Frequently Asked Questions
What is Ketamine?
Ketamine is an NMDA receptor antagonist and is a standard anesthetic drug that can alleviate refractory unipolar major depression. It has been used in hospitals for years as a general anesthetic. However, ketamine for psychiatric purposes is administered in a very different way than in hospitals. Research has found ketamine to be an effective and safe manner to treat patients with PTSD, Depression and Chronic Pain.
Is this treatment FDA approved? What is an off-label drug use?
Ketamine is not yet approved by the FDA. However, there have been a number of studies over the past two decades. It has been shown effective in the treatment of major depressive disorders, anxiety, PTSD, and suicide ideation. Please see our Research section for more information.
The data collected in these sessions will be used to contribute to the Ketamine literature and assist in achieving FDA approval. Before FDA approval is achieved, Ketamine used in this manner is considered “off-label.”
Is Ketamine right for me?
Ketamine is indicated for severe depression. Mild to moderate depression is most often successfully treated with therapy and medication. Ketamine therapy is for patients who would otherwise be considered “treatment resistant,” or those who have not responded to any other treatment and treatment options have been exhausted.
Patients with recurrent thoughts of suicide, who need immediate mood stabilization, will benefit from Ketamine infusion therapy.
Patients with Post-Traumatic Stress Disorder, who has not responded to in-patient therapy, medicine, or other forms of treatment, are eligible for Ketamine infusion therapy.
Are there any medical conditions that will exclude me from treatment?
Individuals with a history of schizophrenia, drug and alcohol abuse, uncontrolled high blood pressure, glaucoma or previous allergic reactions to ketamine should not receive Ketamine infusion therapy.
Can I eat or drink before my appointment?
You cannot eat for 4 hours before your scheduled appointment. You may have clear liquids up to two hours before your appointment. Clear liquids include black coffee without creamer, tea, Sprite, apple juice, water, etc. Orange juice and milk are not considered clear liquids.
Do any medications interfere with Ketamine therapy?
Lamictal (lamotrigine) is known to interfere with Ketamine treatments. If you cannot be weaned off Lamictal, please allow 12 hours between taking Lamictal and the start of the infusion. Wait 6 hours after the infusion before taking your next Lamictal dose.
Benzodiazepines, such as Klonopin (clonazepam), Valium (diazepam), Xanax (alprazolam) and Ativan (lorazepam) are known to decrease the effectiveness of ketamine if used daily and at higher doses. If you are not able to wean off the benzodiazepine prior to treatment, you may still receive a ketamine infusion, however, as stated above, your chances of success may be lower.
Aminophylline for asthma or COPD may increase risk of seizures with Ketamine treatments.
Any illicit drug use in contraindicated with Ketamine infusions and will results in refusal of treatments.
**You should not adjust your dose or frequency of use of any prescribed medication without first speaking with your prescribing physician.
Will I have to stop other antidepressant medications?
Other antidepressant medications should be safe and you should not have to stop these medications.
SSRI’s, tricyclics, opiates, muscle relaxers and anti-inflammatories do not have any interaction with Ketamine.
However, be sure to review medications with your doctor before starting Ketamine therapy.
Is Ketamine Safe?
Ketamine has been widely used as an anesthetic for minor procedures for over 50 years. The dose used in Ketamine therapy is much smaller. Ketamine is short-acting and the mind-altering effect is often compared to a mild alcohol intoxication.
Ketamine as an anesthetic is FDA approved, however it has yet to achieve FDA approval for depression and PTSD treatment.
See our Research section for more information.
How many infusions will I need?
The number and frequency of treatments varies from patient to patient.
Typically, a series of infusions in a short amount of time followed by monthly maintenance treatments provide the greatest and longest-lasting relief.
We recommend six infusion over one to three weeks. If successful, we will conduct follow-up evaluations to determine long-term treatment plans. Follow-up visits may be once a month.
Are there any risks?
Blood pressure has been known to increase during infusion, however it usually normalizes after roughly four hours. Other common side effects include blurred vision, dizziness, and nausea or vomiting. The intensity of many of these side effects appear to diminish over repeated infusions.
The effect of Ketamine on pregnant women and their unborn children is unknown. If you are pregnant, it is not recommended that you seek Ketamine infusion therapy.
What does the procedure entail? What can I expect?
CNS Center of Arizona follows the American Psychiatric Association (APA) recommendations for the evaluation of Ketamine Treatment.
