Andro Giorgadze, MD

Board Certified  Psychiatrist



Training: Emory University

Clinical Experience: 19 years
 

Research experience: Dr. Giorgadze has been involved in clinical research  of new medications including Ketamine, Esketamine ( Spravato) ,   Rapastinel and other NMDA receptor antagonists/ agonists since 2009. 

 

Private Practice: Dr. Giorgadze opened the first private clinic specializing in ketamine therapy in the southeast in 2012. 

You can easily schedule an initial consultation or ketamine treatment using the link:

Book an Appointment.

We provide consultations  regarding treatment resistant Depression and Bipolar Depression, as well as chronic personality and anxiety related issues. 

 

 

Indications for Ketamine treatment are: 

 

  • Depression and Bipolar Depression 

  • Anxiety disorders and PTSD 

  • Personality issues 

  • Certain Chronic Pain conditions , usually of neuropathic nature 

 

Treatment Course: 

 

It is recommended that patients try at least 6 treatments over a period of 3 weeks, e.g 2 treatments per week. The standard dose is 0.5mg-1mg/kg over 40 minutes. Some patients may benefits from lower or higher dose. After 6 initial treatments, if there is no response, it is unlikely that additional treatments would help. In case of a good response - e.g 50% reduction in symptoms, additional treatments which are called booster treatments maybe be required. Frequency of booster treatments varies from patient to patient and falls anywhere between once every 2 weeks to once every 3 months.

 

 

Safety Profile: 


Ketamine treatment provided by an experienced clinician is a remarkably safe treatment and much safer than taking many psychotropic medications on a regular basis. 

Most of the side effects are transient and quickly go away after an infusion is stopped and respond well to additional medications, for example Zofran is very effective in preventing occasional Nausea. 

Most common side effects are transient nausea, dizziness, sedation, some anxiety , euphoria, feeling relaxed or tired, feeling weird, and conscious dream-like state. 

Treatment of Treatment resistant depression ( TRD )  from pharmacological point of view follows established guidelines.

 

It is important to determine the reasons for treatment resistance including co-morbid conditions which must be addressed along with the treatment of depression.

 

Below are the most frequently followed pharmacological strategies for the treatment of TRD. 

 

1- changing antidepressants ( ADT ) , especially if one is poorly tolerated. 

2- combining ADTs- usually with dopamine or norepinephrine enhancing ADT ( for example Wellbutrin or Remeron ).

3- combining ADT and antipsychotics at low dose ( Abilify, Seroquell etc ).

4- combining ADT and mood stabilizers ( Lithium, Lamotrigine , Depakoate ), especially in patients with some symptoms suggesting sub-threshold bipolar.

 

Ketamine could be tried after a failure of 2 ADT and/or 1 combination strategy.  Ketamine could also be effective in treating co-morbid depression and PTSD ( post-traumatic stress disorder). 

 

ECT ( electro-convulsive therapy ) could be tried after ketamine in patients with debilitating depression, especially with catatonic and psychotic symptoms. 

 

The use of TMS ( trans-cranial magnetic stimulation ) in TRD is controversial and is not supported by rigorous double-blind studies. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3514332/

 

VNS ( Vagal nerve stimulation )  is approved for TRD, but in practice it is extremely difficult to get. 

DBS ( Deep brain stimulation )  is too experimental to recommend at this point. 

 

Due to the nature of TRD and its association with long-standing psychological difficulties, the use of high-quality therapy is often recommended. 

 

Spravato 

 

Spravato is a brand name for S-ketamine in the US and has been recently approved for TRD. 

The regular ketamine in the US used for anesthesia and of-label for depression is a mixture of R-ketamine and S-ketamine. It is possible that R-ketamine has a different and additional  antidepressant effect  from S-ketamine. 

Ketamine treatment cost - $350 per 1 hour treatment ( not covered by insurance). 

If you are interested in this treatment and would like to schedule a consultation, please call 678-701-7725 or email androg@gmail.com. To expedite the consultation, please complete the following: 

New Patient Registration 

Depression Scale 

Additional Resources: 

TV interview showing an actual patient getting a treatment. 

@2015 Atlanta Center for Ketamine Therapy