What is a Ketamine Clinic and How Do I Choose One?
November 29, 2021
What is a Ketamine Clinic and How Do I Choose One?
Ketamine clinics are popping up all over the country, but what are they exactly? How do you know which one is right for you? If you’re considering ketamine therapy, it’s important to know what to look for and how to select the best provider near you.
Ketamine clinics vary significantly in philosophy, oversight, cost, and quality of care. This post will give you information on what to look for in a ketamine clinic and how you can find the best one near you!
What is Ketamine infusion therapy and how does it work for depression, anxiety, and PTSD?
Ketamine is a dissociative anesthetic that was first used in the Vietnam War as a battlefield painkiller and anesthetic for soldiers undergoing surgery. Ketamine is FDA-approved for anesthesia, but now it is being used by medical professionals as a treatment for mood disorders such as depression, anxiety, and PTSD with exciting results. It has been shown to be an effective treatment, providing rapid relief of symptoms, and working within hours to days as opposed to weeks or months with conventional antidepressant medications.
Ketamine works as an NMDA receptor antagonist, meaning it reduces NMDA glutamate neurotransmitter signaling. Chronic depression and prolonged stress cause persistently high levels of NMDA glutamate signaling in the brain which can cause atrophy of neurons and damage to synapses over time.
Ketamine also activates a different Glutamate receptor in the brain called the AMPA receptor. Activation of the AMPA receptor restores synapses and signaling pathways in the hippocampus and prefrontal cortex of the brain, which is felt to be critical to the antidepressant effect of ketamine.
The benefits of Ketamine therapy
Antidepressants have been available for over 50 years, and their emergence was heralded as a major victory. Despite this, success rates of remission stand at less than three-quarters (67%) with an average of 33% failing to improve in any meaningful way in their depression symptoms. Patients that have failed 2 or more traditional treatments are felt to have a form of major depressive disorder called treatment resistant depression.
Ketamine infusions are a new treatment recognized for their rapid onset and excellent response rate. Ketamine infusions do not need to be taken daily. Ketamine patients can experience long-lasting positive effects when given ketamine in low doses over a brief period of time, and it works within hours to days as opposed to weeks or months with other treatments. The side effects are minimal, and its potential benefits outweigh the risks for most patients, which makes it an excellent option for patients looking to find relief without having their routine medication interrupted or changed entirely.
Side effects and risks associated with Ketamine therapy
The most common side effects of IV Ketamine infusion are dizziness and nausea. These side effects are usually minor and manageable with medication that can be given before the infusion session begins.
The low doses of Ketamine used by doctors also mean there’s no need to worry about long-term adverse reactions, which have only been seen in individuals abusing ketamine daily at extremely high doses. Longer-term adverse reactions like interstitial cystitis have not been documented with ketamine therapy for mood disorders.
Certain patients should not be given Ketamine therapy due to a risk of worsening their condition. Patients with a history of psychosis, schizophrenia, and mania are not good candidates for Ketamine therapy.
How to choose the right Ketamine clinic
When choosing the best provider near you, several factors should be considered:
Is the practice run by Physicians, CRNAs, Nurse Practitioners, or Physicians Assistants?
Many clinics today are staffed and run by CRNAs, nurse practitioners, or PAs. While these mid-level practitioners are very skilled up to a point, they are not replacements for the training, safety, and experience a physician provides.
If Physician run, are the doctors Anesthesia, Emergency Medicine or Psychiatry Trained?
Our philosophy at MD Infusions is that Ketamine practices are best run by physicians, specifically Emergency Medicine physicians. We believe Emergency Medicine physicians are best suited to administering IV ketamine infusions for a variety of reasons. Emergency medicine is a specialty trained to use ketamine at anesthetic doses (much high than the doses than those used for mood disorders), and deal with any medical adverse reactions or complications of such medications. Emergency Medicine doctors also have extensive experience treating patients presenting to the ER with mental health crises. Anesthesiologists have the training to deal with the medication and its effects, but they have very limited experience with mental health conditions. A Psychiatrist is most experienced in the treatment of mental health conditions, but their experience with anesthetics and adverse reaction management is very limited.
Are there comfortable private rooms or chairs separated by curtains?
Clinics vary in this regard. Some clinics group patients in a larger room separated by curtains, while most provide each patient with their own room for maximum privacy. At MD Infusions we feel that the treatment room should be private, quiet, welcoming, and comfortable.
