Ketamine

Ketamine

1st IV Infusion: $500
Follow-up Treatments: $250  

 Depression is one disorder that can severely affect the quality of life and may lead to significant disability. Depression has a daunting 11% prevalence among US adults aged between 18 and 25 years.  In 2016, 64% patients of depression reported severe impairment. Moreover, 67% patients needed medications and healthcare professional advice.

About this Infusion

The enthusiasm for the use of Ketamine as an antidepressant has clearly traveled to far off destinations but it started from US. In March 2017, medical experts issued a consensus statement after it was noted that off label use of this drug has spread throughout the US. There were several diverse reasons for the popularity of Ketamine.

Reasons to Infuse Ketamine

  1. was its efficacy in treating depression, both severe depression and treatment resistant depression.

it is safe to administer even in an outdoor setting (Administered to US marines during Vietnam War)

Ketamine is very fast acting antidepressant and works within 24 hours as compared to a couple of weeks for conventional treatments.

Ketamine’s rapid onset of symptoms’ relief is particularly useful in treating suicidal tendencies.

Ketamine has a superior antidepressant effect in alcoholic patients.

Ketamine has significant role in all the major treatment strategies for the management of resistant depression:

Treatment optimization strategies

Optimization involves dose increment to a tolerable level where symptoms start to subside, at least, partially. Ketamine is recommended in low dose of 0.5 mg/kg over 40 minutes for initial therapy and after two weeks, its dose can be increased up to 0.75 mg/kg. It can be given as a single dose and can be repeated several times as per need.

Treatment augmentation strategies

Augmentation involves adding a non-antidepressant drug with the main antidepressant drug. Here ketamine can be used in combination with a variety of drugs like asenapine (Atypical Antipsychotic, or Second Generation Antipsychotic Drug), Benzodiazepines, Modafinil, Lithium and Thyroid hormone (T3). Augmentation strategies are useful in cases of partial response.

Drug
combination strategies

Combination refers to when two or more antidepressant drugs are combined for treatment. Here Ketamine can be combined with traditional first line antidepressants like sertraline and escitalopram safely. Combination strategies can be used in both partial and treatment failure cases.

Drug
switch
therapies

Switching refers to change of primary medication when it fails to provide relief. Ketamine, with novel mechanism of action offers particular promise to treatment resistant depression patients. The results between augmentation and switching are comparable but switching is relatively safe because patient has to take only one drug. Switching strategies are usually applied after initial treatment failure.

Is Ketamine IV Therapy safe?

 
In a 2010 study, depression 24 patients were given six repeated doses of Ketamine infusion and no side effects were reported. The patients remained symptom free for 28 days in that study. (5) Another report published in 2015 examined the safety and tolerability of Ketamine in 205 ketamine infusions and only 4 infusions were stopped due to side effects and even those side effects subsided after withdrawal of the infusion.

What is the Standard Operating Procedure for Ketamine Infusion Administration?

 

When the consensus report on Ketamine was published in March 2017, several experts in psychiatry and mental health expressed their opinions on it. On March 10, 2017, Dr. Brian Bailey (Psychiatry/Mental Health) had said that Ketamine is a neuromodulator and therefore, it aides psychotherapy. He further shared his experience, “Another reason that this central aspect of its (Ketamine) use does not receive the emphasis it deserves, is that it is so effective that some of its users become their own best therapists and don’t really need help”. (7) The major guiding points of the expert consensus report are outlined in the following bullets:

  1. Evaluate procedural requirements
  2. Obtain patient consent for infusion treatment
  3. Assess and document vital signs (BP, heart rate, oxygen saturation)
  4. Before starting the treatment ask for patient name one more time
  5. Reconfirm the Ketamine dosing parameters and correct any anomalies (if any)
  6. Diligently monitor the patient’s physiologic and mental status during the infusion treatment
  7. Best dosing schedule is “twice a week for four weeks” administration of .5 mg/kg infusion administered over a period of 45 minutes.
  8. Once clinical response is achieved, treatment should be stopped. (8)