The burden of depression, bipolar disorder, PTSD, and suicide are extreme and well documented. The National Institute of Health predicts depression will be the 2nd leading cause of disability in Western nations in the next 20 years. Suicide is the 2nd leading cause of death among youth aged 10-19 years. PTSD is particularly prevalent among our veterans, as much as 12% per year for veterans from Operation Iraqi Freedom and Enduring Freedom, for example. These are a mere fraction of the statistics available at our fingertips. These disorders are also evident in our day to day interactions with others. It seems everyone is impacted by a loved one or friend who struggles with one or more of these disorders. Our scientific researchers have provided hope, a new use for a common drug that combats these disorders. Ketamine.

Yale University published a revolutionary article in 2000 explaining the new use for ketamine. Since then multiple institutions, including Harvard, National Institute of Health, and Mt. Sinai Hospital to name a few, have corroborated these amazing results. This drug ketamine, in use around the world for over 50 years, was proven to have a significant, rapid effect of relieving symptoms for treatment resistant patients with depression, bipolar disorder, suicidal thoughts, OCD, anxiety and PTSD. Rapid is defined here as in minutes to hours and days. What a stark contrast to typical oral medications that often take two weeks to three months to have any measurable effect, and come along with possible severe side effects, and difficulty weaning off.

How does ketamine work?

Ketamine is a dissociative medication drug that produces profound pain relief and amnesia. In use for over 50 years, ketamine is a great resource from the battlefield, to the emergency room and to most commonly, the operating room. Now, to explain how it helps with mood disorders: Ketamine specifically inhibits the N-methyl D-aspartate (NMDA) receptor in our brain. This NMDA receptor is

stimulated with excess glutathione, a neurotransmitter that in excess, is thought to be one cause of depression. Other medications that inhibit NMDA receptors do not have the same rapid relief as ketamine, leading us to believe it is more complex than singling out one mode of action.

What are the benefits of delivering by IV?

The gold standard delivery of ketamine is by an IV infusion over about 40 minutes. This allows the medicine to be delivered directly to the brain with a slow continuous and predictable dose. Doses may also be titrated, or changed with each treatment to adjust for results. The IV route skips the organ metabolism and varied uptake that occurs with medications we take by mouth, transdermal, nasal spray, or injections. Some of these forms deliver higher concentrations to our brain, but again, IV delivery is the most predictable.

Over 70% of treatment resistant patients feel relief.

Results may be felt as early as immediately after the first infusion, or take up to 3 infusions to notice. Typically, a course of up to 6 treatments over about 2 weeks is needed for ongoing benefit. This relief can last from a couple weeks up to 6 months. When symptoms start returning, often just one treatment is adequate until the next “booster”. This period of relief provides opportunity for healing with psychotherapy and other modes of treatment.

Is ketamine infusion safe?

The dose of ketamine is very small compared to what is used in an operating room, or emergency room. And, the dose used is extremely small compared to ketamine use as a street drug. It is also given over a long time, 40 minutes. The purpose is not to get a “high” from treatment, but to induce beneficial changes in the brain. It is important to note that ketamine can only be provided by prescription from a

medical provider at a facility that safely monitors and administers the drug. When researching a facility, make sure you ask who will be giving you the treatment and how will you be monitored.

Are there side effects?

Ketamine may have some side effects during the treatment including elevated blood pressure, an out of body sensation, or blurred vision. A quiet, calm environment will help reduce and tolerate these feelings. One does not lose consciousness and remains aware of their surroundings. Many find the experience pleasant and relaxing. Sensations during the treatment go away quickly when finished.

Will insurance cover this?

Ketamine is approved by the FDA for use as an anesthetic. However, treatment of the disorders discussed here is considered off-label, despite the strong research showing dramatic benefits. As such, insurance companies are reluctant to pay. The FDA requires lengthy and costly trials to approve a medication as a new treatment. Unfortunately, the pharmaceutical companies don’t have any incentive to pay for this. Ketamine is a generic drug that will not pay for the trials. What they are doing instead is creating ketamine-like drugs that they can get FDA approved and sell as a brand name, with big profits. These new drugs may not be as effective, or may have side effects, but if FDA approved, insurance will pay. It is still highly encouraged to submit your itemized bill to your insurance provider, as some may provide a partial payment.

Who can get this treatment?

Ketamine infusion therapy is used for multiple disorders as discussed above and also many chronic pain conditions. A referral from the primary treating physician may be required for some treatment facilities. Alternatively, some psychiatrists are providing this treatment in their own office. What is most important is continued support and care during and after these treatments by either the psychiatrist,

psychologist, or primary physician. Just as antidepressant pills are not a cure, ketamine therapy is not a cure, rather it is a breakthrough treatment that can be a springboards to a road of recovery. Communication, counseling, and follow-up among the professionals caring for an individual is of utmost importance.

DR. Van Praag

Disclaimer: This article represents my informed opinion and/or the opinion of others. This does not constitute medical advice and should not be relied upon to make decisions about medical care. Please consult your physician for questions regarding your specific conditions and possible treatments.