Intravenous (IV) Infusion & Intramuscular (IM) Ketamine Q & A
What is Ketamine?
Ketamine was originally developed in the 1960s and FDA-approved for use in anesthesia in 1970. It has been on the World Health Organization’s Essential Medications List since 1985. It works as an NMDA receptor antagonist which strongly effects the neurotransmitter glutamate. Changes in glutamate along with other neurotransmitters can signal the formation of new connections as well as re-wiring of existing connections between nerve cells in the brain; a change commonly referred to as neuroplasticity.
What is Ketamine Therapy?
Ketamine therapy is a process that works differently than your prescribed oral anti-depressants, anti-anxiety, mood stabilizing and opiate pain medications. It is a catalyst for change. An initial treatment protocol of 6 ketamine treatments spaced out over a 4-6 week period of time is often recommended in order to get the process started, to find your optimal dosing range and to determine if ketamine therapy is effective for you. Some patients require a slower initial protocol in order to feel safe and to have more time to process and integrate each treatment before receiving the next. This treatment is not intended to be used for the rest of your life; however, patients may also continue to use this treatment intermittently as part of a larger treatment plan to address symptoms, ongoing challenges or to make other changes in their life. If maintenance or booster therapy is necessary, Dr. Stefany Wolfsohn will propose a safe and reasonable treatment plan to you and your Treatment Team for ketamine therapy moving forward.
Why IV Ketamine Infusion Therapy?
Medical professionals are finding more and more uses for ketamine. Although ketamine can be administered in many forms (pills, creams, sprays, sublingual tablets, suppositories, subcutaneous injections, intramuscular/intravenous injections, and as IV infusions), IV ketamine infusion therapy is the most researched route of administration for mood disorders and chronic pain conditions.
Slow, intravenous (IV) ketamine infusion therapy is a frequently used route of administration for ketamine therapy in our practice. The bioavailability of ketamine, when given IV is 100%. IV ketamine therapy is often combined with IV hydration, supplements and other medicines which can decrease side effects and make your treatment experience more comfortable. The onset, timing and intensity of the physical and psychological effects of an IV ketamine treatment can be controlled more tightly and modified during the entire treatment period. The total dose of ketamine needed to be effective is lower compared to other routes of administration (sublingual / oral) and can be titrated more evenly over the length of time of the infusion.
Why IM Ketamine Infusion Therapy?
IM ketamine therapy is a frequently used route of administration for ketamine therapy in our practice. The bioavailability of ketamine, when given IM is approximately 93%. IM ketamine therapy is a cost-effective alternative to IV ketamine infusion therapy in our practice. Other oral, sublingual and IM medications can be used in conjunction with IM ketamine therapy to decrease some of the side effects of ketamine and make your treatment experience more comfortable. The intensity of the physical and psychological effects of an IM ketamine treatment can often be controlled by dividing the total dose of ketamine over 2-3 smaller injections, given at 15-30 min intervals. The total dose of ketamine needed to be effective is lower compared to other routes of administration (sublingual / oral).
How soon after a ketamine treatment will I feel better? How long does it last?
Patients receiving ketamine treatments can report “feeling better” during the ketamine treatment and can often sustain that feeling well after the medicine has been metabolized and eliminated from the body. “Feeling better” can be a subtle change and you may notice an improvement in your day-to-day function before you notice an improvement in your mood or pain. This effect has been reported to last from a few hours up to several weeks. When used in conjunction with other treatment modalities, the results can last up to several months or longer. Ketamine therapy is not a cure; however, it can be used to facilitate long-term change and transformation. Ketamine therapy is often paired with additional psychological support before, during and after the actual medicine session. Ketamine therapy used together with psychotherapy can help strengthen the benefits from ketamine therapy alone.
How safe is ketamine therapy if done in a physician office setting?
Ketamine is often referred to as a “dissociative” anesthetic and it has been used with a wide margin of safety in a variety of medical settings for more than 50 years in adult and pediatric anesthesia as well as in veterinary medicine. How ketamine is used and by whom determines how safely this medication can be used in the outpatient setting. Advanced training on how work with ketamine can vary considerably amongst ketamine clinics and providers. Dr. Stefany Wolfsohn is a board-certified anesthesiologist with additional mental health, trauma and psychedelic medicine training. She has administered ketamine to tens of thousands of patients over the span of her anesthesia career and to thousands more in her ketamine clinic. She has maintained ACLS certification, equipment for monitoring as well as a crash cart with emergency airway equipment and medications for all services performed in the practice.
How does ketamine therapy get incorporated into a comprehensive treatment plan?
Anyone can call to inquire about ketamine infusion therapy. Before initiating treatment, a plan must be set in place to optimize the possibility of successful treatment. At Ventura Center for Advanced Therapeutics, all patients start with a consultation before treatment is offered. During this time, a medical and mental health assessment are done and previous medical records are reviewed. Patients are given mental health screening inventories to help evaluate the presence and severity of common symptoms treated with ketamine. A complete mental health evaluation needs to be done prior to your consultation by the referring provider. Information about ketamine therapy, routes of administration, informed consent including risks / benefits / alternatives to ketamine therapy, treatment protocols, and adjunctive therapies are discussed. Communication with new and/or your existing mental health providers is established to coordinate care. A supportive family member or advocate is also encouraged to participate in this process.
What is the success rate of IV or IM ketamine therapy?
Current research supports that approximately 70% of patients receiving ketamine therapy can report “feeling better” during the treatment experience. Most ketamine infusions are initially scheduled as a series of 6 infusions within a 4- 6 week period of time to in order to provide relief anywhere from weeks to months. A high degree of importance is placed on the initial patient evaluation and candidate selection for this intervention. Some conditions, can be more challenging to treat and may require different infusion schedules, dosages and length of infusion times to maximize the patient’s benefit.
Are there side effects with ketamine therapy?
Patients are monitored closely throughout the infusion process and additional psychological support is provided to help patients navigate challenging ketamine therapy experiences should they arise. The presence of medication side effects depends on the dose of ketamine given and the frequency of use. In general, the side effects of ketamine infusion therapy are mild and not every patient experiences them. Some side effects are anticipated and can be easily treated at the time of infusion such as anxiety, headache or nausea.
Other side effects that could occur during an infusion include increased heart rate and blood pressure, respiratory depression or a deeper level of dissociation than intended. Although all patients are pre-screened to assess the likelihood of these side effects from occurring, on the rare occasion they do occur, either stopping the infusion or treating them with IV / IM medications, these side effects usually resolve within 5-15 minutes. The most common side effect following ketamine infusion is feeling tired for a few hours. Long-term side effects are not commonly reported by experienced ketamine providers and it is important to choose a ketamine provider who is maintaining a high standard of care.