Ketamine infusions have been used in the management of depression (unipolar, bipolar and treatment resistant depression), PTSD (post-traumatic stress disorder), anxiety, suicidality, CRPS (complex regional pain syndrome)/RSD (reflex sympathetic dystrophy), fibromyalgia, OCD (obsessive compulsive disorder) and other chronic pain syndromes. Ketamine has not been shown to be useful in schizophrenia, psychosis or seizures. Studies at Yale, NIH (National Institutes of Health), and Mt. Sinai Medical School have shown that approximately 3 out of 4 patients will respond favorably to ketamine.
Typically, before trying ketamine, most patients will have tried many different medications. They’ll have waited months for a benefit, dealing with the interruption of life’s enjoyment, possible costs of hospital admissions and coping with side effects. It can be a very frustrating and disheartening process. As a trauma anesthesiologist, Dr. Harrison has provided care to too many patients who committed suicide or attempted suicide. With low dose ketamine, she now has the ability to offer hope to her clients and their families.
What is ketamine?
Ketamine is one of the four medications that can be used to put people to sleep for surgery (anesthesia). It was introduced into clinical practice in 1970, more than 40 years of use now. It has been valuable for anesthesia in children, which speaks to its safety. What is different about ketamine is that it is also a powerful pain killer that does not use the same pathways as opioids (narcotics). It is related to PCP and has been used as a street drug called “Special K”, but not at these controlled doses.
Using ketamine to treat psychiatric and pain syndromes is a relatively new use of ketamine. The two most important ways that ketamine acts are as a NMDA blocker and as an increase in BDNF (Brain Derived Neurotrophic Factor). Glutamate is one of the important chemicals (neurotransmitters) in the brain. It has two receptors, NMDA and AMPA. By blocking NMDA, more glutamate goes to AMPA. BDNF stimulates new nerve cell growth, connections (synapses) and organization of the synapses. Ketamine seems to actually rebuild the synapses, reverse atrophy due to stress and aging, and essentially “heal” the brain. This may be where the long-term benefits from ketamine come from. You can think of it like taking a tree from winter and turning it into a springtime tree with new leaves growing.
Low Dose Ketamine Infusion
Ketamine is a unique, promising and effective treatment for patients who have had stubborn syndromes. Whereas typical anti-depressants or other treatments can take months to demonstrate an effect, ketamine is fast acting. People can show benefit within 1-2 hours. In a study at Yale School of Medicine, one injected dose of ketamine alleviated the idea of suicide within an hour. There have been more than 30 clinical trials now and the list keeps growing. Based on these trials, 70-80% of people receive help from ketamine. The duration of benefit shows a lot of variability. Initially, two infusions are done to see if ketamine offers benefit for a particular individual. Assuming that there is benefit, then four additional infusions complete the series of six total infusions. After that series is completed, some people will show benefit for months. Others will come in for a monthly maintenance infusion. Some will get benefit for weeks. There is no way to predict if or how often you will require booster infusions.
Ketamine can be used along with your other prescribed treatment plans based upon approval from your physicians. Ketamine should not be thought of as a cure for depression, but rather as an addition to ongoing treatment that can help reset your baseline, relieve some suffering and hopelessness. It gives other therapies, such as oral medications and psychotherapy, a chance to progress.
If you or your loved one have suffered with psychiatric or chronic pain problems with little or no relief, ketamine infusions may help.
How do I make an appointment?
Please obtain a referral from your psychiatrist or pain management specialist. A referral form can be downloaded from our Forms page. Please complete the Patient Questionnaire form also. Fax both forms to 480-999-4447. When we have both forms, we will contact you to schedule your first visit. Patients who take benzodiazepines (alprazolam, lorazepam, clonazepam, valium, etc.) or lamotrigine (Lamictal) should work with their physicians to wean off these medications prior to beginning ketamine infusion therapy in order to maximize the
treatment’s efficacy, if at all possible.
How much does each infusion cost?
Each infusion costs $650. The initial two infusions cost $1100 to see if ketamine is right for you. Approximately 70-80% of patients will respond to ketamine. We accept Visa, MasterCard, American Express and HSA cards. We do not bill insurance companies, but we will provide you with a receipt that you can use to apply for reimbursement. Insurance companies are not likely to cover ketamine infusion therapy
How many infusions will I need?
