Ketamine as a Medication
There are many uses for ketamine.
Ketamine was first, and still is, an important human general anesthetic agent. It has been used in hospitals for the past five decades and has a proven record of safety. More recently it is being used to treat neuropathic pain and the symptoms of PTSD. The small doses and methods of administration used to treat psychiatric patients differ greatly from those used in hospitals.
- Severe Depression
- Chronic Pain
What We Do
The above conditions can be severe and debilitating. Currently, patients are being treated with various oral medications such as SSRIs, mood stabilizers, benzodiazepines, neuroleptics, and narcotics. Some patients achieve success with these traditional therapies, while many do not.
We offer cutting edge Intravenous Ketamine treatments for refractory Depression, PTSD, OCD, Fibromyalgia, RSD/CRPS and other chronic pain conditions via IV infusions as well as nebulized breathing treatments. Ketamine is an anesthetic medication that has been used since the 1960’s with an excellent safety profile. In the last two decades this medication has been increasingly studied for its ability in alleviating symptoms related to depression, mood disorders, and chronic pain. Studies completed at multiple large and reputable academic institutions have shown great outcomes for patients that have not previously had good results with standard therapies.
We pride ourselves in doing our best to take care of the individual needs of our patients. This treatment is about more than just the medicine. It is a positive change for your life, but those changes require quite a bit of guidance. We know how to counsel you and will take the time to guide you to prevent any of the pitfalls while recovering from mood and pain disorders.
What to Expect
Your first treatment will be a discussion of your past medical history, to discuss ketamine, to go over treatment plan and goals, review the risks and benefits of the procedure and answer all your questions. If you do have insurance, we do accept insurance for this visit.
Patients typically receive a series of 6 infusions over the course of approximately 2 weeks for mood disorders. Each infusion typically lasts about 45-55 minutes. Most clinical trials have consistently shown a 70% success rate with this approach. The treatment does require booster infusions as time passes to keep the effect going and to keep patients symptom free. These boosters are the same duration.
For initial consultation, we accept insurance. We will take vital signs and there will be a discussion of your past medical history, to discuss ketamine, to go over treatment plan and goals, review the risks and benefits of the procedure and answer all your questions.
Unfortunately, ketamine infusions are not covered by insurance carriers as of yet. Until that happens, these treatments are considered an out of pocket expense. We will provide you with our billing sheets so you can submit to your insurance company, but we do not directly do preauthorizations with insurance companies.
Mood Disorder Treatments usually consist of a series of 6 treatments over a 2 week period. Each IV infusion lasts approximately one hour.
$550 per infusion for Mood Disorders
Chronic Pain Disorder Treatments usually consist of a series of at least 3 treatments depending on the type of pain syndrome you have, but may require 7-10 total sessions. These are generally 4 hour infusion sessions.
$1250 per treatment for Chronic Pain
Infusion cost includes every aspect of treatment, no added costs.
We accept all major credit cards and cash. No checks accepted.
Infusion Day: What to Expect
On the day of each infusion, you will need someone to accompany you to your appointment and drive you home as the Ketamine will leave you a little tired. Please wear comfortable loose clothing so we are able to easily place the cardiac monitor leads under your shirt. Bring a light blanket of your choice. You may bring headphones and listen to music of your choosing, preferably something soothing to you. Infusion times vary depending on the disease we are treating.
We will pretreat you with nausea medication when you first arrive to the center as Ketamine can cause some nausea in a minority of patients. We ask you to eat something light, and if you eat, please make sure it is 2 hours prior to infusion.
Most people find the ketamine infusion experience to be pleasant. Infusions are given in private rooms. Patients do not usually sleep as the dose given is lower than an anesthetic dose. Patients should read about the actual infusion experience here.
