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Questions to ask your Ketamine Treatment Provider about Depression
What are the chances that ketamine will work for my depression?
The general statistics appear to be that 70% of all treatment-resistant-depression patients will have a 50-70 % improvement in their depression. Some will have remission in their symptoms.
How Long will It take to see results?
Will I feel better immediately after the first session? This is a question we are frequently asked at NOVA Health Recovery Ketamine Center in Fairfax, Virginia. The answer is that ketamine is given in a series of infusions because it takes time for the neuroplasticity to rebuild the networks that make you feel better. Many will have an afterglow feeling of wellness the day after. Others may see rapid dissolution of their depression in that next day, but I always caution patients that it might be as long as 4-5 sessions before things start to happen, especially when you have been unwell for a long time. Again, this is a rapid treatment that demonstrates its power by the 7-10-day mark in terms of seeing some improvement. Once there is any improvement noted, the person should continue with the full series.
What are the risks of ketamine treatment?
The main risk is financial. As many insurances do not cover the procedure, many people pay out-of-pocket or use CareCredit or such to help offset the costs. Each infusion can cost around $480, and generally 6 infusions are needed to complete a recovery. This is around $3200 over 2 and ½ weeks. However, many clients will submit a superbill to their insurance to get the treatment partially covered for out-of-network costs. As the treatment can propel a depressed individual to a much happier mood and level of functioning when everything else has failed, the cost can certainly be worth the results.
Other side-effects include the nausea and vomiting that may occur during an infusion. Ask your provider for an anti-emetic to help offset that. Others will describe dizziness, hallucinations, anxiety, and other odd feelings during an infusion. These resolve immediately after the infusion is stopped; However, you will have coordination changes for about 4 hours after the infusion, so driving is not permitted after the treatment. Generally, you should be able to return to work the following day.
Is addiction a risk of ketamine therapy?
Ketamine has many street names, including ‘Special K’ and ‘Horse tranquilizer’. It is one of the safest drugs in the world and is on the WHO list as a “must have drug” due to its anesthetic properties and safety. It has been around since 1962 and has an extremely safe track record. That said, it can be abused, especially in the setting of raves, but it has no real withdrawal properties. Few people crave it, and in the United States, there are very few cases of ketamine addiction documented. In fact, ketamine can be and is used for the treatment of Alcohol Use Disorder, drug addictions, and opiate withdrawal.
What is the dosing of Ketamine that I should receive?
Many ketamine programs initiate at 0.5 mg/kg and escalate through the session series. This allows for consolidation of the treatment over time. At NOVA Health Recovery Ketamine Center in Fairfax, Virginia we may proceed up to 1 mg/kg or higher if needed. For some with PTSD, higher dosing allows for more emotional recovery to occur. We generally do this over 40-55 minutes per comfort level of the patient. Be certain to ask the provider what they will do if you have anxiety. We generally will use Versed or another benzodiazepine if required. Comfort is important during the infusion.
How will I know if I am feeling better?
For many patients, they just know they are feeling better: more energy, better focus, more concentration, better mood, and feeling hope. Family members may notice better mood in the treated individual as they may be more social, less agitated, and more motivated, especially at work and in the home environment. Sleep may be a bit disrupted during the infusion series, but with mood improvement, sleep will follow.
At NOVA Health Ketamine Treatment Center in Northern Virginia, we use Osmind to monitor mood and recovery. This gives us quantifiable data about progress. We also monitor cognition, such as memory, processing speed, and executive functioning (decision-making) through an online portal with Cambridge Brain Testing . This allows us to assess the results of improved neuroplasticity that one receives from ketamine treatment.
Will I still need my therapist and psychiatrist?
Yes, as with any treatment, Ketamine is part of a larger, lifestyle picture. It is necessary to eat well, intermittently fast, avoid processed carbohydrates, stop alcohol use, exercise, and set good sleeping schedules. Dr. Christopher Sendi, at NOVA Health Recovery Ketamine Clinic is Board Certified in Obesity Medicine as well and likens depression treatment to an overhaul of multiple systems and domains of lifestyle over a period just like medical weight loss. As the fog and heaviness of depression lifts, depressed individuals need to continue the improvement with an assortment of lifestyle modifications if they are not already incorporating that into their routines. We offer telehealth services with dietitians and health coaching to assist in this process.
As part of this process, rebuilding your toolbox of coping skills is essential, and the very person to help with that is your psychologist and psychiatrist. Whether it is cognitive behavioral therapy, EMDR, or other therapies, it is important to allow your now-malleable brain to continue to learn about better coping mechanisms and responses to the woes of daily life through continued therapy with your therapist. The best days for your therapy are the day after an infusion, as neuroplasticity is rampant, meaning that is the time to learn new habits and thoughts.
Can I stop my mental health medications?
Never stop your medications unless you have consulted with your physician. We generally tell patients to stay on their regular medications through the ketamine infusion process to avoid changing too many variables. There is some background talk that benzodiazepines such as Xanax and Lamictal may impede recovery with ketamine. That is not very well studied and does not appear to be the case in practice.
Do I need a referral for Ketamine Infusions?
Many centers require a referral from your doctor or psychiatrist. NOVA Health Recovery Ketamine Center does NOT require a referral, but we do like to see some mental health records and recent lab work results to initiate the intake process.