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Precise and Safe Ketamine Treatment in Jacksonville
We are here to help you feel better and like yourself again.
TALK TO US ABOUT YOUR MEDICAL CONDITIONS AND ALL YOUR MENTAL AND PHYSICAL PROBLEMS.
Our Ketamine infusion therapy can offer immediate relief from:
- Emotional pain
- Hopelessness
- Severe social isolation and lack of communication with family or others
- Persistent and chronic lack of motivation and initiative
- Severe loss of interest in things that make you satisfied and happy
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What is ketamine infusion therapy
What is ketamine?
Ketamine is a dissociative anesthetic drug that has been used medically since 1962. It is FDA Approved for the induction of anesthesia and for diagnostic and surgical procedures. It rapidly induces general anesthesia while preserving the patient’s protective reflexes and vital functions such as breathing and swallowing.
The main mechanism of action of ketamine is its non-competitive antagonism at the NMDA and glutamate receptors. Ketamine signaling is involved, directly or indirectly, at more than 10 distinct receptor pathways in the central nervous system including the opioid, γ-aminobutyric acid A (GABA-A), dopamine D2, nicotinic and muscarinic cholinergic (nAChR and mAChR), and serotonin 5-HT2A receptors. Ketamine also restructures the brain dopamine system by a process called synaptic plasticity or synaptogenesis.
What is ketamine used for?
Ketamine generates cognitive, antidepressant, analgesic, and neuroprotective effects in the brain. At low doses, or sub-anesthetic doses, Ketamine is well tolerated, and has shown good results for pain control and treatment-resistant conditions such as depression, anxiety, PTSD.
Esketamine (Spravato®) is the mirror image molecule of ketamine, and is the only FDA approved Ketamine-related drug that is indicated for the treatment of treatment-resistant depression. Intranasal Spravato® and low-dose intravenous ketamine administration require constant monitoring in a clinical setting with all safety measures in place.
How does ketamine work in the brain?
During ketamine infusion treatment, different areas of the brain are either activated, such as the hippocampus and dorsomedial prefrontal cortex, or suppressed, such as the thalamus. These brain areas are said to be “dissociated” from each other.
At the cellular level, Ketamine has been shown to increase synaptic plasticity through higher expression of brain-derived neurotrophic factor (BDNF). This BDNF enhances synaptic formation, and promotes axonal connectivity. Ketamine also prolongs synapse survival which explains the lasting antidepressant effects of ketamine in the days and weeks after treatment.
How does Ketamine work for depression, PTSD and anxiety?
Ketamine effects have been described as a “brain reset” and its effectiveness in the treatment of depression, anxiety, and PTSD are long lasting with fewer side effects. Ketamine can improve symptoms of depression in patients with bipolar disorder.
Clinically, ketamine action is observed instantly (within hours) which explains its robust, and sustained antidepressant effects including partial or complete resolution of suicide ideation.
As mentioned above, Ketamine acts strongly in the dorsomedial prefrontal cortex of the brain. This area of the brain is responsible for the following processes:
- Processing a sense of self
- Integrating social impressions
- Morality judgments
- Empathy
- Decision making
- Information processing
- Altruism
- Fear and anxiety.
Small doses of intravenous ketamine can effectively treat severe or treatment-resistant depression with prompt results seen within hours or days after each ketamine infusion therapy. The immediate relief of patients’ depressive symptoms, anxiety, and acute stress can provide more time to work on positive behaviors and positive thoughts.
Ketamine can also be administered during an active session of psychotherapy. This form of treatment is called ketamine assisted psychotherapy (KAP).
Low-dose ketamine therapy can be an alternative option for treating PTSD, and can reduce anxiety and trauma symptoms.
Complete remission of depression, anxiety or PTSD symptoms can be achieved with or without concurrent treatment with traditional medications. Treatment with ketamine should be a multidisciplinary endeavor. At Medic Health, we will work in conjunction with your psychiatric doctor or clinician to provide you the best results possible.
How many ketamine treatments are needed for depression?
The best results with ketamine are achieved when ketamine infusion therapy is administered in succession once, or twice, or 3 times a week over a period of 2 to 6 weeks. This period is called the “Induction period”. Administration of Ketamine in this controlled manner can improve symptoms of depression rapidly, and due to the low dose used, any undesirable side effects can be prevented as well.
The frequency of weekly infusions varies depending on the severity of depression or PTSD.
Some patients benefit from having monthly or biweekly “maintenance” infusion treatments to achieve complete remission and for long lasting effect on mood and executive functioning to prevent relapse of depression or PTSD symptoms.
