Studies indicate that Ketamine infusions may help patients with treatment-resistant severe depression, suicidal ideation, bi-polar depression in non-manic phase, Post Traumatic Stress Disorder (PTSD), and major depressive disorder. Ketamine infusions may also help some patients with Reflex Sympathetic Dystrophy (RSD) – now called Complex Regional Pain Syndrome (CRPS). Ketamine infusions do not guarantee successful symptom relief for depression or CRPS/RSD. However, thousands of patients treated with ketamine have shown significant improvement in their symptoms. You can read more about what ketamine is and how it works in What is Ketamine?.

Addiction has not been seen in ketamine infusion therapeutics given the dose used, treatment schedule, supervised medical setting, and lack of withdrawal symptoms.  Ketamine is currently also being used to treat addiction in some instances at treatment centers throughout the US.  Ketamine has a proven track record of being an FDA-approved anesthetic medication since the mid 1960’s.

It is important during the Initial Medical Evaluation with the physician to determine if any interactions amongst your present daily prescribed and over the counter medications and nutritional supplements may occur.  Instances are very rare, but we evaluate each patient’s unique situation individually with a board certified physician.

Two types of medications may commonly interfere with your ketamine therapy: medications in the Benzodiazepine class and Lomotrigine (Lamictal).

Benzodiazepines, which includes medications like Diazepam, Clonazepam, and Alprazolam, have been shown to decrease the efficacy of ketamine.  This is likely caused by the Benzodiazepines inhibiting or decreasing the neuroplasticity and the dendritic spine growth amongst the nerves after the ketamine infusion has stopped.  The latest studies indicate that dosages over 7.5mg of diazepam or equivalent to diazepam per day is the dosage at which this may become an issue, but smaller dosages do not appear to have the same issue.  Conversions about your specific benzodiazepine use will occur with one of our physicians.  It might be appropriate for some patients to wean down the levels of Benzodiazepines they take daily or to completely wean off of their Benzodiazepines.  We insist that this be done in coordination and under the care of the physician who prescribed these medications.

Lamotrigine (Lamictal) is a medication used as a mood stabilizer that works at the NMDA receptor and competitively blocks how Ketamine interacts with that receptor and can block the efficacy of ketamine.  We traditionally ask that our patient’s hold the Lamotrigine for 24 hours before and 12 hours after the ketamine infusion.  It is important to discuss these changes to your medication regimen with your prescribing physician.

Individuals who drink more than two alcoholic drinks per day may experience similar blocking of dendritic spine growth.  We discuss the usage of alcohol and the intake levels on a regular basis during your Initial Medical Evaluation to determine if the amount may cause decreased efficacy of the ketamine infusion therapy.

Any medical condition that is not well managed may preclude you from treatment. Uncontrolled high blood pressure or any serious cardiac or respiratory conditions need to be disclosed during your treatment to avoid complications. An attending physician at MindPeace Clinics will review all your conditions and medications with you at your Initial Medical Evaluation.  We encourage patients to provide a list of all of their medical conditions on their patient intake form, for the physician to review prior to their Medical Evaluation.

Some patients have reported mild, short-lived dissociative symptoms during their infusions. While not unpleasant usually, some effects of floating, blurry visual changes, and dizziness can occur. Some patients have reported nausea during the infusion. These effects can be treated with other medications to make you more comfortable during your infusion.

Yes, we provide other medications as needed to help with side effects of the Ketamine.  The physician will discuss all medications with you at the beginning of each appointment.  

No, IV administration of ketamine has been found to be the most effective.  Studies have found that the nasal Ketamine sprays and oral medications are not as effective. Oral medication typically gives patients 20-25% of the effective dose, while the nasal sprays typically gives patients 30-50% of the effective dose.  

During the Initial Medical Evaluation, we establish a baseline with digital mood monitoring, and have you complete clinically validated surveys based on your treatment protocol. We define success as 50% improvement based on these scales.  We have you complete these questionnaires throughout your initial series of treatments and into the booster phrase. 

Often, close friends, loved ones and even coworkers might notice subtle improvements in mood prior to your awareness that the Ketamine infusions are beginning to work.

We strongly encourage our patients to complete the initial series of infusions to ensure the greatest chance of success and longevity of symptom remission.  We base our practice on the latest published articles and the work being done at the National Institute of Mental Health.  If you have any questions regarding your care, we encourage you to schedule a time to speak with the physician to ask about adjusting your treatment plan.

The published rates of success vary from 62% to 85%. In our practice, we have seen success of approximately 75% across patients who complete all six Ketamine infusions.  When we published our paper in September of 2022, the overall results of this study showed 72% of patients responded (50% or more resolution of symptoms) and 38% were in remission for depression after ten infusions.  Eighty five percent of patients experienced complete resolution of suicidal ideations after 15 infusions.

The overwhelming majority of these patients continue to have remission of their symptoms with “Booster Infusions” provided on an as needed basis.

Many first-line treatment options are medications in pill form. It can take several weeks to a few months to determine if they are affecting a patient’s mood, and they may depress your mood for the first few weeks. Many of these medications have side effects that include weight gain, sexual dysfunction, interruptions in sleeping patterns, and blunting of emotions. Some other medications that may be added onto other medications may cause diabetes.

Non-medication options may include:

• Transcranial Magnetic Stimulation (TMS) Therapy, which uses magnets on the outside of your head to attempt to stimulate brain cells to improve your mood. The exact mechanism of action isn’t well understood. This course of treatment isn’t invasive, but requires treatment five days a week for up to six weeks. Each session lasts approximately 20-40 minutes.
• ElectroConvulsive Therapy (ECT) works by putting you to sleep and inducing a seizure in your brain. You are sedated using medications, so that your body does not shake. Many individuals who undergo an initial series of ECT have depression relapse and require additional sessions. The mechanism of ECT is not well understood, but one major side effect can be permanent memory loss.

Ketamine is safely used daily in Emergency Departments and operating rooms both in the United States and around the world. Administering this medication requires a set of skills with emergency airway, cardiac, and vascular management, which are possessed by physicians working in a hospital based setting.

We request that you continue your relationship with your primary care provider. Our physicians will reach out to speak with them on an as needed basis regarding any care provided related to non-infusion related care.  

Our physicians will consult with your psychiatrist and other mental health providers on an as needed basis. We ensure that the ketamine infusions are provided in a safe environment, with experienced critical care and emergency registered nurses, and a board-certified physician.