elevate medical

Psychiatry located in New York, NY

Ketamine Q & A

What is Ketamine?

Ketamine is an FDA approved anesthetic that is considered safe and effective. It has been used since 1970 worldwide and has been listed as an essential medicine by the World Health Organization since 1985.

Over 50 years, providers worldwide have noticed that Ketamine has other medicinal benefits, including but is not limited to improving mental health conditions as well as chronic pain.

What is Ketamine's mechanism of action?

Ketamine binds to NMDA receptors and creates a glutamate surge, releasing growth factors that help make new synaptic connections in your brain. This paves the way for healthier thought patterns and increases your resilience to chronic stress.

How is Ketamine Administered?

Ketamine has several routes of administration, including Intravenously (IV), Intramuscularly (IM), Sublingually (SL), Orally (PO), and Intranasally (IN).

IV Ketamine - 100% bioavailability, rate of infusion can be controlled (decreased if experiencing side effects or increased to achieve optimal effect); Duration of action = 5-10 minutes for bolus dose

IM Ketamine (injection) - 93% bioavailability, can result in very rapid uptake of Ketamine from the muscle. Once you give it, you cannot take it back. Duration of action = 30-75 minutes

SL Ketamine - 25-50% bioavailability, bypasses hepatic metabolism by directly being absorbed in the mouth; Duration of action = 2-3 hours

PO Ketamine (lozenges) - 16-20% bioavailability, due to extensive 1st pass hepatic metabolism; Duration of action = 2-4 hours

IN Ketamine (nasal spray*) - 45-50% bioavailability, less invasive with rapid systemic absorption; Duration of action = 45-120 minutes

Is Ketamine FDA approved for the treatment of depression?

In 2019, Spravato (esketamine), which is the s-enantiomer of Ketamine, was FDA approved for Treatment-Resistant Depression (TRD). It is administered via nasal spray under the supervision of a health care provider. It is one-half of racemic Ketamine, known as S-Ketamine. It demonstrated recovery of mental functions quicker than pure Ketamine and has also shown to increase glucose metabolism in the frontal cortex while R-Ketamine does the opposite. However, while R-Ketamine is devoid of psychotomimetic side effects, S-Ketamine has dissociative/hallucinogenic effects.

All other routes of Ketamine are not FDA approved, but considered "off-label" use for depression and other mental health conditions.

What does "Off-label" mean?

"Off-label" medications are legal and very common. An estimated 30% of all medications are prescribed "off-label" to patients. Why? FDA approval can only be obtained after undergoing clinical trials that can take 6-7 years on average to complete. However, once a medication goes off patent, lower-priced generic versions become available so drug companies do not find it worth their while to do further research on the medication. However, over the years of a medications' use, health care providers discover that patients report, "It also helps with this!"

FDA explains off-label use:

What other conditions are treatable with Ketamine?

There is evidence showing that IV Ketamine can be effective in treating Generalized Anxiety Disorder (GAD), Obsessive Compulsive Disorder (OCD), Social Anxiety Disorder, and Post-traumatic Stress Disorder (PTSD).

Other evaluations showing promise are the use of Ketamine to help against eating disorders such as Anorexia Nervosa (AN) and Bulimia Nervosa (BN).

Ketamine has a successful history of relieving Chronic Pain Disorders including Complex Regional Pain Syndrome (CRPS), a.k.a. Reflex Sympathetic Dystrophy (RSD), and Fibromyalgia.

Do I need a referral?

No, it is not required. You may call, text, or email for an appointment.

How likely will it work for treating severe depression?

Multiple ketamine trials report 70-80% of individuals with treatment-resistant depression respond positively after receiving the initial round of low-dose infusions.

Will my current psychiatric medications interfere with IV Ketamine treatment?

Antidepressants (SSRIs, SNRIs, TCAs, MAOIs and atypicals) and most mood stabilizers do not interfere with Ketamine so there is no need to stop them before starting your Ketamine treatment.

Lamotrigine (Lamictal) in doses over 100mg daily blocks the effect of Ketamine. You should not decrease or stop this medication without consulting your psychiatrist or prescribing physician.

Benzodiazepines (Alprazolam (Xanax), Lorazepam (Ativan), Diazepam (Valium), Clonazepam (Klonopin)) may reduce the response to Ketamine. If this class of medication is used regularly, it may take longer to notice improvement in your mood.

How soon will I begin to feel better?

 Some patients begin to feel better within hours of their first infusion. Individuals with thoughts of self-harm often notice those thoughts dissipate first. There can be a dramatic relief of dread and hopelessness. Other patients may not notice any mood improvement until the next day. Some individuals will require 3 or 4 infusions before they begin feeling better. Some patients may need more than 8 or 9 infusions instead of 6.

How long is the treatment course?

The typical treatment course involves 6 infusions, which are given 2-3 times per week for a period of 2-3 weeks. Thereafter, some individuals will return for a booster infusion when they feel necessary.

Other individuals with particularly severe symptoms will be placed on a regular maintenance treatment schedule, typically monthly infusions.

Where is the Treatment Performed?

IV Ketamine is administered in our relaxing office using state of the art technology for administration and monitoring.

Are there any medical conditions that will exclude me from treatment?

  • Uncontrolled/untreated high blood pressure
  • Untreated Hyperthyroidism
  • History of Psychosis (Hallucinations/Delusions/Paranoia)
  • Pregnancy/Breastfeeding
  • Bipolar with Most Recent Episode Mania/Hypomania
  • Severe Liver or Kidney dysfunction
  • Active alcohol and substance use

Are Ketamine Infusions Addictive?

No, administered at small doses in a medical setting, there is no evidence that Ketamine is addictive. In contrast, those who abuse Ketamine recreationally do so at very high doses to induce psycho-active effects, which can cause psychological dependence, not physical.

How long does an infusion take?

The infusion takes about 45 minutes and the recovery period is about 1 hour.

What will I experience during the infusion?

During your 45-minute session, you will remain awake, but feel very relaxed. Most individuals tolerate their Ketamine infusions beautifully, and many people find them pleasant. Some say they never felt more relaxed in their lives.

Ketamine can dissociate the mind from the body. Some individuals describe this as a "dream-like state" with vivid imagery. A few may complain of mild nausea, which is easily treatable with an antiemetic. Mild elevation in blood pressure may also occur. We monitor your vitals throughout the session.

Can I eat or drink before the infusion?

It is recommended that you stop eating 4 hours before your appointment and avoid drinking liquids 2 hours before your appointment.

Do I need to bring someone with me?

It is not mandatory for someone to accompany you, but it is recommended as you may feel a bit cloudy and have a bit of an unsteady gait for an hour or so after treatment. This is why we have you remain at the clinic for an hour after your treatment concludes to provide time to recover from the after effects.

Individuals generally report a full recovery to normal activities after 1 hour from completion of your infusion. However, there are some individual variations in response to Ketamine.

Are there any long-term side effects?

No, there are no long-term side effects.

When can I resume normal activities after a Ketamine infusion?

Ketamine is rapidly metabolized. Within 10-15 minutes after the infusion, you will feel substantially more alert. Individuals generally report that a full recovery to normal activities takes about 1 hour, though there are some variations.

Regardless, we recommend not driving for 24 hours after your treatment.

Will my insurance cover Ketamine treatment?

Currently, Ketamine infusion therapy is NOT a covered benefit by any insurance plan as it is considered an “off-label” use for the treatment of mental wellness. as well as other medical credit cards may be an option for patients who qualify.