Ketamine is a medication that was first synthesized in 1962 and approved by the U.S. Food and Drug Administration (FDA) for anesthetic use in 1970. It has a variety of medical uses, with the most common being for induction, maintenance and as an adjunct of anesthesia. It is referred to as a dissociative anesthetic because it can distort perceptions of sight and sound, making the patient feel detached from their environment. Ketamine has a remarkable safety profile that does not slow the patient’s breathing or heart rate like other anesthetic medications. For this reason, it is safely utilized in surgery for adults, pediatrics, obstetrics, trauma and veterinary medicine.
Ketamine is a noncompetitive N-methyl-D-aspartate (NMDA) and glutamate antagonist. Research has shown the NMDA receptor has a significant role in the cause of depression. Ketamine, through its NMDA antagonistic action, can work rapidly in controlling symptoms of depression and acute suicidal ideation. In people with long term depression and stress, it is thought that the brain may prune or lose connections between neurons (basic working unit of the brain). Research shows that within 24 hours of a ketamine treatment, synaptogenesis begins to occur. This is the formation of synapses or connections in the brain that allow nerve cells to communicate. The more synapses or lost connections that start to regrow, the better the antidepressant effects. Ketamine also may increase glutamate and brain-derived neurotrophic factor (BDNF) levels, which exerts antidepressant-like effects.
The most commonly prescribed antidepressant medications are called selective serotonin reuptake inhibitors (SSRIs). Only about 1/3 of people with major depressive disorder achieve remission after treatment with SSRIs. If the first SSRI is not effective, a different one can be tried or a second one can be added. Almost 70% of people with depression will be able to achieve remission after trying different SSRI options or combinations. Unfortunately, the remaining 30% of people will not be able to find a treatment that works and are said to have treatment resistant depression (TRD).
According to research studies, ketamine infusions can be an effective treatment for 70 to 80 % of individuals with TRD. Unlike SSRIs, which can take weeks or months to begin taking effect, a single dose of ketamine may produce antidepressant effects within a few hours. Although the effects of ketamine usually last for several weeks, some people can remain depression free for months.
Ketamine is generally safe when administered under the supervision of a licensed, certified provider specially trained in appropriate management. Prior to receiving an infusion, a physical assessment is performed and a thorough history is obtained. Your heart rate, blood pressure and oxygen level are monitored continuously throughout the infusion. Ketamine has a remarkable safety profile that does not slow the patient’s breathing or heart rate like other anesthetic medications. For this reason, it is safely utilized in surgery for adults, pediatrics, obstetrics, trauma and veterinary medicine. The doses used to treat depression and other mental health conditions are subanesthetic or much lower doses than required for anesthesia. During the infusion, patients may feel some mild dissociation or detachment from their environment. Patients may also experience a temporary increase in blood pressure and heart rate, which are continuously monitored. Other possible side effects include: increased salivation, nystagmus or blurred vision and nausea. All side effects are gone approximately two hours after the infusion is stopped.
The ketamine doses used to treat depression and other mental health conditions are subanesthetic or much lower doses than required for anesthesia. Due to these lower doses that are administered in a healthcare setting under the supervision of a licensed, certified provider specially trained in appropriate administration, there is virtually no potential for addiction or abuse. According to the American Society of Ketamine Physicians, caffeine, alcohol and nicotine all have a higher potential for dependence.
Ketamine infusion therapy is not recommended for patients diagnosed with psychosis, schizophrenia or schizoaffective disorder. You are not a candidate if you have an ongoing addiction to or misuse of alcohol or illicit drugs, including marijuana. Ketamine can interact with illicit drugs and alcohol in a manner that produces unpredictable reactions and possibly psychosis. If you are pregnant or receiving dialysis, you are not eligible for treatment. If you have cardiovascular disease or pulmonary issues, medical clearance may be required from your primary care provider prior to beginning your ketamine treatments. Blood pressures must be well controlled before treatment begins.
Ketamine infusion therapy is not for those suffering from temporary or situational depression. Therapy is geared toward those who have failed first line treatment and have been referred to Hoosier Ketamine & Wellness by their mental health provider.
Patients must participate in an initial consultation with one of our clinicians. This consultation will take place prior to the first infusion and is usually completed as a phone call. During the consultation, one of our clinicians will review the patient’s current medications and symptoms, discuss the treatment and potential side effects, as well as address any concerns or questions. Afterward, if the patient wishes to proceed with an infusion, they may schedule their first visit.
Individuals who are 18 years and older are eligible to receive treatment.
Unfortunately, ketamine infusion therapy is not covered by most insurance companies. It has been approved by the U.S. Food and Drug Administration (FDA) for anesthetic use since 1970, but is not currently approved by the FDA for treatment of mental health conditions. When used to treat depression, it is considered an “off-label” use. Off-label prescribing is when a medical provider gives you a drug that is FDA approved to treat a different condition than yours. This practice is legal and common as one in five prescriptions written today are for off-label use.
