Albuquerque, NM -- Ketamine IV and Esketamine intranasal are helpful for treatment-resistant depression. Check the difference and weigh in on what’s best for you

If you have undergone several therapies and treatments for depression but to no avail – then you just might have treatment resistant depression (TRD).

Treatment resistant depression (TRD) is an illness that not anyone can relate to. It remains to be an important challenge worldwide, even to healthcare providers. 

It continues to affect overall health, impair productivity, and even reduce life expectancy. 

For people with major depressive disorders, quality of life is restored once antidepressants are started. Sad thing with TRD is that none of these antidepressants get the job done. 

Furthermore, 10-30% of patients suffering with a major depressive disorder actually have TRD (Al-Harbi, 2012).

The operational definition of TRD is proposed as a state of major depression which has a poor or unsatisfactory response to two trials of two different classes of antidepressants given at the optimal dosage and duration (Al-Harbi, 2012). Hence, the diagnosis of TRD should be verified by a qualified clinician, though it poses a huge diagnostic and therapeutic challenge to health providers.

With numerous researchers trying to crack the code behind TRD, a huge veil has finally lifted. Ketamine and esketamine are the most studied treatments for TRD these days.

Ketamine is primarily approved and has been used as an anesthetic for over 50 years.  Recent research support its potential as a rapid-onset antidepressant (please link to ketamine article). Esketamine, an enantiomer of ketamine, is FDA approved as a drug for treatment-resistant depression. Esketamine is half of the IV version, specially only the left isomer.

What is Esketamine

Esketamine, the newest FDA-approved drug for TRD, is a less potent form of racemic ketamine (please link ketamine article with this one). It has a rapid action against TRD and is noted to significantly reduce suicidal ideation in most patients.

Esketamine, just like ketamine, works as a non-selective, non-competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor thereby initiating glutamate release(NCBI, 2020). This is believed to account for the rapid onset of antidepressant properties of the drug.

Ketamine was approved in 1970 as an anesthetic but is used recently off-label for cases of severe depression. It gained notoriety as a drug of abuse because of its dissociative effect (Kim et al., 2019).

Ketamine, just like most molecules, is made up of a 50:50 mixture of two different versions of the same molecule, otherwise referred to as enantiomers. The two enantiomers of ketamine are known as the S-ketamine (or esketamine – the left-handed orientation of the molecule), or the R-ketamine (also known as arketamine, the right-handed orientation of the molecule). 

Janssen pharmaceuticals, a subsidiary of Johnson & Johnson, found a way to isolate esketamine and patent it as a drug against TRD in 2019, marketing it as the Spravato nasal spray (Pierce, 2019). Though with FDA approval, Spravato is to be administered only inside a doctor’s office or only at an accredited clinic or hospital, under the supervision of a healthcare provider (FDA, 2019).

The FDA also suggests that the drug be used in conjunction with an oral depressant and should be administered at either intermittent doses or flexible doses (NCBI, 2020; FDA, 2019). Since esketamine comes in the form of a nasal spray device, it is noninvasive and more convenient compared to IV infusion (FDA, 2019). 

The device delivers a total of 28mg of esketamine. Dosing given during the induction phase is 56mg of esketamine, given through using two devices, with two sprays per nostril twice a week (FDA, 2019).

Research and Statistics

Researchers have consistently presented evidence for the rapid onset of ketamine’s antidepressant properties (Kim et al., 2019). A substantial number of patients reported dramatic improvement as early as four hours after the first dosing (Wilkinson, 2020).

Having documented ketamine’s efficacy for depression (please link to ketamine article), further research paved the way for the isolation of esketamine, now identified as effective enantiomer against treatment resistant depression.

The first randomized controlled trial for intranasal esketamine was conducted from January 2014 to September 2015 among 67 adult participants who were diagnosed with TRD. Patients were given 28 to 84 mg administered twice weekly (Daly et al., 2018).

Significant improvement was noted as early as one week after the first dosing. Maintenance of improvement was noted for more than two months. Antidepressant effect was concluded to be rapid-onset and dose-related (Daly et al., 2018). 

