Ketamine therapy represents the first rapid interventional treatment for depression in years. A series of six infusions over two to three weeks can improve depression in 70% of treatment resistant cases.
NOVA Health Recovery is a Ketamine Treatment Center in Fairfax, Virginia (Northern Virginia Ketamine) that specializes in the treatment of depression, anxiety, bipolar disorder, OCD, and chronic pain such as CRPS, cluster headaches, and fibromyalgia using Ketamine therapies, both infusion and home-based ketamine nasal spray and oral tablets. We also offer addiction treatment services with Suboxone, Vivitrol, and Sublocade therapies for opiate addiction as well as alcohol treatment regimens. Contact us at 703-844-0184 or at this link: NOVA Health Recovery Ketamine Infusion Center
Contact us Below for more information about Ketamine for your condition:
Depression Treatment in Arlington, Virginia
Depression is a debilitating mental disorder that brings feelings of intense sadness and isolation. According to NIMH (The National Institute of Mental Health), somewhere around 16 million American adults suffer from at least one major depressive episode in any given year. Unfortunately, many suffering from depression feel incredibly isolated or shameful and decide not to seek treatment. While depression usually can not be “cured” with treatment, the symptoms can be managed. If you or a loved one is searching for depression treatment please read below.
What are the different types of depression?
Depression itself varies greatly from case to case. Some people may suffer from persistent depression, while others may only get it temporarily or episodically. There is a litany of different versions of depression, each with their own symptoms and triggers.
Some of the typical diagnoses of depressive disorders may include:
- Major Depressive Disorder (MDD): Also known as Clinical Depression or Unipolar Depression. The most common form of depression. It can be just a single episode, but some people may experience it periodically throughout their lives.
- Postpartum Depression: A type of depression usually brought on by the hormonal shifts women experience the months or year following childbirth.
- Seasonal Affective Disorder: (SAD) Depression caused by a change in the circadian rhythm of the body, usually bringing on depression during a specific season of the year.
- Situational Depression: While the symptoms are much like Major Depressive Disorder, this is depression brought on by a specific event, such as the death of a loved one or a life-threatening event.
- Persistent Depression: Also known as dysthymia or chronic depression, this is depression that lasts for two years or more.
- Manic Depression/Bipolar Disorder: Characterized by periods of mania alternating with periods of intense depression.
What are the symptoms of depression?
Those suffering from depression will have trouble functioning in their daily life and may fall behind at work or school. Depression may also affect personal relationships and physical health. That said, the symptoms of depression can sometimes be greatly different between different cases.
The common symptoms include, but are not limited to:
- Sadness or melancholy
- Loss of interest in hobbies
- Change in eating or sleeping patterns
- Trouble concentrating
- Fatigue or lack of energy
Depression also has a risk factor for developing other problems, such as higher rates of chronic disease. Depression tends to also bring an increased risk of both blood clots and more general heart disease. Some may even turn to substance abuse in an attempt to alleviate the symptoms of depression.
Clinical Depression, sometimes referred to as Major Depressive Disorder, is usually diagnosed when someone is suffering from depression that has persisted for two weeks or more and experiences the symptoms throughout most of the day.
Usually marked by disinterest in hobbies and persistent sadness, which then leads to negative changes in diet, concentration, hygiene, and overall behavior.
Millions of people suffer from depression every year. You should feel no shame in deciding to find treatment.
Symptoms of Clinical Depression
- Changes in sleep pattern
- Weight fluctuations
- Mental fog
- Loss of sexual interest
Causes of Clinical Depression
- Genetics: Clinical depression can pass through genetics from relatives who also suffered from depression.
- Brain Signals: Neurotransmitters within the brain may not be responding to how they should. This miscommunication causes feelings of depression to intensify.
- Chemical Imbalances: Research shows that the chemical structure of the brain is wired differently in those with clinical depression.
- Hormonal Irregularities: Clinical depression is sometimes triggered by the hormones in the body is unbalanced. Some bodily changes (like pregnancy, thyroid problems, or menopause) may be responsible for these irregularities.
Ketamine for Depression Treatment
Ketamine, first developed and approved by the FDA as an anesthetic, is a promising new innovation in the field of depression treatment. While you may know it as the club drug often abused as Special K, Ketamine is what some doctors are calling the biggest breakthrough in depression treatment in decades. When infused at a low dose into the bloodstream, research shows that Ketamine may be up to 80% effective at providing relief for depression symptoms.
If you or a loved one is seeking Ketamine for depression treatment in Alexandria, VA, we would like to invite you to contact us to learn more about how Ketamine can provide relief. Schedule a consultation today.
- Treatment Resistant Depression
- Bipolar Depression
- Multiple Painful conditions
- Suicidal Thoughts
- Social Anxiety
- CRPS | RSD
- OCD (Obsessive Compulsive Disorders)
- Cluster Headaches
- Chronic Fatigue Syndrome
- Neuropathic pain
- Migraine Headaches
- For Mindfulness, hypnosis, guided imagery
- Post-herpetic neuralgia
- Phantom limb pain
- Trigeminal neuralgia
- Cancer pain
Some articles have praised ketamine therapy for being a mental health breakthrough, and it is true that ketamine is very effective in the rapid treatment of mood disorders. A series of infusions can result in significant improvement of depression over the course of several days.
Symptoms of depression include:
- Feeling sad or having a depressed mood
- Difficulty thinking, concentrating or making decisions.
- Loss of energy or increased fatigue
- Thoughts of death or suicide
- Loss of interest or pleasure in activities once enjoyed.
- Changes in appetite — weight loss or gain unrelated to dieting.
- Trouble sleeping or sleeping too much.
- Increase in purposeless physical activity (I.e., inability to sit still, pacing, handwringing) or slowed movements or speech (these actions must be severe enough to be observable by others)
- Feeling worthless or guilty
- Depression affects one in 15 adults (6.7%) every year.
- One in six people (16.6%) will be depressed at some point in their life.
- Women are twice as likely to suffer from depression.
- One-third of women suffer from depression at some point in their lifetime.
- There is a high degree of heritability (40%)
- Risk factors include biochemistry, genetics (If one identical twin has depression, there is a 70% chance the other will get depressed), personality (low self-esteem, pessimistic people, or those who are easily overwhelmed by stress), environmental factors such as neglect, violence, poverty, early childhood traumas all increase risk of depression.
- Grief reactions create painful feelings and sadness due to job loss, relationship loss, or death of a loved one. This situation is different than depression in that painful feelings come in waves mixed with positive memories and may be similar to depression in that intense sadness and withdrawal from usual activities may occur. One may fantasize about ‘joining’ the loved one in death, but feelings of low self-esteem and worthlessness occur in depression, not grief.
- Many patients with treatment resistant depression, a history of substance abuse, ADHD history, restlessness, insomnia, and combinations thereof may actually have bipolar disorder, which ketamine therapy can treat.
Depression, insomnia, anxiety, and other mood disorders can be ‘calculated’ using various tools such as the PHQ-9 for depression, a medically validated measure of depression. Some parameters of depression are hard to track. At NOVA Health Recovery Ketamine Center, we use multiple measurements to track mood scores.
Online calculators for depression and mood can be found at:
- Brain Fog – may require neurocognitive testing (CNS Vitals)
- Poor processing abilities
- Poor short-term memory (working memory as in the ability to recall a phone number)
- Difficulty with visuospatial abilities – difficulties visualizing information and images in your memory.
- Poor executive functioning: difficulty with decision-making, impulse control, and processing new information.
- Difficulty with motivation due to the low reward value of basic things such as reading a good book, watching a movie, spending time with friends and family, and in deeper stages of depression – getting out of bed, brushing your teeth, or even combing your hair.
- MRI’s demonstrate that poorly treated depression can result in diminished brain volumes in key areas such as the prefrontal cortex (involved in decision-making) and the hippocampus (working memory). Likewise, areas of the brain such as the lateral habenula and the amygdala are overactive and over wired resulting in ruminations, fear, and excessive anxiety.
- Alterations in functional brain networks
Treatment of depression with ketamine
Why Chose ketamine for your therapy?
- Rapid antidepressant response within days
- No weight gain or sexual side-effects.
- You can stop the therapy without withdrawal symptoms.
Whether you have tried multiple antidepressants, TMS, ECT, or other therapies, ketamine still has a significant response rate. The response rate is approximately 70% of TRD (treatment resistant depression) have improvement over the course of the 6 sessions. Ketamine can be the first line treatment for depression as it promotes neuroplasticity and prevents glutamate toxicity. Neuroplasticity is diminished in depression and excess glutamate can be neurotoxic. Over time, these issues can erode your brain’s neural pathways involved with learning (resulting in brain fog) as well as producing depression as reward and motivation are decreased. These changes can be seen on MRI scans in the form of smaller volumes in key areas of the brain such as the prefrontal cortex (involved with executive functioning, decision-making, planning, and impulse control) as well as the hippocampus (involved with working memory).
Many traditional medications such as SSRI’s (Prozac, Paxil, Lexapro) have side-effects such as weight-gain and sexual side-effects. Atypical antipsychotics such as Abilify, Risperdal, and others are associated with excess weight gain and hyperglycemia (high blood sugar). Ketamine is neutral regarding weight gain and metabolic consequences. In fact, poorly treated depression is associated with early death due to cardiovascular complications such as stroke and heart attacks. Ketamine can cause some psychomimetic effects such as dissociation, bizarre dream-like states, incoordination, and nausea during an infusion or nasal spray use. These symptoms go away within minutes, yet the antidepressant effects can start immediately and last from hours to days. There are no sexual side effects from ketamine used for mental health purposes.