Although recent research has shown overwhelmingly positive results from ketamine infusion therapy, FDA approval requires large, costly trials. Since the medication is very old, the patent has long since expired. This means manufacturers other than the initial developer may take advantage of an abbreviated approval process to introduce lower-priced generic versions of ketamine. As a result, pharmaceutical companies that usually pay for the trials have no incentive to invest the time and finances required to get ketamine FDA approved to treat mental health conditions.
Ketamine treatment costs vary depending on the condition treated, infusion time, medication dose and number of infusions needed. Please contact us to learn more about pricing for a treatment individualized for your specific needs.
Unfortunately, ketamine infusion therapy is not covered by most insurance companies. As a result, Hoosier Ketamine & Wellness does not bill insurance. We do require treatments to be paid in full at the time of service; however, we are happy to provide a “superbill”, which is essentially a medical receipt, that can be submitted to insurance companies for possible reimbursement. The majority of Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs) can be used. We have also partnered with Advance Care for medical financing. They work diligently to provide patients the most affordable options to finance their procedures or treatment plans. Their programs provide interest free financing, affordable monthly payments and flexible terms. Please click here to be taken to our finance page, you will receive an answer almost immediately.
Yes – Hoosier Ketamine & Wellness providers work in collaboration with mental health providers to create a customized plan that treats the whole person. Ketamine therapy is not a cure, but rather a very successful and fast acting treatment that research shows can help 70-80% of people who have not been helped by first line treatments. Ketamine therapy has been shown to be especially effective when used in conjunction with other forms of therapy offered by mental health providers. Since our treatments are intended to work as a supplement, we ask that all our patients continue to follow up with their licensed mental health provider while undergoing ketamine infusion therapy.
Most medications do not need to be stopped prior to ketamine treatment. Benzodiazepines (such as Klonopin, Xanax, Restoril, Valium and Ativan) and narcotics (pain medications) can interfere with the effectiveness and safety of a ketamine infusion. Patients that are prescribed these medications should try to time their infusions for first thing in the morning prior to taking their benzodiazepines or narcotics.
A Hoosier Ketamine & Wellness provider will discuss specific recommendations with you prior to receiving a ketamine infusion. Do not stop taking scheduled medications without discussing it with the medical provider prescribing your medication first.
We ask that you stop eating for 6 hours and stop drinking for 2 hours prior to your scheduled infusion. You may drink clear liquids such as: water, fruit juices (without pulp), carbonated beverages, Gatorade, tea (without cream) and black coffee up until 2 hours before your infusion.
Absolutely avoid alcohol or the use of any illicit drugs. These substances are extremely dangerous in combination with ketamine.
Please plan on being at the clinic for 1.5-2 hours for an infusion. We estimate 15-20 minutes for paperwork, medication preparation, and an IV placement, 45 minutes for the infusion, and at least 30 minutes of monitoring post infusion.
On the day of your procedure, please arrive 15 minutes prior to your appointment, so you have time to complete any required paperwork. Once all paperwork is completed, a staff member will take you to a private room. We ask that you use the bathroom at this time, as you will not be able to once your infusion has started. You may choose to bring a family member, friend, or if you prefer, your psychotherapist/counselor into the room with you.
Once you get to your room, you can take your shoes off and get comfortable in our recliners. Your vital signs will be continuously monitored throughout the infusion. The nurse will put a blood pressure cuff on your arm or forearm, a pulse oximetry monitor on your finger to monitor your oxygen level and if you have a cardiac history, you may also have EKG patches to monitor your heart rhythm and rate.
You will have a few minutes to set up your music or visual preferences as we prepare your infusion. Once prepared, an intravenous (IV) catheter will be placed in a vein. We ask that you wear loose, comfortable clothing on the day of your infusion and that you either wear short sleeves or sleeves that can be rolled above the elbows. Generally, the infusion will run through an IV in your hand, but if we are not able to obtain access via your hand, we will use a vein in the crease of your elbow. After the IV is placed, the infusion will begin. We encourage you to bring items from home that provide you comfort. If you forget or choose not to bring these items, most can be provided for you. Suggestions of what to bring include: a device to play music, headphones, eye masks, a soft blanket, a neck or regular pillow, comfortable clothes and shoes, and sunglasses to wear after the infusion as you may be sensitive to light. The medication will infuse over approximately 45 minutes.
At the start of the infusion, you may not have noticeable effects. As the infusion progresses, you will not lose consciousness and should feel relaxed. Most patients experience a dissociative effect, which is an out of body experience where they partially lose awareness of their body. It has been described as a feeling of “lightness” or “floating”, which some say feels as a “weight being lifted off their shoulders”. Most patients find this bizarre, but pleasurable and the experience is generally well tolerated. A staff member will be checking on you throughout the infusion at regular intervals to monitor your vital signs. After every infusion, patients are monitored for at least 30 minutes before leaving the clinic. Patients must not operate heavy machinery or a vehicle for 24-hours. All patients have to arrange transportation or a ride home after each infusion.
After the infusion, you may notice positive effects in as soon as 30 minutes, but typically improvements begin several hours post-treatment.
The effects of a single infusion typically can last up to two weeks. After a series of six infusions, some people can remain symptom-free for several months. We offer the option of booster infusions, which can be given monthly or a few times per year as needed.