Frequently Asked Questions - Ketamine
1) What is ketamine? Ketamine is a medication developed more than 50 years ago, and is FDA approved for anesthesia in surgery, and has been frequently used in children and adults in the OR and in the Emergency Room. Over the past 15 years it has been widely studied for its rapid and profound effectiveness for treatment resistant depression and many other disorders. It is given in much smaller doses than in anesthesia and in a specific way that makes it most effective. Ketamine starts a process of neuroplasticity within hours, which allows the brain to start healing itself. Coupled with counseling and other therapies, it provides the best chances of restoring your brain to normal functioning and allowing the real you to emerge. It is not yet FDA approved for depression and like many treatments, is used "off-label."
2) Why did you start using ketamine and why aren't other doctors using it? Our physician is a Board certified Emergency Physician and has been safely using ketamine for over a decade. This has mostly been for procedural sedation in children and elderly patients, or sedation of agitated or violent patients. This has been in much higher doses than is used for Ketamine Infusion Therapy for depression and the other uses we are talking about here. Dr Sullivan has also been treating psychiatric emergencies and substance abuse in the ER for over a decade as well. During the period he has observed that the aftercare for these patients is sparse, and that there were no good options for patients with severe depression or suicidal thoughts other than inpatient psychiatric admission. He started researching ketamine for depression several years ago realized that it was a perfect fit for him. This is not something that most family doctors are familiar with or trained to do. Anesthesiologists use ketamine in the OR, but are usually not experienced in treating mental illness. Most psychiatrists do not perform "procedures" and do not have the necessary equipment and experience to use intravenous medications. Dr Sullivan has assembled a team at Initia Nova to utilize his experience and knowledge of ketamine infusions, with a psychiatric nurse practitioner and ER nurse, and a licensed and experienced therapist. This comprehensive approach provides the best opportunity for you to find your new beginning, or Initia Nova.
3) Is it safe? Studies on low-dose (subanesthetic) Ketamine Infusion Therapy for depression began in 1990, and since then, there have been multiple studies showing it to be both safe and effective for depression and many other psychiatric conditions. For a few minutes during your infusion, heart rate and blood pressure may rise. These are monitored to ensure safety. You may feel a little groggy, lightheaded or nauseous for a few hours after your infusion, and you cannot drive that day, but there are no known long-term or permanent side effects of IV ketamine therapy.
4) Are there any medical conditions or medications that could prevent me from receiving IV ketamine infusions? There are very few. Call now to discuss with our physician. 856-466-6961.
5) Is there an age requirement to have IV ketamine infusions? There are no formal age restrictions. We will consider patients under 18 and over 65 on a case by case basis.
6) Is there a risk of addiction to ketamine? No. While some people have abused oral ketamine, Ketamine Infusion Therapy has not been shown to cause addiction.
7) What is it like to have a ketamine infusion? You will be escorted to our treatment room and seated in a comfortable reclining chair. We will insert an IV and monitor your heart rate, blood pressure and oxygenation. The doctor and/or nurse will be with you during your infusion, which typically takes about an hour. Our therapist may sit in as well if we are doing ketamine assisted psychotherapy. You will not be unconscious during your infusion. Many patients describe extreme relaxation and may drift off for a short nap if they choose, or prefer to bring headphones and listen to music. You may have a dissociative or out-of-body experience and find it difficult to move or talk for a short time, but our objective is to use a dose where you are still able to communicate with us. It is often described as feeling "weird" or "odd," but many describe it as fascinating, joyful or relaxing. Your expectations do affect the experience, so it is helpful to decide ahead of time that you will be safe, might feel "weird" for a little while, and that is OK because it will quickly pass and you will leave feeling much better. We encourage you to bring a friend or family member into the treatment room with you if that makes you more comfortable. The infusion with run for about an hour, and we will continue to monitor you for at least 30 minutes after your infusion. The total visit will last about 2 hours.
