Frequently Asked Questions
- Are higher doses of ketamine preferable to lower doses?
Yes. There are only a few medical studies that address this question, but they consistently report that more favorable results are obtained when higher doses of ketamine are administered.
The very low doses that nasal ketamine (also called Spravato) delivers to patients provide relief of symptoms for only a short period of time, requiring long-term administration at least every two weeks, and often every week. Also, very low IV doses are less effective than the modest doses most clinics administer.
Anesthesiologists understand that the higher doses of ketamine they can safely administer to patients provide greater relief of symptoms in a shorter period of time and also allow a longer time period between infusions once the initial treatment regime is completed. Lengthening the time between maintenance infusions saves patients money and is far more convenient for them.
- Is ketamine safe?
Safety is our #1 concern. We believe that a team led by physician anesthesiologists is best suited to provide comprehensive medical management of your condition and to safely administer ketamine and anesthetic sedatives such as propofol anesthesia. Clinics that are staffed by nurses or doctors who are not anesthesiologists must limit their doses of ketamine and other sedatives to levels that may not be as effective.
- Is ketamine a good treatment for depression?
Yes. Ketamine has emerged as one of the major treatment options for patients suffering from depression, along with oral medications, electroconvulsive therapy (ECT), and transcranial magnetic stimulation (TMS).
- Should ketamine therapy be used before any other treatments for depression?
Ketamine is generally reserved for patients that have not had relief of their depression using oral medications.
- Is ketamine better than other treatments for depression?
No. Unfortunately, none of the major treatment modalities listed above are effective in all patients. Each has a success rate of approximately 60 – 70%.
- Which patients benefit from ketamine treatment for depression?
As with the other major treatment options, there is no way of predicting which patients will respond favorably to ketamine infusions. It is simply a matter of giving several infusions and then assessing whether or not relief is being obtained.
- How many treatments are given for depression?
Generally, a series of four to six infusions are given to a new patient over a two-week period. Patients are assessed halfway through the series for benefits. If they have no improvement in their symptoms, we generally do not give any additional infusions and treatment is stopped.
- Why do some ketamine clinics initially schedule patients for six infusion sessions while your clinic does not?
Since all patients do not receive a beneficial result from ketamine infusions, we assess every patient during the course of their treatment and together make a determination as to whether additional treatments are advisable. This assessment is ongoing with each treatment, and for most patients no further infusions are given if there has been no relief after the third infusion (though there may be a few exceptions to this policy).
We believe it is inappropriate to sign up and charge any patient for 6 infusions when approximately one-third of patients will be non-responders who should not complete the full 6-session course of therapy.
- What are maintenance infusions?
Once an initial series is completed, many patients need “booster” or maintenance infusions to continue receiving the beneficial effects of ketamine. It is unusual for a patient to only need the initial 2 week course of therapy. The time period between maintenance infusions varies widely from approximately every 4 weeks to many months between infusions.
- How will I know when a maintenance infusion is needed?
You know yourself better than anyone. When you feel your symptoms of depression returning, that is generally when a maintenance infusion is needed.
- What is a treatment with ketamine like?
Treatments are given by intravenous infusion. That is, a health care professional will start an IV, and then ketamine is given continuously into the vein over approximately a one-hour period. Patients are given other medications such as propofol along with ketamine to make the experience pleasant and to prevent nausea.
Patients are given the treatments in a room with low lighting while sitting in a comfortable reclining chair. Most patients have little or no memory of the actual treatment period once it is started. When the infusion is completed, patients feel like they are slowly awakening from a very deep sleep.
- Who is with me during the treatments?
Patients have a nurse in continuous attendance with them during a ketamine infusion. The nurse is there to monitor the patient’s vital signs and to make sure the infusion goes smoothly.
- Should a medical doctor be on site when I receive ketamine?
Yes. A comprehensive medical evaluation, including a medical history, physical exam, assessment, plan, discussion of risks, benefits, alternatives, and medical treatment with the administration of ketamine and propofol anesthesia along with the management of potential complications and side effects, is considered the practice of medicine. By law, only medical doctors are licensed to practice medicine in the State of Tennessee.
Patients should understand that there are practitioners in Tennessee who are not medical doctors, yet they may advertise themselves as “Doctor”; similarly, some clinics may not have a doctor on-site at all times. We suggest you ask your primary physician whether ketamine should be administered in the setting of a medical doctor or not.
- Is a doctor available if I have trouble?
Yes. A board-certified anesthesiologist is on-site and always immediately available should any difficulties, which are rare, arise.
- Are there side effects to the treatment?
Ketamine is a drug that sometimes causes vivid dreams or mental images. These can be unpleasant for some patients. We generally give an infusion of a drug called propofol along with the ketamine to lessen the chance of this occurring. Propofol is also an anesthetic drug, and we are specifically trained to administer it safely.
Occasionally, we give other medications such as a sedative to further decrease the chance of unpleasant side-effects. Ketamine typically increases the amount of urine a patient produces, so you are likely to need to use the bathroom prior to discharge.
Finally, we administer an anti-nausea drug to decrease the chance of nausea, which can occur in some patients. Propofol also has a beneficial side-effect of nausea prevention.
- Will I have disturbing dreams or visual hallucinations?
