The Ketamine Guide

The Ketamine Guide

A Comprehensive Resource To Learn More About Intravenous Ketamine In The Treatment Of Mood Disorders And Pain Syndromes.


Ketamine For Restorative Relief

While ketamine is not a new medication, for many people its usage for relief from mood disorders (depression, anxiety, PTSD) and chronic pain may seem experimental. For over fifty years, ketamine has been used as a safe and effective anesthetic in both the medical and veterinary settings. It was approved by the FDA in 1970 for use in children, adults and the elderly and has been used safely throughout the world since. It was used extensively in the Vietnam War and gained the nickname “buddy drug” due to the fact it was so safe that a soldier with little to no medical training could administer it to a wounded comrade.

Astounding new research has demonstrated the therapeutic effect of ketamine on mood disorders and pain syndromes, an area of medicine lacking innovative breakthroughs. More compelling is how rapidly it works and how sustainably it prevents those symptoms from returning.

This easy-to-follow guide is meant to enhance the knowledge and understanding of ketamine’s medicinal repurposing for the benefit of those suffering with debilitating and chronic conditions. At Alchemy Wellness, we are breaking down the stuffy medical jargon, providing transparency and giving you useful information about this powerful pharmaceutical agent.

In a crisis, call 911 or 1-888-273-8255.
For non-urgent matters, contact your provider.


An introduction

How it works

There are two main theories on why ketamine is so effective. The first one is brain chemistry-based. In the case of mood disorders, ketamine works by blocking a specific type of brain cell receptor that is turned on by a chemical called glutamate. This affects the levels of several other chemicals and proteins in the brain, thereby creating a healthier balance and allowing the regeneration of damaged, dysfunctional cells within the brain’s mood and emotion centers. The second theory is that by inducing a dissociative or dream-like state, ketamine enables the mind to transform the perception of traumatic experiences and negative thoughts. Patients report a state in which internal negative dialogue is disrupted. The worn ‘track’ in the brain is replaced, and continuous loops of negative thoughts are halted, creating a healthier mindset.

“What happens in depression is there’s a shriveling of these branches and these leaves and It looks like a tree in winter. And a drug like ketamine does make the tree look like one back in spring.”

— Dr. Carlos Zarate, MD – Mood and Anxiety Disorders Program at NIMH

Therapeutic Indications

The full list of conditions that benefit from ketamine infusion is still evolving. Yet, research demonstrates that patients with the following conditions experience positive therapeutic outcomes: depression, bipolar disorder, anxiety, postpartum depression, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), chronic pain syndromes (post-herpetic neuralgia, phantom limb pain, neuropathy), complex regional pain syndrome (CRPS or RSD), fibromyalgia, chronic migraines, pain from lyme disease and cancer treatment-related pain.

Ketamine treatment conditions

The ketamine experience

The mind-altering effects begin about ten minutes into the infusion. Patients describe the ketamine experience as relaxing and pleasant. There is often perceptual distortion, or the alteration of how one perceives size, shape, and distance. Many patients have a mystical, religious, or spiritual experience; some have a type of ‘out of body’ experience. We are using what is called ‘sub-anesthetic’ doses, so you are never unconscious. However, moving, thinking, and speaking may be altered during and shortly after the infusion, so we don’t recommend driving or making any important decisions until the following day after some restful sleep.

“It’s just been transformative.”

— Michael L.


Treatment considerations

Side effects

While generally mild and self-limiting, some side effects are to be expected. Most commonly, you may experience nausea, dizziness, perceptual distortions or hallucinations, vomiting, anxiety, or elevation in your blood pressure or heart rate. We have medication available to treat any of these side effects, in the event you experience them. Ketamine is rapidly metabolized by the liver and excreted in the urine, so it is out of your system within hours.

Based on individuals that have abused ketamine as a party drug (at a dosage and frequency excessively higher than medically recommended) there may be issues with the bladder and cognitive function. However, long-term side effects of ketamine in the clinical setting have not been established. There have not been any studies performed to evaluate this specifically, but there are providers in the community who have performed thousands of infusions over many years and have not had clients report these effects.

Addiction & abuse

Given the opioid addiction crisis in America, any substance with the potential for abuse and addiction should be examined with some level of concern. It has been reported that recreational ketamine usage can be habit forming and harmful, but this is usually at doses that are 10 times or higher than the medically recommended dose. In the medical setting, however, this is pretty much unheard of. By administering ketamine in a supervised setting, we are using precise doses that are tailored to effect and given as a slow infusion over a period of time. Treatments are periodic, spaced apart, and only used when they are truly needed. Apart from all these measures, it has been shown that ketamine is less addictive than alcohol, tobacco, or even caffeine.

