Ketamine

About Ketamine

Ketamine is a dissociative anesthetic medicine synthesized in the 1960’s which became popular for use in surgery due to its potent analgesic properties with minimal cardiovascular and respiratory depression. In more recent years, scientists have discovered Ketamines usefulness in sub-anesthetic doses for the management of depression, OCD, PTSD, and certain pain disorders.

While the exact science behind Ketamine’s efficacy is still unknown, the medicine is thought to alter communication between brain cells via its interaction with NMDA receptors, AMPA receptors and opioid receptors. Studies show that Ketamine, even though only in the body for a short period of time, may have an extended impact on pain and depression.
 

Ketamine: Frequently Asked Questions

Is Ketamine right for me?

Is your quality of life suffering from your depressive illness and/or chronic pain? Are your traditional treatments not helping? Here at City IV we strive to help improve your quality of life. While every applicant for treatment is considered, unfortunately, ketamine may not be suitable for you. Only applicants that we feel will undoubtedly benefit from ketamine infusions will be offered treatment and should we feel there is no improvement after two treatments, no further infusions will be offered. It is, of course, always your option to stop treatment at any time. You will never be asked to commit to something you do not find useful or with which you are not comfortable.

How successful are Ketamine treatments for Depression?ketamine-for-depression

Studies have shown that approximately 70% of people respond to Ketamine treatments. The response typically occurs within one to two hours after receiving the first treatment, but may be up to 24 hrs. Usually two treatments are enough to determine if ketamine infusions are right for you. If we, along with your Psychiatrist/Mental Health Care Provider feel there is no improvement after two treatments, no further infusions will be offered.

Do I have to switch my Psychiatrist or Mental Health Care provider in order to receive treatment?

Absolutely not. We work in conjunction with your current Psychiatrist and/or mental health care provider as a consult service to provide treatments they are not able to. If you do not have a current provider, we can refer you to one of the highly skilled Psychiatrists we work with.

Should I receive ketamine treatments from an Anesthesiologist or a Psychiatrist?

While commonly offered by anesthesiologists and psychiatrists, both specialties have their unique qualifications. Anesthesiologists are well versed in the pharmacology of Ketamine, as this is a common medication used in their daily OR practices. Ketamine has the ability to cause airways secretions, which can lead to laryngospasm (closing of the vocal cords), considered an airway emergency! In addition, loss of consciousness can occur even with the most carefully titrated ketamine infusions so continuous monitoring is required at all times. Anesthesiologist are unique in that they receive extensive training in airway management and patient resuscitation and will be present throughout the entire treatment should an emergency arise. Anesthesiologists do not have any psychiatry or psychotherapy training. Psychiatrists are medical doctors specializing in disorders of the mind and brain but do not have any experience in airway management or patient resuscitation. As a licensed physician who is Board Certified in Anesthesiology, Dr. Hanks is uniquely qualified to manage your ketamine treatments. If you wish, you may choose to consolidate all of your mental health care (eg, medication management, psychotherapy, and ketamine treatments) with our providers or keep your current provider(s), with whom we will happily liaise.

Are there contraindications to receiving Ketamine?

For your own safety, you will not be considered a candidate for ketamine infusions if you have the following conditions: cardiovascular disease, congestive heart failure, history of psychosis, Schizophrenia, uncontrolled blood pressure, previous failed Ketamine treatments, hyperthyroid, bladder dysfunction, active substance abuse or dependence, current manic episode, or are pregnant.

What disorders can Ketamine help with?

IV Ketamine in tiny doses has been used with success in disorders such as major depression, treatment resistant depression, obsessive compulsive disorder (OCD), anxiety, post-traumatic stress disorder (PTSD), Migraines, Phantom Pain, complex regional pain syndrome (CRPS) and fibromyalgia. If other modalities haven’t provides relief of your symptoms, IV Ketamine may be right for you.

Are there any side effects?

Although rare and usually minor, there are a few side effects that can result from IV Ketamine treatments. These include nausea, blurred vision, headache, sweating and dizziness. Although not really considered a “side effect” but more of a property of Ketamine, you may experience mild dissociation/euphoria with heightened visual, sensory and auditory experiences. These side effects are short lived, usually require no intervention and resolve shortly after the infusion is discontinued. The drug itself, when administered properly and in a controlled manner, is harmless.

Will I fall asleep during the infusion?

The ketamine dose given for depression is very low and will not be enough to put you under. However, if you are feeling tired prior, you may fall asleep naturally. Your vital signs will be monitored for safety throughout the infusion so you do not need to worry if you fall asleep. Ketamine Infusions for conditions other than depression may require higher doses which will make you unconscious. You will be monitored by our board certified Anesthesiologist in our Five Star A+ AAAHC (Accreditation Association for Ambulatory Health Care) rated facility.

How many Ketamine infusion treatments will I receive?

We will tailor a specific schedule in conjunction with your referring physician but a typical course consists of 6 infusions every other day for 2-weeks, followed by booster treatments every 1-4 weeks if necessary. We will be able to tell if you’re having a favorable response usually after two treatments. After 1-2 booster treatments, you will have a good sense as to about how long you have symptom abatement for following each infusion, and your booster schedule will be adjusted accordingly.

Which medications that I’m currently taking can affect my treatments?

Benzodiazepines and certain medications for Bipolar Disorder can decrease the efficacy of Ketamine. Please be sure your physician has a complete list of your medications prior to scheduling an appointment.

Will I become addicted to Ketamine?

Although Ketamine has been abused recreationally as a street drug, the doses given for depression are much lower. Ketamine has been used safely in hospital patients for decades and there has been no evidence to support that IV Ketamine is addictive.

How long can I expect to see results for after treatments for Depression?

Single treatments have been shown to provide effects lasting up to 14 days. After completing all 6 infusions, results may last up to a few months, with single booster treatments given if determined by your Mental Health Care Provider.

Do I need a referral before I can begin treatments?

You do not need to currently have a treating physician, however, in order to provide you with the highest possible care you will need to have been seen by a Mental Health Care Specialist/Pain Specialist prior to beginning Ketamine Infusions. If you are currently under the care of a Psychiatrist/Pain Specialist they can refer you directly to us without delay.

Ketamine vs. pain medications?

Most people will have painkillers in their homes. Acetaminophen/Tylenol is the most common over-the-counter pain medication used for mild-medium pain. More severe/chronic pain requires stronger medications and unfortunately there are a number of side effects and issues with theses medications. Opiates are a class of painkiller used in treating more intense levels of pain. Opiates cause a euphoric state which people find highly enjoyable and as a results they are highly addictive. Opiate based painkillers, such as morphine, are safe for short term pain relief, but not suitable for long term use. It is impossible to function normally while under the influence of opiates, and if abused long term, can cause countless psychological issues. Opiates can also cause itching, nausea, constipation and drowsiness.
Ketamine has a half-life of 2.5 hours, is completely out of your system within 24hrs, yet the subsequent chemical changes caused by Ketamine act long after (weeks-months) the drug has been eliminated from your body. There are minimal side effects from ketamine infusions including nausea, blurred vision, headache, sweating and dizziness but these side effects are short lived, usually require no intervention, and resolve shortly after the infusion is discontinued. The drug itself, when administered properly and in a slow controlled manner, is harmless.

Can I eat prior to my infusion?

No. You will be receiving a dissociative anesthetic which can induce unconsciousness. For your safety we ask that you refrain from eating 6 hours prior. You may however drink clear liquids up to 2-hours prior.

Can I drink alcohol afterwards?

While there are no fluid or dietary restrictions after your treatment, we do recommend no alcohol consumption for 24-hours after.