Ketamine Assisted Therapy
To Help With
Treatment Resistant Depression
Relief without hospitalization
Ketamine infusions have been shown to help regulate mood and to be highly effective in providing fast relief from major depressive symptoms without hospitalization. A person receiving ketamine may have relief of symptoms as early as the first infusion. However, more often, improvement is seen gradually over a series of infusions.
Like all medicines, Ketamine therapy is a treatment, not a cure. At Altasano, we believe that along with psychotherapy and mindfulness training, Ketamine can be another tool used in the fight against treatment resistent depression, anxiety and PTSD.
Our practice model follows a collaborative approach with your psychiatrist/prescribing physician and therapist. We administer the ketamine infusions to stimulate neurochemical pathways and your therapist works with you to help guide you through the integration of the experience to gain meaning and insight. During the process we monitor you everyday and provide support before and after the infusions. The information we collect is sent to your psychiatrist after the initial loading doses and then periodically to help in your continued treatment plan.
Because mental health issues affect all aspects of day-to-day life, they can interfere with relationships, employment, and nutrition. They even make it difficult to seek treatment and practice proper self-care. This puts people with treatment resistant depression and major depression at greater risk of alcohol and drug abuse, chronic disease, hospitalization, and suicide attempts. Electroconvulsive therapy (ECT), a mainstay therapy, can be life-saving, but it requires hospitalization and has a high incidence of memory loss as a side-effect.
Treatment resistant depression is not uncommon. About 30% of adults with major depression fight persistent feelings of sadness, sleep disturbances, low energy and thoughts of death or suicide that do not respond to treatment. Oral medications take several weeks to have an effect. In some cases, that may be too much time. There is a link between the experience of a major depressive episode with no symptom relief and the occurance of suicide. Prompt symptom relief and support for those struggling with treatment resistant depression can be life changing and life-saving. National Suicide Prevention Hotline 1-800-273-8255. https://suicidepreventionlifeline.org/
Treatment Resistant Depression, PTSD, severe anxiety, and drug and alcohol addiction have all been theorized, up until recently, to simply be due to chemical imbalances in the brain. But it’s much more complicated than that. Newer research is looking at the electrical signaling of the brain that impacts neurotransmitter concentrations and the role of inflammation on the brain. Ketamine’s ability to “re-boot” the brain and stimulate the production of brain derived neurotrophic factor (BDNF) is believed to impact neuroplasticity. This neuroplasticity is what can allow a person to break a repetitive cycle long enough to have a chance to do the impactful work that can put a person on a new path to living. https://www.youtube.com/watch?v=hNsIiq-5354
This appointment will be an initial evaluation. We will perform a medical history review and determine if you meet established criteria for ketamine infusions and are a good candidate to proceed with ketamine treatment. Once the review of history is completed and you are determined to be a good candidate, we will perform a physical assessment and draw blood for lab testing. After we receive and review your lab results, we will develop your treatment plan. You’ll schedule a follow-up appointment to review the plan and schedule six induction infusions. Ideally these infusions will fall within a two-week period.
Unfortunately, ketamine infusions are not covered by insurance carriers yet. Until this happens, ketamine treatments are considered an out- of-pocket expense. You may be able to recover some out-of-pocket expenses if you provide your insurance company with a superbill (a detailed insurance receipt) for reimbursement. We facilitate this process by providing you with a superbill (insurance receipt).
Payment for the infusions can be made at each of the 6 appointments or up front for the entire series. The cost of each infusion is $400.
- Infusion cost includes every aspect of treatment, no added costs.
- We provide a detailed invoice (“superbill”) for submission to your insurance for plan approved reimbursement.
- We accept all major credit cards and cash. No checks accepted.
At your initial follow-up appointment, we will go over your medications and prepare you for which medications you should take and/or “hold” on your infusion days. Some medications can interfere with ketamine. Follow these instructions and please call if you need any clarification. We will review the process and go through a preparatory session. During this time, we will get you acclimated to the infusion room, make sure WiFi is set up on your phone/iPad and go over how to best prepare for the infusions. We will also review your current involvement in therapy an ensure that you have sessions lined up and are with a therapist who can provide you with suitable guidance through this process.
