In an attempt to help patients make informed decisions about their healthcare, we have included some frequently asked questions about ketamine treatment. If you have questions not addressed here, please contact us. We will respond quickly and thoroughly.
What is Ketamine?
* Ketamine was first synthesized in 1962 by a chemistry professor at Wayne State University. It is a fast acting, quickly metabolized, non-opioid anesthetic. It has been used in and out of the hospital for safe, effective pain relief for decades and is the most common anesthetic used in third world countries. For these reasons, The World Health Organization has deemed it an essential medication.
* In the United States, ketamine is routinely administered (in much higher doses) by civilian and military paramedics, emergency room physicians and anesthesiologists for acute pain relief and anesthesia. In the past two decades, researchers and medical providers have discovered that ketamine can treat emotional pain, as well as physical pain. It has been proven to quickly (days to weeks) reduce symptoms associated with depression, anxiety and PTSD, facilitating psychotherapeutic support and improving quality of life. Ketamine therapy has also shown benefit with some chronic neurological pain conditions, including migraine and complex regional pain syndrome.
How does Ketamine work?
Ketamine acts at many different sites in the brain. Although its mechanisms are not fully understood, current thinking supports the actions of ketamine on the surface of certain brain cells as responsible for its rapid and prolonged effects (reduction in depressive symptoms). Ketamine is an N-methyl D-aspartate (NMDA) receptor blocker. Blocking this receptor allows for the regulation of glutamate, an abundant neurotransmitter responsible for several central nervous system functions. Effects of ketamine on other brain cells lead to increased levels of brain-derived neurotrophic factor (BDNF) and mammalian target of rapamycin (m-TOR), both elements involved in neural plasticity.
Since glutamate is so prevalent within the central nervous system, it is not surprising that investigations into origins and progression associated with certain neurological pain conditions have implicated it as a likely culprit. Receptors responding to glutamate are believed to play a role in the development and proliferation of migraine headache, complex regional pain syndrome and fibromyalgia. As such, ketamine therapy is a reasonable treatment consideration, and has shown encouraging results.
Research has shown that repeated or prolonged exposure to stress (physical or emotional pain, fear, trauma) damages the connections between brain cells. Ketamine has been proven to help repair those damaged connections.
Simply put, Ketamine repairs and enhances neural connectivity in the brain, leading to rapid and prolonged symptom resolution. In addition to treating physical pain, it treats the emotional pain associated with traumatic experiences or memories, allowing patients to comfortably address the underling pathology, internal and external stressors as well as feelings of being overwhelmed. For example, patients with major depression or obsessive-compulsive disorder, tend to have thoughts that occur in repetitive patterns (chatter, negative thoughts, perseveration, or anxious thoughts). Ketamine gives us a tool to reset the internal conversation, essentially breaking the cyclical patterns associated with relapse.
How do I know Ketamine is right for me?
SKI offers free phone consultations with our medical director. She will do her best to respond to your questions about ketamine infusions, psychotherapy services and other services we provide, specific to your circumstance. In addition to talking with us, we encourage discussing the possibility of ketamine therapy with your primary care physician, psychiatrist or psychotherapist before determining what is best for you. We are thrilled to share our knowledge and experience with your providers and answer their questions as well.
What is the Cost of treatment?
For depression, bipolar disorder, PTSD, OCD, anxiety and other psychiatric conditions, the cost of each infusion is $450. The number of infusions will differ depending on the patient’s condition and their response to the initial treatment.
For CRPS and fibromyalgia, these conditions usually require longer infusions for 4 consecutive days. Infusions for pain conditions are $1800.
The cost for infusion for migraine is $1800. Occasionally, more than one infusion is required.
Office visits with the physician are $200.
Oral ketamine is provided in a small group setting. The group is moderated by our psychotherapist and patients are monitored by a registered nurse. The group meets 2 times per week for 4 weeks and the cost is $1,400, which includes your initial evaluation.
How many treatments will I need?
Our goal is to provide an individualized plan to specifically address each patient’s needs. Therefore, the following is intended as a general guideline and will depend on the patient’s specific condition, circumstance and response to treatment.
A. Infusion for Mood and Anxiety Disorders and PTSD
Individuals with treatment resistant depression, and other mood disorders generally receive 4-6 infusions, over a period of 3-4 weeks. Infusions are given over 1 hour. Patients typically return for a single infusion (booster) every 6 to 8 weeks to maintain benefits. Patients with mood and depressive disorders may be monitored daily via text. We use this information for scheduling future infusions and monitoring progress.
B. Infusion for chronic pain/CRPS
Treatments for pain conditions vary with each individual. Dr. Coakley will assess and develop a plan, likely involving longer infusions and monitoring (4 hours) for multiple days in a row. Sublingual therapy may also be recommended.
D. Infusion for Migraine
Infusions for migraine typically begin with a 4-hour infusion. Depending on the patient’s response, additional infusions or sublingual therapy may be indicated.
Does Ketamine work for all types of depression?
Unfortunately, no. Research indicates that 70% to 80% of patients respond to IV ketamine therapy. The individuals in the studies were defined as having treatment resistant depression. That means that they failed to benefit from at least 2 oral anti-depressant medications before trying ketamine. Approximately 60% of patients with major depression do not respond to conventional antidepressant medications.
How ketamine might perform with patients that have major depression, not deemed treatment resistant or are medication naïve, is unclear. This, as well as the effectiveness of IV ketamine therapy with concurrent psychotherapy have not been widely studied. If you are interested in participating with our research efforts, please inform a staff member.
