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What is Ketamine?

Ketamine is a medication that has been used therapeutically since 1970 in humans as well as in veterinary medicine as an FDA approved anesthetic and pain reliever during medical procedures.  It has been used on ambulances and in hospitals around the world for years and is considered to be very safe when used appropriately.  

It has received a reputation as a club drug due to the fact that it has been used illegally by some individuals at high doses for its psychedelic effects in the same way that many other prescription medications today are obtained and misused. 

This is in unfortunate because prescription ketamine, when administered in low doses and with supervision, has had significant, and at times life changing positive results for people who suffer from treatment resistant depression and pain. 

How is it used in mental health treatment?

Ketamine is a medication that can provide relief of symptoms of depression and other mental health conditions such as anxiety, PTSD and chronic pain. It is also currently being evaluated and studied for use in Bipolar disorder, Parkinson' disease and Dementia. 

It's use in mental health is off-label, which is legal and very common.  In fact, about one in five prescriptions written in the U.S. is for off-label use. 

It can be administered via IV infusion (in the vein), by an IM (intramuscular) injection, intranasally (nose) or by mouth/ under the tongue. 

The most bioavailable method of administration is through IV.  The next is IM, then intranasal. oral and nasal ketamine are the least bioavailable, and the most variable mental effect.  These routes of administration are less precise than IM/IV.  

How does it work?

There is clear evidence that demonstrates ketamine's ability to produce a rapid onset of antidepressant effects using a treatment that works on the brain differently than typical antidepressants. 

Ketamine has repeatedly been demonstrated to induce clinical improvement in a substantial portion of medication treatment resistant depressed patients within 24 hours of initiating treatment. 

Increasing evidence demonstrated the ability to sustain this positive response for months with repeated dosing.  

The mechanisms by which ketamine relieves symptoms of depression are not fully known. Ketamine works on the NMDA glutamate receptor to reduce transmission, and it also has effects on the opioid system and on neuroinflammation processes. It has shown anti-inflammatory and antioxidant effects, is involved in activation of neuroplasticity (new synaptic connections) and has been shown to improve cognitive function when used in therapeutic doses. 

How will you determine if it is the right treatment option for me?

We will perform a comprehensive psychiatric evaluation and review your medical history to determine if ketamine is right for you. 

There are several medical conditions that would prevent you from being a safe candidate for this treatment. 

These exclusion criteria are listed below.

Exclusion criteria:

uncontrolled Hypertension

acute cardiovascular disease

aneurysmal vascular disease (including thoracic or abdominal aorta)

arteriovenous malformation

intracerebral hemorrhage

increased intracranial pressure

hypersensitivity to ketamine, esketamine

individuals with schizophrenia, psychotic disorder

pregnancy

How it is used in this clinic?

We administer ketamine in several forms, depending on what works best for you. 

IV ketamine therapy-

This has the most robust research behind it and is extremely effective for treatment resistant depression and suicidal thoughts. 

Treatment consists of twice a week treatments for three weeks, then maintenance sessions as determined by your individual response and ongoing need.  Some people benefit from a monthly maintenance session, but many people can go several months between sessions. 

IM ketamine- 

This involves one or two injections per session into your shoulder muscle or thigh. The initial treatment program and frequency is similar to IV treatment as listed above.  

Intranasal ketamine or Esketamine- 

Esketamine is the only form of FDA approved treatment that is covered by insurance.  We will work with your insurance to get pre-authorization for treatment approval. 

oral ketamine- troche 

This form of ketamine has inconsistent availability and variable effect due to extensive metabolism in the body, with the least amount of research available to support its therapeutic effectiveness. 

It is therefore not used in this clinic for initial ketamine treatment, but may be considered for maintenance therapy  if requested and on a case by case basis.