Ketamine Infusion @Kyle ER

What is Ketamine

Ketamine is a very safe anesthetic that has been used for the last fifty years, all over the world, in much higher doses to put patients to sleep before surgeries. Recently, evidence emerge suggesting that low dose therapy is very effective for mood disorders and chronic pain treatment. Such doses are often 4-6 times smaller than what is administered for anesthesia.

During the Treatment: Ketamine Side Effects

The infusion will be done in a monitored bed in a hospital setting, where Vital signs, and patient condition will be closely monitored by our experienced nurses and physicians.

During the infusion, you will be encouraged to get comfortable. Many people listen to calming music. Feel free to bring any family into the room. Talking and excessive stimulation is often discouraged, especially during the first treatment. If you need to use the restroom, please inform the infusionist so that you may be assisted as needed. At all times, you will be able to move and walk; nevertheless, Ketamine can impair your balance, and you will be connected to an IV, so it is important that you ask for assistance before walking. As a side note, while the nurse or physician is in the room to check on you, it is important to let them know of side effects during the infusion like nausea, feeling faintness or a headache.

Like the quick onset of dissociative sensations near the beginning of the infusion, you will find that these sensations dissipate rather abruptly near the end as well. After your infusion, you may feel groggy and that is why having a driver or other third-party transportation is essential after the infusion. Most times, the grogginess completely dissipates within 3 hours after the infusion and very rarely lasts into the next morning. Of note, alcohol can contribute to a continued groggy feeling the next morning so please abstain from drinking alcohol before or after Ketamine therapy. A similar effect is possible with benzodiazepines such a Xanax, Ativan, Klonopin, Valium, and Librium — be careful to avoid these to prevent side effects. Because this description is meant to be succinct, writing down any outstanding questions and having a thorough discussion is recommended before the first Ketamine treatment.

Ketamine Infusion Experience

At the beginning of the infusion, you may not feel the Ketamine immediately but after a few minutes, you may experience a benign tingling sensation in your lips and/or extremities. Soon after, some patients describe a sense of “feeling heavier”. Sometimes, patients feel they are lighter, and “hovering” over their bodies You may even feel as though your mind is detached from your body. Though this sounds quite strange, most patients find this calming and even soothing and very rarely do patients feel uncomfortable. Some patients express concerns about a “bad trip” or “hallucinations,” but really those words are not appropriate given Ketamine is a dissociative anesthetic rather than a hallucinogen like LSD or psilocybin mushrooms. In as much, Ketamine has not been shown to directly affect the same receptors that are affected by popular hallucinogens. Rather, patients may have mild illusionary experiences, meaning that light or other senses are perceived in a less than normal or enhanced way. ¹ Therefore often in preparation for infusion, light will be minimized by dimming, providing the patient with an eye mask, or other various ways. On the other hand, do not be surprised if you do not feel these effects as is the case with many patients. The evidence is still lacking as to whether these illusionary experiences are correlated with better response, so it is important to let expectations go if you are getting an antidepressant response.

IV Ketamine vs. Other routes of administration

We use IV Ketamine because intramuscular and intranasal routes have unreliable and variable absorption from patient to patient. IV administration is also preferred over other routes because of the most robust trials to date use IV Ketamine.

How many infusions do I need?

There are many protocols for Ketamine use. When used for depression, it is usually given 2-3 times a week, for 2-3 weeks. The evidence show that after 2 weeks of treatment, patients treated with ketamine 2 times weekly showed a 69% rate of response and 37.5% rate of remission.

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References
Krupitsky EM, Grinenko AY. Ketamine psychedelic therapy (KPT): a review of the results of ten years of research. J Psychoactive Drugs. 1997;29(2):165-183.
Singh JB, Fedgchin M, Daly EJ, et al. A double-blind, randomized, placebo-controlled, dose-frequency study of intravenous ketamine in patients with treatment-resistant depression. Am J Psychiatry. 2016;173(8):816-826. doi:10.1176/appi. ajp.2016.16010037.