Ketamine is a safe, effective anesthetic that has been in use worldwide since 1970 and has been listed on the World Health Organization’s Essential Medicines list since 1985. Multiple studies and trials run at Mt. Sinai, Yale and other prestigious universities and hospitals since 1990 have shown that ketamine is exceptionally effective in treating treatment-resistant depression, PTSD, anxiety, suicidal ideation, neuropathic pain and other related mood disorders. Unlike standard antidepressants like SSRIs and SNRIs which generally take 4 to 8 weeks to work (if they work at all), ketamine is fast-acting and can sometimes show immediate efficacy after a single intravenous dose. Because of its fast-acting nature, ketamine can be an extremely important tool in preventing suicide and immediately alleviating the suffering caused by major depressive disorder (MDD). More recently it has also been used to treat neuropathic pain and the symptoms of PTSD. The small doses and method of administration (intravenous infusion) used to treat depression patients differ greatly from those used in hospitals.
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. It is important to note for those considering ketamine infusions that many drugs are prescribed off-label, and an estimated 30% of all prescribed medications are not FDA approved for that particular purpose. Although it has shown the potential to help millions of people find relief from the crushing effects of depression and neuropathic pain, pharmaceutical companies have been hesitant to invest the tens of millions of dollars required to fund the extensive and expensive clinical trial process necessary to get official FDA approval. Since the drug is and will remain off-patent, no company can own the revenue stream. Efforts are being made to create a national registry of the thousands of patients treated by ketamine providers across the country to date which can hopefully pave the way for ultimate approval. With or without it, however, ketamine’s use for depression and neuropathic pain treatment follows all required rules and regulations, and has safely and effectively been prescribed as a fast-acting depression and pain treatment for almost a decade in private medical practices and some hospitals and HMOs.
Yes. Ketamine infusions for depression and pain are both outpatient procedures requiring no hospital admission. All infusions are administered in our office and all patients will have their own, private treatment room in which to receive the infusion and relax before leaving the office.
Not necessarily. Mild to moderate depression is often successfully treated by mental health professionals with antidepressant drugs and/or psychotherapy, which we encourage. The treatment of severe depression, major depressive disorder (MDD) and treatment-resistant depression is more difficult and requires a higher level of care, such as ECT, TMS or ketamine therapy. Ketamine infusion therapy is reserved for those patients with severe depression that is considered treatment-resistant or those with suicidal ideation.
Not necessarily. Mild to moderate depression is often successfully treated by mental health professionals with antidepressant drugs and/or psychotherapy, which we encourage. The treatment of severe depression, major depressive disorder (MDD) treatment-resistant depression and other mood disorders is more difficult and requires a higher level of care, such as ECT, TMS or ketamine therapy. Ketamine infusion therapy is reserved for those patients with severe depression and anxiety that is considered treatment-resistant, or those with suicidal ideation.
The patients we see are all considered treatment-resistant. That is, they have not responded to any available antidepressant medications and in many cases have not responded to ECT or TMS. While we cannot predict with certainty who will respond to ketamine, clinicians across the country have reported that roughly 70%-75% of patients who have not been helped by any other treatment do show a dramatic improvement in their mood with ketamine, and 3 out of 4 patients who present with suicidal ideation cease to have such thoughts. A meta-analysis by the American Psychiatric Association using data from multiple ketamine trials reported similar results, with 70% of treatment-resistant patients responding positively after receiving the initial round of low-dose infusions. We will usually know after the first two treatments if ketamine infusions will help you.
We cannot predict with certainly which patients will respond, but we’ve shown very good results for patients suffering from all of these conditions.
About an hour, with an additional half hour of quiet time before discharge.
Assuming you begin to feel better during the initial treatments, a total of six infusions is recommended within a twelve-day period, which will maximize the ketamine effect on new dendrite and synapse growth. Thereafter, patients are placed on a maintenance program and are asked to return when they feel it necessary for a single infusion booster. During the maintenance period, the duration of relief following the initial infusions and the first booster, and between subsequent single booster infusions, varies between patients. The average duration of relief between booster infusions is 4-6 weeks. There is no way to predict what your needs will be. Some patients find that as they go through this process, the time between boosters lengthens, prompting them to come in every other month, every 3 months, or even less frequently. In our experience, patients find ketamine boosters effective for as long as needed with no long-term side effects.
