What is ketamine?
Ketamine is FDA approved for use as a dissociative general anesthetic which has been in world wide use since the 1960s. Ketamine is on the World Health Organization’s (WHO) List of Essential Medicines. Ketamine has been proven to be safe and effective for human use in the higher, anesthetic doses, for general anesthesia. A growing body of evidence indicates that ketamine used at a sub-anesthetic dose, a much smaller dose than that used in general anesthesia, is highly effective in alleviating treatment-resistant depression, suicidal thoughts, bipolar depression, anxiety, OCD, PTSD, and select types of chronic pain. This use of ketamine for psychiatric disease is an “off-label” use.
What does ketamine treat?
Ketamine is not used to treat mild to moderate illnesses since, often, these mental health conditions are effectively treated with talk therapy with or without traditional medications. The Midwest Institute for Hearts and Minds focuses on treating individuals with treatment-resistant depression, bipolar depression, generalized anxiety disorder, obsessive compulsive disorder, post-traumatic stress disorder, chronic neuropathic pain and chronic headaches/migraines. Treatment resistance means that a patient has not achieved response (> 50% reduction in symptoms) or remission (>90% reduction in symptoms) after two full dose trials of antidepressants.
How does ketamine work?
Low-dose ketamine for the use of depression has been researched at Yale, Mount Sinai School of Medicine, the Mayo Clinic, the National Institute of Mental Health and other well-respected institutions. These studies show very promising results. Research done by Dr. Carlos Zarate, a lead researcher of ketamine at the National Institute of Mental Health, found that ketamine blocks the NMDA glutamate receptors, which rapidly improves mood. In addition, Dr. Zarate’s research also shows that after ketamine use, a metabolite (a chemical byproduct of ketamine which remains in the body for days) activates AMPA receptors. This activation also has an antidepressant effect. Ketamine's metabolite has not been shown to have addictive properties. Other studies have demonstrated that ketamine triggers dopamine release which affects select pathways in the brain responsible for mood. Perhaps the most exciting finding is that ketamine may also work by facilitating new dendrite growth and synaptic connections, potentially helping to structurally restore the brain to allow for improved mood and functioning. Depression and stress deteriorate these dendritic connections. To summarize, ketamine represents a new class of rapidly acting antidepressants.
Ketamine has been found to act quickly, especially in depression, often within hours or days. This is of tremendous benefit for those who have tried antidepressants or antianxiety medication which often take weeks to months to achieve maximum benefits. The rapid effect of IV ketamine is a benefit not seen with any oral or topical (patch) antidepressant medication.
How is ketamine administered? What are the side effects?
Ketamine is administered intravenously (IV), which means the drug is given through a vein in the arm. The patient is typically given two (2) IV infusions per week for 3 weeks (a total of 6 infusions for induction). Since sub-anesthetic doses of ketamine are used, patients are not asleep during the treatment. Patients may feel a disassociation often described as a daydreaming, spacey, or floating experience. During the 45-50 minute ketamine infusions, some patients may experience confusion, nausea, dizziness and blurred vision. These side effects typically cease within 15 to 30 minutes after the IV treatment is completed. Although each infusion lasts about 45-50 minutes, patients should expect to spend extra time speaking with the doctors who will explain the procedure, and time with the psychometrician for cognitive and psychological testing prior to infusion. Also, you will be monitored for 15-30 minutes after treatment. The total time spent in our clinic will be approximately two hours. This is an outpatient procedure in a controlled, clinical, setting under physician monitoring. Although the potential side effects of the ketamine infusions are short-lived, patients may feel groggy afterwards. For your safety, it is required that you have a driver bring you to the Clinic and take you home.
How long does the benefit of ketamine last?
Each individual is different and his/her dosage and frequency of treatment will vary. However, research has shown that the benefits of ketamine generally last for days to months. After the initial six (6) IV infusions, patients will likely require “booster infusions” if their mood starts to decline or when they show symptoms related to their diagnosis. The average interval between needed boosters ranges from weeks to months.
What are the risks of using ketamine?
Ketamine has long been established as a very safe and effective drug for anesthesia. Some have expressed concern that because ketamine is abused as a “club drug” or “street drug”, people with a history of (any) addiction may become more susceptible to relapse with ketamine treatment. However, there is insufficient evidence to indicate that ketamine, at a sub-anesthetic dose, is addictive or contributes to relapse in patients with a history of addiction. No ketamine will be prescribed or provided to the patient for use outside the Clinic.
