Ketamine Treatment for Mental Health — Everything You Want to Know
By Dr. Benjamin Busch, DO, MBA
December 22, 2022
Stress is an ever-present part of our lives. Since ancient times when the biggest concerns were finding food, shelter, and avoiding predators, the human brain adapted mechanisms to cope with the sources of stress.
Today stressors look quite a bit different but they trigger the same biology. Instead of avoiding danger from large, opportunistic carnivores, people are navigating ever more complex situations — endless emails, demanding workloads, and busy schedules. Add to that the ongoing COVID-19 pandemic, the rampant civil unrest, illness, tragedy or personal trauma, it’s safe to say stress takes its toll on everyone, in different ways.
It can happen slowly and all at once — a deadline missed here, a forgotten appointment there, another day or night spent alone, working your way through on autopilot just to get by. You start to feel down, depressed, and anxious about the way things are heading. Before you know it, things you used to love doing now are uninteresting and you can’t bring yourself to leave your house for much more than the essentials. The meaning your life once held all but vanished and the motivation to fix it is just not there.
When people are stuck in that space, it can feel like they’re stuck there alone. It can be even harder to talk about the experience because there’s so much shame and stigma associated with psychological disorders like depression, anxiety, posttraumatic stress disorder (PTSD), bipolar disorder, even though millions of Americans suffer from at least one, if not a combination, each year.
For decades, the standard treatment for major depressive disorder (MDD) has been antidepressants. But in recent years, scientists and doctors are understanding that there are alternatives that work faster and better for many patients suffering from mood disorders. Ketamine can radically transform people’s lives when nothing else has worked.
A new paradigm for mental health treatment
Ketamine is a drug that has been used in medicine for nearly 60 years. It recently gained popularity due to its profound ability to “wake” people out of severe depression. Others report they experience meaning in life again after a traumatic experience. Ketamine is useful for a variety of mental conditions.
- Treatment-resistant Depression (TRD)
- Post-traumatic Stress Disorder (PTSD)
- Personal trauma
- Bipolar Disorder
- Obsessive Compulsive Disorder (OCD)
Ketamine was first discovered in 1962, when it was synthesized in a laboratory by chemist Calvin Stevens. A year later, it received a patent in Belgium for use as an anesthetic. The FDA approved the first formulation of ketamine in 1970 for use as an anesthetic during surgery, and it is still used today for this purpose daily. Ketamine’s novelty was its pain-relieving properties without the uncomfortable mental side effects of previous anesthetics.
It was not until the early 1990s when Yale researcher, Dr. John Krystal, discovered that ketamine worked quickly and effectively to reduce depressive symptoms in patients with major depressive disorder. This was a time in medicine when psychiatry was still dominated by the “one-size fits all” approach, where patients were seen as a person with a certain disease, rather than as a unique individual with a genetically determined chemistry suffering from an illness.
Ketamine therapy is effective for patients with depression and other mental disorders, but it can be made more effective by understanding a patient’s medical history, genetics, and unique metabolic profile. This is the frontier of ketamine treatment and the new paradigm that is changing lives. That’s how we make our Enhanced Ketamine Protocol more effective than standard ketamine therapy.
Ketamine creates long-term healing — FAST!
The way ketamine works is by blocking the NMDA-glutamate receptors in our brain — resulting in faster results than standard antidepressant therapy. Glutamate is a type of neurotransmitter, which means it transmits electrical signals from one brain cell to another. Specifically, it is one of the neurotransmitters that “excites” the brain. Scientists don’t understand exactly how, but the actions of ketamine on this receptor produce rapid antidepressant effects in patients, with many seeing some benefit after just one treatment.
At the right dose, ketamine’s actions on these receptors change the way your brain is connected, like how other forms of therapy, such as cognitive behavioral therapy, work. This concept of “rewiring” is called neuroplasticity, an idea founded on emerging evidence about the way the brain works. Ketamine infusion therapy is like a “reset” for the brain, reversing patterns created by chronic stress and trauma. Contrary to what neuroscientists thought previously, no matter how old you are, your brain can build new connections and grow to experience the world in new ways.
Ketamine rapidly initiates long-term changes, instead of temporarily adjusting levels of “happy hormones” in your brain like other antidepressants.
As a result, Ketamine does NOT need to be taken every day, or even on a regular basis, like common SSRIs/SNRIs do.
The neuroplasticity created by ketamine means that your brain cells are building new bridges with each other. The new connections from ketamine are built in part by a protein called BDNF (brain-derived neurotrophic factor), which is described as “steroids” for the brain. Ketamine enhances the expression of BDNF, just like exercise, good nutrition, and sleep, which is why we believe this medicine enacts deep healing processes in the right patient.