The infusion for mood disorders generally lasts about 45 minutes, while for pain disorders, can be several hours. Most effects of the medicine wear off within minutes after the infusion, but patients can feel more tired than usual for a few hours after the infusion. Ketamine is generally well tolerated, but if any side effects are encountered such as visual disturbances or elevated blood pressure, our staff will quickly give IV medications to counteract them.
After infusions are completed, the duration of symptom relief can be variable. Most patients will feel well for 1-2 months, but some can respond for up to 6 months. Single booster infusions can be scheduled to achieve symptom relief again, and generally, no more is needed than a single booster infusion to achieve similar length of symptom relief.
Frequently Asked Questions
Is this treatment FDA approved?
Not yet. Over the past two decades dozens of studies in prestigious medical centers and The National Institute of Mental Health have proven ketamine’s safety and efficacy in treating major depressive disorders, anxiety, obsessive compulsive disorders and suicide ideation. Yet, without very large controlled studies generally required by the FDA to get approval for any psychiatric drug, approval has been delayed. Since ketamine is a generic drug, no pharmaceutical company will spent the hundreds of millions of dollars required for such a study. Efforts are being made to create a national registry of the outcomes of the thousands of patients treated by ketamine providers across the country to date. This data will be used to expedite FDA approval. In the meantime, ketamine is being used “off label,” as is true with many other medications prescribed by physicians.
Why doesn’t insurance cover it?
Insurance doesn’t cover ketamine therapy because it’s not FDA-approved for use on depression. In order to obtain approval, the FDA requires extensive trials that are hugely expensive, costing billions of dollars. No one is willing to fund these trials, because the cost can never be recovered. Ketamine is a cheap generic drug that produces only a small profit margin for manufacturers. FDA approval won’t change those economics. Since ketamine can’t produce blockbuster profits, no for-profit corporation is going to invest billions in FDA trials.
How many infusions will I need and how long will I feel better?
If you have a favorable response to the first two infusions, a total of six is recommended within a twelve day period. That will maximize the ketamine effect on new dendrite and synapse growth. Thereafter, patients are placed a maintenance program where they return when they feel it necessary for a single infusion booster. During the maintenance period, the duration of relief following the initial infusions and the first booster, and between subsequent single booster infusions varies between patients. The average duration of relief between booster infusions is 3 to 4 weeks. There is no way to predict what your needs will be.
If ketamine does work, will I be on it for the rest of my life?
No, right now ketamine infusion therapy is, perhaps, the most exciting and successful new treatment for severe depression. But, there are large pharmaceutical companies developing ketamine like drugs for more convenient nasal and oral administration. It may be a few years, but those drugs will become available. In the meantime, ketamine has been proven effective in most cases, and is available to you or your loved ones. Patients with debilitating severe depression with constant thoughts of self harm can not afford to wait.
How long does an infusion take?
About an hour, with an additional half hour before discharge.
Will I be asleep?
No. The dose of ketamine you will receive does not cause any loss of consciousness.
What will I experience during the infusion?
Most patients experience a mild dissociation or inner reflective experience that is generally well tolerated. If you find it unpleasant we can treat it. Within 15 minutes of ending the infusion your thinking will be clear. There are no delayed “flashbacks.”
Are there any medications that will interfere with ketamine treatment?
Yes. The benzodiazepines, such as Klonopin, Xanax, and Ativan do interfere with ketamine if used daily and at higher doses. Lamictal (lamotrigine) in doses above 100mg/day also can block ketamine efficacy.
Will I have to stop other antidepressant medications?
No, 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.
Should I be concerned about any risks or addiction with ketamine therapy?
No, ketamine has been proven safe in humans over five decades in and out of hospitals and battle fields for surgical anesthesia and trauma management. Those patients experience longer exposures and at much higher doses than those used to treat severe depression. Although it has been abused recreationally in high doses as a club drug, there is no evidence that ketamine is addictive.
How quickly can I be seen?
True emergencies, can be seen within a day if the physician who administers Ketamine is at the clinic. But, in general, five to seven days are required to get you onto the schedule.