“But I never felt any withdrawals or addiction to the ketamine. In therapeutic doses, there were no problems with withdrawals or addiction. After five treatments, it wasn’t like I felt the need to go out on the street to illegally obtain some K, unlike what happened with my other psychiatric medicines… I felt normal for the first time in a long time.”

— Brent M.

The gold standard – intravenous infusion

The route of administration (ROA), or how a medication is given, is incredibly important. The body absorbs, breaks down, and gets rid of medications differently depending on how they get into the body. Ultimately, this has a great effect on how much of it ends up where it is supposed to be. You may have heard the term “bioavailability.” This refers to what amount of the medication actually enters the bloodstream after being introduced into the body. Intravenous refers to medications, fluids, or other compounds being directly injected into the bloodstream through a vein. After knowing these simple concepts, it is easy to understand why receiving ketamine intravenously is superior to all other methods of administration. When infused into the bloodstream through an IV, it is 100% bioavailable. Compare this to intranasal which is only 25-50% bioavailable, or oral, which is less than 25% bioavailable. By getting IV ketamine, you are receiving every bit of the medication that has been put into the syringe or bag of fluid. Besides this, we have a much greater degree of control over your experience. We can either speed it up or slow it down. It also allows us to maintain perfect consistency. We know exactly how much you received during your previous infusion, and we can repeat, increase or decrease accordingly. This means we are able to deliver a customized treatment plan tailored for each individual patient.

“I was living for the first time in months. It’s been three months since my last treatment, and I’ve even started to feel excited about my future.”

— Alice L.

Off label prescribing

When ketamine is used to treat depression or pain, it is considered an “off-label” use. Contrary to what you may think, this does not mean it is either illegal or unsafe. When medications are approved by the FDA for human use, they are approved for a specific purpose. Oftentimes, it is discovered later that it is also useful for other purposes that were not included on the original “label.” Literally, hundreds of drugs we prescribe today are being used for purposes other than what they were originally intended. In fact, one in five prescriptions today are written off-label. Recently, a form of ketamine called “esketamine” (which comprises 50% of regular generic ketamine), was approved by the FDA for the use of depression. This was after almost 20 years of compelling research demonstrated the efficacy and safety of ketamine for these purposes.

 

Off label drug image

The investment

Individuals living with mood disorders and chronic pain experience profound challenges in all domains of their lives.

Relationships, careers, self esteem, and even the simplest day to day activities can be a struggle. Careers often suffer, creating further emotional and financial strain. Effective treatments should be considered an investment–not only in one’s health, but in the future.

At Alchemy Wellness, every patient works with a ketamine provider to develop a personalized treatment plan. Treatment consists of an initial series of infusions and subsequent periodic maintenance sessions. The duration and number of sessions is dependent upon the  condition and patient response. The following image is a general guide (treatment plans will vary by provider, condition, and response).

Treatment sessions

Ketamine is not currently covered by insurance. Providers typically charge $400-$800 per infusion session. This is consistently less than similar procedures such as hemodialysis or chemotherapy. Pricing is reflective of the equipment, supplies, legal and business fees, rent, utilities, well-trained medical staff, and support personnel needed to provide quality care in a safe and comfortable environment.

The next step

Finding the right ketamine facility

Factors to consider in choosing a ketamine clinic:

Atmosphere. A relaxing environment is strongly recommended to achieve optimal response. Neither a sterile clinic setting nor cattle-call experience encourages a calm and open mental state, which many patients report leads to better ketamine experience. Private rooms, not curtains or dividers, provide more comfort, privacy, and noise reduction for patients and caregivers.

Provider. Look for ketamine facilities with board certified physicians with specialties and experience in mental health and pain such as emergency medicine, anesthesia, internal medicine, and psychiatry. Ask and/or research if the provider has attended specific conferences related to ketamine management of mood disorders or chronic pain, or belong to a ketamine-specific organization. Professional organizations publish if providers have had board actions taken against them or if their license has ever been impacted by malpractice.

Online Presence. A clinic’s website, social media content, and reviews are important. Internet presence reflects culture–hopefully of respectful care, commitment to safety, and a positive patient experience. Be cautious of facilities that make unrealistic and unproven claims of a “cure”. Ketamine is a groundbreaking agent in the treatment of mood disorders and chronic pain, but it is not right for everyone and requires a personalized, patient-centered approach.

Services. Before your first infusion, you should expect a thorough medical and psychiatric evaluation to ensure you are an appropriate candidate. Quality ketamine clinics may have support services in-house or should be able to refer you to qualified mental health providers for things like psychotherapy, group therapy, or psychiatric medication management. Many clinics utilize daily “check-in” apps to track your symptoms and target when you might be ready for a booster infusion. Additionally, your clinic should coordinate with your existing mental health and medical professionals. Be wary of clinics that offer services unrelated to mood disorders or pain, as the focus should be on alleviation of suffering instead of profit.


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