Ketamine Infusion Therapy

Ketamine is a general anesthetic widely used in operating rooms since the 1970s. In the late 1990s, researchers at Yale first showed that a subanesthetic (low-dose) intravenous infusion of ketamine had rapid and profound antidepressant effects. Subsequently, a large (and growing) research literature evolved over the next 20 years demonstrating the efficacy of ketamine infusion therapy to help patients with TRD, bipolar depression, suicidal ideation, PTSD and other anxiety disorders.

Ketamine acts differently than commonly used antidepressants like Prozac and Lexapro (known as “SSRIs”). Unlike these medications that act on serotonin, ketamine is thought to act on NMDA (N-methyl-D-aspartate) receptors and to stimulate glutamate activity. Glutamate is a neurotransmitter that is critical in helping the brain change by making new neural connections.

Because the ketamine infusion is given intravenously and is considered a controlled substance, it must be administered by specially trained medical personnel in a certified clinical setting. Most patients receive it as an outpatient and go home in a couple of hours.

Scientists are still studying the exact mechanism by which depression is relieved by ketamine. However, research suggests that by blocking the NDMA receptors, ketamine stimulates a rapid increase in glutamate within the brain. This increase in glutamate strengthens and restores the vital neural connections and pathways in the regions of the brain most impaired by depression. As a result, there are positive changes in brain circuit function and improved mood regulation. When given in low doses, ketamine infusion therapy can produce rapid and significant improvement in symptoms, often within a few hours to days.

IV ketamine treatments are an office-based, outpatient procedure. At MHS, we currently have ketamine infusion therapy in San Francisco and Oakland, CA. The infusion lasts 40 minutes and the entire session takes about 90 minutes to complete. The session process will begin by getting you situated in a comfortable chair. Then, your clinician will inform you when the IV has started.

The first thing you will feel is a sense of relaxation of mind and/or body. You may then begin to feel slightly light or light-headed. Some people report a sense of feeling a slight warmth. Eventually, you may feel even lighter, almost a slight separation between yourself and your body. Your hands and legs may feel far away. Some people progressively feel more separation between themselves and the different components of consciousness (e.g., their thoughts, feelings, bodily sensations, and perception). Occasionally, people continue to progressively experience an even greater physical sensation of lightness – sometimes to the point of feeling above the room. Patients generally tolerate these sensations very well reporting the experience as “spiritual” or “pleasurable”.

If someone is struggling with depression, anxiety, or rumination, this point is when they feel much less of and/or distant from these feelings. This experience is frequently described as an immense relief – like the blanket of depression has been temporarily lifted. This experience can also serve as a very hopeful reminder to patients that depression or anxiety does not define them. These conditions are separate from them, and as such, they can be temporary.

In rare cases, patients may have a more negative experience. We have psychiatric professionals on-site to help manage these rare events which are generally brief and usually resolve completely within 10-15 minutes after stopping the infusion.

Ketamine is also a drug of abuse. It’s known as “Special K” on the streets and it’s the number one club drug in some Asian countries. Although it’s not common for patients receiving controlled ketamine administrations for the treatment of depression to turn into ketamine abusers, we have to be careful about regulating the drug so that it doesn’t end up in the hands of people who don’t need it.

With the exception of Kaiser insurance, Ketamine Infusion Therapy (KIT) is not eligible for insurance reimbursement at this time.

Ketamine Infusion Therapy (KIT) for depression or other psychiatric indications is $600 per treatment.

Initial ketamine infusion therapy consists of 6 IV ketamine treatments over the course of 3 weeks. The details of this protocol are discussed in detail during the initial evaluation. Infusion appointments generally take 90—120 minutes. If the symptoms are successfully controlled with these initial treatments, then follow-up evaluations will be conducted to determine long-term treatment plans.

Maintenance treatments usually consist of one infusion every 2-4 weeks.