Who qualifies for Ketamine Therapy?
- If you have had a stroke, heart attack, kidney or liver failure, you would need a medical clearance for the treatment.
- Schizophrenia is not treated with ketamine therapies.
- Personality disorders are better treated with Cognitive behavioral therapies.
- Consideration for other therapies in conjunction, before or after ketamine therapy, such as ECT, TMS, EMDR for PTSD, DBT, motivational enhancement therapies, and others should be reviewed.
Anyone can get the therapy if they have depression, anxiety, bipolar disorder, or neuropathic pain. Call us at NOVA Health Recovery to see how to start the program. A history of heart attack, stroke, uncontrolled diabetes or hypertension would require a clearance by your specialist. A diagnosis of Schizophrenia would disqualify you for treatment as that condition will not improve with ketamine therapy. Likewise, ketamine cannot change external stressors in your life such as your boss, your spouse, the color of your car, or your occupation. The therapy will improve your resilience in withstanding the daily aggravations you may face. Some patients who receive the therapy have no specific mood disorder but use the experience for a guided journey, self-hypnosis, or self-exploration.
- Ketamine therapy will not change your personality or your preferences. It will not make you prefer pink when you have always liked blue nor will it make you like your job. Ketamine can be used in conjunction with other therapies, and incorporating a structured, enriched lifestyle to prevent boredom promotes recovery.
- Ketamine infusions cannot change your environment. You will go home to the same relationship, the same family, the same job. However, you may become more flexible mentally after infusions and this may allow you to navigate your thoughts in new directions and understandings of a situation. Many people have found they can make better decisions in dealing with toxic relationships after treatment with ketamine.
- Medical clearance for ketamine infusions would be required for heart disease, stroke history, uncontrolled diabetes, uncontrolled hypertension, kidney or liver failure.
- Any recent blood work results or genetic testing is helpful for our evaluation.
Do I need a referral?
You do not need a referral for Ketamine Infusions. Certainly, background information of prior treatments is helpful and contact with your psychiatrist and psychologist would be useful to manage your care.
Exclusions from Ketamine Therapy:
Medical issues such as liver, heart disease, and uncontrolled blood pressure are concerns that may require a more in-depth clearance. Medical conditions that need evaluation and clearance or can exclude infusions are:
- Heart disease
- Liver failure
- Renal failure
- Uncontrolled diabetes
- Uncontrolled blood pressure
Can I replace ketamine for my other medications?
There are very few medical evidence-based studies on how to stop antidepressants or when to stop them. Side effects can certainly provoke one to consider eliminating medications. Ketamine has been used successfully as a stand-alone medication for depression in our practice and as a medication to allow one to wean off their SSRI without getting all the brain zaps and withdrawal effects you otherwise would have. We use ketamine for buprenorphine and alcohol withdrawal as well.
- Ketamine can be used as a stand-alone therapy, but frequently other medications are used in combination to help maintain mood stabilization. Ketamine can help make your medications work better.
- If you are recently depressed, for the first time or a repeat episode, an early use of ketamine therapies may allow you to rapidly feel better as your traditional medications kick in.
- We can work with your psychiatrist or help you adjust the medications to maximize your outcomes.
- Working with a psychologist can be helpful and the best time for a therapy session is the day after an infusion when the mind is more malleable and neuroplastic, and ready to learn new information. Cognitive behavioral therapy, EMDR, and Dialectical Behavioral Therapy are all excellent add-on therapies to help treat personality disorders, PTSD, and cognitive rigidity or repetitive thoughts.
What is ketamine?
Ketamine is FDA approved for anesthesia purposes and Esketamine, the S-enantiomer of ketamine, is FDA approved for office-use of Treatment Resistant Depression (TRD). Ketamine is related to PCP and was developed by Park Davis in 1962. It produces profound pain relief and alters consciousness at higher doses and can be repeatedly administered to maintain the effect. It has fewer emergence side-effects relative to phencyclidine.
Ketamine is an arylcycloalkylamine that exists as S(+) and R(−) isomers and is commonly used as a racemic mixture of the two. Generally, our physiology prefers to use one mirror image over the other. With ketamine, there seems to be effectiveness with either enantiomer in different variations. The IV formula is a 50:50 mixture of the two enantiomers.
Is Ketamine Safe?
Ketamine was added to the WHO Model List of Essential Medicines in 1985 and is also on the Model List of Essential Medicines for Children due to its safety and efficacy for anesthesia. The dosing used in depression, pain, and mood disorders is significantly lower than for anesthetic purposes. In fact, it was discovered that sub-anesthetic doses of ketamine work better for depression than do higher doses. These doses are 1/10 the doses used in hospital settings. Respiratory depression is not a significant issue, although NOVA Health Recovery Ketamine Infusion Center monitors respiratory status with pulse oximetry, EKG, and Blood pressure monitoring with oxygen and ACLS protocols for more medically ill patients.
What are the side effects of ketamine?
Nausea and vomiting are the more common side effect of an infusion. NOVA Health Recovery Ketamine Infusion Center in Fairfax, Virginia uses antiemetics such as promethazine, prochlorperazine, Zofran, and other medications to prevent this. As ketamine is a dissociative agent, one can also have feelings of general numbness, heaviness, hallucinations at higher doses, dizziness, visual distortions and other odd feelings that vary from infusion to infusion. No infusion is the same. Many patients set expectations that one must be happy after an infusion for it to have worked. This is not true. In either infusion case, the end-result is that the same neuroplasticity occurs with the expected antidepressant results improving in most patients.
It can be helpful to focus on a ‘game-plan’ during the infusion, with a specific problem being focused on to see if there may be some resolution during the infusion. In PTSD work, many need higher doses to effectively ‘slay the dragon.’ Ketamine is a language of its own. Words do not describe many things in our world, such as ‘how do you describe the taste of chicken’ or ‘how do you describe the color blue to a blind man who has never seen before.’ Ketamine may allow one to comprehend a complex issue without being able to place arbitrary words to ascribe meaning to it. For some, there may be some synesthetic components to the experience with one feeling the color red or hearing the color yellow. In any case, it isn’t the experience but rather the neuroplasticity that is most important for the healing effects.
Who won’t ketamine work for?
Ketamine does not treat:
- Personality disorders
- External stresses
Will I get nauseated during an infusion?
NOVA Health Recovery has multiple options for nausea medications to insure your comfort. We use IV Reglan, Zofran, Phenergan, Compazine, and even scopolamine.
Will I feel anxious during the infusion?
Occasionally, especially at higher doses, ketamine can produce anxiety in the patient. With self-redirection, many can remind themselves that they are in a safe place and that with the end of the infusion any anxious feelings will stop almost immediately. In some cases, NOVA Health Recovery Ketamine Infusion Center may use midazolam (Versed) or IV Ativan to help decrease symptoms. We utilize anti-anxiety medications for higher dose CRPS infusions for pain.
How is Ketamine Administered?
Ketamine is infused through a vein over the course of 40-50 minutes depending on the patient’s situation and condition. Generally, an initial series of 6 infusions is needed, each done 2-5 days apart. You will be awake during the infusion, so bring ambient music for yourself to listen too, but don’t text or make phone calls during the infusion. It is best not to focus on your cell phone or tablet during the infusion as that distracts from any immersive experience. We start at a weight-based dosing at 0.5 mg/kg and escalate through the program up to 1 mg/kg with comfort in mind. There will be some psychedelic effects, including visual distortions, feelings of floating, dizziness, and other odd feelings. We initiate anti-nausea medications for comfort prior to the infusion.
Expect a 10–15-minute recovery after the infusion as you will be off-balance. You must NOT drive home. Have someone drive you or use Uber. You cannot drive for 4 hours after the infusion. Some people find it hard to sleep during the infusion series and others find they get more agitated at times in between infusions, but generally most people just feel better. Results can come within hours to a week. Everyone is different and it is hard to predict results or the timing of those results.
Does the IV hurt?
NOVA Health Recovery uses small 24-gauge IV needles inserted by expert infusionists using a ‘cold numbing spray.’ For those with needle phobias, oral and home-based ketamine nasal spray options are available. We also can administer a benzodiazepine (I.e., Valium) for those with extreme fear.
Do I take my regular medications the day of the infusion?
Yes, continue your medications as directed. Let the physician know what medications you took.
Can I eat or drink prior to the infusion?
It is best to be without any food or liquids for three hours prior to the infusion except for medications.
When will I feel better?
For depression and mood disorders, one should expect a series of 6 infusions. Some may notice a difference after the first infusion, but others may not notice anything until the fourth or fifth infusion. Again, this process relies on neuroplasticity as well as impacting the amygdala and lateral habenula to decrease anxiety. Everyone is different and 70% of TRD will have some improvements. Improvement may come in many different domains and sometimes it is the family that notices the improvement first, such has improved expressivity, more socialization, and less irritability. The patient may feel like a ‘weight has been lifted,’ more emotional responsivity (for some that includes the ability to cry appropriately), enhanced mood, less anxiety, better cognition, and more energy and motivation.
What can I do or not do in-between infusions?
Get moving! Take long walks, go to the gym. Eat well, including well-rounded protein sources and complex carbohydrates. Don’t eat junk food. Try to go to sleep with a schedule. Some people, especially women, may feel washed out in-between infusions, with malaise and general weakness. That can be expected for some without much impact on the results. Be certain to eat well and get outside in the sun.
