Ketamine Infusions
Ketamine infusions have become a popular and effective treatment for therapy-resistant chronic pain syndromes and depression.
How does Ketamine work?
Ketamine works by blocking certain pain receptors in the brain and spinal cord. Studies have shown that low doses of ketamine interrupt the delivery of pain signals throughout the body, improve brain circuit function, and support the regrowth of synapses. For some people, ketamine may also help reduce reliance on opioids or other pain relief medications.
What conditions does Ketamine treat?
Eligibility for ketamine fusion is determined after one of our physicians has reviewed the patient medical record and history and had an initial consultation with the patient to discuss the treatment. Ketamine might be recommended to patients with:
CRPS or RSD
severe, intractable depression
neuropathic pain
fibromyalgia
spinal cord injury pain
cancer-related back pain
and certain kinds of nerve and back pain
Complex Regional Pain Syndrome (CRPS) or Reflex Sympathetic Dystrophy (RSD)
Studies demonstrate that Ketamine infusions provide many but not all patients fairly significant relief that may last for months at a time. Rarely is this treatment curative and, if successful, it may require periodic retreatment to restore effectiveness. Often it reduces the regionalization of pain, shrinking the area of pain. Initial treatment may consist of one or several infusions on different dates to maximize the treatment effect.
Severe Intractable Depression.
Depression can be a severe, recurring, disabling, and life-threatening condition. This infusion should be considered if other treatments have been only partially effective or have not been effective.
Ketamine has been shown to provide rapid-acting antidepressant effects in many, but not all patients. Rarely is this treatment curative and, if successful, it may require periodic retreatment to restore effectiveness. Initial treatment may consist of one or several infusions on different dates to maximize the treatment effect.
Note: Ketamine may not be appropriate for people with high blood pressure, head injury, or a history of seizure.
Is Ketamine FDA approved to treat pain or depression?
Ketamine has been approved by the Food and Drug Administration (FDA) to treat depression but not Complex Regional Pain Syndrome (CRPS).
The use of ketamine infusions for CRPS and depression is “off-label” from its labeled indication as a general anesthetic.
How do I prepare for the procedure?
You should have no solid foods eight hours before the procedure. You may drink clear liquids up to three hours before the infusion. You may drink coffee or tea, but no sugar or milk should be added.
You will be given a clonidine tablet to be taken before the infusion to decrease the activation of your sympathetic nervous system. This minimizes the potential for elevated blood pressure and a fast heart rate.
If you take blood pressure medication you should take this as scheduled with a sip of water. You should avoid taking insulin or medications for controlling blood sugar before the infusion.
What to expect during the procedure
You will be taken to the treatment room to receive the ketamine infusion. You will be accompanied by a member of the staff.
An intravenous line (IV) will be started to administer the infusion. Your heart rate and rhythm will be monitored through electrodes attached to your chest. The level of oxygen in your blood will be checked by a monitor attached to your finger.
Under the supervision of a physician, you will receive ketamine through a vein in your arm over approximately 40-60 minutes. The dose you receive will be based on your body weight and your response to the ketamine. Patients usually receive between 60 and 100 mg of ketamine.
Your heart rate and rhythm and blood pressure will be monitored during the infusion as arrhythmias (irregular heartbeats) are a known but rare side effect of ketamine.
Many patients report feelings of peace and relaxation and mild disassociation. The patient remains awake and is never fully sedated.
Discharge Instructions
Because ketamine is an anesthetic, you cannot drive, operate power equipment or machinery, or operate a motor vehicle for 24 hours after the infusion. There should be a responsible adult with you during these 24 hours as well.
You can resume your normal activities as tolerated.
You will be monitored and then released to the care of a family member or friend.
Risks/Discomfort of Ketamine
Any procedure has possible risks and discomforts. The procedure may cause all, some, or none of the risks or side effects listed. Rare, unknown, or unforeseeable (unexpected) risks may also occur.
Side effects normally depend on the dose and how quickly the injection is given. The dose being used is lower than anesthetic doses and will be given slowly over approximately 40-60 minutes. The common side effects often go away on their own. No lingering effects have been reported.
Common Side Effects
(greater than 1% and less than 10%: between 1 out of 100 and 10 out of 100)
Vivid dreams and nightmares
Nausea and vomiting
Increased saliva production
Blurred vision
Dizziness
Out-of-body experience during the infusion
Increased heart rate during the infusion
Disrupted motor skills
Increased blood pressure and increased heart rate (approx. 20% of the normal rate is usual)
Increased blood pressure in lungs
Fast breathing
Uncommon Side Effects
(greater than 0.1% and less than 1%: between 1 out of 1,000 and 10 out of 1,000)
Jerky arm movements, which resemble a seizure (as a result of increased muscle tension) and cross-eye
Double vision
Rash
Pain and redness in the site of injection
Increased pressure in the eye
Rare Side Effects
(greater than 0.01% and less than 0.1%: between 1 out of 10,000 and 10 out of 10,000)
Irregular heart rate or slow-down of heart rate
Low blood pressure
Arrhythmia
Allergic reaction
Other Risks
Prolonged Ketamine infusion can result in irreversible changes within the neurons (brain cells). Short duration ketamine infusions have not shown these changes.