Is Ketamine Right for Me?
Ketamine Infusion Therapy is most helpful for those patients suffering treatment-resistant depression, i.e., patients who have tried at least two traditional anti-depressants (tricyclics, SSRIs, SNRIs, MAOIs) without adequate improvement and/or undesirable side-effects. Some studies suggest that conventional antidepressants work in only 20 to 40% of patients. Ketamine has been proven to reduce the symptoms of severe, even suicidal treatment-resistant depression for 75% of patients. Furthermore, ketamine acts very rapidly, often within hours, as opposed to several weeks with conventional anti-depressants.
Ketamine Infusion Therapy is NOT for those suffering temporary or situational depression caused by environmental factors, grief, relationship problems, etc. At Boulder Mind Care, we treat those individuals that have been unresponsive to traditional medications and/or therapy over a sustained period of intense suffering.
What disorders does Ketamine help?
Major Depressive Disorder (MDD), Treatment Resistant Depression (TRD), Bipolar Depression (Types I and II), Post Partum Depression, Post Traumatic Stress Disorder (PTSD), Severe Anxiety, Obsessive Compulsive Disorder (OCD), Fibromyalgia, Severe Migraines, Chronic Regional Pain Syndrome, Chronic Neuropathic Pain, and Phantom Limb Syndrome.
What are the chances that ketamine infusion therapy will help me, and how quickly does it work?
Three out of four, or about 75%, of patients with treatment-resistant depression experience significant and relatively prompt relief. Initially, a series of six infusions are scheduled over a two to three week span to jump-start the brain-repairing effects of ketamine. Some patients notice improvement within a few hours, most feel a definite change by the third session, and occasionally, it is not until the entire series of six sessions has been completed that patients report feeling better.
How long does the improvement last?
Again, patients vary, but the majority of patients who respond to intravenous ketamine will need “booster” infusions from 3 to 8 weeks apart.
What does it feel like during a Ketamine infusion?
You will be in a private treatment room. At Boulder MindCare, we feel it is important to have your own space during the therapeutic experience, unlike some clinics where multiple patients are in the same room. You will be closely monitored including blood pressure, EKG, oxygen saturation, and mental status. An intravenous (IV) line will be placed and the infusion started. The infusion will be given slowly over 40 minutes. You may find it helpful to listen to music, or you may prefer to just sit back and relax. You should feel the effects of the Ketamine quickly. You will not lose consciousness and should feel relaxed. You may feel like you are floating. Some patients experience a dissociative effect, a dreamlike out of body experience with partial loss awareness of the body. Most patients find this effect is a slightly bizarre, but pleasurable experience. Typically, these dissociative sensations resolve quickly after the infusion is completed. The rate of the Ketamine infusion can be adjusted if necessary to minimize any adverse symptoms, although this is a rare circumstance.
Please note that expectations do affect your infusion experience. You will feel different or “weird” during the transfusion. It is best to know this and accept it as part of the ketamine infusion process. You should also know, however, that you will feel like yourself shortly after the infusion ends (with the exception of hopefully being left with a sense of newfound hope and optimism). The IV will remain in place until the you are fully recovered (typically another 20 to 30 minutes; you should plan on a total of 90 minutes to 2 hours).
Do I need to continue seeing my psychiatrist, therapist, or primary care physician?
Yes! Boulder Mind Care is a consultant in your care. You will need to continue to follow-up with your mental health professional and primary physician.
Is there potential for addiction?
No. Some may have heard of Ketamine as a party drug under other names such as Special K, Kit Kat, or Vitamin K. However, Ketamine has a wide safety margin in the hands of clinicians specially trained to administer the medication. The dose used for treatment of depression is much smaller than the dosages used in illicit settings, and It has been found that at these very low doses, in a medical setting, there is virtually no potential for addiction or abuse.
Are there any side-effects or adverse reactions to Ketamine?
Ketamine is generally safe when administered by a trained professional. Some patients may experience an out of body experience, and partially lose awareness of their body. During the infusion, some patients may experience a temporary elevation in blood pressure and heart rate, which will be treated if necessary. Other side-effects may include nausea, increased salivation, and blurred vision. Most patient feels slightly sedated after their treatment, therefore will not be able to drive themselves home and should plan just relaxing at home for the rest of the day.
Do I need to stop any medications prior to treatment?
Most medications do not need to be stopped prior to treatment with Ketamine. Benzodiazepines and lamictal have both been shown to blunt the effectiveness of the infusion. Lamictal (lamotrigine) patients should allow 12 hours between taking lamictal and the start of their infusion. They should wait 6 hours after their infusion before resuming lamictal. Patients taking large doses of benzodiazepines will have a reduced response to ketamine. This does not mean that you cannot receive ketamine infusions while taking benzodiazepines, but to maximize your potential for a successful response you may need to work in advance with your prescribing physician to taper your dose down. Our intention at Boulder Mind Care is to maximize the therapeutic response to ketamine, and get you back to living the life you should.
Is it FDA approved?