Stop alcohol consumption and minimize marijuana use as this adds oxidative stress.
Will I sleep better?
Depression and mood disorders will disrupt the circadian rhythm. It is important to realize that some will find ketamine to be activating and will wake them up, further disrupting their sleep-wake schedule during the initial series of infusions. It is important to take melatonin and night as well as VHP (Valerian, Hops, Passionflower) and L-Glycine to improve sleep. Sleep will improve after the infusion series and as the depression lightens. Keep a sleep log and set a sleep schedule. Get checked for Obstructive sleep apnea or use your CPAP machine if you are already diagnosed with sleep apnea.
Are there any vitamins I should take?
Zinc, Omega-3 fatty acids, B complex, Magnesium, Glycine, Glutamine, CoQ10, Carnitine, Vitamin D3/K2, and creatine may be very helpful in improving efficacy during the infusions. NOVA Health Recovery offers IV Vitamin therapies, Vitamin D injections, and B12 injections during infusions to augment the production of serotonin and dopamine and improve outcomes.
How long does an infusion Last?
- CRPS and pain infusions can last 4 hours and span 3-5 days consecutively.
- For mood disorders such as depression, each infusion is about 40-50 minutes and are done two or three times a week.
How long will the first visit be?
Expect an hour of conversation and evaluation with Dr. Sendi at NOVA Health Recovery to review your medical history and discuss the treatment plan as well as how ketamine will work for your case. Dr. Sendi uses an integrative approach, discussing past treatments, alternative diagnosis, possible testing that may be helpful, add-on therapies, and integrative roles of therapies such as high intensity interval training (HIIT) , intermittent fasting, diet, lifestyle changes, circadian disruption, sleep evaluations, supplement choices, exercise, sauna use, and mindfulness-based therapies to maximize outcomes. If appropriate, an infusion can be done the same visit to get treatment started.
Should I stop any medications during the infusion series? Can I stay on my benzodiazepine?
Do not change any of your medications and take your normal medications the day of the infusion.
Will I be able to work the same day or the next day?
It is best to take the rest of the day off after an infusion if possible. However, many are very functional several hours after an infusion and can return to their desk jobs or light duty. Most people can work as normal the next day. Driving or operation of machinery is prohibited for four hours after an infusion.
What can I take for sleep after an infusion?
If possible, melatonin and Valerian/hops/passionflower with L-Glycine as natural based therapies. Some use a cooliblanket or Ebb device for sleep improvement. Your body temperature should drop in the night and a cool environment assists in this process. Certainly, use your CPAP machine. Others may try OTC Benadryl or Unisom. Prescriptions for sleep aids can be used and can include Ambien, Lunesta, Atarax, Doxepin, Elavil, Remeron, Seroquel, Thorazine, or other medications as needed. Consider using a weighted blanket for sounder sleep.
What type of music should I listen to?
Please bring your own noise-cancelling headsets and music if possible. Ambient music is best, without words. The playlist should last an hour and be relatively free of percussive sounds or excessive dramatic musical flow. Certainly, music that evokes a special feeling or state of mind is especially useful during a guided ketamine journey. It is hard to determine the best musical selection for any individual, but these are some basic pointers. At NOVA Health Recovery Ketamine Infusion Center in Fairfax, Virginia, we recommend each person brings eye shades, noise-cancelling headsets, and a fully charged phone with an ambient playlist such as ‘enigma’ on Pandora Radio, or one can listen to ‘sacred knowledge’ which is featured in the Johns Hopkins psilocybin program for depression.
Here is a Spotify Ketamine List as well: Spotify Ketamine Music
What do I bring to the Ketamine session?
How Do I prepare for my first ketamine infusion?
Here are some simple steps to prepare for your first infusion:
- Don’t eat for four hours before the infusion to minimize nausea. At NOVA Health Recovery Ketamine Infusion Center, we provide Zofran, Phenergan, Compazine, Reglan, or scopolamine to minimize any nausea.
- Have someone Drive you to the appointment or get an Uber/Lyft.
- Take your usual medications the day of the infusion.
- Make certain you don’t over-hydrate before the infusion because ketamine tends to make you have to urinate during the infusion and that will ruin your MindFlow.
- Bring noise-canceling headsets and a good set of tunes. We generally prefer ambient music without words or much percussion as they can be disturbing during an infusion.
- Bring eye-shades to keep the light out as ketamine makes your eyes sensitive to light. Our rooms are very dark and have Philips Hue bulbs that can be changed in color to your preference.
- Bring a weighted blanket if you feel more secure with one.
- Turn off your phone and don’t stare at the screen. Close your eyes and let your mind wander or follow your own internal guided imagery that you should plan out ahead of the infusion.
- Meditate ahead of the infusion. Let work go and let the infusion time be for yourself.
- Plan to relax for the rest of the day after an infusion
What do I do to help maintain and maximize the infusion success?
- Avoid alcohol and marijuana.
- Start moving more – walking or running are excellent choices for activity between infusions. Consider Tai Chi classes or yoga to improve overall fitness.
- Avoid processed foods. A Mediterranean style diet is ideal for mental health improvement.. Avoid MSG and excess glutamate.
- Vitamins are essential to mental health. Here are some important vitamins and minerals to optimize your recovery: Omega 3 fatty acids (2-3 gm/day), Zinc (10 mg/day), Vitamin B6/B complex, Vitamin D3/K2, SAM-E, L Methylfolate/Methyl B12, and Magnesium.
- Sleep can be an issue during the infusion series. Expect a bit of disruption during the treatment. Consideration for prescriptive sleep-aids are fine for temporary use. Natural options include: Melatonin, VHP (valerian, passionflower, hops), and L-glycine. Ashwagandha may be helpful to decrease cortisol levels that may rise at night.
- Consider using an infrared sauna or regular sauna several times a week.
- Structured Time: set a schedule for yourself from sunup to sundown. Have a project to do at all times, new pursuits, educational goals, and set exercise time aside for yourself. Social pursuits are extremely helpful in recovery as many depressed patients may be very isolated. Consider church-related events, joining a gym, or random pursuits, such as group events one can do through sites such as meetup.com. Flow stating is the key – as constant activity and personal interactions are critical in the healing process. It is hard to be depressed while you are rock climbing, skiing, or interacting with peers on the job. Mindfulness is a key as it promotes ‘presence’ in the moment. The default mode network (DMN) is what allows us to think of future contexts and the past as well as self-referential ideas. Excessive daydreaming can provoke anxiety and distress, thus being in the present is key for successful mental health.
- Continued self-treatment with at-home devices such as the Fisher-Wallace device for depression using transcranial direct stimulation.
Do weighted blankets help?
For some people, weighted blankets brought to the infusion provide an excellent internal resource for reducing anxiety. Consider purchasing one for your infusion.
Can I get NAD+ infusions with ketamine?
Yes, but generally we do the ketamine infusion first and then the NAD+ infusion to follow. The benefit of NAD+ infusions are improved inflammatory markers, improved sirtuin function with anti-aging, hearing and vision protection, improved metabolic indicators, and improved mental health.
Can I do less than 6 infusions and still get results?
Yes, it Is possible to do four infusions with results that allow for home-based ketamine therapies as continuation. That can be determined based on your progress during the infusions.
Will Ketamine cure my depression or pain?
Unfortunately, there is no cure for depression, but when you are suffering with depression and pain and have exhausted all possibilities, ketamine can be used to promote the success of your current regimen or rapidly improve symptoms through changing the underlying neuroplasticity. Some patients will have a complete remission and not need any further infusions. Others may need monthly ‘tune-up’ infusions while others will need to use a home-based ketamine nasal spray therapy to maintain the efficacy of the depression treatment. It is hard to predict which patients will need a specific follow up, but generally most patients need monthly infusions for certain periods of the year.
How will I know if it is working for me? Is it a placebo effect?
If you feel happier, more motivated, more energetic, then clearly the treatment is working. Any improvement when you are depressed is progress that will be maintained throughout the procedure. The ‘high’ of ketamine is gone within 30 minutes of the infusion, thus any good feelings that you notice later are due to neuroplasticity, enhanced reward value, increased motivation, and better neurotransmitter response. Any sense of happiness is not placebo as it can only be due to neuritic spine development, enhanced neuroplasticity, and better emotional regulation.
Can Ketamine infusions be used for self-hypnosis, guided imagery, or a mind journey?
Yes, some individuals are not depressed but use ketamine for soul-searching and decision-making purposes. Self-hypnosis and guided imagery can enhance job performance, family interactions, goal setting, motivation, and multiple domains in one’s life. Ketamine assisted psychotherapy (KAP) does provide a role in the treatment of PTSD and mood disorders as does the use of other psychedelic agents
What is the furthest apart I can space my infusions initially?
Generally waiting more than 7 days between infusions will diminish performance of ketamine. It is best to have the infusions twice or three times a week initially.
After I complete my initial series of infusions, when do I come back?
The standard practice is one month for the next infusion to maintain neuroplasticity. You can return earlier for an infusion at any time when you feel your mood is declining or pain is returning.
I have felt depressed ever since I came off my pain medication| Suboxone a few months ago, will this help symptoms of PAWS (post-acute withdrawal syndrome)?