Another randomized clinical trial evaluated the efficacy of esketamine administered along with an oral antidepressant. Esketamine coupled with antidepressant treatment decreased the risk of relapse by 51% among patients who achieved stable remission, and 70% among those who achieved stable response (Daly et al., 2019).

Pharmacology: Uses and Action

The intranasal route of administration of esketamine allows convenience in terms of administration, and a fast onset of action (Drugbank, 2020). This sets it on an advantage above other antidepressants which take several weeks before optimal effects are noted .

Bioavailability of esketamine via intranasal administration is 48%, with a time to peak equal to 20 to 40 minutes after the last nasal spray (Drugbank, 2020). This bioavailability is definitely lower than a ketamine intravenous infusion, which ensures 100% bioavailability – a price to pay for the convenience of a nasal spray (Hashimoto, 2019). 

Esketamine is approved as an antidepressant in conjunction with oral antidepressants, but unlike ketamine, it is not approved as an anesthetic agent. Its safety and efficiency as an anesthetic is not yet established (Drugbank, 2020).

Most antidepressants operate through the modulation of serotonin, norepinephrine, and dopamine, both ketamine and esketamine work as an NMDA antagonist thus increasing glutamate activity (Mount Sinai, 2020). This action increases production of neurotrophic factors thereby improving neuronal connectivity within the brain.

One speculated mechanism of action is that alteration in glutamate signaling increased neuroplasticity. 

Neuroplasticity refers to the ability of the brain to adapt to injury and change, allowing it to form and reorganize synaptic connections and pathways.  Increased neuroplasticity allows the brain to cope with stressors and alter the brain pathways associated with depression (Mount Sinai, 2020).

Side Effects and Contraindications

Although Jannsen has conducted five Phase 3 studies in patients with refractory depression and has deemed esketamine (Spravato) as generally tolerable, some experts are still skeptical of its long-term safety (Pierce, 2019).

The most common side effects of esketamine are the following (Mount Sinai, 2020):

• dissociation
• dizziness and vertigo
• nausea and vomiting
• lethargy or sedation
• hypoesthesia (diminished response to stimuli / decreased sensation)
• anxiety
• increased blood pressure
• feeling drunk

Because of these side effects, patients who are given Spravato are advised to avoid food at least two hours before their appointment. After the administration, patients are required to stay at the clinic for at least two hours before being discharged (Mount Sinai, 2020).11

Contraindications for Spravato are aneurysmal vascular disease, intracerebral hemorrhage, and hypersensitivity to esketamine or ketamine (Spravato FDA Label, 2019).

Esketamine versus Ketamine

Ketamine comes in three forms: the (1) racemic ketamine mixture (50:50) composed of 50% s-enantiomers and 50%r-enantiomers, the (2) purely S-enantiomers (or esketamine), and the (3) pure R-enantiomers (arketamine).

In contrast to racemic ketamine, S-ketamine is reported to be less prone to side effects such as dissociation and hallucinations, hence it is the FDA-approved type of ketamine for treatment-resistant depression (Paul et al., 2009).

The R-ketamine type has been studied extensively in animal models of depression and has exhibited longer-lasting antidepressant effects than S-ketamine (Fukumoto et al., 2017). However, more clinical trials are needed to establish its effects in humans.

What is the deal between racemic ketamine mixture versus esketamine? Here are a few points:

1. Both racemic ketamine and esketamine may be given through a nasal spray or an intravenous infusion. 
2. Racemic ketamine is significantly cheaper than esketamine. This plays a huge role in patient compliance especially if insurance coverage is not guaranteed.
3. Racemic ketamine is not covered by insurance due to its being off-label for use in patients with TRD. Esketamine (Spravato), may be covered with insurance because it is FDA-approved. To be sure though, please check with your insurance provider.  It should be noted that the insurance provider may cover Spravato, but won’t reimburse properly for the 2-hour observation period.  

Both racemic ketamine and the S-ketamine enantiomer are noted to exert similar antidepressant effects in treatment-resistant depression, however S-ketamine was theorized to be more tolerated by patients (Paul et al., 2009).

Conclusion

Racemic ketamine and esketamine are shown to exert a similar degree of antidepressant effects on patients.  This resulted in the approval of esketamine as one of the pharmacotherapy options for treatment-resistant depression. 