Why is Ketamine treatment different?
Traditional treatments for depression often take weeks or even months to improve symptoms. These treatments include medications, behavioral therapy modalities, or transcranial magnetic stimulation (TMS). Some patients need to take several medications daily to treat their mood and other associated symptoms. In severe cases of depression, some patients undergo electroconvulsive therapy (ECT), which is currently the last resource treatment for major depression that fails to respond to conventional therapies.
Intravenous (IV) and slow administration of ketamine in a careful and controlled setting has been associated with good clinical outcomes in patients with treatment-resistant unipolar or bipolar depression, generalized anxiety, and PTSD. Ketamine also provides pain relief in cases of neuropathic or chronic complex pain such as Fibromyalgia.
In severe cases of depression or PTSD, multiple treatment modalities combinations can be administered concurrently at the same time to provide sustained and long-lasting relief. These combination therapies can include traditional medications, behavioral therapy, TMS, and ketamine infusion treatment.
How is ketamine administered?
Ketamine IV Dose
A measured dose of high quality pharmaceutical grade ketamine is mixed in an IV fluid bag and delivered intravenously to the patient over a short period of time. During the infusion, devices are applied that monitor the heart rate, blood pressure, oxygen saturation, and cardiac rhythm (ekg).
Your recovery will be monitored closely before you leave our facility. It’s very important to have someone drive you home and you should make plans to avoid driving or make important decisions for the next 24 hours. You and your companion will be given aftercare instructions.
What is the best ketamine dose for depression?
There is no such thing as a “standard” Ketamine dose for depression. The patient’s clinical needs, treatment goals, and prior infusion responses will dictate the exact dose of ketamine needed in each infusion. A dose of ketamine is calculated based on the body weight and height of the patient, and adjusted further for each patient specific condition and diagnoses, and for the severity of patient’s current symptoms.
Any given ketamine IV dose administered during ketamine infusion therapy is a small fraction compared to the high doses given for anesthesia or other procedures.
Ketamine Infusion Side Effects:
Acute effects of ketamine:
During the Ketamine infusion, patients are “consciously” sedated, which means they are still aware of their surroundings and able to respond and answer questions. It is important to note that the airway reflexes and the breathing mechanism are preserved during the entire ketamine infusion session.
Patients can experience vivid feelings and perceptions can be enhanced or suppressed at will. Some patients experience a sensation of floating or an “out of body” feeling. There are also reports of seeing flashlights of different colors. As soon as the infusion is finished, many patients experience a sense of relief or even euphoria, while others may feel fatigued and ready to go to bed.
Short term side effects of ketamine infusion therapy:
The most frequently reported short-term side effects are dissociation, sedation, headache, dizziness, and/or blurred vision. These side effects are usually not present and are mostly evident in the first ketamine infusion treatment and usually last for couple of hours after completion of the treatment. These symptoms are less frequent and minimal with each subsequent ketamine infusion. Medications can be given to treat these common side effects before leaving the clinic.
Long-term side effects of ketamine for depression treatment?
Ketamine infusion therapy given over a long period of time reduced the density of dopamine in the areas of the brain responsible for our hearing and vision, while it increased dopamine in the brain’s cognitive centers, as well as an increase in dopamine neurons in the hypothalamus.
Long-term side effects of ketamine are an active area of investigation. The ketamine dose used by “recreational” users of ketamine can be up to 10 times or more higher than the usual dose received in a controlled intravenous ketamine infusion therapy session. Patients who abuse ketamine at high doses or use it “recreationally” for a long period of time, can experience memory impairment and executive functioning abnormalities.
In comparison, cognitive function and performance were not affected after prolonged treatment with FDA approved intranasal esketamine (Spravato®) or with low doses of Intravenous ketamine.
Ketamine indications and contraindications
Ketamine Indications:
ARE YOU A CANDIDATE FOR KETAMINE INFUSION THERAPY?
The following conditions can benefit from Ketamine infusion therapy:
1. PROVIDES RELIEF IN TREATMENT-RESISTANT CONDITIONS:
- Depression
- Bipolar Depression
- Anxiety
- Post-Traumatic Stress Disorder (PTSD)
- Obsessive-Compulsive Disorder (OCD)
- Seasonal Affective Disorder (SAD)
2. KETAMINE MAY HELP WITH CHRONIC PAIN CONDITIONS:
- Fibromyalgia
- Peripheral neuropathy
- Complex regional pain syndrome (CRPS)
- Reflex sympathetic dystrophy (RSD)
- Post-herpetic neuralgia
- Trigeminal neuralgia
3. KETAMINE CAN HELP ANY OF THE FOLLOWING SITUATIONS:
- Failure to improve symptoms with multiple medications.
