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How many ketamine infusions are recommended when treating mental health conditions?
Studies that have compared treatment with a single infusion versus a series of infusions have generally demonstrated a greater reduction in depressive symptoms with a series of infusions over 2-3 weeks. However, there is no consensus as to the exact number of infusions to optimize benefit. One study showed that there was not a significant difference in total improvement between 4 infusions versus 6 infusions. On the other hand, other studies have demonstrated a steady decrease in symptoms with each additional infusion up to 6 total. We generally recommend starting Initial Ketamine Infusion Therapy with at least 4 infusions, possibly increasing to 6 depending on your response to treatment.
How long will I feel improvement?
Studies show that a single IV ketamine infusion can reduce symptoms of depression for up to one week. Repeated infusions can increase the duration and strength of effect for at least several weeks. Thereafter, you may benefit from our Maintenance Ketamine Infusion Therapy, consisting of a single infusion every 4-6 weeks or longer depending on the length of your response to the initial therapy.
Do I need a referral?
We do not require a specific referral for Ketamine Infusion Therapy. We do, however, require that you are currently under the care of a mental health professional. Achieving maximal reduction of your symptoms is more likely to occur when ketamine therapy is provided in the setting of ongoing mental healthcare, including psychotherapy and oral anti-depressant medication. Prior to your first infusion, we will review documentation from your healthcare provider(s) related to your diagnosis and past treatment. We may contact them to discuss your diagnosis and treatment plan. If you do not have a current mental health provider, we would be happy to assist you in finding a qualified professional.
Why do you administer ketamine through an intravenous (IV) infusion?
Ketamine can be given through multiple routes – IV, intramuscular, intranasal, oral, subcutaneous, etc. Only the IV route has 100% bioavailability – in other words, 100% of the dose given will exert an effect. Other routes of administration have substantially lower and less predictable bioavailability, either because the dose is not fully absorbed (nasal spray) or the medication is partially inactivated by the digestive system (pill). For example, intranasal administration has a bioavailability ranging from 25-50%. This creates two challenges. First, low bioavailability increases the total dose of ketamine required to achieve a similar effect. Second, routes with less predictable bioavailability make it more difficult to adjust the dose to an individual patient’s response.
Can I drive home from my appointment?
No. Ketamine will impair your ability to drive. We require that a family member or close friend drive you home from your appointment. We also advise that you do not operate heavy machinery, care for young children, sign any legal documents or engage in strenuous activity for 24 hours after your infusion.
Can I eat or drink before my appointment?
We require that you avoid eating or drinking 4 hours before your infusion. You may take a small sip of water for any required medications up to 2 hours before your infusion.
What should I expect during my appointment?
After you check in at the front desk, you will be brought into your own private room with a comfortable reclining chair for your infusion. Your healthcare provider will conduct a brief history and physical. We will review the consent form with you and answer any questions. Once the consent form is signed, a peripheral IV will be placed as well as monitors to measure your vital signs. The room lights will be adjusted to your preference and you will be offered head phones for relaxing music. The infusion will then begin. Your healthcare provider will be monitoring your vital signs and making any adjustments to the infusion to optimize its benefits. After your infusion is complete, you will recover for approximately 20 minutes in the room. You will then be escorted to the front of the office where your driver will meet you to take you home.
How will I feel during the ketamine infusion?
You may feel as though you are in a dream-like state or having an out of body experience. Some patients may feel changes in their perception, speech or thoughts. If you experience any unpleasant sensations or hallucinations, we will adjust the infusion to reduce these experiences.
How will I feel after the ketamine infusion?
We will monitor you for approximately 20 minutes after your infusion and make sure that it is safe for you to leave the office. You may feel a bit drowsy, unsteady on your feet, or as though your brain is in a “fog” for a couple hours after the infusion. We recommend you spend the rest of your day relaxing at home.
Is ketamine addictive?
The Drug Enforcement Agency (DEA) classifies ketamine as a Schedule III Controlled Substance, defined as a drug “with moderate to low potential for physical and psychological dependence”. Ketamine is generally very safe when administered at appropriate doses by trained professionals. However, if used inappropriately as a recreational drug (known as “Special K”) there is a high risk of addiction and overdose.
What are side effects of ketamine?
Ketamine may cause temporary dizziness, blurred vision, and nausea and vomiting. You will be given anti-nausea medication prior to the start of your infusion which usually prevents these symptoms. Ketamine may also temporarily increase your blood pressure and heart rate. Your vital signs will be monitored throughout your infusion and recovery time. More serious, but rare side effects include liver toxicity and bladder irritation (cystitis). These cases, however, have been documented primarily in abusers of street ketamine or high doses of ketamine. The dose you will receive during your infusion is referred to as “sub-anesthetic” and is a low dose of ketamine.
Are there any conditions which may make ketamine infusions unsafe?
Yes. Patients with the following conditions should not undergo a ketamine infusion:
- Uncontrolled high blood pressure
- Unstable heart disease (congestive heart failure, irregular heartbeat, chest pain)
- Untreated thyroid disease (hyperthyroidism, goiter)
- Untreated glaucoma
- Active psychotic symptoms (delusions or hallucinations)
- Active manic phase of bipolar disorder
- Current substance abuse (recreation drug use, excessive alcohol use)
Sanacora G, Frye MA, McDonald W, et al. A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders. JAMA Psychiatry 2017; 74:399.
Singh JB, Fedgchin M, Daly EJ, et al. A Double-Blind, Randomized, Placebo-Controlled, Dose-Frequency Study of Intravenous Ketamine in Patients with Treatment-Resistant Depression. Am. J. Psychiatry 2016; 173:816.
Phillips JL, Norris S, Talbot J, et al. Single, Repeated and Maintenance Ketamine Infusions for Treatment-Resistant Depression: A Randomized Controlled Trial. Am. J. Psychiatry 2019; 176:401.
Shiroma PR, Johns B, Kuskowski M, et al. Augmentation of Response and Remission to Serial Intravenous Subanesthetic Ketamine in Treatment Resistant Depression J. Affect. Disord. 2014; 155:123.
Cohen SP, Bhatia A, Buvanendran A, et al. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Reg. Anesth. Pain Med. 2018; 43:521.