Ketamine is a medication that was approved by the FDA in 1970 for use as a general anesthetic. It is especially useful because it is very safe with low risk for toxicity. Compared to other anesthetics, it has minimal effects on the heart and respiratory system. Over the past 20 years, clinical research has led to an expansion of its use for treatment of mood, anxiety, and pain disorders.
What is Ketamine Therapy?
Ketamine therapy involves the administration of ketamine by multiple routes for the treatment of a psychiatric or pain condition. Ketamine has been used to treat Major Depression, PTSD (Post Traumatic Stress Disorder) and chronic pain conditions like fibromyalgia and migraine.
Ketamine can be administered via a variety of routes including intravenous (IV), Intramuscular (IM), Intranasal (IN) and orally. At CARMAhealth, we administer ketamine both IV and IM. If you are new to the effects of ketamine, we recommend that you have your first treatment as an IV infusion. With an IV infusion, we can carefully monitor your response to ketamine and adjust your dose almost in real time. After your first infusion we will have a good idea of how ketamine affects you and the dose you will be able to tolerate. Subsequent doses can be administered IM.
During your IV or IM treatment, you will be closely monitored, and we will check your heart rate, oxygen saturation and blood pressure before and after your infusion. During the treatment, you will be seated in a comfortable recliner in a softly lit room. The experience can be enhanced by listening to music and wearing eye shades.
Is Ketamine FDA approved?
A very specific form of ketamine ( esketamine) is FDA approved as an IN (intranasal) spray for the treatment of treatment resistant depression and people with Major Depression with acute suicidal ideation or behavior. Although ketamine infusion has been used in clinical trials for treatment of depression, PTSD and chronic pain, a pharmaceutical company was able to obtain a patent for the esketamine molecule giving them rights to own this form of ketamine. There is almost no difference between ketamine and esketamine. We are using generic ketamine "off-label" as an IV or IM treatment.
Is there a big difference between IM and IV Ketamine?
Not really. IM absorption is only slightly less compared to IV administration. The major difference is that with an IV infusion we can tightly control how much ketamine you receive over time. Once patients are familiar with the effects of ketamine, they don't experience a major difference between IM and IV administration.
Do I have to get an IV infusion?
No. Some people have a history of being a "hard stick" (meaning it's very hard to draw blood from the hand or arm) due to lack of surface veins, long term damage to your veins, dehydration, etc .. Some people are afraid of needles and prefer to get a shot in the arm instead of an infusion needle in their arm or hand. Whatever your situation, we will work with you to ensure you have a safe and therapeutic expenence.
How many treatments should I receive?
The number of treatments a person receives is an individual decision made in collaboration with your healthcare provider. There are different protocols that have been researched. A typical course of treatment for depression is 6 sessions conducted 2-3 times per week. Treatments for PTSD range from a single high dose of ketamine to 2-3 infusions per week over 2 weeks. Generally, we recommend that you receive a minimum of weekly IV or IM treatment for 3 to 6 weeks.
What is Ketamine Assisted Psychotherapy?
Ketamine Assisted Psychotherapy (KAP) is talk therapy and personal support provided as an adjunct to ketamine therapy. A KAP therapist is a person who has been trained to assist people before, during and after a ketamine therapy session to enhance your treatment experience. KAP can help prepare you fully for ketamine therapy and help you integrate the powerful experiences you have during and after your ketamine therapy session. We strongly recommend KAP for first time ketamine therapy and for those who want to make progress dealing with trauma, or long-standing depression and pain conditions.
What are possible side effects of Ketamine?
As with any medication therapy, ketamine therapy has potential risks and side effects. We assess your risk for ketamine therapy based on review of your psychiatric and medical history and current medications and known allergies. Most side effects from the treatment go away on their own within a few minutes or after the treatment is over. There are no reports of long-lasting side effects in published studies.
Common side effects include: fast or irregular heartbeat, increased blood pressure, lucid dreams, confusion, irritability, floating sensation, feeling "out-of-body," breathing problems, coughing, nausea, vomiting, muscle twitching, muscle jerks, muscle tension, increased saliva (spit), increased thirst, headaches, metallic taste, constipation, and blurry or double vision.
Rare side effects include: allergic reactions, skin rash or pain at the infusion site, ulcerations (open sores) and inflammation (swelling or irritation) in the bladder, hallucinations (seeing or hearing things that are not really there), euphoria (a feeling of extreme happiness), involuntary eye movements, low mood, or suicidal thoughts.
Does insurance cover ketamine?
Insurance plans do not cover IV, IM or oral ketamine for any psychiatric, substance use or chronic pain disorder. FDA approved esketamine is only covered for the conditions mentioned above. Currently the out-of-pocket cost for esketamine for most patients is roughly the same as for IV or IM ketamine.
Is ketamine addictive?
Ketamine is a controlled substance and can be abused. Ketamine may carry the potential for abuse, but since this treatment is administered in a medical office over a short period of time, the risk for developing tolerance, dependence or addiction is quite low. Ketamine has been used for the treatment of some substance use disorders. These problems have not been reported with repeated administration of ketamine for the treatment of depression.
If you have any additional questions, please don't hesitate to contact your CARMAhealth provider or our program staff.