It was assumed that the lower dose esketamine will discourage propensity towards dependence and abuse. However, this comes at a significantly higher price especially in the absence of insurance coverage.  The costs will hinder patient compliance and might encourage relapse instead, defeating the purpose of ketamine therapy in the first place.

The good news though: aside from ketamine infusions, The Infusion and Injection Clinic of ABQ offers racemic ketamine nasal spray through a home-use program. The clinic decides which clients are eligible based on adequate response to the initial series of ketamine IV without significant side effects.

In our protocol, specific patients who have completed a course of ketamine infusions may be deemed eligible for the home-use program of racemic ketamine nasal spray. This allows the healthcare provider to establish the patient’s tolerance levels to ketamine, and determine which dose is most ideal to the patient. 

It is important to ascertain that the patient responded well to the ketamine IV infusions, without any side effects. Only then can the patient become a good candidate for the home-use program.

Call The Injection and Infusion Clinic of ABQ at 505-445-4300 and book an appointment with us to learn more about our ketamine infusions and nasal spray. 

Albuquerque, NM - Cannabidiol or CBD and Silexan™ lavender oil ease anxiety, depression, pain, and sleep problems. Both are available with a prescription.

You may realize it by now the COVID-19 pandemic has caused drastic changes in all aspects of our lives. According to the CDC, fear and anxiety about this new disease affect adults and children alike. 

A recent study reveals COVID-19 has a significant impact on mental health. Based on a review of published medical journals as of May 2020, the prevalence of stress, anxiety, and depression were evident among 9,074 obtained samples.

Could you just imagine what it’s like for people suffering from anxiety even before the pandemic? Psychological interventions and medications may improve the mental health of vulnerable people, especially at this time of uncertainty. 

There are therapeutic products available with prescriptions from licensed healthcare providers. For one, the Injection and Infusion Clinic of ABQ dispenses cannabidiol (CBD) oil and lavender oil for anxiety. We have Quicksilver full-spectrum CBD oil with less than 0.3% THC and a broad spectrum that’s THC-free. We also carry Lavela WS 1265, known as Silexan lavender oil. 

Both of these products do well with your anxiety and other mood disorders. CBD and lavender oils are only two of many substances for anxiety. Let’s discover their therapeutic properties

• CBD: How it works
• Therapeutic effects of CBD oil
• CBD potential side effects
• Controversy on the legality of CBD and THC 
• Silexan lavender oil: How it works
• Therapeutic effects of Silexan lavender oil
• Silexan potential side effects

CBD: How it works

Cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) are the most common compounds derived from the Cannabis sativa/Indica plant. These two binds with receptors in your body.

The endocannabinoid system comprises CB1 and CB2 receptors that your body produces. CB1 receptors are found all over your body, specifically in your brain. They’re involved in anxiety, appetite, movement, pain, and sensory learning. CB2 receptors, located iCBD: How it worksn the immune system, aid in the regulation of inflammation.

Your body can produce its endocannabinoids as CBD stimulates the receptors. THC, though, binds to CB1 receptors, which disrupts your normal physical and mental functions.  Unlike THC, CBD is non-intoxicating and doesn’t produce psychoactive effects.

Therapeutic effects of CBD oil

A study reveals that CBD oil had the therapeutic potential for medical conditions, most commonly pain, anxiety, depression, and sleep disorders. An anonymous questionnaire was used to assess participants recruited in social media. Sixty-two percent of the CBD users reported using CBD to manage their medical condition. Almost 36% rated CBD oil as “very well by itself.” 

Let’s zoom in to anxiety as one of the top answers. The THC component of cannabis can worsen anxiety. CBD, though, has the opposite effect of relief from anxiety. The following studies support this claim.

• A study found that CBD may effectively reduce anxiety behaviors of people suffering from a general anxiety disorder, panic disorder, post-traumatic stress disorder, social anxiety disorder, and obsessive-compulsive disorder. 
• Seventy people with anxiety and sleep problems participated in a retrospective study with positive results. They received CBD in capsule form in various doses depending on the participant’s condition.  During the first month, 79.2% of participants reported decreased anxiety. Sleep scores also improved among 66.7% of the participants, but it waned over time. In contrast, 19.5% of the participants reported worse symptoms after CBD therapy. The researchers noted, though, there were no safety issues with the use of CBD.
• Another study found that CBD may be an effective and safe therapy for anxiety and non-chronic pain. The participants reported no significant adverse effects as CBD was well tolerated. But, doses of CBD varied among the 400 participants that warrant further clinical trials.