On infusion days:
- Please do not eat food or drink anything that has milk in it at least 6 hours prior to your scheduled time. You may drink clear liquids (i.e. water) up to 2 hours prior to your infusion. If you are diabetic, you will have specialized instructions. Some people find that good hydration and “clean” eating (minimal processed foods) several days prior to the ketamine infusion helps improve well-being during the process.
- Please avoid caffeine/nicotine (cigarette/vape) 4 hours prior to your scheduled time.
- Please bring a bag with your necessary items – i.e. headset, eye shades, neck roll, particular blanket, journal for note taking, water bottle, etc. We have all of these supplies in the room for “back-up” should you forget.
- You will not have any activity restrictions immediately after the treatment, except…….. NO DRIVING! There are no exceptions to this rule.
Although the clinical application of IV ketamine for mental health issues is not the same as receiving anesthesia, please remember that we provide 1:1 care for you with the same high safety standards. The anesthetist giving your IV ketamine is board certified, licensed and highly qualified to manage any situation that may arise during your infusion. Everyone in the office is trained to manage an office-based emergency, should one arise. The ketamine infusion room has emergency equipment and medications, and is just down the hall from a main surgical operating room, should a higher level of care be needed prior to the arrival of emergency transport to the hospital. The medical director has admitting privileges at the Level 2 hospital located 2 miles from the surgery center.
We place a very high value on trust and are prepared to give you exceptional care.
We ask that you follow our guidance and prepare with the same level of diligence.
Allow yourself 2 hours for the ketamine infusions. Your treatment will be in a quiet, private room that allows you to be free from interruption or exposed to external stimulation. At your first treatment visit, we will again go over the treatment plan and goals, review the risks and benefits of the procedure, and answer any further questions you may have. We will assess your vital signs and then start your IV.
Once the infusion starts, your perceptions will change and your sense of your body may alter. You will be with a board-certified registered nurse anesthesiologist while you undergo your infusion. You will not be alone. You will be monitored through the experience. We will seek to maximize the benefits of the inner experience, while at the same time ensure that you are safe.
The ketamine infusion is administered over 40-60 minutes. We have eye shades to minimize external visual input, if you choose. Free Wi-fi, snacks/drinks, and seating is available for loved ones who accompany you.
After the ketamine infusion, plan to rest about 30 minutes post treatment.
For those who respond to Ketamine, the effect is usually noticed within the first few hours of receiving the first IV treatment. 6 treatments are typically done in a two-week time period. After the initial infusions, a booster treatment may be necessary 2-3 weeks later, and then every 1-3 months, as needed. It is normal to feel tired the day of treatment, so no driving or operating heavy equipment for the remainder of the day. You’ll need a friend or family member to drive you home.
We expect that you will be able to eat normally, but use common sense. Stick with foods that are good for you. Avoid alcohol. Take your normally scheduled medicines.
We encourage you to express your experience in the form of journaling, artwork, or other creative means of processing.
Attention on ketamine in the treatment of severe treatment resistant depression, PTSD, postpartum depression, severe anxiety, and other mental health conditions, has made the pharmaceutical industry rethink its focus on traditional antidepressant medications. Although traditional medications have helped many people, for others, they just don’t work. Worse yet, suicidal ideation is a known side-effect of SSRIs, especially on younger populations.
Ketamine inhibits the N-methyl D-aspartate (NMDA) receptor in our central nervous system. This receptor is activated by a neurotransmitter called glutamate. Glutamate is found at excessive levels with stress, depression, and certain pain conditions. Blocking the effects from this excess can help alleviate symptoms.
Ketamine is a drug that has been used for over 50 years, traditionally as an anesthetic by anesthesia providers, emergency physicians and surgeons. In 1985, the World Health Organization added Ketamine to its list of essential medicines. In 1990’s, Yale University began studies on Ketamine and it’s use in psychiatry. In 2006, ketamine began being studied in its effects on treatment-resistant depression. A 2009 study of ketamine conducted by Price, Charney, Knock, and Matthew, showed a correlation between ketamine and the alleviation of depressive symptoms as well as a reduction in suicidal thoughts. Current studies are showing beneficial effects in other psychiatric disorders such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), anxiety, and alcohol/substance abuse.