8) Do I need to bring someone with me to my ketamine treatments? You do not need to have someone bring you or remain with you during the infusion, but you cannot drive yourself home. Someone will need to come into the office to pick you up, or if you are taking a cab you will be required to stay for a longer observation period in the office. You cannot drive or operate dangerous equipment for the rest of the day, but can return to normal functioning the next day.
9) Can I eat or drink prior to my infusions? As some patients get nausea or vomiting from ketamine, we ask that you do not eat food for 4 hours or drink liquids for 2 hours prior to your first infusion. This may be adjusted for future infusions once we have evaluated your response.
10) Does it work the same if I took it orally or nasally? No. ketamine is absorbed very differently and unreliably when taken orally, nasally or intramuscularly. IV ketamine infusions have been shown to be far superior for most applications.
11) How do I know if ketamine is right for me? Call or email us for a free phone or office consultation. For depression, ketamine is used for people who have failed to respond to traditional medications and treatments. It is also effective for rapid relief of depression and suicidal ideations for those individuals who cannot safely wait the many weeks or months that it takes traditional antidepressants to work. In additional many patients cannot tolerate the troubling side effects of traditional medications such as weight gain, sexual dysfunction, emotional blunting, fatigue and insomnia. Ketamine has also been found to be helpful for severe anxiety, OCD, PTSD, fibromyalgia, chronic pain and some forms of addiction. The 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." Ketamine does not help and may worsen schizophrenia and other psychotic disorders.
12) How likely is ketamine to work for me? On average ketamine improves depression in about 70% of patients, far better than traditional therapies. At Initia Nova we combine the infusions with traditional medications if warranted, individual counseling and other therapies to provide the highest possible response rates.
13) If ketamine therapy works for me, how soon will I begin to feel better? For mood disorder patients, some will begin to feel better within 1 hour of their first infusion. Thoughts of hopelessness and suicidal ideations often begin to lift and dissipate. Others will not notice and effect until after their second or third infusion. It is important to note that although the results of ketamine can be sudden and dramatic, more commonly they are gradual and subtle. Function often improves before mood does. This is significant though in that your improved functioning allows you to more fully participate in your treatment plan with counseling, exercise, improved diet and sleep.
14) How many infusion do I need and how long do they last? Most patients will know after the second infusion if ketamine is working for them. If you are responding to the treatment, we recommend completing 6 infusions over a 3 week period. This time frame is sometimes varied depending on individual responses. Everyone responds differently as to how long the results will last, varying from a few weeks to a few month or longer. At Initia Nova we also employ traditional medications, counseling and other techniques in an attempt to prolong this response. Many patients will require maintenance, or "booster" infusions about once a month to maintain the effects. However, it is possible that an initial series of infusions can be enough to enhance the impact of oral medications, other therapies and lifestyle choices, and provide long lasting remission of your depression and other symptoms.
15) Do I need a referral? No. Unlike most other providers, our comprehensive treatment team can evaluate if our service are right for you. We will be happy to consult with your physician or therapist if you'd like.
16) Is it more expensive than taking oral medications? Ketamine infusions are initially more expensive than a typical doctor's visit and medication copay. However, when you consider the financial toll of ongoing depression and how it affects your work and social functioning, as well as multiple office visits and ongoing medication costs, quickly being restored to a normal level of functioning is an excellent value.
17) How much does ketamine infusion therapy cost and does insurance cover it? There are several different treatment options. A single infusion costs $500. A package of 6 infusion costs $3000 and includes a psychiatric evaluation, prescribing traditional antidepressants if warranted and 4 individual counseling sessions. Maintenance ketamine infusions cost $450. We do not directly take insurance but will provide you with a bill to submit to your insurance company. While we cannot guarantee any reimbursement, some patients with "out of network" benefits are able to recoup a portion of their out of pocket expenses, and many insurers will cover the psych eval and counseling. Payment is due at the time of treatment. We accept all major credit cards, personal checks and cash.
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