Ketamine is very helpful to address the post-acute withdrawal symptoms of depression, anhedonia, and low mood that may cause relapse when you have detoxed from opiates. NOVA Health Recovery uses ketamine infusions, home nasal ketamine, and oral ketamine to improve mood due to opiate use.
Is Ketamine addictive?
Ketamine may be abused in some populations, but there is no true withdrawal from ketamine if it is stopped suddenly. Most cases of abuse are in the context of other substances. In fact, ketamine has shown efficacy in the treatment of alcoholism, opiate abuse, and cocaine abuse. NOVA Health Recovery utilizes this therapy in conjunction with traditional therapies for certain addictions.
Can Ketamine be used to treat alcohol and opioid addiction?
Ketamine is used at NOVA Health Recovery for alcohol use disorder and opiate withdrawal and post-acute withdrawal syndrome as well as for cocaine use disorder. Ketamine can rewrite drinking memories and this treatment is useful in conjunction with traditional psychotherapy. Ketamine has been shown to treat multiple addiction disorders in various studies through neurogenesis, neuroplasticity, functional brain network repair, and the reconsolidation of memories.
Do Benzodiazepines and Lamictal interfere with Ketamine?
There is some literature that these medications, especially benzodiazepines, may decrease results, but the studies were poorly designed. Clinical experience has shown that these medications do not impact our treatment. NOVA Health Recovery Ketamine Infusions Center does not require that the patient stop these medications as such an intervention can lead to life-threatening withdrawal and worsened mood disturbances.
Is ketamine helpful for PTSD?
Yes, there are several studies with a lot of clinical experience demonstrating that ketamine can improve PTSD symptoms. NOVA Health Recovery Ketamine Infusion Center utilizes both IV and oral ketamine approaches for the treatment of PTSD.
What should I wear to the infusion?
Be comfortable. Wear fuzzy, comfortable clothing.
When can I eat or drink before an infusion?
Generally, a few hours before the infusion, it is best to stop any food intake. NOVA Helth Recovery will provide bottles of water during lighter infusions.
If I get scared during the infusion, what should I do?
NOVA Health Recovery monitors patients closely and if there is any anxiety, options for helping with that are to stop the infusion briefly or administer a mild sedative. We will occasionally extend the infusion time in cases where anxiety is a significant issue. Scopolamine infusions prior to the ketamine can also help with symptoms as well as improving nausea and antidepressant responses.
Can I look at my phone during an infusion?
It is best to not look at your electronic devices but rather focus on your mind journey. Prepare your music playlist in advance or listen to ours.
Is there any special diet I should follow?
Avoid processed foods and carbohydrates. If it has a label on it, it is not a whole food. The Mediterranean Diet represents a wholesome lifestyle choice that is anti-inflammatory and has evidence of being beneficial as an antidepressant treatment.
Can I return for infusions earlier if I feel symptoms returning?
Yes, you can return at any time for further infusions. Some clients may do several more infusions in quick succession after the series of 6 infusions. Others may come in weekly for treatment. Cost is the main prohibitive factor.
Does Insurance cover this therapy?
Not directly. NOVA Health Recovery Ketamine Infusion Center does not accept insurance, but we provide a superbill with the ICD codes for the procedure so you can submit it to insurance. Some patients do receive a reimbursement of a certain percentage, especially PPO’s. However, Medicaid, Medicare, and Tricare do not accept Superbills.
Basic CPT and ICD codes for Ketamine
|IV Infusion 96365|
|Rhythm ECG 1-3 leads 93041|
|Ketamine IV J3490|
|Infusion Normal Saline J7030|
|Intro Needle Cath Intracath IV 36000|
|Each Additional Hour of Infusion 96366|
|Therapeutic IVP of drug 96374|
|Injection of Midazolam J2250|
|Injection of Ondanstetron J2405|
|Injection of Metoclopramide J2765|
Initial Visit: 99205
Follow Up visit: 99215
How many hours after its use can I drive?
Four hours after the infusion are required before driving, whether it is an infusion or the nasal spray or troche Ketamine.
Do I need someone at home with me after the infusion?
If you have someone to stay with you, that is perfectly fine, but generally you will be awake and capable after departing the office. The only restriction is no driving for four hours after an infusion.
What is the cognitive assessment testing used for?
Brain fog, poor cognition, poor memory, poor processing speed, and many other cognitive impairments result from depression and bipolar disorders. Improvement of cognition is tracked using our cognitive assessment tools such as CNS Vitals and Cambridge Neurosciences. NOVA Health Recovery tracks mood changes through the OSMIND app, which tacks depression and anxiety scoring through traditional metrics like the PHQ-9 and the GAD-7 scoring system.
Do I need someone at home with me after the infusion?
Many patients will Uber in or have family or friends drive them back and forth. You will be fine to be at home alone unless we are doing the multi-hour pain protocol as for CRPS.
How will I feel the next day after an infusion?
Everyone is different, but for women, some will feel washed out and have more malaise. This has to do with hormonal differences in specific brain areas. N-acetyl cysteine (NAC) and melatonin with CoQ10 can help improve recovery and decrease headaches. In some cases, biweekly infusions may be the better treatment route. The responses to ketamine are ultimately the same for men and women.
Is there any benefit to getting Vitamin D and B12 shots during my ketamine series?
Do I need to dissociate to get benefit from an infusion?
No. The weight-based therapy provides the necessary dose for neuroplasticity regardless of the way one feels during the treatment. The infusion experience does not affect outcomes.
Can I smoke Marijuana and drink alcohol after an infusion?
Marijuana is not neuroplastic and affects only the endocannabinoid system, especially with high THC concentrations. It is best to avoid THC during ketamine therapy. Alcohol is also destructive and best avoided.
After I complete my initial series of infusions, when do I come back?
We set a follow up appointment a month later for an infusion and utilize home-based ketamine nasal spray on a prescriptive basis at NOVA Health Recovery Ketamine Infusion Center in Fairfax, Virginia.
How do I use the home-based nasal spray?
NOVA Health Recovery will instruct each patient on their protocol for the home therapy – oral or nasal spray based.
What will it feel like when I use the nasal spray?
The use of the home-based spray is not as powerful as an infusion and dissociation is less likely. The nasal spray and oral troche may give some mood elevation, visual distortions, dizziness, and even nausea which generally go away in 20-30 minutes. The home medication is designed to enhance neuroplasticity in between infusions.
What is the difference between the ketamine nasal spray and Esketamine?
Esketamine is the FDA approved version of office –based ketamine nasal spray. It is administered twice a week in the office for the first month and requires a two-hour office stay. Home-based ketamine spray uses racemic (R and S ketamine) in the home arena on a prescriptive basis. There has been no clinical difference seen from our experience at NOVA Health Recovery, except for the convenience of home use.
Can I get ketamine oral troches or ready-dissolved tablets instead of nasal spray?
Yes – it is the patient’s choice to use either or both options. Some will use a combination of nasal spray with the oral formulation. Using a Neti-pot and the MAD-100 atomizer may enhance nasal delivery.
What will it feel like when I use the nasal spray?
It will not be as powerful an experience as the infusion. Expect a bit of light-headedness, but no dissociation. Either way, the treatment will continue to enhance neuroplasticity and maintain gains from the infusion series. Dissociation and ‘getting buzzed’ are not required for efficacy.
How many hours after the nasal spray use can I drive?
No driving for four hours after ketamine use
Can I just start with the nasal spray alone
Yes, that is possible, but it is much slower for effectiveness and is better used for maintenance therapy. If the nasal spray does not work alone, it does not mean that ketamine infusions won’t work. Some will start with the nasal spray and move on to periodic single infusions.
Will Ketamine change my personality?
No. Ketamine will not change your personality. It will not change your preferences or behaviors directly. It will give you resilience to handle the day-to-day issues you may face because you are less depressed, but it will not make you like your job or your boss. Likewise, ketamine cannot change your occupation, your spouse, your financial situation, or other external stressors.
Why isn’t Ketamine FDA approved?
Esketamine is an office-based ketamine nasal spray that is FDA approved, but ketamine otherwise is a generic medication that is not patentable due to its being around for 50 years. As such, its use is off-label and insurance companies will not cover the treatment. Any research would need to be federally funded.
Can I get NAD+ infusions with ketamine?
Ketamine can be given sequentially with NAD+ for oxidative stress, depression, and anti-aging. Many patients with Post-covid symptoms have found relief with this treatment as well as IV Vitamin therapy. NAD+ is a molecule used for energy currency as well as in the repair of DNA. Its levels decline throughout life and low levels lead to muscle loss, neurological decline, weakness, and depression.
Are there lab test I should get to evaluate my depression?
Lab testing can be very helpful for the integrative treatment of pain and depression. Hormonal aberrations can produce depression and as such, one can order the DUTCH test to evaluate hormonal options or order labs such as estradiol, pregnenolone, progesterone, cortisol, testosterone (free), sex hormone binding globulin, DHEA-S,, prolactin, FSH, and LH. The thyroid can also play a role in weight gain and depression and so TSH, T3, free T4, reverse T3, antithyroid antiglobulin, and Anti-TPO antibodies should be checked for low or high thyroid. Drug and alcohol use should be evaluated is appropriate. Vitamin D levels can produce depression when they are low. Rare diseases such as porphyria and Wilson’s disease may play a role, thus a porphyria workup and serum copper/ceruloplasmin levels should be evaluated. Obviously, kidney, liver, and electrolyte testing should be done.
