Ketamine Infusion Therapy FAQ

Frequently Asked Questions About Ketamine Treatment

Ketamine was developed in the 1960s and FDA-approved for anesthesia in 1970. It is classified as a dissociative anesthetic as it has some unique properties that temporarily help separate the mind from the body. It is one of the most widely used medications today for a variety of conditions, and is on the World Health Organization’s List of Essential Medicines. It was studied in the 1980s and 90s for its ability to treat addiction and pain, as well as used for surgery/sedation for children due to its excellent safety profile. In the early 2000s it broke out in the psychiatric world and would come to be known as the biggest breakthrough in 50 years for treatment-resistant depression. Over the past decade it has been studied and used off label for a variety of conditions described below.

Ketamine is most effective against treatment-resistant depression, suicidal thinking, and post-traumatic stress disorder. At Initia Nova we also offer ketamine-assisted psychotherapy (KAP), in addition to ketamine infusions alone (KIT), We recognize these mental health conditions are best treated by a mental health professional, skilled in these areas as well as skilled in psychedelic therapies. By combining ketamine with therapy, our patients are able to not only harness the benefits within their session in our office, but integrate their breakthroughs in their day-to-day lives beyond their treatments.

In fact, many mental health conditions are so deeply ingrained in the mind and body that we have found that working with an experienced therapist can improve your success rate with a variety of conditions in addition to the above, including anxiety, OCD, eating disorders, and pain as these are often closely intertwined with depression and trauma.

Alcohol use disorder when comorbid with depression and anxiety can respond very well to ketamine infusions. Particularly when combined with oral medications such as naltrexone and baclofen, and therapy.

Certain neuropathic pain disorders such as complex regional pain syndrome (CRPS/RSD) and fibromyalgia, as well as migraine headaches can be quite responsive to ketamine infusions at higher doses than we typically use for depression, and we have found success with patients when including ketamine-assisted psychotherapy (KAP) therapy as well.

After your initial evaluation we can help you decide if KAP is the right option for you.

Dr. Sullivan is a Board Certified Emergency Physician and has been safely using ketamine for almost 20 years. This has mostly been for procedural sedation in children and elderly patients, or sedation of critically ill patients as it is safer than other medications. 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 this 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 or electroconvulsive therapy.

He began researching ketamine for depression and realized that it was a perfect fit for him. In 2016 Dr. Sullivan became one of the first physicians in the country providing outpatient ketamine infusions. 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 with Dr. John Dougherty, Rena Beyer and Winden Rowe to combine the skillsets of some of the most experienced physicians and trauma therapists in the field. This comprehensive approach provides the best opportunity for you to find your new beginning, or Initia Nova.

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.

There are no formal age restrictions. We will consider patients under 18 and over 65 on a case by case basis. Dr. Sullivan has treated patients as young as 13 and as old as 97.

No. While some people do abuse oral or nasal ketamine, ketamine infusion therapy in the medical setting has not been shown to cause addiction.

You will be seated in a comfortable reclining chair and have your IV inserted. Our Board Certified Physicians and critical care nurses are always on site and monitor you during your infusion, which typically takes about an hour. Our therapist may work with you in person or virtually if you 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 goal is to use a dose where you are still easily 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. And our treatment team will guide you through it every step of the way.

We encourage you to bring a friend or family member into the treatment room with you if that makes you more comfortable. The infusion typically runs for about 40 minutes, and we will continue to monitor you for at least 20 minutes after your infusion. The total visit usually lasts about an hour for mental health infusions, 90 minutes for KAP, and possible longer for pain infusions. You cannot drive for the rest of the day.

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 an Uber or Lyft you will be required to stay for a longer observation period in the office. Most people feel back to themselves 10-20 minutes after the infusion is over, but to be extra cautious you cannot drive or operate dangerous equipment for at least 12 hours after your infusion, and only if you are completely back to normal. Some people feel a bit tired the rest of the day and sometimes the next day.

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.

No. Ketamine is absorbed very differently and unreliably when taken orally, nasally, or intramuscularly. IV ketamine infusions have been shown to be far superior than other routes of administration. Infusions also give us a lot more control over your experience and it can be paused or adjusted at any time.

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 ideation for those individuals who cannot safely wait the many weeks or months that it takes traditional antidepressants to work. In addition, many patients cannot tolerate the troubling side effects of traditional medications such as weight gain, sexual dysfunction, emotional blunting, fatigue, and insomnia.

Ketamine combined with working with an experienced therapist has also been found to be very helpful for PTSD. Patients with alcohol use disorder have had good success with ketamine infusions combined with oral medications and therapy. And those with pain conditions such as migraine find ketamine infusions to be life-changing. 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.

On average, ketamine infusions improve depression in about 70% of patients. This is a far better chance than trying another oral antidepressant, but not 100%. At Initia Nova, we encourage you to combine the infusions with KAP or individual counseling and other therapies to provide the highest possible response rates.

For mood disorder patients, some will begin to feel better within the first week. Thoughts of hopelessness and suicidal ideations often begin to lift and dissipate. Most patients begin to notice improvement after the second week. 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.

We start with an initial series of 8 infusions, initially twice a week. Many patients start to see improvements after the 4th or 5th infusion. If you respond well we start to taper off the infusions with longer intervals in between. This time frame is often 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.

Most patients treated for depression will require maintenance, or “booster” infusions about once a month to maintain the effects. For patients with depression secondary to PTSD, we have seen many of them respond very well to KAP and not require maintenance infusions. We approach each patient on an individualized basis.

No. Our physician will do a comprehensive evaluation to determine if our services are right for you. He may however require you to have additional consultation with other medical of psychiatrist specialists to coordinate care. We will be happy to consult with your physician or therapist as well.

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 and investment in yourself and your future happiness.

There are several different treatment options depending on your specific history and needs. For depression and PTSD, the initial series costs $3400 which includes your initial evaluation and the first 8 infusions. This is a cost of $425 per infusion. Maintenance infusions cost $450. We do not directly take insurance, but you can submit a superbill if you have out of network benefits to try to get partially reimbursed for your treatments. If you are doing KAP, there is an additional cost paid directly to the therapist you are working with.

Payment is due at the time of treatment. We accept all major credit cards, personal checks, Venmo and cash.

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