FAQs About Ketamine

While the success rate of ketamine is notably high, it doesn’t work for everyone. Fortunately, in most circumstances, it only takes four infusions to determine whether or not you will benefit from this therapy. If there is not an adequate response after four infusions, we typically recommend discontinuing ketamine therapy.

If you do not respond significantly after 4 ketamine infusions, you will be considered a non-responder. In this case it is unlikely further doses will be of benefit to you.

Initiation Treatments for Depression( 4 treatments total ) 

• 2 treatments the first week
• 2 treatments the second week
• Our Ketamine infusion specialists will monitor your improvement and manage the dose of Ketamine during these sessions, to provide you maximum benefit.

Initiation Treatments for Pain Conditions ( 3 treatments total ) 

• 3 treatments the first week.  Each treatment is approximately 4-hours in length.
• Our Ketamine infusion specialists will monitor your improvement and manage the dose of Ketamine during these sessions, to provide you maximum benefit.

Maintenance Evaluation and Treatment for Depression/other Conditions

• The first maintenance evaluation treatment ( 5th treatment overall ) begins 2 weeks after the last initiation treatment.
• The second maintenance evaluation treatment ( 6th treatment overall ) is given 3 weeks after that.
• After this time we will see you solely based on your clinical response to therapy (75% of patients need maintenance infusions every 4 weeks).
• The interval between future maintenance treatments will depend on how long you feel good, after your maintenance interval evaluation treatments. If you feel good for only one week, then you will need maintenance treatments once a week. If you feel good for 3 weeks, you may need maintenance treatments once every 3 weeks. We can try to extend treatments up to 4 week intervals, or even longer, depending on your response.

Minimizing the costs are very important to us. Multiple touch points are required in the early stages of your treatment to evaluate how the dose, duration, and maintenance intervals for future treatments.

Maintenance Evaluation and Treatment for Pain Conditions

.  Depending on how long you feel good after your initiation treatments, you will require a maintenance infusion.  This typically ranges between 1-3 months and is dependent on the person.  We will stay in communication to help figure out what your particular pain relief duration is.

Minimizing the costs are very important to us. Multiple touch points are required in the early stages of your treatment to evaluate how the dose, duration, and maintenance intervals for future treatments.

Absolutely Not. You may find in time, with the help of your psychiatrist or other managing physician, a decreased need for some of your medications, but this is not the norm. We do not encourage you to change any medications for pain until you get on maintenance Ketamine therapy and in direct consultation with your pain management, psychiatrist or other managing physician. Failure to continue your current medication regimen, could compromise your Ketamine response and potentially put you in danger of worsening your condition. We will need to correspond with your provider before you make any medication changes.

Yes you should. You may find in time, with the help of your psychiatrist or other managing physician, a decreased need for other depression medications. We do not encourage you to change any medications for depression or anxiety until you get on maintenance Ketamine therapy and in direct consultation with your psychiatrist or managing physician. Failure to continue your current medication regimen, could compromise your Ketamine response and potentially put you in danger of worsening your condition. We will need to correspond with your provider before you make any medication changes.

Ketamine infusion treatment is successful and immediate after only one treatment in about 70% of patients. The relief after the first treatment, however, can be only hours to days. Research has determined that the depression-relief can be extended like many drugs by increasing the number and dose of early treatments before determining a maintenance treatment regimen.

For Pain patients, patients will need three, approximately 4-hour infusions in the first week. Depending on your response after the third infusion, a maintenance plan will be customized individually for you. Maintenance Ketamine infusions for pain syndromes, are every 1-3 months, depending on your response to therapy.   

Data is limited on immediate response and duration across all pain syndromes.  Pain relief rates depends on the pain condition being treated. However about ⅔ of patients have meaningful benefits. Some patients may have significant pain relief and can even be pain free for 6 months or more.

Shortly after you arrive here at Virginia Infusion Therapies, you will be escorted back to our infusion room. You will be seated in a comfortable reclining chair and soft lighting.  Prior to this, you will be asked to empty your bladder before the infusion starts.  You will not be able to get up and walk to bathroom during the infusion. A bedside commode for women and a bedside urinal for men will be provided if necessary.