Finally, a urine organic acid test to evaluate metabolic functioning, mycotoxin testing for mold, and environmental toxicity testing for heavy metals and pollutants should be evaluated. Small bowel overgrowth with Clostridia and Candida is associated with depression and mood changes.
- DUTCH testing
- MitoSwab – mitochondrial testing
- Organic Acid Testing – Great Plains Lab
- Environmental mycotoxin testing
- Heavy Metal testing
- Sex hormone testing: estrone, estradiol, pregnenolone, progesterone, free testosterone, sex hormone binding globulin, Prolactin, DHEA-S, FSH, LH
- Vitamin D levels 25 – hydroxy Vitamin D
- Serum Copper/ceruloplasmin
- Urine drug screen
- Alcohol level
- TSH, free T3, T4, reverse T3Anti-TPO, anti-thyroglobulin
- Vasculitis and autoimmune workup
- Lyme disease and tick-born panels
- CRP, ESR – inflammation markers
What is the protocol for treatment at NOVA Health Recovery Ketamine Center AFTER the initial series of infusions?
Most patients will do infusions once a month for several months after the initial series. A home-based nasal spray is used in-between infusions to maintain neuroplasticity and diminish a ‘fall-off’ into depression or further anxiety. Some prefer oral ketamine and others prefer the nasal spray or use both. This is determined on a case-by-case scenario.
Can I return for infusions earlier if I feel symptoms returning?
You can get infusions as often as needed. Some will do weekly infusions during difficult times while others maintain infusions every 2-3 weeks during their low times. Remember that ketamine is part of an on-going, overall health maintenance program which includes structured time, exercise, socialization, meditation, meal planning, goal setting, exercise, supplements, regular medication support, and circadian rhythm retraining (regular bedtimes).
What is the difference between Ketamine infusions for pain versus mood disorders?
Ketamine can be used for both pain management and for depression. The infusion series for CRPS (RSD) is a multi-day (4-5 day) higher dose infusion (1 mg/kg/hour or higher) that spans 4 hours for each day. It is not as effective for depression as the two-week protocols for depression which are 0.5 mg/kg over 40-50 minutes. CRPS and neuropathic pain protocols may need monthly, single or double-day infusions with the same dosing. At NOVA Health Recovery, we frequently use between 500-1000 mg over the 4-hour infusion for CRPS and neuropathic pain.
Do topical ketamine therapies work for neuropathic pain and CRPS?
NOVA Health Recovery Ketamine Infusion Center uses topical ketamine with oral ketamine troches, intranasal ketamine sprays, and dextromethorphan therapies to augment and maintain results after ketamine infusions for CRPS/RSD, post-herpetic neuralgia, arachnoiditis, and diabetic neuropathies.
What types of painful conditions can ketamine therapy help with?
Ketamine can be used to assist in general pain management with traditional opioids and augment their effect. Depression is frequently associated with pain and ketamine can decrease catastrophic thinking. Ketamine does not work well as a stand-alone therapy for nociceptive pain such as knee arthritis or back pain from mechanical sources such as a slipped disk or arthritis. Ketamine works best for neuritic and neuropathic pain – meaning the nerve is inappropriately activated or there is central sensitization to pain. Examples of nerve-related pain that NOVA Health Recovery Ketamine Center treats include:
- Trigeminal neuralgia
- Phantom limb pain
- Diabetic neuropathy
- Cluster Headaches
- Migraine Headaches
- Post-herpetic pain/shingles
- Cancer pain
- End-of-life care
- Small fiber neuropathic pain
- Lyme disease
Can Ketamine help with Arachnoiditis?
Yes, mixed with additional therapies, ketamine infusion with home-based ketamine oral troches and nasal sprays have been very helpful in cases of failed-back surgery with arachnoiditis. The infusions are multi-day, sequential, high dose ketamine infusions, generally 4 hours a day for 5 days in a row.
Can ketamine be used for migraine headaches? Cluster headaches?
Can you adjust my other medications for me?
NOVA Health Recovery will work with you to titrate your medications, alter them, or add additional treatments through the process. We also can manage Suboxone as well as Vivitrol and Sublocade injections for opiate addiction and Alcoholism.
Can NOVA Health Recovery treat my brain fog and ADHD?
Yes, we can assess and treat brain fog. We utilize IV vitamin therapies, IV NAD+, Low Dose Naltrexone, and other interventions to assist with this. Also, we can diagnose and initiate treatment for ADHD with medications.
Can Scopolamine infusions help with the treatments?
Scopolamine has been found to have efficacy in anxiety, nausea, and depression. We use scopolamine infusions at NOVA Health Recovery to augment responses to ketamine for anxious depression. It is safe, effective, and enhances neuroplasticity and is an anti-emetic.
If someone has MCAS, EDS, POTS syndrome, histamine intolerance, fibromyalgia, or chronic fatigue, can Ketamine help?
Yes, ketamine is able to promote diminished pain, enhanced neuroplasticity and neurogenesis, better neural functional connectivity in all these conditions.
Can you perform ketamine assisted psychotherapy?
NOVA Health Recovery does offer KAP therapy at an additional cost.
Will Ketamine infusions interfere with sleep?
In general, sleep is disrupted already in many mood disorders. Ketamine may interfere with sleep in many during the infusion series. Consider using a seasonal affective lamp, Melatonin, and VHP (Valerian, Hops, Passionflower) to help sleep.
Does NOVA Health Recovery Offer Nitrous Therapies for Depression?
Yes. Nitrous therapies have been noted to have rapid effectiveness in depression with 45 minutes of inhaled therapies that you can actually drive home after.
Does Nitrous Oxide Help Veterans with Post-Traumatic Stress Disorder (PTSD)? A Case Series
Ketamine Therapy has become mainstream in the treatment of depression mood disorders, and pain. Recent articles in the press have reflected the growing awareness of this highly effective therapy:
The Mayo Clinic
National Public Radio
National Institute of Mental Health
New York Times
Ketamine in the Mainstream
Ketamine Therapy Depression and Pain 2019
Multiple infusions for depression are more effective: Rapid and longer-term antidepressant effects of repeated ketamine infusions in treatment-resistant major depression
NOVA Health Recovery Ketamine Therapy Literature
Ketamine was created in the 1960’s as a congener of PCP for anesthetic purposes and is used for chronic pain, cancer pain, neuropathic pain, as well as mood disorders more recently. Ketamine is a noncompetitive inhibitor of the N-methyl-D-aspartate glutaminergic receptors and is linked to analgesic, dissociative, and neuroprotective effects. For a review of ketamine through the years look at these articles: Ketamine: 50 years of Modulating the Mind , A Review of Non-Anesthetic uses of Ketamine and The Repurposing Potential of Ketamine.
Standard therapy for depression only works 40% of the time and may take several weeks to begin to have effect. When someone is extremely depressed, they want instant relief, which is why the allure of rapid acting antidepressants, such as ketamine, are so pressing. See these articles for more:
The standard neurotransmitter theory of depression doesn’t account for the entire story behind mood disorders. Many factors go into the development of mood disorders, including genetics, environment, toxins, sleep disorders, medications, small bowel overgrowth, addictions, obesity, poor nutrition, vitamin deficiencies, lack of exercise, mold exposures, heavy metal exposures, and medical illness are a few that contribute. Depression and mood disorders have been shown to alter functional neuron connectivity in the brain and result in neurons with fewer dendritic spines that can produce connections. See the article links below:
It has been found that a downregulation in CAMP and Phosphodiesterase 4 (PDE) is associated with depression, and PDE4 inhibitors may act as antidepressants. The Glutamatergic system has also been found to be important in mood as well, with overactivity being harmful. The Glutamate system has been targeted for research in this regard. What is most important is the remodeling of synaptic connections in the brain: Neuroplasticity. See further articles on this below:
Ketamine is a rapid acting antidepressant shown to rapidly reduce suicidal ideation in Major Depressive Disorder (MDD) and reduce anhedonia (loss of pleasure – no mood states). Placebo-controlled trials have provided strong evidence for the rapid-acting (within hours) and sustained (lasting up to 7 days) antidepressant effects of a single administration of a sub-anesthetic dose of the non-competitive N-methyl-D-aspartate receptor (NMDAR) antagonist ketamine in treatment-resistant depressed patients [ Berman, Zarate, suicidality study, Price Study] Suicidality can be relieved with a single ketamine infusion in several studies.
The first clinical trial reporting antidepressant actions of ketamine was published in 2000, where ketamine was administered intravenously (40-min infusion) at the sub-anesthetic dose of 0.5 mg/kg with depression relief achieved in 4 hours of the dose. The Second trial in treatment resistant depression (TRD) patients demonstrated the antidepressant effects of ketamine manifested within 2 hours post-infusion and 35% of patients maintained response for at least 7 days.
In the effort to address the functional un-blinding of treatment status (ketamine versus placebo) due to the acute dissociative effects of ketamine, Murrough et al., (2013) using a psychoactive placebo, midazolam, demonstrated a 64% response rate for the patients administered ketamine compared to 28% for those who received midazolam. In other words, it was ketamine infusion that created the antidepressant effect and not just the ‘buzz’ effect.
What factors are associated with improved outcomes with ketamine? See this article: Clinical predictors of ketamine response in treatment-resistant major depression and Anhedonia as a Clinical Correlate of Suicidal Thoughts in Clinical Ketamine Trials
Brain-Derived Neurotrophic Factor Val66Met Polymorphism and Antidepressant Efficacy of Ketamine in Depressed Patients results suggest that MDD patients with the Val/Val BDNF allele at rs6265 are more likely to exhibit increased antidepressant response to ketamine than Met carriers. So, there are genetic polymorphisms that may decrease response to ketamine.
