Treatment-Resistant Depression (TRD)

The first step to receiving ketamine treatment is to be evaluated by a psychiatrist or a mental health nurse practitioner. If you currently see a psychiatrist or a mental health nurse practitioner, you can speak with them about ketamine/Spravato treatment to see if they believe that it is the right treatment for you. If so, please ask them to send us a referral.

If you do not have a psychiatrist, please contact us to set up an appointment with our psychiatrist. Once the psychiatric evaluation is complete and you have been deemed to be a good candidate for ketamine treatment, we will then set you up for an initial consultation with our physician. A thorough medical evaluation will be done to make sure that there aren’t any medical reasons why you should not receive ketamine. At that same appointment, we will also go over what treatment is, what to expect and answer any questions that you may have. At the end of that visit, we’ll set up your first treatment to begin your own ketamine journey. Please note that if you are going to be receiving Spravato, we’ll need to request prior approval from your insurance to cover the treatment. Once that’s approved, we’ll request the medication to be sent to us from a specialty pharmacy. This entire process generally takes about 2-3 weeks. Once we have your medication, we can then begin your treatment.

If you have any questions at any time, please feel free to reach out to us. We’d love to hear from you! 

Ketamine has been proven to be effective for major depressive disorder (MDD), including treatment-resistant depression, as well as bipolar depression.

While two-thirds of people with depression respond adequately to traditional antidepressant therapies, one-third do not. When depressive symptoms do not respond appropriately to two or more separate antidepressants, this is known as treatment-resistant depression (TRD). This type of depression can be very difficult to treat and has limited therapeutic options. Fortunately, approximately 75% of people with TRD respond well to ketamine treatment!

Bipolar disorder is when major depression is associated with either manic or hypomanic episodes. These episodes are typically characterized by an extremely positive mood, rapid speech, racing thoughts, difficulty concentrating, insomnia, irrational thinking and risky behaviors. While ketamine is not able to treat the manic/hypomanic episodes, it can significantly reduce the depressive phases associated with bipolar disorder.

Approximately 70-75% of people with depression respond positively to ketamine therapy. Many people begin feeling the beneficial effects of ketamine within 2-24 hours following treatment. For some people, however, it may take four treatments before they begin to feel any improvements, while others may not respond until the sixth treatment. Every person is unique. The only way to know if ketamine will work for you is to try it out for yourself.

As you can see, both the neuronal thickness (freeway size) and connectivity (on- and off-ramps) of each neuron are greatly increased. This leads to healthier, more robust neurons that are able to transmit and receive signals as they are naturally intended to.

There are different theories about how exactly ketamine achieves this effect. Two main theories that scientists have proposed include:

1) Glutamate Imbalance: For decades, we believed that the main cause of many mental health disorders was an imbalance of specific chemicals, called neurotransmitters, inside our brains. Neurotransmitters are simply the chemicals that neurons send to each other as a form of communication (cars on the freeway). The neurotransmitters that we have believed that are out of balance include: serotonin, dopamine and norepinephrine. For that reason, most of the medications used to treat mental health disorders have focused on altering the levels of these neurotransmitters, trying to bring them back into their proper balance.

As it turns out, the real imbalance may not be of the previously mentioned neurotransmitters at all. It may actually be an imbalance of a different neurotransmitter called glutamate. Glutamate is the most common stimulating neurotransmitter inside the brain. Ketamine is able to increase glutamate levels, which promotes communication between our neurons and, ultimately, restores our brains' neuroplasticity.

2) An Increase in BDNF levels: Another molecule that stimulates nerve growth and communication is called brain-derived neurotrophic factors (BDNF). It is kind of like a fertilizer for our neurons. It greatly increases neuronal health and function by restoring the connections between each of our neurons.

This is extremely exciting news! It is so exciting that some experts say that it is the biggest breakthrough in the field of mental health in decades!

Every person responds to medical treatments differently. Many people experience a sudden relief of their depressive symptoms, including any desire to commit suicide (if present). Others may notice more subtle improvements. They may realize that they have more energy than they previously did. They may also feel motivated to do things that they haven’t had the desire or energy to do for months or even years. While most patients say that their depression doesn’t completely go away, they do say that it becomes much more manageable. They are able to work through issues that they weren’t able to in the past. They can think about their problems more objectively and come to solutions more easily. Although ketamine might not be the entire solution, it may be the missing component needed to finally begin your individual journey through the healing process.

