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  • Writer's pictureLogan MacLean

Ketamine Infusions - FAQs - Part 1

Question marks

We realize that many people may not have heard of ketamine therapy for mental health conditions. We also acknowledge that the unknown can cause stress. With this in mind, we include the most common questions we receive regarding ketamine infusion therapy and hope our answers will help bring you peace of mind.

What does “off-label” ketamine use mean?

Ketamine was first approved by the FDA in 1970 as an anesthetic agent for diagnostic and surgical procedures. In the early 2000s, studies found that ketamine was an extremely effective alternative treatment for depression and other mental health disorders. Since ketamine was not initially FDA approved for treating depression, this makes its use in this area considered “off-label.” This in no way prohibits the use of ketamine in this area. In fact, many drugs are used for non-FDA approved indications under the discretion of the prescribing clinician.

Several organizations are undertaking studies that could lead to its approval in this area. However, the approval for ketamine for the treatment of mood disorders is prohibitive since ketamine is a generic drug that is no longer owned by one specific person or company. Because of this, the cost of going through the steps for FDA approval generally outweigh the financial return to the company that would attempt this.

What is the success rate of ketamine for depression?

It has been shown that approximately 60–80% of patients, who previously tried at least one antidepressant medication from two separate medication classes without significant benefit, respond to ketamine by the end of their final loading dose infusion.

How quickly will the ketamine work on my depression?

Ketamine’s effects can work very quickly but generally are not felt immediately after the first infusion. Its effects work slowly and can be very subtle in the beginning for many people. Do not be surprised if you initially feel worse or experience a flare up in your depression. This is very common and not unexpected. Infusions can take 2 to 3 weeks to kick in. This is why the infusions take place over a period of 4 weeks. It takes time for ketamine to work on the brain. The changes may initially be subtle but grow over time.

What else should I be doing throughout the week while I am receiving ketamine?

It is important to continue to take your other medications as prescribed to you by your provider as well as continuing to see your counselor. It is also important to work on small things that help you feel better. Go for a walk outside if the weather is nice or get coffee with a friend – do things every day that bring you joy.

How should I expect to feel after my ketamine infusion?

Most patients won’t feel better overnight or after their first infusion. You may initially feel worse with the potential of feeling dizzy or nauseated for a couple hours after the infusion. It is not uncommon after an infusion to see shapes or colors when you close your eyes. This is normal and will usually go away in 24 to 48 hours.

Mood swings and mild anxiety can occur after the ketamine infusion is complete. This is not unusual since it takes time for ketamine to work on the brain. For this reason, do not make any important decisions about your work or personal life in the first few days after your infusions. Attempt to rest as much as you can.

Do I need to stop my other medications?

Benzodiazepines, such as Xanax, Ativan, Valium, and others, interfere with low dose ketamine’s effects on the brain. In order to improve the chances of a rapid and positive response to ketamine treatments, we attempt to reduce or eliminate the intake of these drugs especially around the time of treatments. We ask that you do not take these medications in the 48 hours leading up to your infusions if possible. We will work with you and your healthcare team in making the necessary adjustments.

Alcohol has similar effects to benzodiazepines on low dose ketamine treatments. Because of this, we also ask that you do not drink alcohol within 48 hours of your infusion. Ketamine can still be helpful in both of these patient populations. However, it may take longer to achieve initial and long-lasting results from ketamine infusion therapy.

Patients do not need to decrease or stop their other antidepressant medications when taking ketamine. Ketamine will work best when combined with therapy as well as possibly an antidepressant combination. The combination of ketamine with other medications should always be discussed with your provider.

Do not change any of the medications you take for mental health without first consulting your medical team. Your ketamine provider will also work closely with your team.

When should I stop eating before my infusion?

Avoid eating 6 hours prior to your appointment.

What will the “dissociation” I feel with ketamine be like?

Everyone’s experience with ketamine infusions is different. However, many patients will describe the sensation as dreamy, floaty, or spaced out, feeling detached from their surroundings. A more technical definition is the discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior. These sensations, although new and different, are not necessarily scary or dysphoric. Your ketamine provider will help prepare you for your infusion and give you tips to make your experience relaxing and enjoyable.

Does ketamine make you high?

It is right and good that Christians pursue being “sober minded.” We walk in a physical and spiritual realm that is hostile to our faith. We are commanded to keep watch (1 Peter 5:8–9). Getting a “high” from marijuana, being drunk with alcohol, or altered by any number of illicit substances puts us in a vulnerable position physically, mentally, and spiritually.

So how should we view ketamine’s ability to alter mental status?

- The “high” or “dissociation” of a ketamine infusion, though not fully understood, is believed to be somewhat necessary for ketamine to have its therapeutic effect on the brain.

- Temporary alterations in mental status commonly occur in other areas of medicine such as when patients emerge from anesthesia in the operating room or dentist’s office. It also can occur when attempting to control acute pain after surgery or soon after a mother gives birth.

A Christian using ketamine infusions as an end (the feeling) is inappropriate. It is similarly wrong to drink to feel drunk or to seek pain medication because “I like the way it feels.” The appropriate use of ketamine infusion therapy is a means to pursue mental health. Similarly, patients receive anesthesia or pain medication for the means of accomplishing a specific goal that aids in the body’s recovery.

In addition, this is why we are honored to be present while patients are receiving ketamine infusions. We believe it matters what you read, listen to, and who you surround yourself with before, after, and during treatment. As both medical professionals and professing Christians, it is our duty and joy to walk alongside patients through this process.

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