How does Ketamine work?
Ketamine works in a completely different way from any medication you've ever taken for depression, bipolar, PTSD, or anxiety. Most medications prescribed for major depression work by manipulating the quantity of certain neurotransmitters in your brain, and their side-effects can be miserable. Ketamine works differently: it briefly blocks a certain type of receptor in the brain from being triggered. This blockade only occurs during the treatment, while you are actually connected to the IV. Afterwards, the acute effects of the infusion dissipate within minutes, and any lingering side-effects like fatigue rarely last more than a few hours.
When ketamine is administered via slow infusion, unique conditions are created in the brain which trigger a delicate cascade of events. This cascade affects certain receptors and signalling pathways, and produces a protein that triggers rapid growth of neural connections. Researchers suspect this “rewiring” is part of the antidepressant effect. Ketamine is also a powerful anti-inflammatory agent, and since depression is highly correlated with chronic inflammation, this may also be part of the antidepressant effect. There may well be other factors that haven’t been identified yet.
How long will the treatment last?
Ketamine is not a one-time, permanent cure but it has the potential for lasting relief.
For most patients who respond to ketamine, the symptomatic relief will begin to diminish eventually. Duration varies from patient to patient. In general, a series of multiple infusions provides longer lasting relief than a single infusion, and younger patients tend to get longer relief than older ones. For patients who relapse, getting additional infusions can often restore the relief. Only a few hundred patients so far have been treated longer than one year, which is a tiny fraction of the the world’s 350 million sufferers, and we don’t yet know if the infusions can be repeated indefinitely with sustained effect.
Many patients find that during the initial period of relief they are suddenly able to break out of persistant negative behaviors and thought loops, and achieve massive emotional healing rapidly, so that even if the physical symptoms of depression return they are much better able to handle it than before – even if they don’t get ongoing infusions. This period can enable them to make lasting behavioral changes that were previously impossible, and to get real value out of talk therapy even after years of futility.
Why is the route of Ketamine administration important?
The route of Ketamine administration is critically important to achieve the desired results. Only IV administration allows for enough medication to reach the brain, while allowing precise titration of the medication to avoid unwanted side effects. Oral, intra-muscular, and nasal administration do not allow for precise and immediate titration of Ketamine.
Who is not a good candidate for Ketamine infusion therapy?
Some individuals with specific medical conditions are not appropriate for this type of therapy. The conditions, which would represent a contraindication to ketamine therapy, include anyone with:
• Hypersensitivity (Allergy) to ketamine:
• A recent heart attack – less than 6 months ago
• A recent stroke – less than 1 year ago
Also, the use of certain medications may interfere with obtaining the best possible result from the infusion. For example, patients taking large doses of benzodiazepines may have a reduced response to ketamine. This does not mean you can’t receive ketamine treatment while taking benzodiazepines. It is perfectly safe; we just want to ensure the best possible chances for your success. We may ask you to skip a dose 24-48 hours before the start of your infusion and wait until 6 hours after before resuming your benzodiazepine. Some common brand names for benzodiazepines are Xanax (Alprazolam), Ativan (Lorazepam), Valium (Diazepam), and Klonopin (Clonazepam).
There are currently two other medications, which are known to significantly interfere or block the response to ketamine, and these are risperidone (Risperdal) and olanzapine (Zyprexa). They are “relative contraindications” to therapy and may need to be reduced or discontinued prior to treatment.
Prior to arranging for treatment, we would like to speak with you and discuss your current medical issues and medications. You should not adjust your dose or frequency of use of any prescribed medication without first consulting with your prescribing physician.
What is the cost?
The cost of each infusion is similar to other outpatient treatments requiring starting an IV, monitoring vital signs, etc. A non-refundable deposit of 60% of your fee is due prior to each appointment. The balance is due on the day of treatment. Please see the COST tab.
Do you accept insurance?
We do not accept any insurance plans or Medicare.
Will it work for me?
Ketamine infusions have been shown to work for treatment of depression, anxiety, PTSD, and OCD, as well as other chronic pain conditions, at a rate of up to 70%. Some patients receive relief after only one infusion, while others require multiple infusions. Please see references to the studies in the KETAMINE section of the website.
How many sessions will I need?
If you respond well to the first 2 infusions, treatments for depression and other mood disorders usually require 6 sessions in a 12 day period, with monthly maintenance treatments thereafter, as needed. Multiple infusions over several days have the longest benefit, with relief of symptoms for weeks.
How effective is Ketamine for depression, bipolar and PTSD?
Approximately 70% of patients with these conditions experience rapid relief after a low-dose Ketamine infusion, a fact made only more astounding when one considers that these patients have failed most other treatment regimens over many years.
Is it safe?
Ketamine is considered safe when administered by trained professionals who can recognize and manage its side effects. Side effects at the low doses needed for treatment of mood disorders are rare, but may include elevated blood pressure or heart rate, increased respiratory rate, double vision, seizures, and hallucinations.
Tell me about the procedure
Our infusions take place in a comfortable outpatient office setting. Patients sit in comfortable reclining chairs for about an hour, and stay another 20 minutes before leaving. Patients are required to be accompanied by an adult who can drive them home. During the infusions, patients may listen to music, or just relax. Patients will experience some amount of dissociation, or altered reality, but not hallucinations. 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”. Most patients find this experience pleasurable, but remember, we are there with you, so we can stop the infusion at any time. Stopping the infusion will end the dissociative thoughts within a minute. There are no side effects between treatments.
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).
Should I continue with my current psychiatric provider?
Yes. Boise Ketamine Institute physicians are serving in a consulting capacity to provide this procedure. We strongly encourage you to continue with your current psychiatric provider.
How does Ketamine compare to alternatives?
Typical antidepressants take weeks to months to work, and there is no reliable way to know which we will be effective and well-tolerated. Therefore, you may wait weeks to months to find out which medication will work for you. In addition, 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.
ECT is a highly effective procedure , which costs between $800. and $1000. per treatment. Common side effects include muscle pain, short term or long term memory loss, and the risks of general anesthesia. ECT usually requires 6 treatments for maximal long term benefit.
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.
Are there support networks?
ketamineadvocacynetwork.org is a tremendous resource.