What is Ketamine?
Ketamine is a safe, effective anesthetic that has been in use worldwide since 1970 and has been listed on the World Health Organization’s Essential Medicines list since 1985. Multiple studies and trials run at Mt. Sinai in New York, Yale and other prestigious universities and hospitals since 1990 have shown that ketamine is exceptionally effective in treating treatment-resistant depression, PTSD, anxiety, suicidal ideation, neuropathic pain and other related mood disorders. Unlike standard antidepressants like SSRIs and SNRIs which generally take 4 to 8 weeks to work (if they work at all), ketamine is fast-acting and can sometimes show immediate efficacy after a single intravenous dose. Because of its fast-acting nature, ketamine can be an extremely important tool in preventing suicide and immediately alleviating the suffering caused by major depressive disorder (MDD). More recently it has also been used to treat neuropathic pain and the symptoms of PTSD. The small doses and method of administration (intravenous infusion) used to treat depression patients differ greatly from those used in hospitals for anesthesia.
Is Ketamine infusion therapy FDA approved?
While ketamine can be legally prescribed and administered “off label” by licensed physicians, the drug has only been officially approved by the FDA as an anesthetic and not as a treatment for depression. By way of comparison, an estimated 30% of all medications are prescribed “off-label,” including many cancer drugs, and are frequently used by physicians even though they are not FDA approved for that particular purpose. Although ketamine has shown the potential to help millions of people find relief from the crushing effects of depression and neuropathic pain, pharmaceutical companies have been hesitant to invest the tens of millions of dollars required to fund the extensive and expensive clinical trial process necessary to get official FDA approval. Since the drug is and will remain off-patent, no company can own the revenue stream. Ketamine’s use for depression and neuropathic pain treatment follows all required rules and regulations, and has safely and effectively been prescribed as a fast-acting depression and pain treatment for almost a decade in private medical practices and some hospitals and HMOs.
Is it an outpatient procedure?
Yes. All infusions are administered in our offices in comfortable, private treatment rooms.
Do I need a referral from a psychiatrist?
A direct referral from a psychiatrist is not required. While a referral from any mental health care provider is encouraged, an initial phone or office consultation with one of our doctors can determine if you are a good candidate for ketamine therapy. We provide this initial consultation free of charge.
Is Ketamine suitable for any depression patient?
Not necessarily. Mild to moderate depression is often successfully treated by mental health professionals with antidepressant drugs and/or psychotherapy, which we encourage. The treatment of severe depression, major depressive disorder (MDD) treatment-resistant depression and other mood disorders is more difficult and requires a higher level of care, such as ECT, TMS or ketamine therapy. Ketamine infusion therapy is reserved for those patients with severe depression and anxiety that is considered treatment-resistant, or those with suicidal ideation.
How likely is it that it will work for my severe depression?
The patients we see are all considered treatment-resistant. That is, they have not responded to any available antidepressant medications and in many cases have not responded to ECT or TMS. While we cannot predict with certainty who will respond to ketamine, clinicians across the country have reported that roughly 70%-75% of patients who have not been helped by any other treatment do show a dramatic improvement in their mood with ketamine, and 3 out of 4 patients who present with suicidal ideation cease to have such thoughts. A meta-analysis by the American Psychiatric Association using data from multiple ketamine trials reported similar results, with 70% of treatment-resistant patients responding positively after receiving the initial round of low-dose infusions. We will usually know after the first two treatments if ketamine infusions will help you.
Does it work for bi-polar depression, anxiety, ptsd or mood disorders?
We’ve shown very good results for patients suffering from all of these conditions, though we cannot predict with certainly which patients will respond.
How long does an infusion take?
About an hour, with an additional half hour of quiet time before discharge.
How many infusions will I need? For how long will I feel better?
Assuming you begin to feel better during the initial treatments, a total of six infusions is recommended within a twelve-day period, which will maximize the ketamine effect on new dendrite and synapse growth. Thereafter, patients are placed on a maintenance program and are asked to return when they feel it necessary for single infusion boosters. During the maintenance period, the duration of relief varies by patient. The average duration of relief between booster infusions is 4-6 weeks. There is no way to predict what your needs will be. Some patients find that as they go through this process, the time between boosters lengthens, prompting them to come in every other month, every 3 months, or even less frequently. In our experience, patients find ketamine boosters effective for as long as needed with no long-term side effects.
