What are the risks of Ketamine?

The dose used for the treatment of mood and anxiety disorders is very low and safe. During ketamine treatments, blood pressure and heart rate may increase. This is monitored closely to ensure safety. The doses used to treat chronic pain are higher doses and sometimes require using other sedative medications to ensure patient comfort during the treatment. Dr Barnett is highly skilled in the practice of anesthesia and has been using ketamine in her daily practice for many years. She will ensure both comfort as well as safety during the treatments.

Are there any conditions that may make ketamine dangerous?

Uncontrolled high blood pressure, unstable heart disease, untreated thyroid disease, active substance abuse, current manic phase of bipolar disorder, active psychotic (hallucinations or delusions) symptoms, severe liver disease, renal disease and pregnancy may preclude you from having ketamine infusions. If you have questions about your specific medical conditions, give our office a call for more information.

Are there any other side effects I should be concerned about?

Patients commonly feel tired following an infusion. On rare occasion, some patients experience nausea after an infusion. If so, we have medication that can relieve this. If you are prone to nausea, we can administer a prophylactic medication before the infusion to help prevent it. Side effects usually dissipate within a few hours and are completely gone by the following day. There are zero long-term or permanent side effects of IV ketamine infusion therapy when administered by a responsible clinician in a medical setting.

What is ketamine infusion therapy?

Ketamine infusion therapy is a series of medication treatments used to rapidly and effectively address a number of conditions. It is effective because it works with your nerves by interfering with nerve receptors to block signals, allowing those receptors a chance to reset.

How does ketamine work?

Depression, anxiety, pain, and other forms of stress damage the communication system between areas of the brain responsible for memory, learning, and higher-order thinking. Ketamine is able to promote the materials necessary to make repairs to this damage within hours. The proposed mechanisms include N-Methyl D-Aspartate (NMDA) receptor antagonism, the promotion of the neurotransmitter glutamate and lastly, the enhanced neuroplasticity of the neurons within the central nervous system.

Is ketamine safe?

Since the 1970s, ketamine has been used as an anesthesia medication and for pain management in operating and emergency room settings. As a treatment for treatment resistant depression (TRD), anxiety, and post-traumatic stress disorder (PTSD) ketamine is administered at sub-anesthetic doses, or doses below those necessary to induce general anesthesia. In the right hands, ketamine is a safe treatment that can effectively improve mood disorder symptoms in upwards of 70% of patients. Anesthesiologists and emergency room physicians are the most highly trained individuals when it comes to safely administering ketamine due to their extensive training in both administering the medication as well as their training in airway rescue and crisis management.

How many ketamine infusions will I receive?

For our mood disorder patients, we provide a series of six infusions over 2-3 weeks. Most patients see some improvement after their second or third infusion, if not before. For those who don’t see benefit after the second or third infusion, we may attempt a higher dose infusion. It is crucial to complete your whole series to maximize ketamine’s brain-repairing abilities. For our chronic pain patients, we provide anywhere from three to five 4-hour long, higher-dose ketamine infusions. After each infusion, Dr. Barnett will assess several parameters to determine if the treatment has been effective. These may include functional status, pain scores, opioid use, quality of sleep and emotional well-being. If you have had a positive response to treatment Dr. Barnett will usually recommend maintenance treatments as needed, although many pain patients are able to extend the time between infusions after the initial series. Ketamine is effective at relieving the depression and anxiety symptoms that are commonly associated with chronic pain as well.

If ketamine therapy works for me, how soon will I begin to feel better?

For mood disorder patients, some will begin to feel better within 1 hour of their first infusion. Patients with thoughts of self-harm or suicidal ideation often notice those thoughts and feelings dissipate first, and almost immediately. There is often a dramatic relief of dread and hopelessness. Other patients may not notice any improvement in mood until the day after their second or third infusion. Some patients will require more infusions and more time following their infusions before feeling significantly better. It is important to note that the results of ketamine can be sudden and dramatic, but they are not always. It is more common for patients to see gradual, subtle improvement. Sometimes function improves before mood does.

Will I require ketamine therapy for the rest of my life?

No. Some patients achieve long-term relief after one series of infusions. Others find that infusions enhance the impact of antidepressants or provide initial relief that is then sustained by oral medicines, other therapies, and lifestyle choices. If ketamine therapy is the only solution for you, you may be able to space your infusions apart by 3-6 months. After the initial series of infusions restores the brain to a healthy balance, it is generally easier to maintain that balance than it was to attain it in the first place. Follow-up or “booster” infusions are provided on an as-needed basis for maintenance.

What should I expect from ketamine IV Infusion therapy?

You will have a comprehensive medical history and exam to determine if ketamine infusion therapy is appropriate for you. Depending on your condition and other medications you are on, you may be offered three to six sessions of either high or low dose ketamine therapy. Based on the plan devised for you, you’ll either relax for an hour or four hours per session while having the infusion, and then spend 20 minutes to 2 hours recovering afterwards. 

For mood disorder patients, ketamine is administered over a period of 40 minutes. The amount given will not cause you to lose consciousness. During the infusion, most patients have a mild dissociative experience, with an increased sensitivity to light and sound and an altered perception of time and color. Most patients tolerate these experiences without discomfort and many people find them to be pleasant. In the rare case these side effects are considered unpleasant, other rapid acting medications can be used to relieve or eliminate this discomfort. Once the infusion is complete, the dissociative effects of the drug rapidly dissipate and are often mostly gone within 20-30 minutes. There are no delayed “flashbacks” and patients generally leave our clinic within 30 minutes following the infusion and aside from mild fatigue, feel much like themselves. 

For pain patients, ketamine is administered over a period of 4 hours. The amount given is higher than what mood disorder patients receive and can increase side effects such as dissociation. We use a number of adjuvants to decrease or eliminate the side effects that are associated with higher doses of ketamine. Patients generally need 60-120 minutes of recovery following the infusion before they feel comfortable leaving our clinic. There are no delayed “flashbacks” and aside from being tired or fatigued, most feel much like themselves. We require all patients to be picked up inside our clinic by a responsible adult.

I don’t have a psychiatrist, is that a problem?

We require collaboration with your mental health provider or physician to verify your diagnosis as well as to verify the efficacy of treatment, monitor your progress and ensure a successful treatment plan. Dr Barnett highly recommends that you follow up with your mental health provider at least weekly while receiving infusions to help process the thoughts and emotions that may occur during the infusions. She strongly believes this gives the highest chance for success. If you do not already have a mental health provider, we can refer you to one nearby.

Is ketamine covered by insurance companies?

At Physicians Ketamine Institute in Destin we have partnered with Osmind, a ketamine specific electronic health record company who will submit a superbill to your insurance company on your behalf. The rates of reimbursement are variable and depend on your insurance carrier. However, many patients are successful at obtaining partial reimbursements for their treatments. We submit the bill on your behalf and follow up on it for you as well.