According to PubMed, a medical database for journal articles, there have been 19,120 studies performed on ketamine as of October 2019. Of that number, 4,445 of them were related to mental health disorders and 3,385 were related to ketamine’s effect on pain. 

Treatment with ketamine is only indicated for people living with treatment resistant depression which is generally defined as having failed to respond to 2 types of anti depressant medications. If you have symptoms of depression, we recommend that you speak with your primary care provider and/or a psychiatrist about this to get the care you need. They can refer to our clinic if they think that you are an appropriate candidate for ketamine treatment. If you do not have a primary care physician or a psychiatrist, give us a call and we will take care of you.

Prior to beginning treatment, a medical consultation/evaluation will be done by one of our physicians to ensure that you are an appropriate candidate for ketamine treatment and also explain in depth what treatment with ketamine entails. If you do not have a psychiatrist, we will have our psychiatrist do a psychiatric evaluation to confirm your diagnosis and determine whether ketamine treatment is appropriate for you.

Once that has been completed, we will then schedule your initial ketamine treatment. All of our treatment rooms are private and set up to be very comfortable and relaxing. We have recliners, sound canceling headphones, calming music, warm blankets to help make your treatment session as smooth and therapeutic as possible. The treatment session typically lasts 2 hours as we monitor you carefully with state of the art monitoring systems. The first thing that you’ll most likely feel is an incredible sense of relaxation. This is a very comforting feeling. As the ketamine continues to go into your system, you may start to see colors or objects when you close your eyes. As your neurons begin to wake up, your mind may become very active. You may have a number of thoughts seamlessly passing through your mind. You will likely experience a very close connection with your inner self. These feelings can be profoundly touching and can help you understand your true worth as a human being. Many people describe these feelings as exquisitely spiritual and deeply moving. Ketamine is an activator and can stir up feelings and emotions of all types. As a result, you may experience an array of feelings, such as sadness or melancholy. These are also part of the healing process.

Every time that you receive ketamine your experience will be unique and will likely be influenced by the frame of mind that you are in when the treatment begins. As a result, we suggest that you try and minimize your stress levels as much as possible on the days of your treatments. We also recommend that you use each treatment to work on things that you may be struggling with at the time. Use each treatment as a building block toward improved mental health. This will become easier and easier with each treatment that you receive. It is difficult to describe the beauty of a ketamine experience in mere words and is something that you truly have to experience in order to fully appreciate.

As the ketamine begins to wear off and you float back to reality, you may want to jot down a few things about your session on the note cards that we provide. You may want to draw some of the images that you saw or describe the comforting feelings that you felt during the treatment. Taking notes is a way to preserve that experience so that you can reflect on it later. You may also want to take this note card with you to your next psychotherapy session and discuss any issues that may have been uncovered. The note card can be a wonderful way to chronicle your own personal ketamine journey, allowing you to look back at yourself and see just how far you’ve come. 

Every person’s response to ketamine will be unique but many people experience a light, floating feeling. Others may feel a slight disconnection from their bodies and the world. As a result of this “out of body experience”, many people state that this is the time that they are able to see their situation from an objective point of view. They are able to work through dilemmas without all of the associated grief and pain that accompany them. People with severe PTSD can begin to see what life can be like without the heavy weight that PTSD brings. Those with suicidal thoughts may experience them simply disappearing. Colors and sounds may become more intense and your sense of hearing may be heightened. Since ketamine activates nerves inside your brain, you may feel that your mind is very active while your body is nice and relaxed.

It is also possible to experience some unpleasant feelings, such as melancholy or sadness. Not everyone experiences this but if you do, know that it is normal and usually improves over the next few treatments. If you experience these feelings and they become too intense, please let us know. We can adjust your treatment regimen in order to minimize them as much as possible.

Yes! Many people desire to have someone that they know and love by their side, especially during the first couple of treatments. This is something that we encourage, since our goal is to make you as comfortable and relaxed as possible.

Yes, we certainly do. 