What will I experience?
Most patients experience a mild dissociation or inner reflective experience that is generally well tolerated and often quite enjoyable. If you find it unpleasant in any way, we can make adjustments to minimize or eliminate any unpleasant sensations. Within 15 minutes of ending the infusion, your thinking will be clear. There are no delayed “flashbacks.”
Will I be asleep during the treatment?
No. The low dose of ketamine you will receive does not cause any loss of consciousness.
Is the treatment painful?
The treatment is essentially pain-free. Other than a small prick while starting the infusion line, you will feel no pain and may even enjoy the experience.
How will I feel after the ketamine infusion?
Your thinking may be a bit cloudy and your walk a bit unsteady for an hour or so after treatment. You may also find that you will be somewhat tired for several hours. Hopefully, there will be a noticeable improvement in your mood shortly after one or two infusions.
Are there any medications that will interfere with Ketamine treatment?
Yes. Benzodiazepines, such as Klonopin, Xanax, and Ativan do interfere with ketamine if used daily and at higher doses. Lamictal (lamotrigine) in doses above 150mg/day also can block ketamine efficacy. Please speak with the doctor to discuss if and how to modify your existing medication regimen in order to maximize ketamine’s effectiveness.
Will I have to stop taking other antidepressant medication?
Not at all. SSRIs and other antidepressant medications do not interfere with ketamine’s mechanism of action.
Are there any medical conditions that will exclude me from treatment?
Almost none. Uncontrolled high blood pressure or heart failure need to be corrected in advance. Regardless, all patients will be closely monitored while undergoing treatment.
Should I be concerned about addiction with Ketamine therapy?
We’ve treated over 2,000 patients and have seen no instances of ketamine addiction. Ketamine has been used safely for surgical anesthesia and trauma management in hospitals and elsewhere for over five decades, has been included on the World Health Organization’s Essential Medicines list since 1985, and has few side effects. Although it is sometimes abused recreationally in high doses as a “club drug,” there is no evidence that ketamine is addictive.
I’ve heard that ketamine can cause hallucinations. Is that true?
Depression treatments require a very low dose, so hallucinations and any uncomfortable side effects that may come with much higher doses are extremely rare. Ketamine has few other side effects.
How quickly can I be seen?
True emergencies, with a psychiatric referral, and those suffering from suicidal ideation that requires prompt attention can usually be seen within a day. In general, we prefer to schedule patients 5 to 7 days in advance. Since our offices are open seven days a week and we open early and close late, we can meet most patients’ scheduling needs.
What is the cost of treatment?
Our infusions are $395 per session. We offer Ketamine Assisted Psychotherapy at an additional cost. Most patients choose to have a therapist in the room with them. The therapist may be covered by the patient’s insurance if the therapist is in network.
We accept all payment methods and provide financing options if necessary. While we do not accept insurance, some insurance companies will cover all or a portion of the treatment as an “out of network” service. If so, we will gladly provide you the necessary forms to submit to your insurance company for potential reimbursement. Our experience shows that about 30-35% of patients are receiving some reimbursement.
We also offer affordable financing options to our patients, available through Advance Care, a medical funding company. For details please call them directly at 800-432-9470, or visit their website at advancecarecard.com. Veterans of the United States military suffering with depression, MDD or PTSD are encouraged to call us for special fee consideration.
Will someone need to accompany me?
You do not need anyone to accompany you, though they are certainly welcome. You may also leave on your own following our evaluation, but we recommend that a friend, relative or caretaker accompany you home, if possible. We also recommend not driving until the following day.
Can I eat and drink on the day of the procedure?
You can eat, but you should not have any food within one hour of your appointment.
Does the office have WiFi? Can I bring music?
Yes, WiFi is available throughout our entire office and in all treatment rooms. Most of our patients bring their own devices and earbuds or headphones to listen to music while undergoing treatment. We strongly discourage using your devices to make phone calls, texting or emailing during the treatment. Those accompanying you are welcome to bring laptops, iPads, iPods and cellphones as well.
Is the office handicap accessible?
Yes. Our offices are all handicap accessible and ADA compliant.