The main concept is to increase Brain Derived Neurotrophic Factor (BDNF) in the brain to increase neuroplasticity, even in those with VAl66Met Single nucleotide polymorphisms (SNPS). So during the infusion series, avoid alcohol, increase exercise, and eat moderate protein meals without excess carbohydrates. There are Botanicals that can alter BDNF: Botanicals as Modulators of Neuroplasticity: Focus on BDNF . It has been noted that Resveratrol ###/b<and curcumin</and, when chronically administrated, prevent the behavioral and biochemical alterations induced by chronic restraint and unpredictable stress, respectively, and those effects seem to be mediated by an increment in the expression of ###a href=”BDNF” class=”redactor-linkify-object”>https://blog.pureencapsulation… as does Biperiden and exercise: Brain-Derived Neurotrophic Factor : A Key Molecule for Memory in the Healthy and Pathological Brain .
Other Supplements ###/b<also, can=”” be=”” added=”” to=”” your=”” regimen=”” to<b=””> </also,>###a href=”https://selfhacked.com/blog/a-comprehensive-list-of-natural-ways-to-increase-bdnf/”>increase BDNF such as omega-3 fatty acids, Cocoa, Lutein, and coffee fruit. Ketones and intermittent fasting also affect BDNF levels as well as certain antioxidants.
Ketamine has been found effective in bipolar disorders in several studies. Ketamine decreased suicidal ideation rapidly as well in several studies. Ketamine is one of the few treatments available for anhedonia (no mood). Anhedonia is a common substrate for depression, anxiety, and substance use disorder. Ketamine has been mentioned in the lay press numerous times as more and more positive trials demonstrated efficacy in various mood disorders:
Current state of depression therapy can be found here: Article link
Lay Press Links:
###p<again, the=”” first=”” study=”” for=”” ketamine=”” use=”” in=”” depression=”” was=”” by=”” berman=”” et=”” al.=”” 2000=”” :<b=””> ###a href=”https://pubmed.ncbi.nlm.nih.gov/10686270/”>Antidepressant effects of ketamine in depressed patients which was the first double-blind placebo-controlled crossover trial to demonstrate rapid antidepressant effects of ketamine following a single dose (0.5 mg/kg infused over 40 minutes) in 7 patients.</again,>
Additional trials demonstrated efficacy as well soon after:
A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression which demonstrated robust and rapid antidepressant effects resulted from a single intravenous dose of an N-methyl-D-aspartate antagonist Ketamine); onset occurred within 2 hours post infusion and continued to remain significant for 1 week.
A Randomized Add-on Trial of an N-methyl-d-aspartate Antagonist in Treatment-Resistant Bipolar Depression which demonstrated robust results from a ketamine infusion for bipolar depression.
Replication of Ketamine’s Antidepressant Efficacy in Bipolar Depression: A Randomized Controlled Add-on Trial done by Carlos Zarate in 2012 which showed rapid and robust treatment of bipolar depression and suicidality by Ketamine infusions.
Ketamine has been found to be rapidly effective in depression treatment and of similar effect to Electroconvulsive therapy (ECT) : Rapid antidepressant effects of repeated doses of ketamine compared with electroconvulsive therapy in hospitalized patients with major depressive disorder
There are cases of long-lasting effects of ketamine in depressed patients using SQ dosing as well: Long-lasting effects of a single subcutaneous dose of ketamine for treating melancholic depression: a case report
Traditional agents do not work as rapidly as ketamine. Ketamine works rapidly through the production of Brain Derived Neurotrophic Factor and the production of new dendritic spines in neural networks that have been damaged from stress, medical illness, genetics, and toxins:
Ketamine and Rapid-Acting Antidepressants: A Window into a New Neurobiology for Mood Disorder Therapeutics Ketamine functions as an NMDA (N-methyl-D-aspartate receptor) receptor antagonist, impacting glutamate, an excitatory neurotransmitter in the brain. Excess glutamate in the brain can lead to neuronal damage over time and mood disorders. Excess excitation in the brain shunts amino acids such as Tryptophan (which makes serotonin – the happy neurotransmitter) into Quinolinic Acid, which is neurotoxic.
- ###libipolar depression, with a similar response rate : ###a href=”
- Randomized Add-on Trial of an N-methyl-d-aspartate Antagonist in Treatment-Resistant Bipolar Depression
- A Randomized Add-on Trial of an N-methyl-d-aspartate Antagonist in Treatment-Resistant Bipolar Depression
- Rapidly reduces ###b<anhedonia< b=””> : ###a href=”https://pubmed.ncbi.nlm.nih.gov/25313512/”>Anti-anhedonic effect of ketamine and its neural correlates in treatment-resistant bipolar depression</anhedonia<>
- Ketamine provides a rapid ###b in major depressed patients: ###a href=”https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935847/?report=reader”>Effects of Intravenous Ketamine on Explicit and Implicit Measures of Suicidality in Treatment-Resistant Depression and Improvement in Suicidal Ideation after Ketamine Infusion: Relationship to Reductions in Depression and Anxiety
A link to meta-analysis of different administrations of ketamine for mood is below:
You can learn more in youtube lectures such as the following:
For a general review of Ketamine in depression and Bipolar Disorder ( BPD), see below:
Ketamine rapidly decreases suicidal thoughts in Bipolar Disorder according to several studies: Trial Finds Rapid Reduction in Suicidal Thoughts after Ketamine Treatment in Patients with Bipolar Disorder : Ketamine versus midazolam in bipolar depression with suicidal thoughts: A pilot midazolam‐controlled randomized clinical trial Key points: Suicidal thoughts were lower after ketamine than after midazolam at a trend level of significance, likely due to the small pilot sample. Memory improvement and BDNF are promising biomarkers.
Ketamine for Rapid Reduction of Suicidal Ideation Randomized controlled trial of Ketamine for Suicidality showing rapid effects.
Ketamine Could Be the Key to Reversing America’s Rising Suicide Rate – A Bloomberg article on ketamine and its positive role in mental health.
Other articles on Ketamine for treatment resistant depression (TRD) Include the following:
Rapid and Longer-Term Antidepressant Effects of Repeated Ketamine Infusions in Treatment-Resistant Major Depression Biological Psychiatry 2013 Aug 15; 74(4): 250–256. 24 patients treated with six IV infusions of ketamine (.5mg/kg) over 12 days. The overall response rate was 71% as defined as a reduction in the MADRS scale by greater than 50%. The median time to relapse after the last ketamine infusion was 18 days. 25% were symptom free at 90 days, 75% of patients had symptoms free days between 11-27 days.
Augmentation of response and remission to serial intravenous subanesthetic ketamine in treatment resistant depression Journal of Affective Disorders. 2014 Feb;155:123-9. This study concluded: Safety and efficacy of repeated ketamine infusions were attained without medication-free state in patients with TRD. Repeated infusions achieved superior antidepressant outcomes as compared to a single infusion with different trajectories of response and remission.
Ninety-six hour ketamine infusion with co-administered clonidine for treatment-resistant depression: A pilot randomised controlled trial This study provides evidence for the feasibility of prolonged ketamine infusions in treatment-resistant depression. Co-administration of clonidine appeared to mitigate ketamine’s psychotomimetic effects.
A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders This review and consensus statement provides a general overview of the data on the use of ketamine for the treatment of mood disorders and highlights the limitations of the existing knowledge.
An update on ketamine and its two enantiomers as rapid-acting antidepressants Zhang K, Hashimoto K. An update on ketamine and its two enantiomers as rapid-acting antidepressants. Expert Rev Neurother. 2019;19(1):83-92. A number of clinical studies have demonstrated that (R,S)-ketamine has rapid-acting and sustained antidepressant activity in treatment-resistant patients with MDD, BD, and other psychiatric disorders. Off-label use of ketamine for mood disorders is proving popular in the United States. Meanwhile, preclinical data suggests that (R)-ketamine can exert longer-lasting antidepressant effects than (S)-ketamine in animal models of depression, and (R)-ketamine may have less detrimental side effects than (R,S)-ketamine and (S)-ketamine. Of Note, The intranasal ketamine and IV ketamine that we use is R,S Ketamine and not S-Ketamine (Spravato).
Ketamine as an antidepressant: overview of its mechanisms of action and potential predictive biomarkers Matveychuk D, Thomas RK, Swainson J, et al. Ketamine as an antidepressant: overview of its mechanisms of action and potential predictive biomarkers. Ther Adv Psychopharmacol. 2020 This is a 2020 overview of Ketamine mechanisms of action in review.
Ketamine for Anxiety:
Ketamine For OCD – obsessive compulsive disorders: Check this link regarding an article for Ketamine therapy in OCD
PTSD (Post Traumatic Stress Disorder) is also treated with Ketamine therapy. Below is an article link:
Efficacy, Safety, and Durability of Repeated Ketamine Infusions for Comorbid Posttraumatic Stress Disorder and Treatment-Resistant Depression. This was the first open-label study of repeated ketamine infusions in a comorbid population with PTSD that found rapid and sustained improvement in PTSD and depression symptoms. This report suggests that repeated ketamine treatments are safe and may represent an efficacious treatment for individuals with comorbid PTSD and TRD.