Yes, Ketamine is safe when used responsibly. Ketamine does not slow down vital bodily functions such as respiration rate. Ketamine can increase blood pressure and heart rate for some patients, but this is a very temporary and transient effect. Like so many drugs, Ketamine has also been abused. We collaborate closely with your own mental health provider and require you to have one throughout treatment. Comprehensive centers, like Altasano, place a priority on your bodily health and as well as your mental well-being. LEARN MORE
Insurance companies do not usually pay for medications that are given for “off-label use”. “Off-Label” use of a medicine is very common actually. Think of the use of aspirin for people with heart disease. Aspirin was not originally made and tested for that use, but its chemical properties made it beneficial for people with heart disease. In the early 1960’s, the FDA approved Ketamine for anesthetic use. Further research on Ketamine in the 1990s began to focus attention on its therapeutic benefits on the treatment of chronic pain and because of its benefits, many insurance companies cover the costs of ketamine infusions when given for pain. Many studies looking at the benefits of ketamine for mental health issues have been published, but currently the FDA has not approved Ketamine for the treatment of depression or other mental health issues. This may change in the near future.
IV Ketamine therapy remains the gold-standard of TRD treatment, however the FDA approved esketamine (Spravato) is an option. The drug is basically one half of the original ketamine molecule. The attempt was to split the drug to remove the “unwanted” psychedelic effects of the medicine. We understand that the concept of a transcendental experience is not part of mainstream Western medicine, but we are certain that the transcendental experiential effects of a ketamine infusion play an essential part of the treatment. The nasal delivery of the drug is certainly more desirable, however studies show that it may not be as effective, as dosing and absorption will be less precise. The benefit of FDA approval of esketamine is that, depending on your coverage, insurance companies may pay for its higher cost, estimated to be $1000 per dose. Spravato will not be dispensed to patients to take home like ketamine troches. It will only be available in approved and certified treatment centers.
At Altasano, ketamine infusions are administered through an IV, with an infusion pump over 40-60 minutes. Intramuscular ketamine is a popular route of administration for those who may not be as comfortable with IVs, however receiving ketamine IM, means that the dosing and effect is less predictable and it cannot be stopped. Once an IM dose is given, the drug must take its course. Whereas, with an IV route, the infusion can be given slowly and the effects can be dealt with gradually. The IV can also be stopped at any time.
For those who meet the DSM criteria for depression who have tried at least two different classes of traditional antidepressants and found them to be ineffective, the recommended initial “Induction Series” of six low-dose ketamine infusions is administered in an effort to break the cycle. Most clinical trials have consistently shown a 70% success rate with this approach. The treatment does require booster infusions as time passes to keep the effect going. These single “booster infusions” are given at varied intervals for the same 40-60 minute duration, but are single infusions rather than in a series. However, at Altasano, depending on your experience while receiving a ketamine infusion for treatment resistant depression (TRD), we may progressively increase or decrease the doses outside of the “NIH Protocol” in order to optimize the experiential therapeutic effect of Ketamine.
Studies have shown that at infusion doses and frequency, Ketamine is not addictive. The drug itself does not cause physiological “addiction” but, people can become habituated to the experience.
Less than 2% of people will experience side effects. However, some common side effects are: drowsiness, nausea, dizziness, poor coordination, blurred vision, and feeling strange or unreal. Most of these symptoms go away within an hour of the infusion
Anyone with a history of uncontrolled high blood pressure, heart disease, kidney disease, a history of psychosis, or bipolar disorder, history of failed Ketamine infusion treatment, current substance abuse or dependence (patients will undergo a screening process) will not qualify for Ketamine infusion treatments. People with a history of interstitial cystitis (bladder inflammation) will require further screening and preparation.
Unfortunately, there are no predictors for the duration of antidepressant effect after the initial loading series. Everyone is different. The studies show that the variance can be 2 weeks to indefinitely.
Unfortunately, we cannot give guarantee that this will work for you. Studies have shown that 70% of people with Treatment resistant depression will find relief. After the first 3 infusions, if you are not experiencing any improvement, we will work with you on staying the course, increasing the dosage of the infusion, or decide to stop the series.
Yes. You can and should continue to take your prescribed medication. Though some people find that they can reduce their prescription meds or eliminate some altogether, it can be dangerous to stop taking your medications without the care of your doctor or therapist. People have the best outcomes when they combine ketamine infusions with psychotherapy.