A series of infusions has been shown to be more effective than single infusions. Initially, we do the two infusions to see if ketamine is an effective option for a particular client. If the ketamine is beneficial, then we do two infusions per week for three weeks for a total of six infusions. After that treatment protocol, there is a lot of variation for maintenance. Some patients will come in once a month for a single infusion. Some patients may be able to go months without any additional ketamine. Follow up infusions are on an as needed basis to relieve symptoms.
How soon will it work? When will I know if it’s working?
For psychiatric clients, they may notice a change during the infusion or shortly thereafter. Patients with thoughts of self-harm often notice that those thoughts go away almost immediately. Other patients may not notice any benefit after the first infusion, but start to notice the difference after the second infusion.
Will I require ketamine infusions for the rest of my life?
Not necessarily. Some patients receive long term relief after the initial series of infusions. Ketamine will enhance the effect of your oral anti-depressants, which could then become your maintenance plan. If ketamine infusions are the only solution for you, maintenance infusions are provided on an as-needed basis. Each patient is unique.
What is a ketamine infusion like?
Ketamine is administered over 40 minutes with an additional 30 minutes or more after for recovery. You will not lose consciousness. You may listen to music or just close your eyes and relax during the infusion. If you are already calm, relaxed and sleepy, you may drift off for a short nap. 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” and sometimes some numbness in the toes or area around the mouth. These feelings tend to build until the end of the infusion. Other common feelings include euphoria, talkativeness, dizziness, 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). Some have described a lifting of heaviness from their chest. These effects are generally gone in 15-20 minutes after the infusion is completed.
You will be with us a minimum of 90 minutes from when you walk in the door to when you may leave, with no side effects at that point and none between treatments. You will be monitored for a minimum of 30 minutes prior to being released from the clinic. Patients commonly feel tired after an infusion. Side effects are generally gone within a couple of hours. There are no long term or permanent side effects of low dose ketamine infusions.
What should I do during the infusion?
Many find it helpful and relaxing to bring their earbuds and listen to calming music. You may also want to bring a sleep mask, sunglasses or a lap blanket. Preconceived ideas prior to the treatment do affect the experience. It is helpful to decide ahead of time that you will be safe, you might feel “weird” for a little while, but that it is “OK”, because that will quickly pass and you will be left feeling much better.
How do I know if it worked and what should I expect?
It is possible to notice effects as soon as 40 min after the infusion, most typically notice 2-4 hours later, but sometimes take 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. We may ask you to fill out a depression and anxiety scale prior to each treatment and 24 hours after the second treatment depending on the condition we are helping you with. This will help determine response.
How do I maximize the benefits?
When an individual is gripped with depression or anxiety, it can be practically impossible to do the activities that are known to prevent or treat depression and anxiety (nutrition, exercise, sleep, engage in talk therapy, improve your social circle and relationships, stay busy, etc.) Ketamine rapidly enables you to be able to engage in these other activities that are known to make a difference. Ketamine can be the Launchpad for a healthier lifestyle overall. The clients who realize that they need a multi-pronged plan of attack for their situation maximize their benefits. One of the benefits of choosing to work with Incredible Health is that we offer other options to help with the management of chronic pain and depression/anxiety. When you are ready, we can start lifestyle modifications or whatever is appropriate to your situation.
How long will the results last?
Results from a single infusion typically lasts anywhere from a couple of days to 2 weeks. A series of 6 infusions may last anywhere from weeks to months. However, when effects are wearing off, a single infusion may restore response. For those who have not had long-standing chronic depression, it may last much longer than that.
Do I continue with my current psychiatrist, therapist, primary care physician or pain management specialist?
Yes. Incredible Health, LLC is serving as an addition to your normal medical care. We will not take over writing of your prescriptions or the other aspects of your medical care. The best results come about from a multi-approach plan. Ketamine is not a stand-alone treatment plan.
Is it more expensive than taking oral medications?
Yes. An infusion of ketamine is more expensive than a typical doctor’s visit and medication copay. However, when also considering the financial impact of ongoing depressive 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. Typical antidepressants take weeks to months to work. There is no way to predict which antidepressant will work for a particular patient and be well tolerated. These medications have many unpleasant side effects.
