Our Brief History
We opened our center in order to safely provide higher dose ketamine infusions to better treat depression, PTSD, and Anxiety. We also treat a variety of pain conditions including chronic regional pain syndrome (CRPS, previously called RSD), fibromyalgia, migraine headaches, neuropathic pain, amputation pain syndrome, and others.
Board-certified anesthesiologists are physically present and will prescribe the optimal dose and frequency to achieve maximal benefit from treatment.
Our ability to co-administer propofol along with ketamine makes the patient’s experience more pleasant.
We maximize the use of continuous physiologic monitoring on all patients all the time.
We employ only highly trained RN’s with experience and training in conscious sedation and the use of ketamine.
We prescribe an individualized Wellness plan to maximize the likelihood of a positive response as well as improved function and quality of life on a long-term basis.
After consultation with an Anesthesiologist, most patients are scheduled to receive an initial series of 4-6 infusions over a 2 to 3 week period.
We evaluate patients after three infusions — if no benefit is being achieved, the treatments are usually discontinued (there are some exceptions). Patients with depression are monitored both by their subjective symptoms as well as objectively by using the QIDS (Quick Inventory of Depression Symptomatology) scale.
Although a few patients do not require additional infusions after the initial series, most patients find they need additional “maintenance” or “booster” infusions as time passes. Patients generally determine the timing of additional infusions for themselves as judged by the return of their symptoms. Maintenance infusions are given over varying time periods ranging from once every 4 or 5 weeks to once every 6 months or more.
Ketamine infusions have been shown to be beneficial in approximately 75% of patients suffering from depression as well as chronic pain and opioid dependence. Ketamine is usually helpful in other conditions such as anxiety and PTSD. Patients with PTSD are followed objectively with a PTSD Checklist. Please see the medical literature research section below for detailed results.
Anesthesiologists have been safely using the anesthetic drug ketamine since its introduction in the U.S. in 1970. An anesthesiologist evaluates every treatment given, and he or she is immediately available whenever a patient is receiving care in our clinic. All patients receiving infusions are monitored by nurses in constant attendance, who utilize personal observation, pulse rate, blood pressure, ECG rhythm, respiratory rate, and pulse oximetry. Selected patients are also monitored by end-tidal carbon dioxide concentrations.
We are here to assist with their patients’ care, but their regular doctor maintains overall management. We communicate closely with our referring physicians as treatment progresses.
Ketamine is a unique medication, unlike any other, acting on specific areas of the brain and spinal cord.
Historically, researchers have focused on monoamine (MOA) neurotransmitters for the treatment of depression (including serotonin, norepinephrine, dopamine); for example, selective serotonin reuptake inhibitors (SSRI) increase serotonin, which helps decrease symptoms of depression.
However, in the past 10-20 years, there has been more focus on the role of glutamate, an excitatory amino acid/neurotransmitter, which is present in over 50% of the neural connections in the central nervous system.
Ketamine’s mechanism in treating depression, pain, PTSD, and other conditions are three-fold:
- Ketamine increases glutamate in the brain. Stress, PTSD, and depression decrease the function of the glutamate system leading to decreased neural connectivity. Ketamine increases glutamate, which helps restore neural connectivity within the brain – i.e. “neuroplasticity,” the ability for the brain to repair itself or optimize its function with various changes. This neuroplasticity results in less depression and “enhanced fear extinction” in the case of PTSD.
- Within the spinal cord, ketamine modulates descending inhibitory pathways by working as an N-methyl D-Aspartate (NMDA) receptor antagonist. That decreases opioid-induced hyperalgesia (hypersensitivity), neural wind-up, and central sensitization (“resets pain receptors”).
- Finally, ketamine decreases the chronic pro-inflammatory state that exists in patients with depression, pain, and PTSD.
We are approved and qualified to administer the nasal form of ketamine if our referring physician requests that treatment. Once patients complete the initial dosing phase, Spravato maintenance requires a 2-hour clinic visit at least once a week, and sometimes twice every week. Please see the Spravato page for further information.