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Ketamine Treatment - Commonly Asked Questions

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The Case for Ketamine Treatment  

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•  Ketamine ( esp. in the form of IV infusion ) remains the most effective antidepressant currently prescribed. Recent  studies compared the effectiveness of Ketamine IV to ECT ( Electro-convulsive Therapy ). Historically , ECT has  been the most effective treatment for Treatment - Resistant Depression. The results of the studies indicate that  Ketamine IV therapy is non-inferior to ECT for Treatment-Resistant Depression without psychosis- study link

•  Most traditional antidepressants do not work for a lot of patients with Treatment-Resistant Depression.
   Recent analysis of Star-D trial ( one of the most significant studies with antidepressants) shows that only 35% of  patients  with Depression achieve remission ( e.g complete resolution of depression ) even  after 4 different  medication trials-  link

•  Unlike traditional antidepressants, Ketamine may help address not only symptoms of depression but also  underlying causes  - e.g unprocessed adverse experiences through life- study link

•  Ketamine therapy done under a medical supervision is considered to be  safe but FDA warns about  compounded ketamine being used at home  - link 

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Indications

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•  Major Depressive disorder

•  Chronic Depression , e.g when there are ongoing depressive symptoms over 2 years - Depression not  responding to standard antidepressants treatments

•  Inability to take standard antidepressants due to side effects

•  PTSD - post-traumatic stress disorder

•  Anxiety Disorder

•  Chronic Neuropathic Pain

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Contra-Indications

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•  Current manic or psychotic symptoms

•  Hx of  psychotic episodes

•  Current serious substance abuse issues

•  Intent to get pregnant in the near future

•  Unstable epilepsy -  frequent, severe seizures

•  Unstable heart conditions and severe unstable hypertension ( patient with severe and unstable heart conditions must receive a clearance from cardiologist )

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Side Effects

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•  Short-term - lasting no more than a few hours: sedation, fatigue, limited concentration, nausea,  dizziness, impaired coordination

•  Longer-term- lasting a few days: restlessness, insomnia, vivid dreams, feeling energized,  fluctuations in mood and anxiety symptoms 

•  Very short-term- lasting a few minutes: dream-like states of mind, feeling detached from one’s body,  perceptual changes, seeing colorful shapes or patterns, intensification of sounds or lights, sensitivity to noises,  feeing spiritual connections, feeling like melting away, slowed down breathing, elevation of blood  pressure, dry mouth, feeing numb

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Mechanism of Action

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•  The exact mechanism of action is unknown. Current theory is that ketamine treatments when done  repeatedly stimulate growth of neurons and connections between neurons — this process is called  neurogenesis and neuroplasticity. This in turn may enhance psychological flexibility and ability to change

• Other mechanisms of actions including psychotherapeutic are possible

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 Treatment Protocol

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•  Usually, six initial treatment are recommenced over a period of 3-4 weeks

•  This may result in complete resolution of symptoms which is called remission

•  Some patients with severe or chronic depressive symptoms may require additional treatments

•  Some patients benefit from ongoing maintenance treatment after initial six treatments , frequency is established on a case by case basis and usually tapers off as patients become more stable 

• Ketamine could be delivered in several different ways . The most effective way is a slow intravenous infusion which provides maximum dose flexibility and control over the experience

• American Psychiatric Association advises to receive ketamine therapy in a medical , supervised environment 

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Reasons to choose our practice  ​

 

Expertise

 

Dr. Giorgadze opened one of the very first in the US  practices specializing in ketamine therapy in 2012.  Since then, we have successfully treated thousands of patients. Prior to 2012 we have been involved in clinical research  on ketamine and similar medications. We opened this practice because we believed in the significant potential of ketamine therapy  to improve mental health.

 

 

Specialization 

 

Ketamine has been in use since 70’s in the context of acute pain management or anesthesia. 

While many physicians are familiar with ketamine, ketamine therapy for a psychiatric indication is a specialized treatment and requires significant expertise. 

It is important that ketamine therapy is integrated with other interventions as part of a comprehensive treatment plan.  As a board certified psychiatrist, Dr. Giorgadze is able to integrate ketamine therapy and advise on additional steps as part of a treatment plan, this may include other medications or forms of therapy. 

 

 

Method 

 

We specialize and focus on infusion (e.g intra-venous administration - IV ) of ketamine as a preferred method of administration. Multiple studies indicate superiority of IV administration of Ketamine. Here is the link to the article discussing this more in depth- article.

While intra-mascular and intra-nasal methods are also viable and require less expertise from the staff administering them, they do not provide the same degree of control, dose adjustment and effectiveness as IV therapy. 

 

 

Environment 

Ketamine therapy is very dependent on mindset and setting of the treatment. It is important that the setting is neither too casual ( IV-spas )  or overly medical. 

On the casual side, it is important to note that according to regulations a crash cart must be available on site wherever ketamine is administered. Administration of ketamine requires ACLS certification by staff.  Spa settings or IV-therapy  centers do not carry crash carts, and are not medically equipped to provide ketamine therapy. On the other end of things , busy and noisy hospital environment  or pain clinic with several patients getting treatment in a large room separated by curtains is not private and too overstimulating for a relaxing experience. 

 

Practical considerations 

 

When looking for a treatment center, it is important to have an easy access to scheduling and communication with the treatment team.  All patients are seen by Dr. Giorgadze in person during the treatment and have an easy access to physician in between treatments via phone or email. 

We can usually schedule a new patient for a consultation within days and can accommodate an urgent treatment request. We also provide treatment on Saturdays.

We work with several insurance companies and assist with billing which minimizes the out of pocket costs. 

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Thank you for reading this and if you have any questions , do not hesitate to call us at 678-701-7725. 

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