Much of the research done over the past two decades has shown that intravenous (IV) ketamine at low to moderate doses has been shown to have rapid and remarkable benefits on about 70% of those suffering from severe depression or treatment-resistant depression (TRD). There’s no doubt that the benefits of ketamine are remarkable and very real when it comes to depression.
For our mood disorder clients (depression, bipolar, anxiety, PTSD, etc.), and during the acute phase of your symptoms, your treatment plan will include 6 office visits with 1 infusion per visit for a total of 6 tailored infusions over the course of 2-4 weeks. After meeting with the specialist and reviewing your unique case, we will establish a series of infusions at your calculated ketamine target dosing with the goal of slowly increasing your dose with every injection to maximize your relief of symptoms. By giving IV infusions with our unique dosing protocol and schedule, we can safely administer ketamine with one goal of safely and effectively relieving your suffering.
Some patients can see improvement the day after their first Infusion but some may not see benefits until after their 2nd or 3rd infusions depending on the severity of their symptoms. On the first infusion, we want to get your body and mind used to ketamine by giving you a low to moderate dose. This will allow us to see how you respond and tolerate ketamine injections. However, our goal will be to safely increase your dose with every injection until you experience relief or remission of your suffering or we hit your maximum pre-calculated target dose. This unique dosing protocol will be optimized to your response to the series of ketamine infusions and give us the best chance of relieving your suffering and ending your struggle with depression, anxiety, and other negative symptoms.
PLEASE READ: It’s important for you to understand that the greatest benefits of ketamine often occur at low to moderate dosing. For some people, these doses can come with some very short-term discomforts including dissociation, anxiety, fear, worry, nausea, a short spike in blood pressure, or a sense of unease that only lasts about 10-15 minutes. On the other hand, others may feel more relaxed with a sense of wellbeing and a feeling of being more connected to self and others. It’s impossible to predict how you will respond to ketamine until you actually experience it.
Regardless of a good or bad ketamine experience with each infusion, you will most likely still obtain the full benefits of ketamine. Regardless of your experience, we will be there to help and guide you through this and offer support or calming medications when needed. The peak of ketamine’s effects occurs about 10 to 15 minutes after your infusion. The peak is when you get the full benefits of ketamine and there is a strong correlation with those that do have an altered state of mind and dissociative experience with receiving greater relief and even remission from their symptoms.
Initially, We will need to complete a medical and psychiatric history in our online forms followed up by an initial consultation by a ketamine infusion/injection specialist, who is licensed and trained in ketamine Injections. During the initial consultation, we will determine if your medical, physical, and psychiatric history make you a good candidate for ketamine infusions and treatment. If you’re a good candidate, you may start receiving your treatments ASAP. You can expect to be at the treatment center for about 1-2 hours prior to having a friend or loved one drive you home. You may not drive yourself home after your IInfusions as this is extremely dangerous! You will need to wait for at least 12hrs before driving any vehicle and will need to have a ride home, no exceptions! The process is a step by step process as follows:
1. Before your Injection: a specialist will assess how you’re doing and feeling.
2. Then to ensure your safety, we will apply monitors that allow us closely assess and monitor your blood pressure, respiratory rate, heart rate, and oxygen levels, which will continue to be monitored throughout the course of your injections.
3. Next, you will receive a pre-calculated dose of ketamine based on safety and your unique treatment plan. You will receive this as an injection in the soft part of your upper shoulder area (deltoid muscle). This will be with a tiny needle (30 gauge) and will only take about 5 seconds to inject the medicine. Many people don’t even feel the injection but some can experience some minor discomfort for a few seconds during the injection.
4. After the injection, we will continue to monitor your vital signs and your response to the ketamine throughout the duration of your session. You may sit back and relax and listen to music or contemplate some things you want to change or work on moving forward in your life. The pre-calculated ketamine dosage given to you will be safe and you will be awake and conscious but may feel like you’re drifting in the clouds at times especially during the peak of the ketamine injection. During the injection, some clients have a dissociative experience with increased sensitivity to sound and light with an altered perception of time and color. Many clients tolerate this experience without any discomfort as well as find the overall experience to be pleasant. However, some may feel some mild to moderate discomfort in the form of anxiety or not feel in control during the peak or dissociative episode. Once the injection has peaked in 15 minutes, the dissociative experience of ketamine rapidly goes away and is often gone within 10-15 minutes.
