Is there good, sound research to support the use of ketamine?

The short answer to this question is “yes,” and a lot of it.  Please visit the research section of this website for links to some of the impressive research being done in this area.  There, you will find links to articles from studies originating at reputable institutions like Yale, the National Institute of Mental Health, Mayo Clinic, and Mt. Sinai.

What do Ketamine Infusions treat?

Ketamine has been shown to effectively treat depression, the depressive phase of bipolar disorder, and PTSD. Ketamine has been shown to be particularly effective in treating forms of depression that have not responded to other therapies and medication interventions (treatment resistant depression).  Also of particular note is that it has been shown to have benefit in its impact on suicidal ideation (Murrough et al, 2013).  Research involving ketamine is robust.  It is now being shown in the research literature to positively impact such psychiatric issues as Obsessive Compulsive Disorder and Substance Abuse Disorders.  Ketamine infusions have also been shown to treat some chronic pain syndromes like CRPS.

Ketamine is NOT indicated in the treatment of any psychiatric disorder involving a psychotic component such as schizophrenia.

What is the response rate to ketamine infusions?

Current scientific research and clinical trials support an approximate 70% response rate.

How long does ketamine take to work?

Amazingly, ketamine’s effect can begin to take place anywhere between 1-12 hours after the infusion.  Most patients feel effects at the latest the day after the infusion.  Patients may continue to have bad periods of time either during or after the course of ketamine infusions, but the overall trend of mood symptoms tends to be in a positive direction following serial ketamine infusions.

How long do the positive effects of ketamine last?

Outcome data differs amongst patients.  That being said, serial infusion can provide relief anywhere from one month to several months. Even after patients report the lessening of some of the positive effects of ketamine, many feel like their overall abilities to cope and adapt are improved.  While complete remission has been observed, it should be considered an exception and not the rule.  This is unfortunately the case with most all psychiatric interventions. However, ketamine infusion treatment allows an individual to acutely become “unstuck” in rigid negative thought patterns and behaviors, and facilitates them reengaging in life, therapeutic processes, and allows time for other psychiatric medications to begin to have an effect.

What is an infusion?

An infusion is the administration of a medication via an intravenous line over a certain period of time.  Ketamine infusions last between approximately 40 to 45 minutes.

How many infusions will I need?

There is not yet a standard established regimen for ketamine infusion delivery.  That being said, there have been some consistent themes that have developed from the ongoing ketamine research and studies.  Most importantly, serial Infusions have been shown to be more effective and have a longer lasting effect than a singular infusion.  The typical number currently established through the research and literature is a series of six infusions spaced out over a two week period.  This is found to maximize new dendrite and synapse growth.  Some individuals choose to have “booster” infusions over time.  Because each individual’s response varies to some degree, we try our best to get to know the patient so that we can deliver the most personalized care.

You mentioned maintenance.  How often would that be?

Length of response can vary from person to person.  To use an example, let us suppose that  Erik successfully treated his depression with ketamine infusions.  Every 5 months, however, Erik begins to feel his depressive symptoms coming back.  If considering ketamine, Erik might get a booster infusion every four and a half months to stave off the relapse of symptoms.  This type of maintenance program has been shown to be an effective treatment of depressive symptoms that would otherwise impact Erik’s life in potentially detrimental ways.

What is getting a Ketamine infusion like?

You will arrive at our office, check in, and then fill out appropriate scales and forms.  An IV is started and the infusion will begin.  The total time of the actual infusion will be approximately 40-45 minutes.  Patients typically do not feel anything different for the first 10-15 minutes.  After that time, you will begin to feel effects that are typically described as being “unusual,” “odd,” and almost always “interesting.”  Patients report experiences of it being dreamlike, tingly like Novocaine, feeling like you are floating, feeling disconnected from one’s body or the physical space.  Patients may feel more introspective.  Perceptions can become distorted and sometimes seem more intense. The experience ramps up in intensity and then begins to subside after the 40-45 minute mark.  Less common side effects include nausea, headache, and anxiety.  If bothersome for the patient, those side efects can be treated during the infusion with fast acting IV medications.  All infusion related experiences cease approximately 10-15 minutes after the infusion is completed.  Patients relax in our office for an additional 20  to 45 minutes, and are then driven home by a prearranged trusted driver.

Please note that expectations do affect your infusion experience.  You will feel different or “weird” during the transfusion.  It is best to know this and accept it as part of the ketamine infusion process.  You should also know, however, that you will feel like yourself shortly after the transfusions ends with the exception of hopefully being left with a sense of newfound hope, optimism, and less feelings related to depression.

What do I do during the ketamine infusion?

The best thing that you can do is to sit back and relax.  Our staff do everything possible to create a comfortable and relaxing environment for the infusion.  Watching t.v. or being on your phone is discouraged as ketamine can sometimes temporarily blur vision during the treatment.  We recommend listening to calming music, such as the type you might hear at a spa or while receiving a massage.  Most patients find this type of music to be anchoring and relaxing.  Patients sometimes choose to close their eyes or wear a sleep mask.  You will be awake throughout the infusion as the low dose of ketamine delivered does not produce the “going under” effect of that of higher dose anesthesia. Our staff is present to speak to you if you would like to process the experience during or after.  Most patients electively choose to relax in silence.

How much does each infusion cost?