How is the ketamine infusion being monitored to ensure safety?
Although Ketamine has long been acknowledged as a medication with a very wide safety margin, each person reacts to medication differently. At MD Infusions we take vitals signs before and after your treatment and we actively monitor your treatment with cardiac telemetry monitoring and video monitoring (not wirelessly broadcast or recorded to ensure patient privacy). A doctor is always present to adjust treatments, answer questions and oversee therapy. These are the standards we recommend you seek before starting therapy at a clinic near you.
Can the providers be reached between treatments if I have questions or concerns?
After you get home from your treatment, or even on the days between treatments, you may have questions about your therapy. You should ask if the doctor or provider is available between sessions to address any concerns you may have. At MD Infusions we make ourselves available by phone, text, or email 7 days per week.
What is the typical process followed at a Ketamine Clinic?
A consultation is required before a patient can begin therapy. The consultation is the means by which the provider determines if the patient is a good fit for therapy, or if the patient has any contraindications to therapy that would make treatment dangerous. In addition to taking a medical and psychiatric history, a physical exam is performed.
These consultations can be free, or the Ketamine clinic can charge a fee for a consultation. Be sure to establish this before agreeing to be seen. At MD Infusions consultations are free of charge.
If you are a candidate for therapy. You will be asked to sign consent forms before starting treatment. This is the time to be sure that all of your questions have been answered before signing the consent for treatment.
Many clinics will allow you to start therapy the same day as your consultation provided that you have a ride home from the clinic.
The treatment itself consists of being shown to a room, having your vital signs taken, and a cardiac monitor placed. Your nurse will place an IV. Often you will be provided soothing music and eye shades for the treatment. The provider will confirm your dose, which is based on your weight, and the nurse or provider will hang the IV bag with the medication. The infusion takes place over ~45 minutes. This is followed by a 15-30 minute rest and recovery period after the medication has stopped flowing.
Once you have recovered from the medication, you can get up and move around. You will likely have a feeling of “wooziness” which gradually fades over the next 1-2 hours.
All of our Ketamine patients are instructed not to drive or make major life-changing decisions for the rest of the day.
What are the costs associated with Ketamine treatment?
Many Ketamine clinics charge a fee for consultation ranging from $300-$500. The treatment itself consists of 6 infusions over 2-3 weeks. Prices range from $350-$500 per treatment depending on your location.
Since Ketamine IV therapy is an off-label use of ketamine, insurance companies most often do not cover the cost of therapy. You can, however, ask your provider for a superbill for your treatments and try submitting it yourself to see if your insurance will provide partial reimbursement.
Spravato, the nasal spray form of Esketamine, is FDA approved for the treatment of depression and it is covered by insurance. Due to the poor absorption of the medication intranasally, many patients find this option a disappointing alternative to IV therapy.
How frequently will I need to have Ketamine infusions?
Ketamine Infusion Therapy Part 1: Induction
The treatment regimen consists of an initial 6 treatments of IV Ketamine given over 2-3 weeks (approximately every other day). This is called the “Induction” phase of therapy where the concentrated effects of the 6 ketamine treatments over 2-3 weeks cause changes in your brain’s glutamate levels, encouraging new pathways and synapses to form in the brain.
Ketamine Infusion Therapy Part 2: Maintenance
This is followed by the “Maintenance” phase of therapy where the patient comes back every ~4 weeks for a single ketamine treatment to maintain the beneficial effects of the initial 6 treatments. Maintenance therapy can last as long as the patient desires to continue with ketamine treatments.
At MD Infusions we gradually ease the patient into a 4–6-week maintenance treatment interval. After the initial 6 treatments, we recommend coming in 2 weeks for a single ketamine treatment, then another in 3 weeks, then another in 4 weeks. We have found this gradual lengthening of the maintenance interval to be the best way to preserve and uphold the gains made during the 6 treatment induction series.
This article was written to help those with treatment resistant conditions interested in ketamine treatment but unsure of how to choose a clinic.
Hopefully, we’ve alerted you to the factors you should consider and the kinds of questions you should be asking before starting ketamine treatment.
Remember, if you are looking for a physician-run Ketamine clinic with concierge-level service in a comfortable and safe environment located in the Chicago area, please consider MD Infusions. Consultations are free of charge, and we welcome all questions.