You will be conscious and awake throughout the injection and able to interact with anyone around you including a loved one or the specialist. However, the best experience is often when the client is able to quietly relax or listen to some relaxing music or sit quietly contemplating one’s hope and aspirations for change. The sedative effects of ketamine will wear off within 1-2 hours after your last injection. However, to ensure your safety and others we ask that you do not drive a vehicle until 12hrs after your last injection.
5. After your last injection, we will monitor you for approximately 20-30 minutes to ensure your safety and that you’re cleared to go home by a clinician. When you’re ready, we will remove the monitoring equipment and you can be released to a friend or loved one who can safely drive you home. Most clients experience some mild fatigue after the injections but very much feel like themselves. Please do not consider driving or operating any motor vehicles until at least 12 hours after your last injection to ensure your safety as well as others; no exceptions.
You may experience some nausea during your course of injection. If you experience nausea, the specialist can give you some anti-nausea medication via mouth or injection. Or if you’re prone to nausea we can give you anti-nausea medication prior to your treatment to help prevent it. Also, if you’re having trouble orienting yourself a specialist or loved one will be there to help guide you through this process. Any sides effects are usually gone within a few hours after completing the injections and completely gone by the following day. There are no known long-term side effects of ketamine injection therapy when it is administered by a responsible and knowledgeable clinician in a medical setting.
The four primary and most common side effects and dangers are:
1. Nausea –we can help you with this. 1/3 of clients experience nausea
2. Short-term Increases in 2. Blood Pressure–we will be monitoring this and can treat it if needed. This is a short-term side effect and won’t last more than an hour. most people see a slight elevation in blood pressure during their injections.
3. Dissociation: can be perceived as pleasant or unpleasant and hard to predict. this only lasts about 10-15 minutes at the peak of the injection. Remember, this is when ketamine is really doing the hard work of creating new neuronal pathways and rebooting your brain so it’s worth the potential discomfort of the peak ketamine experience.
4. At the peak, ketamine can cause people to feel unstable on their feet due to sedation. Thus, if you need to go the bathroom please have a loved one escort you or have a clinician escort you for your safety.
We will be happy to address any of your medical or mental health concerns before starting ketamine treatments.
Overall, ketamine is a very safe medication that has been around for decades and is used daily in the medical and mental health community
We will stay committed to you long after your series of injections are completed. We understand that it is vital that ketamine therapy be a part of a bigger treatment plan for you, which is why it’s important that we have formulated an aftercare plan that best supports your recovery.
Following your initial series of injections, some clients will begin an injection maintenance program and return for additional injections called “boosters” as needed. Often 1 booster injection is all that is necessary to restore the client and significantly extend the client’s results.
The time between maintenance “booster” injections will be different and unique to each client and the severity of their symptoms. Some clients will have 1 booster per month approximately 2-3 months after their initial series of injections. Other clients have gone 3 to 12 months before needing to come back for a booster. It truly is unique to each individual and there is no way to predict how often you will require a booster injection until you start your treatments and we can assess your response.
In your intake form: it’s very important that you inform us of any and all medications, supplements, and substances you are taking/using. Please do not stop taking these medications without informing your current prescriber or psychiatric provider.
Some medications that have raised questions in regards to blunting the full benefits of ketamine and will need our assessment prior to starting ketamine therapy are:
Lamictal (generic name Lamotrigine): If this is a medication you’re taking please let us know. Clients will be asked to not take Lamictal 6 hours prior to and 6 hours after their injections to get the best results from the ketamine series. Lamictal has been noted to blunt the response of the ketamine.
Clients that are taking higher doses of benzodiazepines can have a reduced response to the full benefits of ketamine. This does not mean you can’t receive ketamine treatment while taking benzodiazepines such as Xanax (Alprazolam), Ativan (Lorazepam), Valium (Diazepam), and Klonopin (Clonazepam). Taking these medications with ketamine is perfectly safe. However, to ensure the best outcomes and response to treatment we ask that you skip a dose 6 hours prior to your injection and 6 hours after your last injection.
SSRIs like Prozac and Zoloft, SNRIs like Effexor and Cymbalta, or Tricyclics like amitriptyline or nortriptyline, do not interfere with ketamine nor does Wellbutrin (bupropion). Generally speaking, most medications are safe with ketamine infusions but it’s crucial we know all your medications, supplements, vitamins, and illegal drugs including alcohol you may be using for your safety.