The physician will answer all the questions you have. Next, a small IV will be placed for the ketamine infusion.  We will monitor your heart rate, blood pressure, and oxygen, using a state-of-the-art monitor and you will be observed for any signs of adverse side effects. During the infusion you will be able to communicate with the physician and family, but may have difficulty with any conversations. We do not encourage conversations, as your experience will be enhanced in a quiet environment.  You are strongly urged to bring soothing music and your headphones to make the experience even more enjoyable.

Shortly after the infusion starts, you may start feeling strange and possibly have an “out of body” experience. You may also experience some blurred vision, double vision, decreased coordination, and mild dizziness. You can still talk and communicate your needs. These effects are the normal and expected response to the dissociative effect of ketamine. Having the music helps you stay connected to reality and decreases any fears you may have. During the infusion, the physician or nurse will try to minimize stimuli in the room and give you your space, but will be immediately available for any questions or concerns.

Ketamine will heighten your senses and make you feel like you are in a dreamlike or illusionary state. Please note that during the infusion you will not process information in the usual way. Therefore, you may feel anxious. Medication is available to help during the infusion, if it is necessary.

Near the end of the infusion you may feel nauseous, due to the blurry and double vision associated with the infusion. Closing your eyes may help stop or diminish the nausea feeling. Medication is available if this occurs. Remember, you are being treated by Board Certified Emergency Medicine Physicians and we are trained to deal with any complications that may occur.

After the infusion, we will monitor you for approximately 1 to 1.5 hours or until we feel you are safe to be able to get up and walk around safely. Even though the majority of the side effects of ketamine resolve at the end of the treatment, some studies have shown minimal effects lasting up to 4 hours after infusions.

We ask that  you don’t eat any solids or non clear liquids for 4 hours or drink clear liquids for 2 hours before appointment as you are getting a sedative medication.  Failure to comply with this requirement could potentially require us to cancel your infusion for the day and reschedule you for another day. There will be a $100 cancellation fee if this happens. Please setup a ride back home or to your hotel room. You may not drive or use heavy machinery for 24 hours after the infusion. 

Ketamine infusion therapy has been found to be helpful in treating a variety of medical and mental health conditions including major depression, postpartum depression, anxiety, ptsd, migraine headaches, cluster headaches and fibromyalgia.

Ketamine was initially noticed in anecdotal reports from anesthesia cases. They noticed anxiety, depression and pain improvement for some of their patients who underwent anesthesia for other reasons.  Some patients with severe anxiety, depression or intractable pain would report they had, at least temporary relief, of their symptoms. 

John Krystal, MD in the 1990s, now the chair of psychiatry at Yale, as well as other investigators began to study how ketamine could affect the neurotransmitters in the brain.  They discovered that ketamine’s interactions with glutamate produced a rapid antidepressant effect in patients with major depressive disorders.  Prior to these studies, most efforts in the treatment of anxiety and depression focused on medications that controlled serotonin and norepinephrine. These medications continue to be used and are helpful in conjunction with ketamine therapy.

When used by appropriately trained physicians, in the proper clinical setting, the answer is yes. However, ketamine has a potential for adverse side effects, such as nausea, vomiting, rapid heart rate, transiently elevated blood pressure and temporary “out of body experience”. In the safe hands of an appropriately trained physician, these side effects can easily be managed.

Virginia Infusion Therapies’ board certified emergency physicians have the qualifications and training to administer ketamine in a quiet, comfortable and safe environment. We are committed to you and your well being.

Ketamine is not designed to be a recreational drug, but like other medications used to treat diseases, has been abused as a recreational drug.  As a street drug, it has been used in doses much higher than those administered for therapeutic treatment of depression, other mental health diseases, and chronic pain.

When abused chronically and at high doses, ketamine can become psychologically addictive. It has not been shown to be physically addictive.

However, when used at therapeutic doses, current data suggests that ketamine to treat depression, other mental health conditions, and chronic pain may be used without any long term negative effects.  This makes it a viable treatment option for patients concerned about addiction, especially from chronic use of opiates, benzodiazepines, and other medications. In addition, there are no known long term negative side effects as with other medication used to treat these illnesses.

Ketamine can be given in an intranasal, oral, intravenous, or intramuscular fashion.

For medical purposes, ketamine is usually either injected into a muscle or given through an intravenous (IV) line.

It is considered safe as an anesthetic, because it does not reduce blood pressure or lower the breathing rate.