Most patients experience a mild dissociation or inner reflective experience that is generally well tolerated and often quite enjoyable. If you find it unpleasant in any way, we can make adjustments to minimize or eliminate any unpleasant sensations. Within 15 minutes of ending the infusion your thinking will be clear. There are no delayed “flashbacks.”
No. The low dose of ketamine you will receive does not cause any loss of consciousness.
The treatment is essentially pain-free. Other than a small prick while starting the infusion line, you will feel no pain and may even enjoy the experience.
Your thinking may be a bit cloudy and your walk a bit unsteady for an hour or two after treatment. You may also find that you will be unusually tired for several hours. Hopefully there will be a noticeable improvement in your mood shortly after beginning one or two infusions.
We don’t believe so. After the first year or so, many patients being treated for depression and mood disorders find the need for booster infusions decreases over time. In the meantime, several large pharmaceutical companies are sponsoring clinical trials with ketamine-like drugs for more convenient nasal and oral administration. It may be a few years, but those drugs will likely become available. But for now, patients with debilitating severe depression with constant thoughts of self-harm often cannot afford to wait. Currently, ketamine infusion therapy is the most exciting and successful new treatment for severe depression, MDD, and suicidal ideation and is the subject of many ongoing trials.
Yes. Benzodiazepines, such as Klonopin, Xanax, and Ativan do interfere with ketamine if used daily and at higher doses. Lamictal (lamotrigine) in doses above 150mg/day also can block ketamine efficacy.
Not at all. SSRIs and other antidepressant medications do not interfere with ketamine’s mechanism of action.
Almost none. Uncontrolled high blood pressure or heart failure need to be corrected in advance. Regardless, all patients will be closely monitored while undergoing treatment.
We’ve treated almost 2,000 patients and have seen no instances of ketamine addiction. Ketamine has been used safely for surgical anesthesia and trauma management in hospitals and elsewhere for over five decades, has been included on the World Health Organization’s Essential Medicines list since 1985, and has few side effects. Although it is sometimes abused recreationally in high doses as a “club drug,” there is no evidence that ketamine is addictive.
Depression treatments require a very low dose, so hallucinations and any uncomfortable side effects that may come with much higher doses are extremely rare. Ketamine has few other side effects.
True emergencies, with a psychiatric referral, and those suffering from suicidal ideation that require prompt attention can usually be seen within a day. In general, we prefer to schedule patients 5 to 7 days in advance. Since our offices are open seven days a week and we open early and close late, we can meet most patients’ scheduling needs.
The fee for our consultation and initial treatment for mood disorder patients is $450. Additional treatments, if necessary, will also be billed at $450. This fee is all-inclusive with no additional charges. We accept all payment methods and provide financing options if necessary. While we do not accept insurance, some insurance companies will cover all or a portion of the treatment as an “out of network” service. If so, we will gladly provide you the necessary forms to submit to your insurance company for potential reimbursement. Our experience shows that about 30-35% of patients are receiving some reimbursement.
We also offer affordable financing options to our patients, available through Advance Care, a medical funding company. For details please call them directly at 800-432-9470, or visit their website at advancecarecard.com.
Veterans of the United States military suffering with depression, MDD or PTSD are encouraged to call us for special fee consideration.
You do not need anyone to accompany you, though they are certainly welcome. You may also leave on your own following our evaluation, but we recommend that a friend, relative or caretaker accompany you home, if possible. We also recommend not driving until the following day.
You can eat, but you should not have any food within one hour of your appointment.
Yes, WIFI is available throughout our entire office and in all treatment rooms. Most of our patients bring their own devices and earbuds or headphones to listen to music while undergoing treatment. We strongly discourage using your devices to make phone calls, texting or emailing during the treatment. Those accompanying you are welcome to bring laptops, iPads, iPods and cellphones as well.
Yes. Our offices are all handicap accessible and ADA compliant.