Do you accept my insurance?
Currently, Insurance companies do not cover ketamine infusions. However, as coverage options evolve, we are happy to assist your efforts to request reimbursement from your insurance provider.
Many insurance companies cover psychotherapy and our providers may accept your insurance for therapeutic services. You are welcome to discuss this with our psychotherapist.
Do I need a referral for treatment?
No. We ask that you provide us with any type of documentation you have concerning your diagnoses, past treatment, adverse reactions to medications and current medications. We recommend informing your physician and or therapist about your plans to start ketamine infusions or other treatments.
You will be evaluated by our medical director or another licensed physician prior to initiating ketamine treatment.
On rare occasion, insurance companies require pre-authorization for psychotherapy. We are happy to assist you with this.
Summit Ketamine Innovations does not require you receive therapeutic services, however we strongly recommend maintaining a relationship with a therapist throughout your treatment course.
What do I bring on the day of my consultation?
- A recently updated list of your medications as well as known allergies or reactions.
- Documentation of diagnoses and past treatments is helpful.
- An adult driver must accompany you in order to bring you home after each treatment.
- Your list of remaining questions, to ensure they are addressed before starting therapy.
- A music playlist you find comforting. Your device can be linked to a bluetooth speaker in the treatment room.
Do I need to stop any of my medications?
No. Continue to take all your medications, including medications for pain or mood disorders. Although you may experience a decreased need for these medications after ketamine infusion, you must work with your prescribing physician to wean off these medications appropriately. It is important not to stop any medication abruptly, as it can cause serious withdrawal symptoms.
Can I eat or drink before I come in?
You may not have anything to eat four (4) hours prior to your infusion appointment or have anything to drink two (2) hours prior to infusion appointment. You may not eat or drink two (2) hours prior to an oral ketamine appointment.
What do I wear on the day of the Infusion?
We want you to relax. Wear what is most comfortable for you. Patients generally find loose fitting clothing works best.
What might I expect on the day of my first Infusion?
You will be greeted by our office staff and be asked to fill out a brief questionnaire. The doctor will then perform a focused history and physical exam, review the consent for treatment and answer any remaining questions. When you are comfortable, we will start a small IV, attach vital sign monitors and begin your infusion. You are welcome to have your driver in the room with you or have them wait in the reception area.
During the infusion, we will continuously monitor your heart rate and oxygen level. Your blood pressure will be measured periodically. We will monitor you for the entirety of your infusion, via video monitor (not recorded) as to minimize distractions. You will have a call button, to request assistance at any time. Typically, the infusion for the treatment of psychiatric disorders takes about an hour, and we will monitor you for 15 to 30 minutes after your treatment.
Infusions for chronic pain disorders including fibromyalgia and migraine are typically longer, 4 hours.
Is it possible I will not get my Infusion?
Yes. It’s a matter of your safety. Any concerning signs or symptoms (ex. severe hypertension, chest pain, mania) during your physical exam or evidence of intoxication (alcohol, marijuana, opiates, etc.- prescribed or otherwise) will prohibit you from receiving your infusion.
Eating or drinking prior to your infusion will also prohibit your treatment.
If you do not have an adult driver, your treatment will be rescheduled. If you have transportation concerns, please call us to discuss your options.
Can I drive myself home?
No. Although ketamine is metabolized rapidly, thinking may be impaired for up to 24 hours after an infusion. For your safety, we require that you have a driver here with you BEFORE starting the infusion. We will do our best to keep your driver comfortable while they wait. For the next 24 hours after your infusion, we advise refraining from strenuous activity, watching small children, operating machinery or entering into legal contracts.
Do we provide Spravato™?
Currently, we do not provide Spravato™ or esketamine. We are in an ongoing process of evaluation to determine if it makes sense for our patients. We are looking at the response rates to esketamine vs IV ketamine infusion and oral administration. In order to clarify cost and relative value for our patients, we have contacted Medicare as well as private insurers to determine how they would cover Spravato™.
Currently, most of our concerns remain unresolved, since the medication has newly been approved. Insurance carriers, researchers, Medicare, the pharmaceutical manufacturer, pharmacies and our fellow physician led ketamine clinics appear to be moving as quickly as possible to understand how Spravato™ fits into the regiment of treatments for treatment resistant depression. We are excited about the possibilities. As soon as we have definitive answers to our inquiries, we will provide that information to you. We encourage you to follow developments on this site or ask us about our efforts.
What is Psychotherapy?
Briefly, at Summit Ketamine, we use talk therapy that takes advantage of the physiological indicators of emotional distress. The patient is provided with demonstrations and strategies to respond to the disquieting situations.
What are the benefits of receiving psychotherapy and ketamine together?
The goal of psychotherapy in conjunction with ketamine is symptom reduction and the development of life long strategies that minimize possibility of relapse. Ketamine repairs and enhances neural connectivity in the brain, leading to rapid and prolonged symptom resolution. It treats the emotional pain associated with traumatic experiences or memories, allowing patients to comfortably address the underlying pathology. Ketamine helps diminish the discomforting feelings that inhibit patients from understanding or effectively caring for their fears, emotional discomforts and pain. Learning and implementing strategies to address the underlying issues with psychotherapy can reduce the need for continued treatment or medications.
How can my support system (family/caregiver) be helpful?
Family members or caregivers are encouraged to ask questions from the SKI staff. We have a Family/caregiver support line to assist loved ones with how to be most helpful during and after treatment. We welcome anyone who the patient feels is helpful to their progress.