Frequently Asked Questions
Ketamine is a medicine developed more than 50 years ago for anesthesia during surgery, and has been used for that purpose since that time in children, adults, and animals. More recently, ketamine has been found to be a valuable and highly effective treatment for depression, anxiety, and certain pain disorders.
Dr. Levine’s training is as a psychiatrist who is a therapist first, medicine prescriber second. However, he has expertise in pharmacology, particularly in the treatment of “tough-to-treat” mood disorders. Dissatisfied with the options available that take a long time to work and cause unacceptable side effects, he was looking for a better option. As the research on ketamine for depression progressed, but was not available outside the research setting, he began to ask, “why aren’t we using this yet?”
Most psychiatrists do not perform “procedures” and do not have the equipment within their offices to use this medicine. The process of establishing a program like this in a hospital or outpatient center is a long and difficult one. In addition, because ketamine is not marketed by a pharmaceutical company, there are no conferences or sales representatives teaching doctors about this and giving them samples. Dr. Levine was one of the first to make ketamine treatment available, but since that time a growing number of top academic hospitals and outpatient providers have followed.
Some may have heard that ketamine is used as a “party drug” and worry about addiction potential. Studies and clinical experience have found that in the very low doses used, medical setting, lack of access at home, and infrequent dosing, there is virtually no potential for addiction or abuse.
No. Ketamine is absorbed by the body very differently and unreliably when taken orally or nasally and has not been shown to be as effective for depression
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.
Major depression, the depressed phase of bipolar disorder (bipolar depression), postpartum depression, anxiety, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), pain syndromes such as fibromyalgia and complex regional pain syndrome (CRPS, also known as reflex sympathetic dystrophy (RSD), and addiction.
Uncontrolled blood pressure, unstable heart disease, untreated thyroid disease, active substance abuse, current manic phase of bipolar disorder, or active psychotic (hallucinations or delusions) symptoms.
The dose used for the treatment of mood and anxiety disorders is very low and safe. For a few minutes during the infusion itself, blood pressure and heart rate may increase. This is monitored to ensure safety.
There are very few medicines that can not be taken in combination with ketamine. For treatment planning purposes, please contact us with any questions regarding interactions between your current medications and ketamine.
The medicine is given very slowly over 40 minutes. The first 15-20 minutes are uneventful with no noticeable effects. At around the 20 minute point, people tend to notice some blurring of vision or double vision, a feeling of “lightness”, “floating”, or intoxication, and sometimes some numbness in the toes or area around the mouth. Over the course of this 20 minute period, these feelings tend to build, so that the medicine is at the peak of its intensity at the very end. Other common feelings include euphoria, talkativeness, a feeling of being “disconnected” or in a dream, heightened perceptions (background noise may seem louder, colors or lights are more intense), and a feeling that people often describe as “weird, odd, different, or interesting”. Less commonly, people may experience some anxiety and headache, nausea, or sweating (typically toward the end). These feelings start to subside approximately 10-15 minutes after the medicine is done and last for a total of 45-50 minutes. Most people can expect to be with us for about 90 minutes from the time you walk in the door to when you leave, with no side effects at that point and none between treatments.
Yes. Ketamine will not put you to sleep. If you are already sleepy and are feeling very calm and relaxed during the treatment, you might drift off for a short nap. People are able to move freely during the treatment.
Many find it helpful and relaxing to listen to music and to wear an eyeshade or sunglasses. It can be difficult to carry on a conversation during the procedure, so you are encouraged to sit back and relax and pay attention to what you are feeling. Expectations coming in to the treatment do affect the experience, so it is helpful to decide ahead of time that you will be safe, will feel “weird” for a little while, and that is ok, because that will quickly pass and you will be left feeling much better.
You will fill out depression and anxiety scales prior to the first treatment and approximately 24 hours later. This will help determine response. It is possible to notice effects as soon as 40 min after the infusion, most typically starting 2-4 hours later, but sometimes taking up to 24 hours. You should not expect to wake up feeling “perfect and overjoyed”, but rather there should be a noticeable difference in feeling more hopeful, less sad, decreased thoughts of suicide, increased calmness, “weight” of depression lifted, or more inclined to engage with people. Further improvements are often seen over the course of treatment.
Yes. KTC physicians are serving in a consulting capacity to provide this procedure. In some cases, patients may choose to see one of our doctors in his/her private practice. But in most cases, people will continue with either their primary psychiatrist or primary care doctor, and are highly encouraged to either begin or continue talking with a therapist.
Typically, it will take just 1 or 2 infusions to know if ketamine will help you, though sometimes response may be more delayed. After an initial series of 6 treatments, maintenance (booster) infusions may be scheduled to maintain response. The total length of treatment is highly dependent on each individual’s unique circumstances.
A single infusion typically lasts anywhere from a couple of days up to 1-2 weeks. A series of 6 infusions may last anywhere from weeks to months, and often a single booster infusion when effects are wearing off can restore response. For those who have not had long-standing chronic depression, it may last much longer than that.
It is common to get advice when depressed that makes sense intellectually, but is impossible to follow through on because of the depressive symptoms. This includes things like, “eat well, exercise, engage in talk therapy, find social support, stay busy, etc”. Ketamine rapidly enables you to be able to act on these important activities, and those who have the best results support the medicine’s effect in these ways. In addition, ketamine likely “primes” the brain for learning and making new connections. Talk therapy can be an ideal way to “lock in” therapeutic learning and capitalize on this unique window of time.
Typical antidepressants take weeks to months to work. There are many to choose from and no reliable way at this point to know which we will be effective and well-tolerated. Therefore, one may wait weeks and find that the medicine does not even work. These medications have common side effects of weight gain, sexual dysfunction, gastrointestinal disturbances, sleep disturbance, fatigue, and emotional blunting. Some newer “add-on” antidepressants also have risks of causing diabetes. Unfortunately not everyone will respond to ketamine, but you will know that almost immediately and not have to waste time or money unnecessarily. Side effects are limited to the time of the infusion, with no side effects in between. In this way, outside of the infusion time, you are not “medicated”.
Approximately 70% of people respond to ketamine infusions.
Yes. Please visit ketamineadvocacynetwork.org
An infusion of ketamine is more expensive than a typical doctor’s visit and medication copay. However, when also considering the financial toll of ongoing depression symptoms affecting work and social function, as well as multiple office visits and ongoing medication costs, quickly being restored to life by ketamine is an excellent value.
Ketamine infusions are not covered by insurance. We are opted out of the Medicare system and do not participate in any insurance plans. However, we do provide a receipt for services at the time of your appointment. While we can not guarantee any reimbursement, some of our patients with “out of network” benefits have been able to recoup a portion of their out of pocket costs. Call 888-566-8774 or email us at firstname.lastname@example.org to discuss this further.
Dr. Levine is nationally recognized as an expert in the clinical use of Ketamine for mood and anxiety disorders. He has pioneered a maintenance protocol and successfully administered thousands of infusions. Dr. Levine and Dr. Dugar provide clinical oversight to all KTC locations, ensuring that our patients have the absolute best possible care.