1. A comprehensive diagnostic assessment should be completed to establish current diagnosis and evaluate history of substance use and psychotic disorders
2. Assessment of baseline symptom severity should be completed to allow later assessments of clinical change with treatment
3. A thorough history of antidepressant treatment should be collected and documented to confirm previous adequate trials of antidepressant treatments
4. A thorough review of systems should be performed to evaluate potential risk factors associated with ketamine treatment
5. Decisions on the specific physical examination and laboratory screening assessments should be made according to established guidelines and advisories issued by the American College of Cardiology Foundation/American Heart Association and the American Society of Anesthesiologists and should be based on a patient’s individual clinical characteristics
6. A careful review of past medical and psychiatric records and/or corroboration of the past history by family members are strongly encouraged; all current medications and allergies should be reviewed, including histories of opiate and benzodiazepine use; the use of a baseline urine toxicology screen is strongly encouraged to ensure the accuracy of the reported substance use and medication record
7. An informed consent process, including discussion of the risks associated with the treatment,d the limits of the available information pertaining to the potential benefits of the treatment, the fact that this is an off-label use of ketamine, and a discussion of alternative treatment options should be completed; this discussion should be complemented with written materials, and the patient should provide written informed consent before initiating treatment
a. Self-report versions of the Inventory of Depressive Symptomatology and Quick Inventory of Depressive Symptomatology (http://counsellingresource .com/quizzes/depression-testing/qids-depression/) are examples of scales that are available at no cost to clinicians and researchers.
b. This review should also include questions pertaining to functional exercise capacity, which has been demonstrated to provide a good screening tool for patients that are at increased risk for adverse events associated with anesthesia exposure and surgical procedures.14,15
c. American College of Cardiology Foundation and the American Heart Association guidelines for perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery16 and practice advisory from the American Society of Anesthesiologists.17
d. The Ketalar package insert (http://www.accessdata.fda.gov/drugsatfda_docs /label/2012/016812s039lbl.pdf) provides essential information related to risk of ketamine administration.
Thus, before your Ketamine infusion is scheduled, a comprehensive diagnostic assessment will be completed. This will include history of psychiatric disorders and substance use disorders, previous antidepressant treatments, medications, allergies, toxicology screen, and an informed consent process.
Ketamine infusions take place in private rooms in an out-patient office setting. The infusion takes about one hour. Patients generally stay another 15-20 minutes before leaving, but you may stay as long as you like. We encourage the patient to be accompanied for at least the first visit.
During the infusion, you will sit in comfortable reclining chairs and are encouraged to list to music of your choice from your own playlists. Wi-Fi is available. Within a few minutes of starting the infusion, you can expect to feel a slight tingling sensation in your lips or extremities. Some patients report feeling “heavier” and others feel slightly detached from their bodies. During the infusion, you will likely experience some dissociation. Dissociations are not hallucinations, but rather altered reality. Most patients find it pleasurable and non-threatening. If it does make you uncomfortable, the infusion can be stopped. While rarely necessary, medication can also be given which will end the thoughts within a minute.
Some people are concerned about hallucinations or a “bad trip.” Ketamine is a dissociative anesthetic rather than a hallucinogen like LSD or mushrooms. Some patients experience mild visual experiences, such as light being perceived in a less or more than normal way.
By the time you leave the office, your mental state will be close to normal. Some patients are able to return to work or carry on an otherwise normal day following the infusion. Others prefer to go home and take a short nap. The only restriction after leaving the office is no driving until the next day.
Your improvement in mood will not be immediate. The earliest you might expect to feel better is several hours following the infusion. Doctors are available 24/7 by phone to answer any questions you may have following the infusion.
Anxiety and depression has become prevalent in the recent years. It affects more than 40 million adults in the United States alone with nearly a third who don’t find relief using antidepressants or other related treatments.
It is critical for those suffering from anxiety and depression to get all the treatment they need because failure to receive treatments increases the chance of drug and alcohol addiction and also suicide.
Ketamine, only known in the past as an anesthetic drug, has been found to work effectively in treating depression and anxiety disorders.
What is Ketamine?
Ketamine is an anesthetic drug developed more than 50 years ago. It is used back then mainly to operate on soldiers during the Vietnam war. Also, it has been used as an animal tranquilizer.
More recently, researchers have discovered Ketamine as a valuable and highly effective substance to treat anxiety, depression and certain pain disorders.
How does it work?
Pain, depression, anxiety disorders and other forms of mental stress cause damage to the communication structure between the areas of the brain responsible for learning, critical thinking and memory. What it does is it provide the essential components to repair that damage quickly. It also blocks certain types of brain receptors such as NMDA and opioid receptors which play a role in depression and pain.
How is it used?
Ketamine has been approved by FDA as an anesthetic drug for surgery operations and diagnostic procedures. It can also be effective in treating mental illnesses such as depression, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), and other mood disorders. It can also give relief to nerve-related pain syndromes. 3
What are the side effects?
Ketamine may cause the users to feel a sense of detachment from their body. Their surroundings may appear to be different after the treatment. They might experience blurred or double vision, dizziness, nausea or vomiting and short anxiety reactions after receiving a dose. These adverse effects may last up to an hour.
When is the right time for a patient to ask their doctor about considering ketamine as treatment for depression?
If you have tried antidepressant medications or any combination of medications at high levels of dosage for at least 8 weeks and still have no improvement.