The FDA has only approved ketamine to be marketed as a surgical anesthetic. Thus, medical uses outside of the operating room are considered “off-label,” but allowed when deemed medically appropriate by a medical doctor. It has been estimated that over 20% of all prescriptions in the United States are “off-label”. Indeed, many academic medical centers, including Yale University, the University of California in San Diego, the Mayo Clinic, and the Cleveland Clinic, have all begun offering ketamine treatments off-label for severe depression.
How does Ketamine work?
Major Depressive Disorder is most often the result of dysfunctional emotional processing of severe stressors, often but not always during childhood or adolescence. Cultural, environmental, genetic, neurological, hormonal, immunological, and neuroendocrinological factors influence how these stressors are processed. Examples of such stressors include family conflicts, divorce, the loss of a loved one, financial stress, physical, mental or sexual abuse, neglect, disabilities, medical illnesses, interpersonal conflicts, and bullying.
The above results in a change in brain chemistry brought on by stress, with subsequent changes in brain anatomy that are difficult to repair. Brain Derived Neurotropic Factor (BDNF) is an important brain chemical. It is responsible for the maturation and maintenance of the neuronal dendrites and synapses that are necessary for normal brain connectivity. That is, in order to have a normal mood, the neurons in various parts of your brain need to be able to connect to each other via their dendrites and synapses. Severe stress and anxiety inhibit the production of BDNF, leading to visible changes in neuroanatomy and subsequent serious mood disorders such as MDD, PTSD, obsessive compulsive disorder (OCD), and anxiety. In fact, many believe that depression and anxiety are flip sides of the same coin.
Over the past five decades, antidepressant research and medications have revolved around the regulation of three neurotransmitters; serotonin, dopamine and norepinephrine. Taken together, they represent only about 15% of the brain’s neurotransmitters. Much more prevalent is the neurotransmitter glutamate, which has only recently begun to receive attention as instrumental in treating mood disorders. It is via the glutamate system and two important receptors, NMDA and AMPA receptors, that ketamine works to relieve depression. It does so by turning BDNF production back on. The BDNF then leads to repair of the damaged neurons, with regrowth of the important dendrites and synapses needed to achieve a normal mood. Brain scans demonstrate that the repair can begin in a matter of hours after the administration of ketamine. This process of brain repair is called neuroplasticity, and ketamine facilitated neuroplasticity offers great hope for patients with MDD who have not responded to other treatments.
Is ketamine therapy covered by insurance?
Ketamine infusion therapy is not a service typically reimbursed by insurance companies. As the treatment gains acceptance, we hope this situation changes. However, depending upon your individual medical insurance plan, some portion of the treatment may be eligible for partial reimbursement. We will provide you, on request, with the paperwork to submit to your insurance company in the event they offer reimbursement for the treatments. Each new patient makes it more likely that insurance companies will add this treatment to their plan of covered services.
What is the cost of treatment?
Boulder Mind Care does not accept insurance for ketamine infusion therapy. Currently, we accept cash, credit cards, debit cards, certified checks, and Care Credit. We require full payment at the time of treatment.
We require you to keep an active credit or debit card on file with us. For those with PPO type health insurance, you may be able to get partially reimbursed for the cost of your visit, though this is not guaranteed. After your visit, you can request a receipt (superbill) from us which details procedure codes, diagnosis, and fees paid. This superbill can then be submitted to your insurance provider for direct reimbursement to you.
We realize there are other clinics that give cheaper ketamine therapy. Some of them adopt a ‘Dollar Store’ approach. Some give intramuscular or intranasal spray ketamine, which yield inconsistent and far inferior results. Some treat multiple patients concomitantly in the same room. We strive to provide you with a private, serene environment. At Boulder Mind Care, our mission is to provide you with the most effective, state-of-the-art care, personally administered and monitored by a board-certified physician. We are dedicated to supporting you to live the life you desire. We do not overbook or rush our sessions with you. We have a strict moral code, and will care for you as we would want ourselves or our loved ones cared for. For more information, and for national pricing information click on the following.
Our fee schedule is as follows:
Initial Consultation: $390 (50% deposit due at time of scheduling appointment).
Infusions for mood disorders: $690 per infusion (50% deposit due at time of scheduling each appointment). These are between 40 and 55 minutes duration.
Infusions for chronic pain: $1,500 per infusion (50% deposit due at time of scheduling each appointment). These are typically 2 to 4 hour infusions, most often done between 3 and 5 days in a row.
Infusions for drug and alcohol addiction: $690 per infusion (50% deposit due at time of scheduling each appointment). These are between 40 and 55 minutes duration.
Is financing available?
Interest-free financing is available for those who qualify. Copy and paste the following link into your browser for the fastest application process:
Why can’t I just get ketamine as a nasal spray, or sublingually?
Other routes of administration are not as successful, have a higher rate of side effects, and have unpredictable and variable absorption. IV administration remains the standard of care based on the vast majority of research studies done on ketamine therapy. It is the most precise method of delivering ketamine to the brain by adjusting the dose to exactly the level appropriate for each individual patient. One size does not fit all. For a more detailed, articulate, and well-reasoned answer please click here.