Ketamine is not right for everyone, however. We determine if patients are likely to benefit from ketamine therapy based on a thorough consultation and when necessary, pharmacodynamic genetic testing.
Is Ketamine Therapy right for you?
Ketamine is not right for every patient. Our primary focus is on helping patients for which there is sufficient scientific data to support its use. Patients suffering from treatment-resistant depression (TRD), bipolar disorder with TRD, suicidal thoughts, PTSD, and obsessive-compulsive disorder (OCD) are most likely to see a benefit from ketamine infusions.
We conduct a thorough evaluation to determine if ketamine will be a safe and therapeutic experience for you based on your medical history, genetics, and metabolism. Some patients should not take ketamine either because they have a condition that would make ketamine less safe or because they are on certain medications that would reduce ketamine’s effectiveness.
Is ketamine safe?
Ketamine was FDA-approved in its nasal form, esketamine, in 2019 for treatment-resistant depression when used with a newly initiated anti-depressant. One year later, the FDA extended its approval for standalone treatment for major depressive disorder and suicidal ideation and behavior due to evidence showing its safety and effectiveness. Though ketamine is FDA-approved as a treatment, IV ketamine treatment is still under investigational stages of use.
The doses of ketamine to treat depression are much lower than those used for anesthesia during surgery. At these low doses, patients benefit from the anti-depressive effects while minimizing the hallucinogenic and sedative effects of the drug. When ketamine is misused as a party drug, people who take higher doses are sedated to dangerous levels, known as a “K-hole”. Due to its history of abuse, ketamine was classified as a C-III controlled substance in 1999. No evidence, however, has shown that ketamine treatments increase the risk of substance abuse.
The ViveWell approach to ketamine
Our Intravenous (IV) Enhanced Ketamine Infusion Protocol is a therapy for patients suffering from serious mental and mood disorders. You will meet with a licensed medical professional during your consultation to answer your questions and determine if IV ketamine is right for you. Only a licensed medical professional can administer patient treatments to ensure your safety and maximize the effectiveness of this new treatment.
Ketamine Therapy pricing
Ketamine is a safe, effective and increasingly popular treatment for depression, PTSD, and more. Results are often dramatic and permanent. Ketamine is a pillar of our approach to mental health services.
Enhanced ketamine infusions | $450
Each 40-minute infusion includes a 15-minute monitored recovery period.
At-home ketamine
With approval from your provider, ViveWell can offer self-administered ketamine dosing from the convenience of your own home.
Get more from your ketamine treatments with oxytocin and NAD+ boosts
Oxytocin is a vital hormone-like peptide essential to bonding, connection — and neuroplasticity. Similarly, NAD+ is a crucial molecule known for its role in producing energy and helping our metabolisms run smoothly, but it also profoundly affects health by helping build new pathways in the brain.
Because we utilize ketamine to stimulate the brain toward a more “neuroplastic” state, many patients benefit from adding oxytocin and/or NAD+ infusions to their treatment regimen. Our Enhanced Ketamine therapy with oxytocin or NAD+ involves the patient receiving a boost infusion directly after the ketamine treatment. So once the ketamine infusion is complete, the patient would move to one of our other comfortable infusion rooms for the treatment to relax for an additional 1-2 hours.
When paired with the Enhanced Ketamine treatments, patients get discounted oxytocin and NAD+:
100 mg NAD+ infused over 1 hour $100
250 mg NAD+ infused over 2 hours $250
Additional oxytocin dosing is fully customized to your wellness needs. Be sure to discuss this option with our team to explore options and pricing.
Why ketamine is so revolutionary
For 50 years, the field of psychiatry has been at a standstill. The central hypothesis—that patients with depression have low levels of serotonin—has dominated the way we treat this condition. Although SSRIs/SNRIs DO help patients feel better, nearly one-third of patients do not feel better. It is exactly this group of patients—those who have already tried anti-depressants with little relief—who may be good candidates for IV Ketamine Therapy. Even patients without treatment-resistant depression, but depression with suicidal ideation, may benefit from ketamine therapy.
SSRIs act slowly, taking 3 weeks to start working. Ketamine acts immediately, with patients experiencing some benefit after one session. Typically, a few sessions are required in the beginning to create sustainable healing lasting from a few months, to a few years. Because ketamine infusions are more expensive, we create an individualized, optimized, enhanced ketamine therapy protocol just for you, with a thorough, pre-treatment evaluation, so that you get the most from your treatment sessions!