- Failure to improve symptoms with cognitive behavioral therapy (CBT), EMDR, TMS, or ECT.
- Non adherence with daily medications intake due to side effects or fear of long term dependance.
- Inpatient psychiatric admissions or intensive outpatient treatments without success.
Ketamine Contraindications:
- Pregnancy
- Uncontrolled or untreated hypertension
- Severe or uncontrolled cardiovascular disease
- Hyperthyroidism
- Elevated Intracranial pressure or brain tumors
- Glaucoma or elevated intraocular pressure
- Severe Sleep apnea
- Severe liver disease
- Active Psychosis
- Active drug or substance abuse
Low dose Ketamine for Pain
Ketamine reduces the activity of the insular cortex and thalamus, which are areas in the brain that are normally activated by pain. Ketamine also blocks the muscarinic acetylcholine receptors (m1ChRs), which play a role in controlling chronic pain.
Animal studies have suggested that ketamine may modulate astrocytic and glial cells, both of which play a role in chronic neuropathic pain.
It can be used safely in patients with head injuries as it does not increase intracranial pressure.
In a recent systematic review, low-dose ketamine analgesic effectiveness was similar to strong opiates such as morphine.
Ketamine infusion for chronic pain
Ketamine is an effective analgesic in acute pain and is indicated for managing severe pain that is not responsive to standard opioid treatment.
In patients with chronic pain, ketamine can reduce hyperalgesia (increased sensitivity to pain), allodynia (increased sensitivity to touch), and tachyphylaxis (opioid tolerance).
In patients who are currently treated with opiate (narcotic) medications, Ketamine reduces pain perception by activating Mu (µ) opioid receptors. This opioid agonistic effect of ketamine can help lower the doses of opioid medications that are required to achieve the desired pain control effect. This property of ketamine is called the “opioid-sparing effect”. Adverse events seen in patients using high doses of opiate medications such as dependance, addiction, respiratory depression and accidental overdoses, are greatly reduced with better pain control management using alternative treatments such as ketamine.
What is the best ketamine dose for chronic pain?
IV ketamine dose requirements varies from patient to patient. For chronic pain, the evidence suggests that frequent dosing schedules provide the greatest benefit. An initial Ketamine IV dose 0.35 to 0.50 mg/kg is a good and safe window for a starting dose, but every patient is unique and the doses are individualized to target their specific needs.
What chronic pain conditions can be treated with ketamine?
Intravenous ketamine infusion therapy is an alternative treatment option for multiple chronic pain conditions including:
- Complex regional Pain syndrome
- Reflex Sympathetic Dystrophy
- Fibromyalgia
- Small Fiber Neuropathy
Some of these conditions respond better than others to the administration of ketamine.
Ketamine for pain and depression
Ketamine infusion therapy is an excellent treatment choice to alleviate both pain and depression. It provides analgesia to ease pain, and through its robust antidepressant effect, it reduces feelings of hopelessness and despair. Symptoms of depression are commonly seen in patients with chronic pain, treating and controlling these symptoms and feelings can modulate our perception of pain.
Ketamine Infusion therapy cost:
What to expect during your Initial visit:
During or prior to your initial visit, you will be provided with screening questionnaires to assess for the presence and severity of your symptoms. These questionnaires include the following:
We will evaluate your answers to these questionnaires and discuss the results.
We will also review all your current and prior medications and other modalities of treatment and discuss ways to improve your mental and physical symptoms.
At the conclusion of your visit, we will discuss if ketamine is an appropriate treatment for you or not. If you are a candidate for treatment, the next step is to proceed and schedule your infusion treatments.
Why choose medic health for ketamine therapy
Our Ketamine infusion protocol ensures the safest and most efficacious outcomes for you or your loved ones in a comfortable, and immersive environment. Ketamine is administered and constantly monitored by Dr Shehadeh who trained with one of the pioneers in the field of ketamine. We follow the highest medical standards and evidence-based guidelines for the safe administration of ketamine treatment.
At Medic Health, our pledge is towards your health, and overall well-being. We are here to listen to you and bring you a targeted and patient-centered treatment. We have a commitment to provide excellent and compassionate care. We want to ensure the best possible outcomes for all our patients. We welcome you to explore the option of ketamine therapy to relieve your ailments and conditions.
Further reading: (links)
Below is a featured list of articles and resources about ketamine therapy and how it has been used recently as an innovative treatment for severe depression, anxiety and post-traumatic stress disorder (PTSD).