Is ketamine right for me?
What happens during a ketamine treatment?
Who is most likely to respond to ketamine therapy?
The most common characteristic of people who respond well to ketamine infusion therapy is presence of severe and prolonged symptoms of depression, which are not relieved by other treatments. Ketamine often rapidly reduces suicidal thoughts and wishes, in persons with severe depression. Ketamine is also frequently effective in persons with severe anxiety disorders. There is no evidence of differences in effectiveness of ketamine based on gender, race, age, or other factors.
Who should not receive ketamine treatment?
Ketamine has not been adequately studied as an initial treatment for depression or anxiety. Other treatments should almost always be tried before ketamine.
Persons who are actively abusing alcohol or other drugs are unlikely to respond to ketamine, and may be at greater risk of adverse effects. These persons should seek appropriate assistance, to achieve a period of abstinence, prior to ketamine treatment.
Ketamine usually results in a mild increase in blood pressure and heart rate, lasting for 1 – 2 hours. For this reason, persons with severe and uncontrolled high blood pressure should not receive ketamine until the blood pressure is under better control. Ketamine should also not be given to persons with conditions which could be worsened by a brief period of elevated blood pressure.
Persons with sleep apnea can be safely treated with low doses of ketamine. However, relief of depression is less likely, unless the sleep apnea is also treated.
Office-based ketamine therapy is not recommended for persons receiving high doses of prescribed narcotic pain medications, due to increased risk of respiratory depression.
Benzodiazepine tranquilizers and sedatives, such as Xanax (alprazolam), Valium (diazepam), Klonopin (clonazepam) and others, may reduce the effectiveness of ketamine therapy. If possible, these medications should be reduced or discontinued prior to ketamine therapy.High doses of tranquilizers should not be stopped without medical supervision.
Ketamine therapy is not usually recommended during pregnancy, because the possible risks of harm to the fetus are unknown. Breastfeeding should be avoided for 12 hours after a ketamine treatment.
Ketamine is not used for treatment of schizophrenia, because it may worsen the condition.
More about chronic pain and ketamine.
A few studies have described ketamine infusions for treatment of certain chronic pain conditions, including fibromyalgia and complex regional pain syndrome (CRPS), also called reflex sympathetic dystrophy (RSD). Short-term reduction of pain has been achieved by some, but results are mixed.
We have observed patients who experience improvement of chronic pain with low doses of ketamine, when it is used for treatment of depression. While further research is needed, we believe that ketamine infusion therapy is sometimes effective for temporary reduction of chronic pain, especially when significant depression is also present. Unfortunately, there is no evidence of long term or permanent pain relief, as a result of ketamine treatment. For patients with chronic pain conditions, consultation and continued treatment with the patient's primary care physician or pain management specialist is essential.
How do I prepare for a ketamine treatment?
All patients must be accompanied by a designated driver, or treatment will not be provided. Do not plan to return to work or school, drive, make important decisions, or operate machinery during the rest of the day. An excuse will be provided if necessary.
You may eat or drink lightly, but please do not eat a heavy meal prior to treatment.
Do not use alcohol, narcotics, tranquilizers, or sedatives before a ketamine treatment. Discuss with Dr. Jackson, if you are regularly taking prescribed narcotic pain medications.
Please call to reschedule your treatment if you have a fever, or if you are suffering from influenza or another acute or contagious illness.
If you wish to listen to music or watch a movie during your treatment, please bring your own player and headphones.
Describe a ketamine treatment.
Ketamine is administered in our office. You will be asked to sign a consent, indicating that you are aware of the nature of the treatment and its possible side effects. A small needle is placed in a vein, usually in a forearm. The patient is seated in a comfortable recliner. The medication is given slowly, over about 40 minutes. During the treatment, the patient is monitored by nursing staff, and the physician is also present. If the patient wishes, a family member or friend may be present. The patient may sit quietly, or may talk or listen to music. The patient usually remains awake and able to remember the treatment. The entire treatment requires about an hour.
What happens after the treatment?
When the treatment is completed, the needle is removed. The patient is observed for a short time. When stable, the patient may go home. Patients often experience improved mood and reduced pain within minutes to a few hours after treatment. Driving, operation of machinery, and making legal decisions are prohibited for the rest of the day. Otherwise, the patient may resume normal activities when the effects of the medication have passed.
What side effects will I experience?
Ketamine is rapidly removed from the body. Any side effects normally resolve within a short time after completion of the treatment.
Patients often feel unsteady, clumsy, mildly intoxicated, or dizzy during and after the treatment. Some patients may experience drowsiness, anxiety, dreams, or other unusual feelings. Nausea or vomiting may occur rarely.
Ketamine infusion usually causes a brief, usually mild, increase in blood pressure and heart rate. These are monitored, and resolve quickly after treatment is stopped. The rate of treatment and dose may be adjusted, if necessary.
Ketamine does not interfere with breathing or respiratory drive, especially at low doses, and in the absence of other sedatives or narcotics. Allergies to ketamine are rare.
When ketamine is used for surgical anesthesia, it is given in much higher doses, along with other anesthetic drugs, to produce deep sedation, amnesia, muscle relaxation, and to reduce secretions. Upon awakening, a short period of agitation, confusion or hallucinations may occur. These have not been observed with use of low dose ketamine in office treatment of psychiatric conditions.
People who use ketamine illegally often consume extremely high doses daily, over months or years. Some of them eventually develop severe bladder inflammation. This uncommon adverse effect has not occurred among patients treated with ketamine for anesthesia or depression.