Each infusion costs $550.  This fee is inclusive of the medication, the nursing staff, as well as the psychiatric staff’s time.  In order to maximize the effects of Ketamine treatment, we ask that individuals commit to at least six infusions.  Payment is expected to be made on the day of the appointment in the form of credit card or cash.

Are Ketamine Infusions covered by insurance?

At this time, ketamine infusions for the treatment of psychiatric conditions are not covered by insurance.  While ketamine is an FDA approved anesthetic medication, it is not recognized at this time by the FDA for the treatment of depression or other psychiatric conditions.

What are the common side effects?

Most individuals undergoing ketamine infusions have little to no side effects.  Those that do may experience mild nausea, drowsiness, headache,  blurry vision, dizziness, and sometimes a temporary increase in blood pressure. These side effects can be treated during the infusion process if they become too bothersome.  To note is that ketamine stays in your system for a very brief time.  Nearly all infusion side effects disappear within 10-15 minutes of the infusion being over.  Less common side effects include vivid dreams, mood swings, or agitation.  These effects can typically be controlled by adjusting the dose of ketamine.

Will I become addicted to ketamine?

If receiving care in the hands of trained psychiatrists and other medical professionals, the answer is no.  Like many other medications used  to treat legitimate medical conditions, it can be abused.  Ketamine has a history of being abused during the 1990’s and early 2000’s in the “Club Drug” or “Rave” scenes.  Ketamine used in those settings was used at much higher doses.  Even at those doses, however, ketamine does not create physical dependence.  The amount used to treat depression is approximately  8% to 12% of that used when it is being abused as a club drug and approximately 4% of that used when used for anesthesia.  It is also important to remember that in the past 50 years there have been no reports in the clinical literature of physical dependence or addiction arising from the controlled medical use of ketamine.

Is Ketamine dangerous?

Ketamine has now been used for over five decades as an anesthetic for both adults and children.  In fact, it is one of the most used medications for anesthesia in pediatric emergency rooms.  Although ketamine is not FDA approved as an antidepressant, it is FDA approved to be used as an anesthetic at approximately 20 times the doses used to treat depression.  In addition, ketamine is a unique anesthetic in that it does not suppress the gag reflex nor does it reduce an individual’s respiration rate.  As a result, it is considered to have a very wide safety margin.  Please see the “Safety” section for additional information regarding this topic.

Are there any reasons that would prevent me from receiving a ketamine infusion?

There are very few conditions that would rule out an individual from being able to receive a ketamine infusion.  Some such conditions include uncontrolled high blood pressure, hyperthyroidism, persistent pulmonary issues, and seizure disorders.  Those with cardiac problems, uncontrolled high blood pressure, or pulmonary problems should be thoroughly cleared by their treating primary care physicians before receiving ketamine treatment. Those with severe glaucoma also should not take part in Ketamine Infusions.

Do I have to stop taking my medications and Can I stop taking my medications?

You should not stop taking psychiatric or other types of prescribed medications at the time of your infusion.  You should not adjust your dose or frequency of any medication without first consulting your prescribing physician.  There are a small number of medications, however, that should cause one to avoid receiving an infusion.  Patients taking aminophylline for asthma or COPD may be at greater risk for developing seizures if they receive ketamine. There are also a few medications, such as lamictal or the class of benzodiazepines that may possibly affect the dose of ketamine or the frequency of infusions needed.  Please make sure to tell your evaluating psychiatrist all of the medications that you are taking before receiving ketamine infusions.

-Lamictal (lamotrigine) patients should allow 12 hours between taking lamictal and the start of their infusion.  They should wait 6 hours after their infusion before resuming lamictal.

-Patients cannot take any MAOIs within 2 weeks of an infusion.

-Patients taking large doses of benzodiazepines will have a reduced response to ketamine.  This does not mean that you cannot receive ketamine infusions while taking benzodiazepines, but your response may vary and your dose may need to be adjusted.

-SSRIs and Tricyclic antidepressants do not interfere with ketamine and should be continued as prescribed.

Do I stop seeing my psychiatrist or therapist?

No.  You will be under the care of Dr. Barton and the staff of the Nashville Ketamine Center for the purposes of the ketamine infusions only. We will assist you in developing a maintenance plan should you desire to do so.  However, you should maintain contact with your referring psychiatrist, therapist, and/or primary care physician during and after your treatment for ongoing medical and mental health needs.

Are there special instructions for the appointment that I need to know about?

-You will not be allowed to drive yourself home.  Please make arrangements accordingly.  We advise you to not drive or operate heavy machinery until the morning after the infusion.  We also advise you not to make any “significant life decisions” like signing a binding contract until the morning after an infusion.

-Please abstain from eating beginning 4 hours prior to the appointment.  You may have clear liquids up to two hours before the appointment.

-Expect the entire process from stepping in the door to leaving to last approximately 1.5 to 2 hours per infusion.  The initial appointment and infusion may take a bit longer.  Please plan accordingly.

Is there an age limit in regards to ketamine treatment?

There is not a formal age limitation.  We recognize that depression is not something that only happens to adults.  Dr. Barton is a licensed and double board certified child, adolescent, and adult psychiatrist.  In addition to the adult population, he possesses a comfort level treating patients under the age of 18 as well.  Treatment will ultimately be decided on a case by case basis.

How soon can I begin Ketamine infusion treatment?

Most patients are able to be scheduled and seen within one week of their initial contact with our clinic, assuming your case is appropriate to receive treatment.