What is Ketamine?
Ketamine is a general anesthetic drug which has been used for all sorts of surgeries world-wide for 50 years. It is remarkably safe, and has even been put on the World Health Organization's list of indispensable medicines that every country should have.
History of Ketamine
Discovered in the 1960's, ketamine was found to provide extraordinarily safe anesthesia, and was used extensively in the Vietnam War. It has since been used frequently around the world for general anesthesia, especially in 3rd world countries. In the 1980's it was occasionally used as a recreational drug (related to PCP), and since then has been used less in the United States. Over the last 10-15 years, it has been recognized increasingly to have significant effects on mood, Multiple studies have shown benefit MUCH FASTER than traditional antidepressant or other medicines.
How Does It Work?
Although the entire mechanism of action is unknown, ketamine is known to affect the NMDA receptors in the brain, altering the levels of active glutamate. It is uncertain as to whether this the cause of benefit with mood disorders, but it is quite possible. It also has a dissociative effect causing odd sensations. During the infusion, people generally feel very relaxed, and it's possible that the level of dissociation could possibly help people process events in their lives better.
What Happens During an Infusion?
Before starting IV Ketamine, patients receive a full medical evaluation, with a review of symptoms, history, medicines tried, etc. Additional medical tests are ordered as needed. Typically 6 separate ketamine infusions are given with a 2 week period as this can lead to a more sustained benefit. For the infusion itself, an IV line is started and the ketamine is infused at a very specific dose and rate which is closely monitored. Vital signs (pulse, blood pressure, oxygenation levels, etc) are also closely monitored. Typically the environment is reasonably darkened, and very relaxing music is played in the background. Patients are easily able to respond to questioning during the entire process, but may want to close their eyes since their vision tends to not track well during infusion. During the infusion, people generally feel very relaxed and peaceful. Sometimes other medicines are given to assist with this. Not uncommonly patients will fall asleep but will be easily aroused. Infusions can last from 30-90 minutes, and afterwards patients are observed until they can walk and communicate without difficulty. They are instructed to not drive for 24 hours, and must be taken home by a friend or family member (we will not infuse without this arranged in advance).
It is possible that with the infusions, patients can have some hallucinations or feel increased depression or anxiety. Occasionally after an individual treatment patients can have increased depression, although this is typically much improved with the next dose. Respiratory depression, while possible is much more rare than with other anesthetics. Elevated blood pressure can occur. Not infrequently patients will have nausea following the therapy, so medicine for this is frequently given.
How Do I Find Out More?
If this therapy looks like it might be helpful for you or someone you love, call our office to schedule a consult with Dr Vance for an evaluation to see if ketamine might be an appropriate treatment option.