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What is Ketamine?

Ketamine is a non-competitive NMDA glutamate receptor antagonist with additional effects on dopamine and mu-opioid receptors. While it does stimulate opiate receptors, much like morphine, its NMDA receptor antagonism at subanesthetic doses is thought to be much more important in the treatment of chronic pain and psychiatric disorders. It is this low dose of intravenous ketamine that has been found to cause a glutamate surge, which appears to play a critical role in the rapid and robust effects of ketamine.

Ketamine is largely different from that of typical FDA-approved antidepressants and pain medications because it works more broadly by reducing NMDA receptor function, therefore, modulating or preventing the brain’s glutamate transmission. This leads to a rapid increase in glutamatergic activity causing regeneration of synaptic connections between brain cells that have been chronically damaged by stress, anxiety, depression, and pain. It is a sort of “rebooting” for the communication system between areas of the brain and body that have previously been damaged by these chronic conditions.

Recently performed and published studies have shown that a very low dose of ketamine infused over one hour has had a dramatic positive effect on clinical depression, especially towards suicidal feelings and in cases that don’t respond to standard treatment. The results indicate an immediate resolution of depression and the relief from a single infusion can last for as little as a few hours to as much as a few weeks. In general, most patients typically experience one to two weeks of relief.

Do I need a referral?

While we do not require a referral, we would like to be in touch with your provider in order to give you the best care.  We will not contact them without your permission.

Does my insurance cover infusion therapy?

Most insurance companies do not cover Ketamine therapy. We do require payment at the time of service.

Are there any side effects with my treatment?

Some patients feel tired after the treatments.  Some also have nausea after the Ketamine infusions.  We can treat patients with anti-nausea medicine such as Zofran before starting the infusion to combat this side effect.  It is usually short-lived and only lasts a few hours after treatment.  All side effects are usually gone by the following day.  There are no long-term or permanent side effects of Ketamine when administered by a trained professional such as those in our office.

Can I eat and drink before and after my infusion?

We ask that you do not eat for four hours before your treatment.  You may have clear liquids for up to two hours before your treatment.  After your treatment, there are no restrictions.

Can I drive myself to and from my appointments?

For your safety, you must have a driver to take you home after your treatments.

How long will the effects last?

After the initial treatments, and assuming you begin to feel better, patients are placed on a maintenance program.  They asked to return when they feel it necessary for single infusion boosters. During the maintenance period, the duration of relief varies by patient. The average duration of relief between booster infusions is 4-6 weeks. There is no way to predict what your needs will be. Some patients find that as they go through this process, the time between boosters lengthens.

Can I continue all of my current medications while receiving infusion therapy?

This will be adjusted and discussed on a case-by-case basis.  However, some medications have been shown to interfere with or dampen the effectiveness of the infusion. These medications include benzodiazepines (such as Xanax, Ativan, Versed, Valium and Clonazepam), risperidone (Risperdal) and olanzapine (Zyprexa). These medications may not need to be stopped but the dose leading up to infusion therapy and for a short period after may need to be adjusted and we will work with your primary provider for that.

What is the cost?

IV infusion treatments vary in cost, dependent on treatment frequency and length of each treatment. We will discuss with you a payment plan and our expectations.  We do not accept Personal checks but cash, credit/debit cards, and cashier’s checks are accepted.

For other information on the cost of treatment please refer to the link:

Cost

How will I feel during my treatment?

The IV infusion will be administered at a very low dose and over an extended period of time. The first 15-20 minutes are typically uneventful but after 20 minutes or so, some people notice blurred vision, a feeling of “floating”, or intoxication, and sometimes numbness in the toes or area around the mouth. Over the course of the next 20-minute period, these feelings tend to build, so that the medicine is at the peak of its intensity at the very end.

Other common feelings might be heightened perceptions or a feeling of being “disconnected”.  Some background noise may seem exaggerated and lights are more intense. Other side effects experienced less commonly, is nausea and hallucinations. These feelings start to subside approximately 10-15 minutes after the medicine is done and last for a total of 45-50 minutes. Most people can expect to be with us for about 90 minutes in total. No side effects are usual after leaving the clinic and between treatments.  We may use other medications to make your infusion experience pleasant and calming.

What can I expect for the infusion?

After the paperwork is completed, an IV will be started.  We will place monitors which include EKG, Oxygen Saturation, Blood Pressure and respiratory monitors.  The medication required for your plan of care will then be mixed into a saline infusion and administered through the IV. Infusions times are variable depending on the patient experience, adverse effects, and current diagnosis. Patients will be monitored throughout the infusion period as well as for the post-infusion period that may last from 30 minutes to an hour.

We strongly believe and studies have proven that the more days of ketamine therapy in a row, the better resolution of symptoms. However, each disease process is different and we work with you to determine a treatment plan that works with your situation.

Are there other infusion medications available?

There are other IV infusion medications that have significant positive effects on mental health and chronic pain management.

Some of these are the following:

Lidocaine:  Lidocaine is a local anesthetic and it is commonly used as a numbing agent. It can also be given in IV injections to minimize whole-body pain by numbing the nerves which are causing discomfort. Lidocaine works by blocking sodium entering the nerve ending at the site of the pain thus blocking the pain impulse.  The blocking of voltage-gated sodium channels may play a role in the attenuation of both neuropathic and inflammatory pain. This type of infusion has been found to be equal to morphine, gabapentin, amitriptyline, or amantadine for the treatment of neuropathic pain.

Clonidine: This alpha 2 adrenergic receptor agonist is believed to decrease the intensity of pain in the peripheral nervous system.

Magnesium: This medication works on the cellular level to decrease acute and chronic pain by abnormal nerve excitation.

Is Ketamine addictive?

Ketamine has developed a negative stigma over time when being used as a street drug. Numerous studies and our experience have shown that there is essentially no potential for addiction. Again, access to ketamine is limited and difficult to attain outside of the controlled atmosphere that we provide so there is virtually no concern for abuse.

What medical conditions exclude me from treatment?

Medical conditions that are not well managed would preclude you from any infusion treatment. Uncontrolled high blood pressure, any serious cardiac or respiratory condition, untreated thyroid disease, a current manic phase of bipolar and active psychosis (hallucinations/delusions) need to be discussed with your clinician to avoid any potential complications. We will review your medical history, contact your primary provider and perform a brief physical assessment to ensure this line of treatment has little to no risk to your physical or mental health.

2255 North Scottsdale Road Scottsdale, AZ 85257

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