Frequently Asked Questions About Ketamine
Ketamine is a nonbarbiturate first developed in 1962 and approved by the FDA as an anesthetic agent in 1970. It is possibly the most widely-used anesthetic in the world because of its high safety profile. It is this high level of safety that makes it unique amongst anesthetic agents. It is considered an essential drug by the World Health Organization. There has been significant research in recent decades on ketamine showing that it is exceptionally effective in treating treatment resistant depression, PTSD, anxiety, suicidal ideation, and some types of chronic pain, such as CRPS and neuropathic pain. It has emerged as a revolutionary therapy that is producng dramatic improvements in the quality of life for many. It is changing lives sometimes within hours, unlike traditional treatments which may take weeks to work, if at all.
It is not completely clear how ketamine works. What we do know is that ketamine is classified as a NMDA (N-methyl-D-aspartate) antagonist, meaning that it blocks that receptor from reabsorbing glutamate, a neurotransmitter. Consequently, the resultant surge in glutamate causes the release of BDNF (brain-derived neurotrophic factor). These growth factors help make new synaptic connections in your brain. That is, ketamine appears to work by helping the brain form new neural pathways within your brain enhancing your brain’s circuitry. This paves the way for healthier thought patterns and helps to increase your brain’s resilience to chronic stress. It also reduces the signals involved in inflammation. Most likely, ketamine works in several different ways, all at the same time.
What is known is that low-dose ketamine infusions offers hope. Thomas Insel, former National Institute of Health director, has stated that ketamine, given intravenously, may be “the most important breakthrough in antidepressant treatment in decades.”
While ketamine is not considered a first-line therapy for mental health disorders or chronic pain, it has been used off-label to treat severe cases that have not responded to conventional medications or therapies. Ketamine, delivered in low-dose infusions, creates unique conditions in the brain which trigger a cascade of events. Research has shown that this series of events helps to restore normal connectivity between key brain regions, relieving symptoms of many psychiatric and chronic pain disorders. Multiple mental health and chronic pain conditions have been treated successfully with ketamine IV therapy. Such conditions include but are not limited to major depressive disorder, bipolar, OCD, anxiety, suicidal ideation, postpartum depression, PTSD, neuropathic pain, migraines, phantom limb pain, cancer-related pain, and complex regional pain syndrome (CRPS). At Mindful Infusions of Tennessee we create a treatment plan that maximizes your chance of success based on your individual condition.
Side effects to low-dose ketamine infusions are generally minimal and self-limiting, most of which occur during the infusion period and abate shortly thereafter. These common side effects include, but are not limited to, elevation in blood pressure and pulse, enhanced muscle tone, nausea, perceptual disturbances, and certain dream-like states, all of which are usually transient. Medications are available to treat any untoward effects should they arise.
Every treatment regimen is unique for every patient, but there are some benchmarks that can be used to better understand how many infusions may be necessary. The number of infusions needed will be determined at the time of your consultation and will be adjusted, if necessary, depending on your response in order to obtain and maintain optimal health. We are flexible with the timing of all infusions to fit your needs. In some circumstances, we are also available by appointment after normal business hours to meet your individual needs.
Currently, research has shown that an initial series of 6 one-hour infusions over a 2-4 week timeframe seems to work best for most mood disorders. By strengthening neuronal connections, this initial series appears to play an important role in achieving longer-lasting benefits. After your prescribed initial course of treatments, most individuals seem to benefit from an occasional booster infusion, approximately once every 4-6 weeks.
Chronic Pain Disorders
Pain disorders are more difficult to treat and require longer infusions (2-4 hours) over a 1-3 week timeframe. CRPS patients often receive infusions for 5-7 days in a row. Migraine patients generally are treated with 1 or 2 infusions in order to alleviate symptoms. Other chronic pain treatments vary from 3-6 infusions over a 1-2 week timeframe. Follow-up or “booster” infusions vary depending on the patient response to treatment.
On the day of your first procedure, we ask that you do not eat or drink for 8 hours before your scheduled infusion to minimize the risk of nausea and vomiting. However, should you not develop any nausea or vomiting with your first infusion, then on subsequent infusions you may have clear liquids including black coffee (no cream) up until 2 hours prior to your procedure. Ketamine is administered IV anywhere from 60 minutes to 4-hours, depending on what you are receiving the treatment for. The proper dose is determined by your weight. You will remain awake since the amount of ketamine administered is not enough to cause a loss of consciousness. During the infusion, some patients experience a dream-like state, enhanced sensations, altered perceptions such as a feeling of disconnect from their body, or mild euphoria often difficult to describe. Most find the treatment very pleasant and generally have a short stay afterwards. Every patient will only be released to a responsible adult. You should refrain from driving an automobile, operating hazardous machinery, and making legal decisions for 24 hours post treatment.
For depression, anxiety, PTSD, and most mood disorders, the cost of each infusion is $500. For chronic pain, the infusions are longer, with the cost starting at ($700 – 2 Hours) ($900 – 4 Hours). A discount is given if a series of infusions are scheduled. The number and frequency of your infusions will be determined at the time of your initial consultation.
Low-dose ketamine infusions are safe and effective. Although it is sometimes abused recreationally, ketamine overdose or dependence is rare. At therapeutic doses, ketamine has a very low potential for dependency, unlike opioids.
While ketamine is not for everyone, there are really very few patients that are not a candidate. We do not prescribe ketamine to those who are pregnant or breastfeeding or have an active substance use disorder or those with psychosis, such as schizophrenia. Ketamine is also not indicated in those suffering from mild depression, or short-term situational depression (with the exception of post–partum depression). If you have serious medical problems, like uncontrolled high blood pressure, cardiac disease, neurological problems or pulmonary problems, a clearance will be requested from your primary care physician before undergoing treatment. We screen all our patients before embarking on a treatment regimen to determine its usefulness and safety.
While ketamine can be legally prescribed and administered “off label” by licensed physicians, the drug has only been officially approved by the FDA as an anesthetic and not as a treatment for depression with the exception of Spravato (esketamine). By way of comparison, an estimated 30% of all medications are prescribed “off-label,” including many cancer medications, and are frequently used by physicians even without FDA approval. Ketamine’s use for depression and chronic pain follows all required rules and regulations, and has safely and effectively been prescribed as a fast-acting depression and pain treatment for several decades. Mindful Infusions of Tennessee is managed by anesthesia professionals trained in the safe administration of ketamine.
Yes, you will need a driver to take you home after your infusion. Prior to your infusion you will be asked for the name and phone number of the individual who will be taking you home. Because we understand that arranging transportation can be difficult for many, we do allow you to take a ride-sharing services. However, if these modes of transportation are to be used, you will be required to remain at the clinic for a longer period of time prior to your departure in order to recover more completely.
Unfortunately, at this time most insurance companies do not cover the cost of ketamine infusions. All treatments are on a cash pay basis. We accept all major credit cards payable prior to each treatment. We will be happy to provide you with a superbill to submit to your insurance company for any possible reimbursement. You can even submit your superbill electronically through the Osmind app for out-of-network reimbursement electronically, with them filing it for you as a complimentary service.
We understand that most people are not familiar with ketamine and may want to research it in depth themselves. For this reason, we have included links to research relating to its safety & efficacy along with several articles of interest. These links can be found on our ketamine research page. Please reach out to us if you have any unanswered questions. We want you to be fully informed before commencing treatment.