine is a medicine developed more than 50 years ago for anesthesia during surgery, and has been used for that purpose since that time in children, adults, and animals. More recently, ketamine has been found to be a valuable and highly effective treatment for depression, anxiety, and certain pain disorders.
Is there potential for addiction?
Some may have heard that ketamine is used as a “party drug” and worry about addiction potential. Studies and clinical experience have found that in the very low doses used, medical setting, lack of access at home, and infrequent dosing, there is virtually no potential for addiction or abuse.
Would it work the same if I took it orally or nasally?
No. Ketamine is absorbed by the body very differently and unreliably when taken orally or nasally and has not been shown to be as effective for depression
How does it work?
Depression, anxiety, pain, and other forms of stress damage the communication system between areas of the brain responsible for memory, learning, and higher-order thinking. Ketamine is able to promote the materials necessary to make repairs to this damage within hours.
What can ketamine help?
Major depression, the depressed phase of bipolar disorder (bipolar depression), postpartum depression, anxiety, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), pain syndromes such as fibromyalgia and complex regional pain syndrome (CRPS, also known as reflex sympathetic dystrophy (RSD), and addiction.
Are there any conditions that may make ketamine dangerous or ineffective?
Uncontrolled blood pressure, unstable heart disease, untreated thyroid disease, active substance abuse, current manic phase of bipolar disorder, or active psychotic (hallucinations or delusions) symptoms.
What are the risks?
The dose used for the treatment of mood and anxiety disorders is very low and safe. For a few minutes during the infusion itself, blood pressure and heart rate may increase. This is monitored to ensure safety.
Do I have to stop my other medications?
There are very few medicines that can not be taken in combination with ketamine. For treatment planning purposes, please contact us with any questions regarding interactions between your current medications and ketamine.
What is it like to have a ketamine infusion?
The medicine is given very slowly over 40 minutes. The first 15-20 minutes are uneventful with no noticeable effects. At around the 20 minute point, people tend to notice some blurring of vision or double vision, a feeling of “lightness”, “floating”, or intoxication, and sometimes some numbness in the toes or area around the mouth. Over the course of this 20 minute period, these feelings tend to build, so that the medicine is at the peak of its intensity at the very end. Other common feelings include euphoria, talkativeness, a feeling of being “disconnected” or in a dream, heightened perceptions (background noise may seem louder, colors or lights are more intense), and a feeling that people often describe as “weird, odd, different, or interesting”. Less commonly, people may experience some anxiety and headache, nausea, or sweating (typically toward the end). These feelings start to subside approximately 10-15 minutes after the medicine is done and last for a total of 45-50 minutes. Most people can expect to be with us for about 90 minutes from the time you walk in the door to when you leave, with no side effects at that point and none between treatments.
Will I be awake?
Yes. Ketamine will not put you to sleep. If you are already sleepy and are feeling very calm and relaxed during the treatment, you might drift off for a short nap.
What should I do during the infusion?
Many find it helpful and relaxing to listen to music and to wear an eyeshade or sunglasses. It can be difficult to carry on a conversation during the procedure, so you are encouraged to sit back and relax and pay attention to what you are feeling. Expectations coming in to the treatment do affect the experience, so it is helpful to decide ahead of time that you will be safe, will feel “weird” for a little while, and that is ok, because that will quickly pass and you will be left feeling much better.
How do I know if it worked/what should I expect?
You will fill out depression and anxiety scales prior to the first treatment and approximately 24 hours later. This will help determine response. It is possible to notice effects as soon as 40 min after the infusion, most typically starting 2-4 hours later, but sometimes taking up to 24 hours. 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.
Do I continue with my current psychiatrist, therapist, or primary care physician?
Yes. In most cases, people will continue with either their primary psychiatrist or primary care doctor, and are highly encouraged to either begin or continue talking with a therapist.
What is the usual course of treatment?
Typically, it will take just 2 or 3 infusions to know if ketamine will help you. If you are having positive results, it is recommended to have 6 total infusions within the first 2 weeks. 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.
How long will the results last?
A single infusion typically lasts anywhere from a couple of days up to 1-2 weeks. A series of 6 infusions may last anywhere from weeks to months, and often a single booster infusion when effects are wearing off can restore response. For those who have not had long-standing chronic depression, it may last much longer than that.
How do I maximize the benefits?
It is common to get advice when depressed that makes sense intellectually, but is impossible to follow through on because of the depressive symptoms. This includes things like, “eat well, exercise, engage in talk therapy, find social support, stay busy, etc”. Ketamine rapidly enables you to be able to act on these important activities, and those who have the best results support the medicine’s effect in these ways. In addition, ketamine likely “primes” the brain for learning and making new connections. Talk therapy can be an ideal way to “lock in” therapeutic learning and capitalize on this unique window of time.
How does ketamine compare to alternatives?
Typical antidepressants take weeks to months to work. There are many to choose from and no reliable way at this point to know which will be effective and well tolerated. Therefore, one may wait weeks and find that the medicine does not even work. These medications have common side effects of weight gain, sexual dysfunction, gastrointestinal disturbances, sleep disturbance, fatigue, and emotional blunting. Some newer “add-on” antidepressants also have risks of causing diabetes. Unfortunately not everyone will respond to ketamine, but you will know that almost immediately and not have to waste time or money unnecessarily. Side effects are limited to the time of the infusion, with no side effects in between. In this way, outside of the infusion time, you are not “medicated”.
What are the success rates?
Approximately 70% of people respond to ketamine infusions.
Are there support networks available?
Yes. Please visit ketamineadvocacynetwork.org
Is it more expensive than taking an oral medication?
An infusion of ketamine is more expensive than a typical doctor’s visit and medication copay. However, when also considering the financial toll of ongoing depression symptoms affecting work and social function, as well as multiple office visits and ongoing medication costs, quickly being restored to life by ketamine is an excellent value.
Will my insurance cover this?
Ketamine infusions are not covered by insurance. We are opted out of the Medicare system and do not participate in any insurance plans. However, we do provide a receipt for services at the time of your appointment.