What is Ketamine?
Ketamine is a medicine developed more than 50 years ago for anesthesia during surgery, and has been used for that purpose since that time in children, adults, and animals. More recently, Ketamine has been found to be a valuable and highly effective treatment for depression, anxiety, and certain pain disorders.
How does it work?
Depression, anxiety, pain, and other forms of stress damage the communication system between areas of the brain responsible for memory, learning, and higher-order thinking. Ketamine is able to promote the materials necessary to make repairs to this damage within hours.
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), and addiction.
Will ketamine therapy help my treatment resistant depression?
Based on a landmark study conducted by the National Institute of Mental Health, up to 70% of all patients can expect significant relief after a series of six ketamine infusions. We have found that by curating the patient experience, providing an exceptional level of support, and setting realistic expectations, we consistently see outcome metrics that outperform the NIMH study. It is important to understand that it is impossible to predict an outcome for a specific patient. Thankfully, owing to the ease and accessibility of treatment and the absence of known side-effects, it is possible to explore the benefits of therapy without risk.
Would it work the same if I took it orally or nasally as a viable alternative to IV therapy?
No. Ketamine is absorbed by the body very differently and unreliably when taken orally or nasally and has not been shown to be as effective for depression. The bioavailability of ketamine delivered intravenously is far superior to any other form of administration. This means that a much smaller dosage yields a superior result. Other forms of ketamine are significantly less effective and likely to produce side effects.
Is there potential for addiction?
No. The dosage and frequency of infusions are such that addiction is not possible. In contrast, patients using oral or nasal ketamine often develop a tolerance, addiction, and side effects.
Are there any long-term side effects with ketamine therapy?
IV Ketamine therapy following the NIMH protocol results in no known long-term side effects.
What medical conditions could keep me from receiving ketamine?
There are very few. Dr. Stratford will discuss contraindications with you before you receive your first infusion.
Are there any conditions that may make Ketamine dangerous or ineffective?
Uncontrolled blood pressure, unstable heart disease, untreated thyroid disease, active substance abuse, current manic phase of bipolar disorder, or active psychotic (hallucinations or delusions) symptoms.
What are the risks?
The dose used for the treatment of mood and anxiety disorders is very low and safe. For a few minutes during the infusion itself, blood pressure and heart rate may increase. This is monitored to ensure safety.
Do I need to stop taking any of my current medications before I begin ketamine therapy?
No. You should not make any adjustments in your current medications without specific approval from the prescriber. It is important to note that while there is some speculation related to benzodiazepine and lamotrigine and their effect on ketamine infusions, there is no actual evidence to support adjustments in either in advance of therapy. While these medications may reduce the dissociative effects of ketamine during an infusion, our experience suggests that they have no negative impact on outcomes.
Will I require ketamine infusions for the rest of my life?
Some patients seem to achieve long-term relief after the initial series of six infusions and others require additional infusions at varying frequencies to maintain relief. Aftercare is an important part of ketamine therapy and Dr. Stratford will work with you to determine the best approach for you to achieve lasting relief.
If ketamine therapy works for me how soon will I begin to feel better?
A very small percentage of patients begin to feel better within hours of the first infusion. Patients with thoughts of self-harm often notice those thoughts dissipating first with a dramatic relief of dread and hopelessness. Many patients do not notice a significant mood improvement until they’ve had several infusions. Almost all patients who will respond feel measurably better after the series of six infusions.
What should I expect during ketamine therapy?
The medicine is given very slowly over 40 minutes. The first 15-20 minutes are uneventful with no noticeable effects. At around the 20 minute point, people tend to notice some blurring of vision or double vision, a feeling of “lightness”, “floating”, or intoxication, and sometimes some numbness in the toes or area around the mouth. Over the course of this 20 minute period, these feelings tend to build, so that the medicine is at the peak of its intensity at the very end. 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”. Less commonly, people may experience some anxiety and headache, nausea, or sweating (typically toward the end). These feelings start to subside approximately 10-15 minutes after the medicine is done and last for a total of 45-50 minutes. Most people can expect to be with us for about 90 minutes from the time you walk in the door to when you leave, with no side effects at that point and none between treatments.