The importance of environment during ketamine treatment
Before a ketamine session, it is recommended to prepare mentally so that you have a smooth journey. For example, filling your mind with a scary movie or murder mystery the night before your session may be counterproductive to your healing. It’s important to ensure proper self-care the week before your session along with managing stress effectively to help you make the most of your session.
We do our best to create a comfortable, safe environment for our ketamine therapy patients. Ketamine is known as a dissociative drug, producing “out of body” feelings. This experience involves many new sensations for patients, and it is important that ketamine is administered in a controlled medical setting to ensure the best results and a therapeutic effect.
When you receive treatments at our clinic, you will be in a deluxe treatment room designed to create a comfortable, peaceful setting to keep you relaxed during your session. All ketamine treatment sessions are supervised by a licensed medical professional who will give you the space to heal, and ensure your treatment is controlled, safe, and therapeutic. Following each of your treatments, our staff will regularly check in with you to review your progress towards remission of your symptoms.
Pre-treatment evaluation
Using metabolic and genetic testing, we curate an individualized ketamine treatment protocol for each patient. The study of pharmacogenetics revealed that people with certain genetic sequences metabolize pharmaceutical compounds differently. That’s why medications have different effectiveness on people. The results of a patient’s certain genetic profiles will guide our clinicians to adjust doses of ketamine. In addition, the way you metabolize drugs influences how you will respond to ketamine, as well as other medications. Using this information, we customize an individualized Enhanced Ketamine IV Therapy Protocol – just for you. We designed this treatment to maximize results in our patients using a precision medicine approach.
References
- Krystal, J. H., Abdallah, C. G., Sanacora, G., Charney, D. S., & Duman, R. S. (n.d.). Ketamine: A paradigm shift for depression research and treatment – neuron. Neuroview. Retrieved December 1, 2022, from https://www.cell.com/neuron/fulltext/S0896-6273(19)30114-X
- Banov, M., Young, J., Dunn, T., & Szabo, S. (2020). Efficacy and safety of ketamine in the management of anxiety and anxiety spectrum disorders: A review of the literature. CNS Spectrums, 25(3), 331-342. doi:10.1017/S1092852919001238
- Mion, Georges. “History of Anaesthesia: The Ketamine Story – Past, Present… : European Journal of Anaesthesiology: Eja.” Editorials, European Journal of Anaesthesia, Sept. 2017, https://journals.lww.com/ejanaesthesiology/fulltext/2017/09000/history_of_anaesthesia__the_ketamine_story___past,.2.aspx.
- Jelen, Luke A., and James M. Stone. “Ketamine for Depression.” International Review of Psychiatry, vol. 33, no. 3, 2021, pp. 207–228., https://doi.org/10.1080/09540261.2020.1854194.
- McIntyre, R. S., Carvalho, I. P., Lui, L. M. W., Majeed, A., Masand, P. S., Gill, H., Rodrigues, N. B., Lipsitz, O., Coles, A. C., Lee, Y., Tamura, J. K., Iacobucci, M., Phan, L., Nasri, F., Singhal, N., Wong, E. R., Subramaniapillai, M., Mansur, R., Ho, R., … Rosenblat, J. D. (2020). The effect of intravenous, intranasal, and oral ketamine in mood disorders: A meta-analysis. Journal of Affective Disorders, 276, 576–584. https://doi.org/10.1016/j.jad.2020.06.050
- Griffiths, C., Walker, K., Reid, I., da Silva, K. M., & O’Neill-Kerr, A. (2021, January 15). A qualitative study of patients’ experience of ketamine treatment for depression: The ‘ketamine and me’ project. Journal of Affective Disorders Reports. Retrieved December 2, 2022, from https://www.sciencedirect.com/science/article/pii/S2666915321000068?via%3Dihub
- Taylor, J. H., Landeros-Weisenberger, A., Coughlin, C., Mulqueen, J., Johnson, J. A., Gabriel, D., Reed, M. O., Jakubovski, E., & Bloch, M. H. (2018). Ketamine for Social Anxiety Disorder: A Randomized, Placebo-Controlled Crossover Trial. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 43(2), 325–333. https://doi.org/10.1038/npp.2017.194
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Disclaimer: All statements and opinions provided are for educational and informational purposes, not for medical diagnosis. As with all medical treatments and procedures, results may vary on an individual basis. ViveWell follows all FDA guidelines related to the treatments provided. You’re encouraged to consult with your primary care provider before undergoing any treatment programs offered by ViveWell. Some of our therapies are not FDA-approved. During your personal consultation, the benefits and risks of any recommended therapies will be reviewed with you.