Ketamine has been a game changer for many who have suffered with treatment resistant depression, obsessive compulsive disorder, post traumatic stress disorder, and suicidal ideation. These conditions can be debilitating and here at Tri-State Progressive Health, we understand the need for relief and aim to offer hope when traditional therapies have failed.
The "how" of ketamine is an item of continued research. It acts on NMDA receptors in the brain which increases the neurotransmitter glutamate in the spaces between neurons or synapses. Glutamate then activates connections in the AMPA receptor. It is thought that the initial blockade of NMDA receptors and activation of AMPA receptors lead to release of other molecules that help neurons communicate with each other along new pathways, a process known as synaptogenesis, which likely affects mood, thought patterns and cognition. Some studies have shown anti-inflammatory properties as well with ketamine interacting with inflammatory cell recruitment, cytokine production, and regulation of inflammatory mediators.
The first step is an initial consultation to determine appropriateness of treatment, personalized dosage, and treatment duration. We will review your medical records and ask about medical history. Research has shown remarkable efficacy, but it is important to remember ketamine is a tool, not a cure-all and is best utilized side by side with ongoing integration therapy in order to empower you to achieve the greatest healing.
There are a few options for treatment, the most common and preferable is via an IV infusion though in some instances, intramuscular injections and oral options may be utilized. Each treatment takes place in our private infusion room which has been designed to maximize comfort and provide for an optimal experience, with comfortable reclinable seating, dimmable lights, and soothing décor. You will be accompanied and monitored throughout the process by a physician or nurse practitioner. If you want, you can have someone accompany you in the room though we recommend guests avoid conversations during treatment. For infusions, an intravenous catheter is placed, and the medication is administered over a given time period. Dosage and time will vary based on the individual, history of previous treatments, and condition being addressed. Generally, for mental health, infusions last about 45-60 minutes. In this setting, low dose ketamine is used. You can expect to feel deep relaxation and some degree of dissociation, which allows for the opportunity to relax and remove yourself from sensations of pain, both physical and mental. Most find the experience pleasant. The infusions are sedating, and some patients experience fatigue afterward, so having a safe ride home is a good idea. After the infusion, you will be monitored until fully recovered and ready to leave.
While proven to be safe when delivered by trained medical professionals in appropriate doses, all drugs have side effects. With ketamine, most side effects go away within an hour of treatment and your provider can offer dose adjustments or treatments to help minimize any unpleasantness. Most common side effects include:
Treatment is not indicated for those with:
Patients at higher risk for exacerbation of their underlying conditions include those with:
Efficacy of ketamine in reducing depressive symptoms patients actively taking benzodiazepines (Ativan, Valium, Klonopin, Xanax) is markedly reduced.
Many patients feel better during treatment or immediately thereafter, but results can vary person to person. Studies have shown that ketamine relieves depressive symptoms for 75% of patients with depression after the intial infusion series.
Most of the research has focused on an initial 6 infusion induction series, though the American Psychiatry Association suggests an initiation series of four infusions within a two-week period as a large number of people who see improvement do so by the fourth infusion. Here at Tri-State Progressive Health, we start with the four infusion series, with additional infusions added to this course on a case-by-case basis as needed. Ongoing care is tailored to the individual and guided by monitoring of symptoms. On average, most patients experience relief in depressive symptoms for about 6 weeks.
For your first consultation it helps to have necessary forms filled out prior to evaluation to save you time. Forms will be available on our website including an intake form with health history questionnaire. In addition, we will need:
For treatments
For anyone aged 16-18, a specific referral from a psychiatrist is required. For adult patients, a referral is strongly preferred, but we will consider patients without a referral on a case by case basis. Additionally, we recommend concurrent treatment by a mental health professional as research has shown ketamine to be most effective when accompanied by continuous therapy.
Currently, based on the best available evidence, we have decided not to offer Spravato, though we remain open to consideration in the future.
While very effective, ketamine is not currently FDA approved for the treatment of depression syndromes or chronic pain, therefore, it is generally not covered by insurance. There are some instances where insurance will reimburse some of the cost per infusion, and we are happy to provide a superbill to submit to your insurance company for possible reimbursement. It is possible to utilize health savings accounts or flexible spending accounts for ketamine treatments.
Initial 4 infusions over 2 weeks, a 15% discount when paid as a package
Initial 4 infusions, up to 3 boosters as needed over the next 6 months, a 15% discount when paid as a package plus discounted rate of $250 for any additional boosters
IM injection, with monitoring period, 1.5 hours on average
Series of 4 IM boosters, 15% discount when paid as a package
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