Ketamine Infusion Therapy – Frequently Asked Questions
Ketamine acts somewhat differently from SSRIs, tricyclics, MOAI inhibitors, benzodiazepines and other antidepressant or anti-anxiety medications. When ketamine is infused in a very precise way, it triggers a cascading sequence of events in the brain, which ultimately results in the re-wiring of neuropathways. Studies suggest that pain and depression are significantly decreased once these neuropathways have been reset with low-dose ketamine infusions.
During the treatment, you may experience something called a dissociative effect. Most patients describe the experience with words like “relaxing,” “floating,” and “pleasant.” It should be noted that some patients may describe feelings of anxiety, disorientation and hallucinations. A qualified member of our staff monitors patient responses to treatment.
Those who have experienced multiple methods of administration often report significant differences in effectiveness from one method to another. The initial dose is based on multiple factors and may be adjusted in later infusions to maximize individual results.
The wide range of chemical processes that occur in the central nervous system are very complex. The following is an explanation of how ketamine interacts with receptors and chemicals in the brain to cause (often immediate) anti-depressant effects, even in patients with severe Treatment Resistant Depression (TRD):
One of the brain’s key neurotransmitters is glutamate, an amino acid found in 80% of neurons. Glutamate influences the formation and number of brain synapses – the vital connections between neurons. Glutamate acts with another important neurotransmitter, GABA, to maintain a healthy, well-functioning nervous system. An imbalance between GABA and glutamate can cause problems, including anxiety, difficulties with sleep, overstimulation and issues with focus. Imbalance in the glutamatergic system is also associated with major depressive disorder (MDD). Growing evidence suggests that ketamine helps rebalance the glutamate system by acting as a receptor “antagonist.”
Ketamine works by blocking the NMDA (N-methyl-D-aspartate) receptor, one of three major glutamate receptors. This receptor is involved in synaptic plasticity and memory function, among other functions. A ketamine-induced blockade of the NMDA receptor results in an increase in glutamate. This initiates a cascade of neurobiological events that researchers believe is a key reason behind ketamine’s rapid antidepressant effects.
With Complex Regional Pain Syndrome (CRPS/RSD) and other chronic pain, a process known as central sensitization is thought to intensify pain by increasing the number of NMDA receptors – thus amplifying the pain signal.
Ketamine’s interference with the NMDA receptor helps block and “reset” pain signaling, providing relief where other treatments have failed. By blocking the NMDA receptors of peripheral nerves, peripheral nerve pain transmission is intercepted before reaching the spinal cord and brain. This allows for “rebooting” of central pain centers and desensitization to peripheral pain signals.
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.
Ketamine Infusion can be tremendously beneficial for many people with serious illness, but just as with any other medical therapy or procedure, there are some individuals with specific medical conditions who would not be appropriate candidates for this type of therapy.
- 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
- A recent heart attack – less than 6 months ago
- A recent stroke – less than 1 year ago
- Uncontrolled seizures, hyperthyroidism, glaucoma, severe liver or kidney disease
- Weight over 250 pounds
- Hypersensitivity (allergy) to ketamine
- Unable to communicate in English (unless there is an interpreter available throughout the procedure and home recovery period)
- No support person to take you home from the clinic or care for you at home
Patients with serious medical conditions would be evaluated by our questionnaire and either disqualified or asked to obtain consultations before treatment.
For treatment planning purposes, please contact us with any questions regarding interactions between your current medications and ketamine.
The use of certain medications may interfere with obtaining the best possible result from the infusion. For example, patients taking large doses of benzodiazepines may have a reduced response to ketamine. This does not mean you can’t receive ketamine treatment while taking benzodiazepines. It is perfectly safe; we just want to ensure the best possible chances for your success. Some common brand names for benzodiazepines are Xanax (Alprazolam), Ativan (Lorazepam), Valium (Diazepam), and Klonopin (Clonazepam).
There are currently a few other medications known to significantly interfere or block the response to ketamine:
- Risperidone (Risperdal)
- Olanzapine (Zyprexa)
They are “relative contraindications” to therapy and may need to be reduced or discontinued prior to treatment.
Prior to arranging for treatment, we would like to speak with you and discuss your current medical issues and medications. You should not adjust the dose or frequency of any prescribed medication without first consulting with your prescribing physician.
Dr. Steven Reichbach, our board-certified anesthesiologist, will have already reviewed the information received from your referring doctor as well as the intake forms you completed on our website. He will have also provided your recommended ketamine treatment care-plan to his staff.
Upon your arrival, you will have a physical examination, then brought to your private ketamine infusion room for treatment. Once your treatment is complete, we will schedule further appointments as needed.
Expectations coming in to the treatment do affect the experience, so it is helpful to know ahead of time that you will be safe and you will leave feeling much better.
- You MUST bring a Government-Issued photo ID with you for each appointment.
- You will be required to have a trusted friend or family member drive you to and from our center and stay with you during your infusion.
- You cannot drive or operate heavy machinery for 24 hours post treatment.
- Please wear comfortable loose clothing, so we are able to easily place the cardiac monitor leads under your shirt.
- You may bring headphones and listen to music of your choosing, preferably something soothing to you.
- Infusion times vary depending on the disease we are treating.
- You are encouraged to sit back and relax and pay attention to what you are feeling.
No. Some patients achieve long-term relief after one series of infusions. Others will find that infusions enhance the impact of antidepressants or provide initial relief that is then sustained by oral medicines, other therapies and lifestyle choices.
After the initial series of infusions, ketamine restores the brain to a healthy balance. Follow-up or “booster” infusions are provided on an as-needed basis for maintenance.
No. Patients have not reported any symptoms of addiction. In fact, we use ketamine to treat addiction, as it has been found to be remarkably effective in preventing withdrawal symptoms and medication cravings.
We accept all major credit cards and cash. We will offer Care Credit to assist our patients with financing.