We can help make recommendations with the guidance of your psychiatrist or current prescriber in regards to some of the above medications. Our primary goal is that you receive the full benefits of ketamine injections with the best chances of being happy, healthy, and optimally functioning.
Ketamine has been used in surgical centers, emergency departments, and operating rooms for decades. In fact, if you have ever had a major surgery there is a good chance you have received ketamine. Ketamine is considered a very safe and rapid-acting antidepressant and anti suicidality when administered by a properly trained specialist.
Ketamine is actually used thousands of times daily in modern medicine as an anesthetic in operating rooms, in psychiatry, ERs, and medical centers across the world for the past 53 years. Ketamine is considered by the World Health Organization (WHO) as one of the safest and most essential drugs in a health system.
There are quite a few different ways to receive ketamine including orally, intramuscularly, sublingually, and intravenously. The response and overall effectiveness of the variety of routes are very different so please ask your specialist about this. Intravenous (IV) infusions are considered the gold standard for depression and other mental health treatments for rapid and controlled relief with a maximum amount of absorption of 94-100%. Compared to the oral and nasal route which only have about 25-40% absorption/bioavailability. Bioavailability is the amount of the drug that is available for use in your body after the drug is metabolized (broken down) by the liver.
Thus, IV is far superior for treating depression, anxiety, PTSD, and other mental health disorders compared to other routes of ketamine treatment (oral, nasal, or sub Q).
Please do not eat or drink any solids 4 hours before the injection, water, and healthy liquids are the only exceptions, and please limit your fluid intake that morning so you don’t have to use the bathroom as much. You may drink water up to 2 hours before the injections. About 1/3 of people get nausea with Ketamine and it’s best to have an empty stomach. We usually administer an anti-nausea medication before treatment to prevent and relieve nausea or vomiting.
Also, please empty your bladder right before your first injection as ketamine does make some people have to urinate and ketamine is sedating, thus walking to the bathroom can be a hazard. If you need to use the restroom please inform the staff before going to the bathroom as we don’t want you to fall!
Please notify your provider if you have any history of post-op nausea or vomiting.
Dissociation is the sense of being detached from yourself or your body. This is often described as a gentle floating or dream-like quality as if you’re daydreaming and very relaxed. Metaphorically, you may feel like you’re floating in the clouds or drifting through the universe but at the same time, you will know you’re sitting relaxed in a recliner. If a clinician speaks to you, you will easily be able to respond and know where you’re at. Generally, dissociation is not an enjoyable or frightening experience but can enhance your sense of well-being while feeling more connected to yourself and others during or immediately after the experience. Often, dissociation is a pleasant to neutral experience.
However, for some, it may induce some anxiety and unease surrounding not being completely in control of their experience. Your clinician or loved one will be there to help guide you through this, and if necessary, a clinician can administer anti-anxiety medications to help relax this short-lived experience that generally only lasts about 10 to 15 minutes.
Clinical studies and experience have shown that the level of the dissociative experience is directly correlated with the reduction in one’s depression and suffering.
Yes, this means the stronger the dissociative experience the more likely you’re to achieve relief and eventually remission. Dissociation helps jumpstart your brain into creating new neuronal pathways that can help you feel more connected with yourself and others. Dissociation can help you feel true joy once the dissociation has warn off. Your initial response to your first ketamine dosage and injection will help us guide your dissociative episode with our primary goal of relief and remission from your suffering.
So what does dissociation feel like?
For some, it may be a way to safely view, analyze, and change their inner workings, strengths, limitations, and how to let go of past traumas, pains, attitudes, or behaviors that no longer serve them.
For others, it can be more of a spiritual and transformative experience where they have deep and lasting realizations that can relieve their suffering and create more resilience from future negative events. Ultimately, this allows them to let go of the heavy mental baggage they have carried for so long.
Ultimately, your ketamine experience will be unique to you and no one can predict it. We will certainly be there for you throughout your experience. No matter what type of dissociation experience you may have, good or bad, the ultimate importance is that ketamine-induced dissociation is a direct indicator that the ketamine is at work attempting to repair synapses in your brain that have been broken or damaged from chronic depression, stress, or anxiety. Dissociation is key to relief and is generally a good indicator that ketamine is starting to repair neurons and create healthier neuronal pathways.