In preparation for your treatment, we ask that you not have anything to eat for at least 4 hours prior to your treatment. You may have clear liquids (i.e. water, soda, black coffee, tea, pulp-less juice, etc.) up until 2 hours prior to your session.

There are no restrictions on what you can eat or drink after your treatment is complete.

Ketamine treatments are used in conjunction with your current medication regimen. For many people, ketamine improves the efficacy of your current medications. As a result, many find that they are able to slowly reduce their dosages and eventually stop many of their medications once they are on ketamine treatment. It is important to remember, however, that all medication changes must be made in collaboration with the provider who is prescribing the medication. Never stop taking a medication on your own without talking with your prescribing provider first. 

Yes. It is important to know that ketamine treatment is an adjunctive form of treatment and does not replace any treatment that you are currently on. Your doctor will continue to see you as they do now and we will collaborate with them to let them know how your ketamine treatments are going. The goal of ketamine treatment is to improve the efficacy of the treatment/s you are currently receiving. 

In order to receive ketamine for a mental health condition, we do require that you be evaluated/referred by a psychiatrist or a mental health nurse practitioner. If you do not have one, you are welcome to see our in-house psychiatrist to determine if ketamine is right for you.

We also ask that you have your primary care provider send us your most recent office visit notes, including any lab results. We will collaborate with your providers to let them know how your ketamine treatments are going, so as to provide you with the best care possible.

For your own safety, we require that a responsible adult drive you home after your treatment.

Of course! You are welcome to stop by any time. We will also provide you with a tour of our clinic during your initial consultation.

Not at all. Many drugs today are used off-label. This simply means that the reason for taking the drug is different than that approved by the Food and Drug Administration (FDA). New uses for drugs are discovered all the time. Some common examples of off-label uses are: propranolol for performance anxiety, prazosin for nightmares, clonidine for ADHD, colchicine for psoriasis, naltrexone for multiple sclerosis and quetiapine for anxiety.

Ketamine is an FDA-approved medication and has been since 1970. It has a long history of safe use in the field of medicine. Ketamine treatments have been given off-label in outpatient settings across the country for many years. They have helped numerous people suffering from mental health disorders and chronic nerve pain to take control of their lives once again. 

It is indeed. The reason for that is that it is commonly used in veterinary medicine to sedate animals of all sizes, including horses.

Many people wonder if ketamine is a new drug because they have never heard about it until now. The following gives a brief history of ketamine and its use in the field of medicine:

1956: Phencyclidine (ketamine’s parent drug) was first synthesized at the Parke Davis laboratory in Detroit, Michigan.

1962: Calvin Stevens, PhD, was experimenting with derivatives of phencyclidine (PCP) and discovered ketamine (CI-581). He found it to be a very safe drug with excellent anesthetic properties.

1970: Ketamine was FDA-approved as an anesthetic agent for humans. It also became widely used in the field of veterinary anesthesia, and thus received the nickname “horse tranquilizer”.

1970-1975: Ketamine was used extensively during the Vietnam War for battlefield surgeries due to its minimal side effects.

1985: Ketamine was placed on the World Health Organization’s list of Essential Medicines. This is a list of medications that are considered so essential that every country in the world should have them readily available for the benefit of their citizens.

1990s: Research into the use of ketamine as an antidepressant began at Yale University.

2019: A form of ketamine called Spravato (esketamine) was approved by the FDA for the management of treatment-resistant depression.

Current:   Ketamine continues to be a vital medication in modern-day anesthesia, as well as veterinary medicine. Its use as an antidepressant continues to grow by the day as more and more people learn about its incredible benefits.

Ketamine is a very safe drug when given by trained medical professionals. It is important to remember, however, that it is still a dissociative sedative. For that reason, it is important that it only be administered in a setting where you can be properly monitored and cared for. The vast majority of ketamine experts do not recommend oral ketamine at this time and we support that consensus. This may change in the future, however, as scientists are continually developing new versions of drugs to improve both our health and well-being.

Ketamine mainly targets the NMDA receptor. This receptor is involved in a number of different processes throughout the body. Therefore, when it isn’t functioning properly, it can result in a variety of different ailments. By selectively targeting the cause of these conditions, ketamine is able to effectively treat them, restoring both physical and mental health to our bodies.