CBD potential side effects

• CBD users tolerated doses of up to 600 mg without central nervous system effects or psychotic symptoms. But caution must be taken until more robust clinical trials are performed to support CBD as a medical treatment.
• CDB users with epilepsy and psychotic disorders reported side effects. The most common of these side effects were diarrhea, tiredness, and changes in appetite or weight. However, the researchers noted that these side effects were not as severe as other drugs used to treat the same medical conditions.
• In a mouse model, researchers discovered high doses of CBD might cause potential liver toxicity. This condition could be possibly the retention of substances in the bile, which should usually be excreted. 
• Researchers noted possible risks in a comprehensive review of published medical journals with animal test subjects. Some of these were developmental toxicity, fetal mortality, neurotoxicity, and alterations in the male reproductive system.
• The combination of fats and CBD may intensify side effects among healthy people. So, you may have to cut down on fatty foods when taking CBD oil. Which is a good thing, right?

It’s best to consult your healthcare provider if you take prescription medications, supplements, and over-the-counter drugs. These may interact with CBD oil if you intend to take it as an adjunct therapy.

Controversy on the legality of CBD and THC 

Since 1970, CBD and THC fall under the drug class of Marihuana listed in the Controlled Substances Act. Categorized as Schedule I substances, CBD and THC had no known medical use. However, both substances had a high potential for abuse, primarily THC, due to their psychoactive effects.

The 2018 Farm Bill changed this regulation on CBD and THC. The FDA removed hemp from the list of controlled substances such as cannabinoids that contained less than 0.3% dry weight of THC. The FDA still has the authority to regulate these products. 

These cannabis products have unsubstantiated therapeutic claims that haven’t been approved for safe and effective use. It includes dietary supplements. The FDA also pointed out some products are mislabeled and misleading. 

The FDA and the Center for Drug Evaluation and Research support and aid companies in developing new drugs such as cannabis-derived drugs. The key here is developing quality drugs that are scientifically proven safe and effective for medical use. 

Silexan lavender oil: How it works

A brand name of lavender oil, Silexan is a substance derived from Lavandula angustifolia flowers. It has been used for the management of restlessness and anxiety. It has also been known to improve sleep. 

The serotonin system plays a role in anxiety disorders. The inhibitory serotonin, serotonin-1A, or 5-HT1A can be found in the brain region where cognition, memory, and mood are regulated.  Increased anxiety may be linked to the lower binding of 5-HT1A. In a positron emission tomography study, the results suggest that the serotonin 1-A receptor is involved in reducing anxiety or the anxiolytic effect of Silexan. 

Therapeutic effects of Silexan lavender oil

The FDA granted lavender oil a “Generally Recognized as Safe” (GRAS) status. The efficacy and safety of Silexan for anti-anxiety has been well-established by scientific studies.

• A meta-analysis study shows Silexan had significant anxiolytic and beneficial effects on sleep problems. In addition, it caused no sedation and improved the health-related quality of life of the participants.
• In a study of 539 adults, Silexan performed well as an anti-anxiety therapy compared to the placebo paroxetine, an antidepressant drug. The results also show it improved general mental health other than its significant antidepressant effect.
• Another study compared Silexan to lorazepam, a well-known anti-anxiety drug. The trials involved 280 people who were given doses of 80 mg/day of Silexan. The results show Silexan for general anxiety disorder was comparable to lorazepam.

Silexan potential side effects

• Researchers in a study reported slightly more adverse reactions among participants who took Silexan than those who took a placebo. 
• Researchers in another study also noted slightly more adverse reactions, but none of these were severe. These included dyspepsia and nausea.
• Pregnant women should avoid using lavender oil as it has a potential emmenagogue effect, or it may cause bleeding and miscarriage.

If you intend to take Silexan as an adjunct therapy, it’s best to consult your healthcare provider. Prescription medications, supplements, and over-the-counter drugs you are taking may interact with it.

