Most frequent questions and answers
Dura Medical offers a wide range of therapies for mental health issues and chronic pain. An evaluation or consultation will determine which therapy most directly meets your needs and targets your goals.
It is a medication primarily used as an anesthetic producing dissociative anesthesia. It can produce analgesia or pain relief, sedation, hypnosis, and amnesia.
Depression is the leading cause of disability worldwide, with over 16 million adults suffering an episode of major depression each year. Emerging data have demonstrated positive results in many patients treating severe depression refractory to medications, reducing suicidal thoughts and multiple somatic complaints seen in patients with severe depression.
Yes, ketamine can be very effective in patients with PTSD, anxiety, bipolar disorder, substance abuse disorder, and OCD, as well as many chronic pain disorders.
The exact effects and feelings differ from patient to patient due to many factors, including the dose, route, rate of administration, medications, genetics, and other factors. Some patients experience sedation and relaxation, while others can experience distortions in the perception of sight and sound, including hallucinations, feelings of floating, out-of-body experience, amnesia, relief from pain, and even agitation, among other effects.
Ketamine can provide rapid relief; many patients feel relief hours after the first infusion. Depression and other mood disorders are hard to describe because they vary amongst individuals, but 50-80% of patients will feel improvement in their symptoms. Most patients decide ketamine will be helpful after the first infusion, but it can take between 3 and 6 infusions before some patients experience relief. As a result, we recommend at least three infusions to determine if ketamine will be helpful for you. We also can discuss the results with your mental health provider and determine if changing doses, extending infusions, or adding KAP might be beneficial. We will follow your results objectively with validated depression questionnaires to help determine if you are achieving your goals for therapy.
Typically 3-6 infusions spread over 1-3 weeks are required to achieve results sustained for weeks to months or even longer. Maintenance treatments, if needed, are typically required every 4-6 weeks, and these can be extended with time. Each patient is different, and we discuss your needs to achieve optimal results. Chronic pain patients may require more prolonged and higher dose therapy with several treatments every 6 to 8 weeks, although there is significant variability between patients.
If administered by Health Care Providers skilled in the use and management of the potential and rare adverse effects associated with ketamine. Our board-certified CRNA or Anesthesiologist will perform an extensive medical history and evaluation before administration to ensure that you can be given the medication safely. Moreover, they will personally administer and monitor you, including your vital signs and breathing, throughout the infusion and afterward. Furthermore, they may adjust or titrate your infusion to minimize adverse effects and maximize the beneficial feelings/results.
Ketamine can cause elevations in blood pressure and increased heart rate, nausea/vomiting, dizziness, headache, uncontrolled emotions, including crying or tearfulness, and an out-of-body experience. It can worsen psychosis in patients with schizophrenia or a history of psychosis. Effects such as muscle cramping and bladder problems are typically seen only with long-term use.
The DEA has classified ketamine as a class III controlled substance with low potential for addiction. Throughout therapy, including maintenance, if required, ketamine has a low potential for addiction.
Patients suffering from treatment-resistant depression, anxiety, PTSD, or other mood disorders are prime candidates for ketamine therapy. Patients with schizophrenia or psychosis are, however, not good candidates. Patients with severe cardiac diseases or poorly controlled high blood pressure (hypertension) may require more extensive medical evaluation and optimization of their medical conditions before therapy.
Ketamine can be administered through many routes, including oral, rectal, sublingual, and subcutaneous. The pharmacological properties of ketamine are unique in many respects, including its high bioavailability through multiple routes. The oral route passes ketamine through the liver before circulating it to the brain and peripheral nervous system, where it causes its effects. The most significant benefit of oral, nasal, and sublingual routes is their availability for more frequent treatment regimens. Daily dosing is sometimes needed, and effects may take weeks to achieve. Many clinics use these routes, supported by research, and allow physicians not trained in anesthesia to use ketamine safely. It also reduces the time, expense, and expertise required for IV placement, monitoring, and managing adverse effects associated with higher doses and titration. Intramuscular dosing is an excellent alternative to IV infusion in cases where starting an IV may be difficult or is the patient’s preference. Almost 80% of the medication is absorbed and available to work at sites in the brain and nervous system. Since the entire dose is administered at one time, there is little control over the onset and degree of adverse effects such as hallucinations. The advantage of intravenous administration is that over 90% of the medication is available immediately, which provides precise dosing, rapid effects, consistent medication levels, and the ability to titrate and adjust dosing on a minute-to-minute basis. The results are seen within minutes compared to over 30 minutes when administered by mouth or nose.
During your comprehensive medical evaluation, we will evaluate your medications for any interactions or contraindications and adjust your therapy if needed. Ketamine can significantly interact with most schedule I and II substances, such as LSD/cocaine/methamphetamine/oxycodone. Patients should not be taking any of these substances and must not use alcohol within 24 hours of their appointment. Additionally, patients on chronic benzodiazepine medications (particularly high doses) may not benefit as much from the longer-term effects of ketamine.
Yes, we require a driver to accompany you to your appointment. You might feel clear-headed shortly after your infusion. However, you should not drive, operate heavy machinery, participate in significant decision-making, or sign legal documents until the next day.
What If I Get Nauseated, Experience A "Bad Trip," Or Prefer Not To Have Hallucinations Or An Out-Of-Body Experience?
During your comprehensive evaluation, we will discuss the goals and outcomes of your ketamine treatment. We will subsequently discuss and counsel you on using other medications to relieve these potential adverse effects. There continues to be controversy about whether the “experience,” including hallucinations and changes in perception, is required to obtain benefits from ketamine therapy. We are not convinced now, and more research is being performed. We have treated patients with and without using short-acting sedatives, both with success. While high, the success rate depends on the individual and many other factors. We will work with you to develop the best individual plan for the first and subsequent treatments to maximize your expectations, minimize unpleasant experiences, and optimize your results.
Typical initial treatments require 2-3 hours, including a short period of observation/recovery after your infusion. Higher doses and some infusions may need an infusion of 4 hours, and the observation/recovery period is extended to 1 hour or more in some cases.
If your therapy plan includes intravenous ketamine, we will start a small IV preferentially in your forearm or hand. If you have a history of extreme pain/discomfort with an IV placement, have “passed out” with IV placement/blood draws, or healthcare providers having difficulty starting an IV or with blood draws, please discuss this with our clinicians. We strive to reduce your anxiety and any discomfort with placing your IV. We have multiple techniques to reduce anxiety and expertly place an IV. Intramuscular Injection is an alternative if your desire for this route or IV placement is precluded.
Yes, each ketamine infusion and therapy session is performed in a private room. Your comfort is essential during therapy. During ketamine therapy, we recommend starting with a quiet, darkened room unless concomitant psychotherapy is occurring.