Feder, Parides et al. “Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial.” JAMA Psychiatry. 2014 Jun;71(6):681-8. In this double blind, placebo-controlled cross over study, a single dose of Ketamine (.5mg/kg over 40 minutes) was compared to midazolam. Authors note a significant immediate reduction in the CAPS score and frequently this reduction was maintained for over 2 weeks. The only side effects noted were transient dissociative symptoms, none of which required stopping the infusion.
Ketamine as treatment for post-traumatic stress disorder: a review This review concludes: “novel treatments are needed for PTSD. One such treatment could be ketamine. As noted, there exists some hesitation for its use based on the fact that it may cause transient dissociation; however, more recent studies suggest that this may not be as frequent as previously thought. Based on the limited data in the form of animal studies, a randomized controlled trial, and case reports, ketamine has been shown to result in a near complete resolution of symptoms over the short term and seems to have similar findings to the use of ketamine in MDD. These clinical improvements are immediate and last well beyond the half-life of ketamine.”
Ketamine for Posttraumatic Stress Disorder The Feder et al1 study published in JAMA Psychiatry found that a single infusion of ketamine was more efficacious in reducing symptoms of posttraumatic stress disorder than midazolam.
High Dose Ketamine has also been demonstrated to be helpful in the treatment of combat-related PTSD as well: High-dose ketamine infusion for the treatment of posttraumatic stress disorder in combat veterans
Ketamine for CRPS Pain:
Ketamine Infusion in the Treatment of Complex Regional Pain Syndrome: a Systemic Review and Meta-analysis. Curr Pain Headache Rep. 2018;22(2):12. The immediate pain relief event rate was 69%. The pain relief event rate at the 1-3 months follow-ups was 58%. The current available studies regarding ketamine infusion for CRPS were reviewed, and meta-analyses were conducted to evaluate the efficacy of ketamine infusion in the treatment of CRPS. The findings suggested that ketamine infusion can provide clinically effective pain relief in short term for less than 3 months.
. This article reviewed 33 cases of patients with CRPS that were treated with Ketamine infusion. The patients received a prolonged low dose infusion of ketamine, on average 10-20mg/hr over 2-4 days. 76% of patients experienced complete pain relief after the first course of treatment. Pain relief lasted at least three months for most patients. Adding a second course of treatment allowed over 50% to be pain free for over a year. One patient had to discontinue additional treatments after the first infusion after developing elevated liver enzymes. These did normalize after treatment was stopped.
A Systematic Review of Ketamine for Complex Regional Pain Syndrome Systematic reviews of ketamine use in CRPS.
Ketamine Therapy for Chronic Pain:
Patil S, Anitescu M. “Efficacy of outpatient ketamine infusions in refractory chronic pain syndromes: a 5-year retrospective analysis. Pain Medicine. 2012 Feb;13(2):263-9. The study concluded that in patients with severe refractory pain of multiple etiologies, subanesthetic ketamine infusions may improve VAS pain scores. In half of the patients, relief lasted for up to 3 weeks with minimal side effects.
Ketamine Infusions for Chronic Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials Evidence suggests that IV ketamine provides significant short-term analgesic benefit in patients with refractory chronic pain, with some evidence of a dose–response relationship.
Ketamine Infusions for Chronic Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials IV ketamine provides significant short-term analgesic benefit in patients with refractory chronic pain, with some evidence of a dose-response relationship.
Efficacy of outpatient ketamine infusions in refractory chronic pain syndromes: a 5-year retrospective analysis In patients with severe refractory pain of multiple etiologies, subanesthetic ketamine infusions may improve VAS scores. In half of the patients, relief lasted for up to 3 weeks with minimal side effects.
Topical Ketamine for Pain: Lynch ME , Clark AJ , Sawynok J , Sullivan MJL . Topical 2% amitriptyline and 1% ketamine in neuropathic pain syndromes: a randomized, double-blind, placebo-controlled trial. Anesthesiology 103(1), 140–146 (2005) Ketamine has also been used topically. In a placebo-controlled DB-RCT by Lynch et al., topical 1% ketamine with 2% amitriptyline was used to treat patients with neuropathic pain. 92 patients were randomized to receive either placebo, 2% amitriptyline, 1% ketamine or a combination of 2% amitriptyline and 1% ketamine three-times a day for 3 weeks. 10% of the patients given ketamine exhibited a 50% or greater reduction in pain score after 3 weeks compared with 18% for placebo.
Chronic phantom limb pain : Eichenberger U , Neff F , Sveticic G et al. Chronic phantom limb pain: the effects of calcitonin, ketamine, and their combination on pain and sensory thresholds. Anesth. Analg. 106(4), 1265–1273 (2008). The effects of ketamine, calcitonin, ketamine with calcitonin, or placebo on chronic phantom limb pain were studied in a DB-RCT crossover study. During the study, 10 of the 20 patients received ketamine infusions (0.4 mg/kg over 1 h once) alone. They found that both ketamine alone and ketamine with calcitonin reduced pain intensity by 50% or more in 60% of patients, versus 10% after calcitonin and placebo.
Oral Ketamine for Pain : C14 Oral Ketamine: A potential addition to your toolbox for chronic pain Compounded Oral Ketamine: A Potential Addition to Your Toolbox for the Treatment of Chronic Pain
The Intravenous Ketamine Test Predicts Subsequent Response to Oral Dextromethorphan Treatment for Fibromyalgia A low-dose (0.1 mg/kg) IV ketamine infusion on 34 consecutive patients with FM, which was subsequently followed by an oral dextromethorphan (DX) treatment regimen. As per previous guidelines, the cutoff value for a positive response to the IV ketamine test was designated to be 67% pain relief, and a positive response to DX treatment was 50% pain reduction at 4- to 6-week follow-up visits. The degree of correlation between pain relief with ketamine and DX was highly significant.
The mindset of the patient and the dissociative effects of Ketamine can be associated with better outcomes according to this study: Do the dissociative side effects of ketamine mediate its antidepressant effects? This was also discussed in a Gizmodo article. The repair of synapses in specific brain areas are a key part of improvement in depression accomplished by ketamine. Synaptic Dysfunction in Depression: Potential Therapeutic Targets
Ketamine use for addiction
Ketamine also has a role in addiction treatment:
Ketamine may treat harmful drinking behavior by ‘rewriting drinking memories,’ researchers say – a CNN article regarding the use of Ketamine in Alcoholism: Nature Article Link Ketamine infusions with specific therapy may allow one to ‘rewire’ their drinking memories. This use of ketamine as a treatment for alcoholism is not new: Links are here:
Ketamine Therapy for Alcoholism:
A Single Ketamine Infusion Combined With Motivational Enhancement Therapy for Alcohol Use Disorder: A Randomized Midazolam-Controlled Pilot Trial
Ketamine Plus Motivational Enhancement Therapy: Leveraging a Rapid Effect to Promote Enduring Change
Ketamine Enhanced Psychotherapy: Preliminary Clinical Observations on Its Effectiveness in Treating Alcoholism
Efficacy of Ketamine for Cocaine Use Disorders:
The effects of subanesthetic ketamine infusions on motivation to quit and cue-induced craving in cocaine-dependent research volunteers
Cocaine self administration disrupted by the N –methyl –D –aspartate receptor antagonist ketamine: Arandomized, cross over trial.
Efficacy in Heroin Use Disorders:
Single versus repeated sessions of ketamine-assisted psychotherapy for people with heroin dependence
Single Versus Repeated Sessions of Ketamine-Assisted Psychotherapy for People with Heroin Dependence Thirteen out of 26 subjects (50%) in the multiple Ketamine Psychotherapy group remained abstinent. compared to 6 out of 27 subjects (22.2%) in the single KPT group (###i
/i### < 0.05). No differences between groups were found in depression, anxiety, craving for heroin, or their understanding of the meaning of their lives. It was concluded that three sessions of ketamine-assisted psychotherapy are more effective than a single session for the treatment of heroin addiction.
Ketamine psychotherapy for heroin addiction: immediate effects and two-year follow-up High dose KPT produced a significantly greater rate of abstinence in heroin addicts within the first two years of follow-up, a greater and longer-lasting reduction in craving for heroin, as well as greater positive change in nonverbal unconscious emotional attitudes than did low dose KPT
Efficacy of Ketamine in the Treatment of Substance Use Disorders: A Systematic Review Seven completed studies were identified. Two studies focused on alcohol use disorder, two focused on cocaine use disorder, and three focused on opioid use disorder. Both cocaine studies found improvements in craving, motivation, and decreased cocaine use rates, although studies were limited by small sample sizes, a homogeneous population and short follow-up. Studies of alcohol and opioid use disorders found improvement in abstinence rates in the ketamine group, with significant between-group effects noted for up to two years following a single infusion.
Ketamine displays many interesting qualities for dealing with all symptoms relating to opioid withdrawal. Accordingly, it could be used instead of many psychotropic treatments, which interact with each other, to help with opioid withdrawal.
Ketamine has been found to have effectiveness in prolonging abstinence in alcohol and heroin dependent individuals as well as decreasing cocaine cravings. This has been seen in preclinical and clinical studies. This may be a result of ketamine-induced neuroplasticity, disruption of maladaptive networks, improvement of depression, reducing drug-related memories, enhancement of psychological therapies, and even neurogenesis.
There are few effective therapies for addictions. Addiction is a chronic relapsing disorder associated with cravings, drug-seeking behavior, and unpleasant feelings during abstinence. Relapse rates can be 40-80% in the first year, with death being more common in relapse as the individual tends to use higher quantities at the time of relapse. As ~3% of the US population is dependent on an illicit substance, this represents a large impact on the economy in both productivity, medical treatment costs, interpersonal costs, accidents, and death.