Will I be awake?
Yes. Ketamine will not put you to sleep. If you are already sleepy and are feeling very calm and relaxed during the treatment, you might drift off for a short nap. People are able to move freely during the treatment.
What should I do during the infusion?
Many find it helpful and relaxing to listen to music and to wear an eyeshade or sunglasses. It can be difficult to carry on a conversation during the procedure, so you are encouraged to sit back and relax and pay attention to what you are feeling. Expectations coming in to the treatment do affect the experience, so it is helpful to decide ahead of time that you will be safe, will feel “weird” for a little while, and that is ok, because that will quickly pass and you will be left feeling much better.
How do I know if it worked/what should I expect?
You will fill out depression and anxiety scales prior to the first treatment and approximately 24 hours later. This will help determine response. It is possible to notice effects as soon as 40 min after the infusion, most typically starting 2-4 hours later, but sometimes taking up to 24 hours. You should not expect to wake up feeling “perfect and overjoyed”, but rather there should be a noticeable difference in feeling more hopeful, less sad, decreased thoughts of suicide, increased calmness, “weight” of depression lifted, or more inclined to engage with people. Further improvements are often seen over the course of treatment.
Do I continue with my current psychiatrist, therapist, or primary care physician?
Yes. Big Sky Ketamine is serving in a consulting capacity to provide this procedure. In some cases, patients may choose to see one of our doctors in his/her private practice. But in most cases, people will continue with either their primary psychiatrist or primary care doctor, and are highly encouraged to either begin or continue talking with a therapist.
What is the usual course of treatment?
After an initial series of 6 treatments, maintenance (booster) infusions may be scheduled to maintain response. The total length of treatment is highly dependent on each individual’s unique circumstances.
How long will the results last?
A single infusion typically lasts anywhere from a couple of days up to 1-2 weeks. A series of 6 infusions may last anywhere from weeks to months, and often a single booster infusion when effects are wearing off can restore response. For those who have not had long-standing chronic depression, it may last much longer than that.
How do I maximize the benefits?
It is common to get advice when depressed that makes sense intellectually, but is impossible to follow through on because of the depressive symptoms. This includes things like, “eat well, exercise, engage in talk therapy, find social support, stay busy, etc”. Ketamine rapidly enables you to be able to act on these important activities, and those who have the best results support the medicine’s effect in these ways. In addition, Ketamine likely “primes” the brain for learning and making new connections. Talk therapy can be an ideal way to “lock in” therapeutic learning and capitalize on this unique window of time.
How does Ketamine compare to alternatives?
Typical antidepressants take weeks to months to work. There are many to choose from and no reliable way at this point to know which will be effective and well-tolerated. Therefore, one may wait weeks and find that the medicine does not even work. 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. 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. In this way, outside of the infusion time, you are not “medicated”.
What are the success rates?
Approximately 70% of people respond to Ketamine infusions.
Are there support networks available?
Yes. Please visit Ketamineadvocacynetwork.org
Is it more expensive than taking an oral medication?
An infusion of Ketamine is more expensive than a typical doctor’s visit and medication copay. However, when also considering the financial toll of ongoing depression symptoms affecting work and social function, as well as multiple office visits and ongoing medication costs, quickly being restored to life by Ketamine is an excellent value.
Do I need a referral to begin therapy?
No. If you are not currently a patient of Dr. Stratford’s, he will meet with you to discuss your diagnosis prior to beginning treatment. Patients who are already seeing Dr. Stratford will work with him to determine readiness during a pre-infusion consultation.
Where is the treatment performed?
All treatments are performed, on an outpatient basis, in Dr. Stratford’s relaxing and comfortable treatment room.
How many ketamine infusions will I receive?
Initially, all patients receive a series of six infusions spaced over two or three weeks. This follows the protocol developed during the NIMH trial and is the best predictor of efficacy.
Will my insurance company pay for ketamine therapy?
No. Because IV ketamine therapy for mood and anxiety disorders is off-label, insurance companies do not provide reimbursement. Thankfully, IV ketamine therapy is not only the most effective treatment, it is also the least expensive.
For more information go to www.KetamineAdvocacyNetwork.org