Does ketamine work for everybody?
It is estimated that about 70% (2 out of 3) of treatment resistant, depressed, patients respond (at least 50% reduction in depressive symptoms) favorably to ketamine treatment. At present we have no markers/testing which will help us preselect those treatment resistant patients who will benefit the most from ketamine. MIHM has selected an induction period of 6 infusions, according to the best timing schedules described in the literature. We ask patients to make a commitment to completing all 6 sessions.
Does insurance cover ketamine treatments?
Ketamine treatment for psychiatric disease is not currently covered by insurance. Using ketamine for the treatment of depression and anxiety is considered an “off-label” use (https://www.fda.gov/ForPatients/Other/Offlabel/default.htm).
This means that the FDA has yet to approve ketamine for the treatment of psychiatric illness. While “off-label” use is quite common with many medications, “off-label” use is typically not covered by insurance companies or Medicare. You may receive reimbursement via your HSA, MSA or FSA plans.
How much do ketamine treatments cost?
The cost depends on the services rendered. Before treatment, the patient will meet a physician who will go over his or her health history and address any concerns. Midwest Institute for Hearts and Minds will provide an objective, quantified, baseline assessment (how the patient is functioning and feeling before treatment) and equivalent post-treatment assessments. We will also provide periodic telephonic or electronic “check-ins” between treatments. The timing and number of periodic booster infusions vary from patient to patient. Therefore, each individual's costs for treatment will vary. You may also receive reimbursement via your HSA, MSA, FSA plan. We encourage you to call or visit us with any questions you may have.
What are the baseline and post-treatment assessments?
Each assessment will include having the patient fill out questionnaires about his or her symptoms of mood, anxiety, obsessiveness, past trauma or pain level, depending on the patient’s presenting complaint(s). The patient will take a brief (approximately 30 minutes) neuropsychological battery to assess several areas of neurocognitive functioning. This brief neuropsychological battery is called CNS Vital Signs and consists of seven short sub-tests that measure simple and complex attention, reaction time, verbal and visual memory, psychomotor speed, fine motor speed and executive functioning. The sub-tests are self-administered on a computer and require no special computer skills on the part of the patient. CNS Vital Signs is an assessment tool that has been in use for 14 years. It has been used in the military and worldwide for clinical trials by major pharmaceutical companies and educational institutions. All of the sub-tests are normed and have well-established validity and reliability. Intractable symptoms in treatment resistant depression, anxiety, OCD, PTSD and chronic pain may affect cognition in several ways and to varying degrees. The CNS Vital Signs assessments are performed at baseline and at periodic intervals during and after treatment to ensure that the patient is receiving the expected benefits of ketamine treatment. Many people may find that once their psychiatric symptoms are alleviated, their thinking and memory (i.e.cognition) may also improve.
Can anyone have ketamine treatments?
No. Individuals with select health conditions and who are taking certain types of medications should not receive ketamine. In addition, there are certain medical conditions which need to be well controlled (e.g. hypertension) prior to ketamine treatment. As stated previously, the Midwest Institute for Hearts and Minds focuses on treatment-resistant patients who have tried and failed to achieve symptom remission with at least two other medications. In cosultation with you and your healthcare team, it will be determined if you are a candidate for ketamine treatment. In most cases, you will continue taking all of your prescribed medications while on ketamine therapy.
Why choose Midwest Institute for Hearts and Minds?
At Midwest Institute for Hearts and Minds, we take a comprehensive approach to treating the whole person: mind, body and spirit. We work with your healthcare team to give a new perspective and new treatment options while reassessing why you may be treatment resistant. We adhere to the highest ethical standards of medical practice. We want to make sure that ketamine is the correct treatment for the correct diagnosis and the right patient. The health of the whole patient, mind, body and spirit, is taken into consideration before proceeding with ketamine treatment.
Are there alternatives to ketamine treatment?
Yes. These are the FDA approved (non-pill) therapies for treatment-resistant depression: Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS), Vagus Nerve Stimulator (VNS) and Deep Brain Stimulation (DBS). All of these brain stimulation therapies are approved for treatment-resistant depression; DBS is also indicated for treatment-resistant OCD. These treatments are briefly described here:
What do I need to do to get started on ketamine treatment?
We ask that all patients interested in receiving ketamine to click on the “CONTACT US” section, fill out their information and then schedule an appointment to meet our team. No ketamine infusions are performed at this introductory visit.