Ketamine does not work for everyone, but you will know that relatively quickly and not waste time or money unnecessarily. The side effects of ketamine are limited to the time of the infusion, with no side effects between infusions. There is more to life than just money. Depression, anxiety and pain have a cost to enjoyment of our lives and relationships.
What medical conditions could keep me from receiving ketamine?
There are very few that would apply to an outpatient clinic like ours. Uncontrolled blood pressure, unstable heart conditions, untreated thyroid disease, active substance abuse, current manic phase of bipolar disease, or active psychotic (hallucinations or delusions) symptoms, pregnancy, breastfeeding.
What are the risks?
During the infusion, heart rate and blood pressure may rise. These can be controlled, but will completely reverse when the infusion is completed. Your vitals will be monitored during the infusion to ensure safety. At this dose and in a monitored setting like we provide, ketamine is very safe and low risk.
Are ketamine infusions addictive?
This is a low dose, controlled setting. There have not been any reported ketamine addiction problems from this type of application.
Do I absolutely have to bring someone with me to drive me home?
Yes. You will not be allowed to drive yourself home or take a taxi. If you do not have someone to drive you home, your treatment will be cancelled for that day at your expense. We advise that you not drive, operate machines, sign any contracts or partake in other risky activities for 24 hours.
Can I eat or drink before my appointment?
You cannot eat for 4 hours before your scheduled appointment. You may have clear liquids up to two hours before your appointment. Clear liquids are black coffee without creamer, tea, Sprite, apple juice, etc. Orange juice and milk are not clear liquids.
Do I need a referral?
We strongly recommend a referral from your psychiatrist or pain specialist. Ketamine is not a stand-alone treatment plan. You will still need monitoring of the effectiveness, your progress and your oral medications.
Will my current medications interfere with the ketamine infusions?
Lamictal (lamotrigine). If you cannot be weaned off the Lamictal, allow 12 hours between taking the Lamictal and the start of the infusion. Wait 6 hours after the infusion before taking your next Lamictal dose.
Benzodiazepines will decrease the effectiveness of the ketamine. Try to wean off the benzodiazepine. If you are not able to, you may still receive a ketamine infusion. Your chances of success are just better when off the benzodiazepines. Benzodiazepines include Xanax (alprazolam), Ativan (lorazepam), Valium (diazepam) and Klonopin (clonazepam).
SSRI’s, tricyclics, opiates, muscle relaxers and anti-inflammatories do not have an interaction with ketamine. Continue with your normal schedule.
Aminophylline for asthma or COPD may be at a greater risk of seizures if they receive ketamine.
You should not adjust your dose or frequency of use of any prescribed medication without first consulting with your prescribing physician. Any illicit drug use is contraindicated with ketamine infusions and will result in refusal of treatments
What kind of payment do you accept?
We accept all major credit cards and cash. We also have financing programs available to help you get the care you need. You can conveniently pay overtime with payments that fit your lifestyle and budget. We offer AdvanceCare and Health Credit Services for our patient
financing. We require payment at the time of treatment.
Does insurance cover ketamine therapy?
Since the use of ketamine is OFF-LABEL, insurance companies will not cover the therapy. We will provide you with the necessary documents to submit to your insurer for any reimbursement you are able to recover. We cannot accept Medicaid (AHCCCS) or Medicare clients for ketamine therapy.
Is there an age requirement to have an infusion?
14 years old and older.
Why aren’t other doctors doing this?
We believe that anesthetics should be given by anesthesiologists or CRNA’s who have the skills and are comfortable dealing with any possible complications. There are too many examples of anesthetics being given by other providers who couldn’t control the situation. Michael Jackson would be the most famous one. Anesthesiologists, by and large, are not used to running a clinic or providing an anesthetic medication without a procedure.
Ketamine is not marketed by pharmaceutical companies. There are no conferences or sales representatives promoting ketamine to physicians and providing samples along with the muffins for the office staff. Unfortunately, medicine has become driven by corporate profits and physicians are just trying to keep their heads above water. There isn’t a lot that can happen in the 6-10-minute appointment time that the insurance companies give for the doctor, except to write prescriptions. We want to help people regain their health for themselves.