Anxiety begun or be gone?

We’re aware this pandemic is taking a toll on everyone’s psychosocial and mental health. The Injection and Infusion Clinic of ABQ offers its services and quality products to alleviate your anxiety.

Quicksilver CBD oil contains only small traces of THC and is thus free of psychoactive effects. It takes just five minutes for you to feel relaxed and in a better mood. For CBD orders, please call us at 505-445-4300 to order.Silexan doesn’t contain corn, dairy, gluten, sugar, and wheat. It’s also safe with no potential for abuse. Silexan is available at The Injection and Infusion Clinic of ABQ

Albuquerque, NM: Ketamine goes well with psychotherapy for treatment-resistant depression. Know if you are eligible, its procedure, and its positive effects

Ketamine has been used as an off-label drug for pain, treatment-resistant depression or TRD, anxiety, suicidal ideation, post-traumatic stress disorder, and substance addiction.

It has been found to provide fast relief from depression and suicidal ideation. It’s safe and effective at low doses. The Injection and Infusion Clinic of ABQ has been administering ketamine IV infusions since 2017. If you have questions about ketamine IV, you may call us at 505-445-4300.If you’re already receiving ketamine IV infusion, you may want to look into a more meaningful experience. Ketamine-assisted psychotherapy is a relatively new therapeutic approach that combines ketamine infusion with psychotherapy sessions. It’s performed by a mental healthcare clinician.

What is Ketamine Assisted Psychotherapy?

Ketamine with psychotherapy was first reported in the 1970s. It’s defined as psychedelic with psychotherapy or “psychedelic-assisted psychotherapy.” Those specific to ketamine is called “ketamine-assisted psychotherapy.” 

Ketamine has been suggested as a means of facilitating psychotherapy with proper assessment and considerations. Mental healthcare professionals may use it as an effective and safe substance in interventions by setting the mind-frame and therapeutic environment. 

Ketamine and psychotherapy form a synergistic effect. You may experience a dreamlike state during the ketamine infusion. At this time, a mental healthcare clinician conducts psychotherapy. Your psychological barrier is lowered which allows for personal reflection and psychotherapeutic intervention. You may feel the dissociative and psychedelic effects at moderately higher doses. This state offers more profound insights and a deeper sense of spiritual connection.

Positive effects of Ketamine Assisted Psychotherapy

There are a few yet compelling studies on the effects of KAP used for various mental health conditions.

• Alcoholism. A study reveals that KAP was significantly more effective in the treatment of alcoholism than standard psychotherapy. It also resulted in positive life changes beyond sobriety.
• The same results were validated in another study. The researchers indicated that KAP resulted in psychological changes in favor of sobriety and a positive view about self and others. It brought significant insights into the meaning of life and increased spiritual development. 
• Anxiety. Terminally-ill people underwent ketamine-enhanced psychotherapy in five stages to treat their death anxiety. It provided a change in attitude about death and overcame their existential anxieties about dying. The researchers concluded that ketamine-enhanced psychotherapy as a promising practice in resolving anticipated grief, such as death anxiety.
• Depression. Findings of a study suggest KAP as an effective means of reducing anxiety and depression in people suffering from severe symptoms and among older adults, too.

5 Questions to ask yourself if you are eligible for ketamine-assisted psychotherapy

You will be interviewed to determine your eligibility before you can proceed with the Ketamine Assisted Psychotherapy. You will be evaluated based on your medical profile and psychiatric history. This includes medications, supplements, and over-the-counter drugs you are taking. 

You are eligible for KAP if you answer “no” to the following questions:

1. Do I have untreated hypertension?

Rationale: Ketamine may increase blood pressure and pulse rate. People with heart disease may likewise be ineligible for KAP. These include arrhythmias, coronary heart disease, and congestive heart failure.

2. Do I have hyperthyroidism?

Rationale: In a study, ketamine increased blood pressure and pulse rate after administration of thyroid replacement therapy. People with hyperthyroidism have an increased heart rate and taking ketamine may worsen it.

3. Am I suffering from substance abuse?

Rationale: Ketamine may be used as a therapy for substance abuse. