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Q: Why is ketamine administered under the direction of an anesthesiologist rather than a psychiatrist?

A: Anesthesiologists have expertise in administering medications intravenously and also have expertise in monitoring the heart, blood pressure and breathing during IV sedation. Dr. Culver has had experience in administering IV ketamine as an anesthetic agent since 1981.

Q: I have depression. Does this mean I am a candidate for IV ketamine?
A: Maybe. First you should have had a trial of oral antidepressants (usually at least 2 different medications). If you fail to experience adequate relief you may be a good candidate.

Q: Is there a guarantee that ketamine will work to treat my depression?
A: No. However, at least 70% of patients who receive IV ketamine do report good results.

Q: I've heard that some doctors give ketamine by intravenous infusion, some as an intra-nasal spray, and some by subcutaneous injection.  Why is IV infusion better?

A: IV infusion is the only way to administer an exact dosage over an exact period of time.  This maximizes safety.  There are fewer variations in blood pressure and heart rate.  Based on the patient's response to the infusion the rate of the infusion can be changed if needed.  If it is given as an intranasal spray there can be great differences in both the rate of absorption and the amount that is absorbed.  Therefore the dosage is not precise and the rate cannot be controlled.  When it is given as a subcutaneous injection or an intramuscular injection the rate of absorption and the dosage cannot be changed or controlled once the injection is administered. If it is rapidly absorbed a patient can experience adverse mental effects and much greater changes in blood pressure and heart rate.  IV infusion of ketamine is considered the ideal route of administration and the best standard of care. Safety is further maximized when IV infusion is combined with appropriate monitoring of heart rate, blood pressure, and oxygen levels under the supervision of an anesthesiologist.

Q: Is ketamine infusion therapy addictive?

A: No. Not one of our patients has displayed or reported any symptoms of addiction.

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

A: No. Some patients achieve long-term relief after one series of infusions. Others will 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.

Q: Will my current medications interfere with my ketamine infusions?

A: Please inform us of any and all medications you are taking. We are particularly interested in learning if you are taking:
1. Lamictal (generic name Lamotrigine). Patients should allow 12 hours between taking lamictal and the start of their infusion. They should wait 6 hours after their infusion before resuming lamictal.
2. Any MAOIs. Some common brand names are Isocarboxazid (Marplan), Phenelzine (Nardil), Selegiline (Emsam), and Tranylcypromine (Parnate). Patients cannot take any MAOIs within 2 weeks of an infusion.
3. Patients taking large doses of benzodiazepines will have a reduced response to ketamine. This does not mean you can’t receive ketamine treatment while taking benzodiazepines. We just want to ensure the best possible chances for your success. We may ask you to skip a dose 24 hours before the start of your infusion and wait until 6 hours after before resuming your benzodiazepine. Some common brand names are Xanax (Alprazolam), Ativan (Lorazepam), Valium (Diazepam), and Klonopin (Clonazepam).
4. SSRIs and tricyclics do not interfere with ketamine. There is no need to stop them.
5. If you are taking opiates, muscle relaxers, or anti-inflammatories, there is no need to adjust your dose.
6. You should not adjust your dose or frequency of use of any prescribed medication without first consulting with your prescribing physician.

Q: What happens after my series of ketamine infusions?

A: You should continue to follow up with any mental health professionals (psychiatrists, psychologists, therapists) who have been involved in your care prior to infusions and also your primary care physician. IV ketamine can be very effective in treating your symptoms, but is not intended to be a substitute for mental health care, counseling or regular medical care. Some patients are more receptive to conventional oral anti-depressants after treatment and most are encouraged to be involved in talking therapy with a trusted, licensed, mental health professional. Following the initial series of infusions, some patients begin an infusion maintenance program, returning for additional infusions as needed. In most cases, 1-2 boosters is all that is necessary to restore patients and significantly extend their results. The interval between maintenance infusions will vary from patient to patient. Some patients may have a booster once per month starting 1-3 months post treatment while others have gone over a year before needing to come back. There is no way to predict if or how often you will require booster infusions. The level of involvement with the above listed aftercare plan may impact the need and frequency of follow-up infusions.

Q:How many ketamine infusions will I receive?

A: An initial series of 6 infusions is performed, typically over a 2 week period of time. In some cases this may vary to accommodate patients who have travelled long distances which require them to stay locally while receiving treatment. Results can be seen very quickly, in as little as one treatment, but often are not seen until after the full course of treatment is complete. Subsequent maintenance infusions (typically 1-2 infusions) can be scheduled as needed approximately 1-3 months after the initial series has been completed. In some cases maintenance infusions are not needed until quite some time after the initial series. Relief may start to last longer and longer such that maintenance infusions are needed less frequently.

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

A: One will begin to feel better after their first or second infusion. Patients with thoughts of self-harm or suicidal ideation often notice those thoughts and feelings dissipate first. There is often a dramatic relief of dread and hopelessness. Some patients will require a third infusion 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.

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

A: Patients commonly feel tired following an infusion. It is best to go home and rest after the infusion. On rare occasion, some patients experience nausea after an infusion. Side effects usually dissipate within a few hours and are completely gone by the following day.

Q. I am bi-polar, will ketamine make me hypomanic?

A: Hypomania has not been reported following IV ketamine therapy. It is best to postpone infusion treatments if you are in the manic phase.

Q. What medical conditions could keep me from receiving IV ketamine infusion?

A: You should not receive ketamine infusions if you have unstable angina, have been taking MAO inhibitors within the previous 2 weeks, have had a recent stroke or recent heart attack, have a history of schizophrenia/hallucinations, if you are taking amphetamines, or if you are using certain illicit drugs such as cocaine in any form.
Q: Where is the treatment performed?

A: All ketamine infusions administered by Ketamine Clinic of Michigan are administered in our treatment rooms located inside The Surgery Center at 5202 Miller Rd. in Flint, Michigan. This is a state of the art modern facility. The treatment rooms are private and each patient is individually monitored throughout the infusion treatments.
Q: Will my insurance company pay for ketamine therapy?

A: No. Although ketamine is an FDA approved medication which has been used in anesthesia worldwide since 1971 its use to treat depression is considered off-label use and therefore is not covered by insurance.

Q: How soon can I be seen?

A: Usually patients are seen within one week of contact.

Q: Is there an age requirement to have IV ketamine infusions?

A: There are no formal age limitations.

 

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"Recent data suggest that ketamine, given intravenously, might be the most important breakthrough in antidepressant treatment in decades."
Thomas Insel, Director, National Institute of Mental Health

Ketamine Clinic of Michigan
5202 Miller Road, Flint, MI 48507
(located inside the Surgery Center)
Call: 810-265-7103
Email: info@ketaminemichigan.com