What to Expect
First and foremost it is important to know that ketamine is a treatment for depression and not a cure. In order to get patients out of depression we try to administer six infusions within a two week period. After that we recommend a single infusion after one week, then a single infusion two weeks after that at which time at home nasal ketamine is prescribed. In the vast majority of patients the nasal ketamine is not able to replace the infusions altogether but it does significantly prolong their benefit. During the first year of treatment the typical patient is able to manage their depression with a single monthly infusion in conjunction with the at home nasal ketamine.
Several ketamine studies in individuals with refractory depression have shown a 70% positive response rate. That is similar to what we see in our patient population. If a patient has undergone four infusions without any response we do not ask for payment for infusions five and six until we see whether or not the patient is a responder. If the patient does subsequently respond then the patient pays for five and six and begins maintenance treatment. If the patient does not respond after five and six then no further payment is required.
The duration of each appointment is approximately two hours. After check-in you will be taken to a private room, seated inn a zero gravity reclining chair. A pillow is placed under your head and you will be covered with a weighted blanket ensuring your comfort throughout the process. Please note- it is advised that you refrain from eating three hours prior to your appointment. Please arrange for someone to drive you to and from your first appointment. Many patients use Uber or Lyft.
The IV Procedure
Prior to receiving the IV you will be given an oral medication to minimize any anxiety. A cuff will be placed on your arm to monitor your blood pressure and sensors will be placed on your chest to monitor your heart. Then a small IV will be inserted in your arm through which the medication will be administered.
As the infusion begins the lights will be dimmed and your choice of relaxing ambient music will be played. You are welcome to bring your own music if you wish. Once underway you may choose to be left alone inn the room or you are welcome to have a loved one sit with you. Be assured your doctor and the medical assistant will continually monitor your condition and respond to any needs.
The infusion itself lasts about one hour. The effects of the ketamine come on in a steady gradual way. Patients say that the experience of each infusion is different but there are some common sensations including:
- Numbness and/or tingling
- Sensation of “lightness” or floating
- Feeling of being “centered” or “grounded”
- Positive shift in anxiety/emotional tension
- Intellectual detachment
- Decreased awareness of your body
- Visual and spacial distortions
- Inability to perceive time
- Dizziness or nausea in rare cases
Most patients find the experience to be pleasant and relaxing and report an improvement in depressive symptoms within 1 to 24 hours of treatment. There is a 30 minute recovery time, during which you may feel drowsy or mildly disoriented.
It is recommended that patients undergo 6 infusions over a two-week period in order to maximize the beneficial effects of the drug. It is not recommended to vary from this treatment protocol but we can make some adjustments to fit your personal schedule. After the initial series of infusions further “booster” treatments are determined on a case-by-case basis but are usually needed anywhere from every 2 weeks to 3 months.
Infusion for Depression:
Each of the first six infusions is $435. After that maintenance infusions cost $360. The nasal ketamine can only be purchased from a compounding pharmacy and usually costs between $70 – $90 per month.
Infusion for Pain:
Each 4 hour infusion is $800