Ketamine was synthesized in 1962 by the chemist Calvin L. Stevens for Parke Davis and initially was known as CI-581. It is an arylcyclohylamine related to PCP (Phencyclidine) Because of its safety profile, it can be administered without oxygen or electricity to monitor its use and is recognized by the World Health Organization as an essential medicine as it is an excellent, safe choice for anesthesia. It produces a dissociative sedation and provides analgesia. It does cause delirium, confusion, mystical experiences, ‘out of body’ experiences, ‘melting into the surroundings’, hallucinations, and dizziness when administered in varying doses to patients. In 1972, Collier studied low doses of ketamine as they produced floating, ‘disembodiment as if being a soul or mind’, disconnection from the surroundings, dying, or even traveling to other worlds.
Studies by Jansen and Sferios (2001) demonstrated that at low 25-50 mg I.M. doses people experience happiness and increased awareness and empathy while at medium does (75-125 mg I.M) a person may experience out-of-body experiences. In the 1990’s, the ‘rave’ culture began using ketamine as part of a recreational construct. Ketamine Dreams
Ketamine impacts the NMDA (N-methyl-D-aspartate) receptor as an antagonist, but it also blocks acetylcholine ion channels, increases dopaminergic transmission as well as noradrenergic transmission. There is also evidence that it also is a weak agonist at the delta and mu-opioid receptors. It does cross the blood-brain barrier as it is lipid soluble and acts within 5 minutes of administration, but its effects resolve entirely within one to three hours. It is effective in diminishing the production of hypersensitivity in neurons of the dorsal horn of the spinal cord (the ‘wind-up’ phenomenon) and so ketamine has been effective in the treatment of burns, neuropathic pain, post-herpetic neuralgia, migraines, and fibromyalgia. Ketamine is also effective in depression, with studies starting in 2000 (Berman et al) and 2006 (Zarate et al) demonstrating rapid resolution of depression with ketamine infusions.
Preclinical studies in rats (Sabino et al 2013) showed that ketamine can decrease the intake of alcohol in rats and that this effect was blocked by rapamycin, which blocks the effects of Ketamine. Ketamine has been shown to disrupt reconsolidation of environmental drug memories. (Zhai et al., 2008) It is known that addiction is characterized by an error of learning in which certain cue-triggered responses result from drug-related cues and these pathways are triggered when a person is using but can be disrupted by ketamine administration so the memories of using are not reconsolidated. Our ability to recall events is periodically reconsolidated over time as a trigger of the memory is presented. This reconsolidation happens during sleep or during an active learning event and this can be altered with the administration of ketamine.
Studies in Ketamine use for addiction was initiated in Mexico by Salvador Roquet as a form of psychotherapy from 1964 to 1974 (Barney, 1977) . Continued studies were completed by Krupitsky and Grinenko (1997) in which ketamine reduced relapse in alcoholics. Also used in this process was Ketamine Psychedelic Therapy (KPT), which was used in the Soviet Union. KPT involved a precession in which the patient would learn about the ketamine psychedelic experience and that they would become aware of their addiction with its negative aspects as well as personal problems and self-identity. After this, the person would receive an injection of Ketamine and would be guided to see new meaning and purpose in life as well as being presented with the cue of the smell of alcohol at intense moments to create negative emotional valence of the thoughts of alcohol. After the ketamine session, the person would use therapy sessions to integrate the insights of what they learned from the ketamine session.
In another study by Krupitskey (1997) 111 alcoholics and 100 patients (controls with usual therapy) were compared after the active group received 2.5 mg/kg IM Ketamine with corresponding preparation. 66% of the KPT group had abstinence at a year whereas only 24% of the controls remained sober.
In 2002, Krupitsky studied 70 heroin detoxed patients who were injected with varying amounts of ketamine in a double-blind manner. The higher dosed patients (2 mg/kg I.M. ) had a greater abstinence at 2 years (17% vs 2%) and it was felt the ketamine effect was dose-dependent. In 2007, Krupitsky found that using three KPT sessions for heroin addiction had better outcomes than one KPT session (50% abstinence rates versus 22%) Other addictions have been treated anecdotally with success by Kolp et al (2009, 2006) and these addictions even included food addictions.
Ketamine Enhanced Psychotherapy: Preliminary Clinical Observations on Its Effectiveness in Treating Alcoholism
Dkwar et al in 2015 used three ketamine infusions (one every 48 hours) and found that cue-induced craving and motivation to quit were higher in cocaine addiction when the individual had greater mystical experiences during the infusion. This generally occurred at the .71 mg/kg dosing. Dissociation did not impact the results as much as did the mystical experience of the infusion. This treatment decreased the frequency and amount of cocaine consumed after the infusion as well. In 2016 the same research group studied a single infusion of ketamine 0.71 mg/kg on cocaine use disorder and this demonstrated a 67% decrease in cocaine choice. Cravings decreased significantly in treated groups, and this is a marker of less relapse. Abstinence lasted over the two-week follow up.
The effects of subanesthetic ketamine infusions on motivation to quit and cue-induced craving in cocaine-dependent research volunteers
Cocaine self-administration disrupted by the N-methyl-D-aspartate receptor antagonist ketamine: a randomized, crossover trial
Why does Ketamine work?
The brain is always learning about the environment, and this occurs through neural plasticity and synaptogenesis, the formation of new connections within the brain. Reduced glutamatergic synaptic transmission and plasticity are thought to be associated with addiction. Ketamine allows synaptogenesis to occur by blocking NMDA receptors and stimulating protein synthesis that increases AMPA receptors to be inserted in the membranes of the neurons. Also, addiction has been associated with a reduction in neurogenesis, which is the formation of new neurons in the hippocampus (the learning center) [ zhao et al 2008 and Ernst 2014] In fact, depression and other mental health disorders are associated with decreased neurogenesis.
Psychedelic Treatments for Psychiatric Disorders: A Systematic Review and Thematic Synthesis of Patient Experiences in Qualitative Studies
Additional Articles and Links:
Links to Academic Articles
RAPID AND LONGER-TERM ANTIDEPRESSANT EFFECTS OF REPEATED KETAMINE INFUSIONS IN TREATMENT-RESISTANT MAJOR DEPRESSION
NEUROBIOLOGY OF STRESS, DEPRESSION, AND RAPID ACTING ANTIDEPRESSANTS: REMODELING SYNAPTIC CONNECTIONS
ANTIDEPRESSANT EFFICACY OF KETAMINE IN TREATMENT-RESISTANT MAJOR DEPRESSION: A TWO-SITE RANDOMIZED CONTROLLED TRIAL
SYMPTOMATOLOGY AND PREDICTORS OF ANTIDEPRESSANT EFFICACY IN EXTENDED RESPONDERS TO A SINGLE KETAMINE INFUSION.
IMPROVEMENT IN SUICIDAL IDEATION AFTER KETAMINE INFUSION: RELATIONSHIP TO REDUCTIONS IN DEPRESSION AND ANXIETY
EFFICACY OF INTRAVENOUS KETAMINE FOR TREATMENT OF CHRONIC POST-TRAUMATIC STRESS DISORDER: A RANDOMIZED CLINICAL TRIAL
RANDOMIZED CONTROLLED CROSSOVER TRIAL OF KETAMINE IN OBSESSIVE-COMPULSIVE DISORDER: PROOF-OF-CONCEPT
RAPID RESOLUTION OF OBSESSIONS AFTER AN INFUSION OF INTRAVENOUS KETAMINE IN A PATIENT WITH TREATMENT-RESISTANT OBSESSIVE-COMPULSIVE DISORDER: A CASE REPORT
ANALGESIC EFFECT OF SUBANESTHETIC INTRAVENOUS KETAMINE IN REFRACTORY NEUROPATHIC PAIN: A CASE REPORT
PAIN ANALYSIS IN PATIENTS WITH FIBROMYALGIA. EFFECTS OF INTRAVENOUS MORPHINE, LIDOCAINE, AND KETAMINE
NOVEL TREATMENT FOR LEVODOPA INDUCED MOTOR FLUCTUATIONS AND DYSKINESIA ASSOCIATED WITH PARKINSON’S DISEASE
Ketamine and Treatment-Resistant Depression
- Murrough, Perez, et al. “Rapid and Longer-Term Antidepressant Effects of Repeated Ketamine Infusions in Treatment-Resistant Major Depression” Biological Psychiatry 2013 Aug 15; 74(4): 250–256.
- Shiroma, Johns et al. “Augmentation of response and remission to serial intravenous subanesthetic ketamine in treatment resistant depression” Journal of Affective Disorders. 2014 Feb;155:123-9.
- Sanacora, Frye, McDonald, et al. “A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders” JAMA Psychiatry. April 2017;74(4):399-405.
- Correll, Maleki et al. “Subanesthetic ketamine infusion therapy: a retrospective analysis of a novel therapeutic approach to complex regional pain syndrome.” Pain Medicine. 2004 Sep;5(3):263-75.
- Patil S, Anitescu M. “Efficacy of outpatient ketamine infusions in refractory chronic pain syndromes: a 5-year retrospective analysis. Pain Medicine. 2012 Feb;13(2):263-9.
- Feder, Parides et al. “Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial.” JAMA Psychiatry. 2014 Jun;71(6):681-8.