It is uncommon for this to occur because we give other medications that counteract these negative effects. However, if you experience anything unpleasant, your nurse should be informed so that your medications can be adjusted.
- Is ketamine a drug that can be abused?
Yes. Like propofol and narcotics, Ketamine is an anesthetic drug that is strictly controlled by the FDA like medications such as propofol and narcotics. When sold illicitly on the street, ketamine is called Special K or Vitamin K. In that setting, it has the potential to be abused. In a medical setting, it is very safe for patients to receive.
- Should an anesthesiologist or a psychiatrist give ketamine?
Ketamine is an anesthetic drug, so only anesthesiologists are specifically trained in giving it safely. However, some psychiatrists and non-anesthesia doctors administer ketamine to treat depression. Because they lack the training to manage patients who are anesthetized, they generally use a much lower dose than anesthesiologists.
Unfortunately, there are some patients that do not get relief with the low doses that non-anesthesiologists administer, but who respond to the higher doses given by doctors trained in anesthesia.
Further, the higher doses that anesthesia doctors give allow patients to go for longer periods of time between maintenance infusions. Finally, only anesthesiologists should administer propofol, which is also an anesthetic drug and a medication we routinely give to minimize the unwanted side effects of ketamine.
We suggest you talk to your primary physician about whether ketamine should be administered in the setting of a medical doctor or not.
- Are ketamine infusions FDA approved?
Ketamine infusions do not meet the strict criteria set by the FDA to be “approved” for treating depression and other conditions. When drugs are approved for use by the FDA, they are generally done so for only the narrow range of conditions studied when they are undergoing development.
For ketamine, that dates back almost 50 years, decades before it was known to help many patients with depression and other conditions; thus, the approval for ketamine by the FDA has always been as an anesthetic agent. Esketamine, the nasal form of ketamine (also called Spravato), which was developed and studied for the express purpose of treating depression, has been given FDA approval for the treatment of depression, thereby demonstrating that the FDA recognizes the ability of ketamine to benefit patients with that condition.
Many of the drugs doctors commonly prescribe for their patients are not “FDA approved,” but like ketamine, there is a wealth of medical literature demonstrating their safety and effectiveness.
- Why do some ketamine clinics charge less?
There are a number of ketamine clinics that are staffed by nurses and not medical doctors. Some of these clinics will even treat patients without a physician referral. We believe that ketamine treatments constitute the practice of medicine, which is why we always have an anesthesiologist on site while a patient is receiving treatment in the center and always work in close conjunction with patient’s personal physician.
Clinics that are staffed with only a nurse are obviously able to charge less for their services. There are also some clinics that are staffed by doctors that are not trained in the specialty of anesthesiology, so they are not trained in giving propofol and other drugs along with ketamine. Administering propofol, as we routinely do, adds expense, but it allows us to minimize the unpleasant side effects of ketamine.
Our charges are in line with other clinics where an anesthesiologist is present, and they are on the low end for ketamine clinics nationwide. We suggest you consult your primary physician as to whether you should have your treatments in a clinic staffed with an anesthesiologist, a non-anesthesiologist doctor, or only nurses.
- Are there patients who should not receive ketamine?
A small number of patients, such as those with dangerously high blood pressure that is not under control, should not be treated with ketamine.
- What about receiving ketamine if I am pregnant?
Pregnant patients should NOT receive ketamine. Also, females of child-bearing age should take precautions to prevent pregnancy while under treatment.
- Can I refer myself to your center or do I need my doctor to refer me?
You can refer yourself to our center for evaluation, but you will need a referral from your primary physician to receive treatment. This assures us that your doctor agrees with treatment and also allows us to communicate your progress back to your doctor.
- Will I still keep my regular doctor?
Yes. Your doctor will still be your primary physician. We are here to help him or her by giving you ketamine treatments. You will continue taking the medications that your regular doctor has prescribed.
- Does insurance pay for infusions?
No. Unfortunately, insurance carriers generally do not pay for infusions.
- Can you treat patients with Spravato, the nasal formulation of ketamine?
Yes. Please visit our Spravato page for more information.
- Is ketamine a good treatment for PTSD?
Yes. Many – though not all – patients can decrease their PTSD symptoms with ketamine infusions.
- Is ketamine a good treatment for obsessive-compulsive disorder (OCD)?
Yes. Many – though not all – patients with OCD receive benefit from ketamine infusions.
- What about ketamine for the treatment of pain?
Ketamine provides benefits to patients with a variety of pain conditions including chronic regional pain syndrome (CRPS), migraine headaches, neuropathic pain, fibromyalgia, amputation pain syndromes, and others. For some pain conditions, more intensive infusions (higher doses and infusions that last longer than one hour) are recommended.
- Will ketamine relieve all my pain?
Unfortunately, ketamine will not usually relieve all the pain a patient suffers. In particular, clinicians treating the pain of CRPS find it very difficult to control. However, many patients with CRPS and other pain conditions will experience less pain when treated with ketamine infusions.
- Will ketamine allow me to reduce the dose of pain medications I take?
Many patients for whom ketamine is effective in reducing pain are able to reduce the amount of pain medications they need to take, and some can entirely eliminate their dependence on narcotic pain medicines, including opioids.
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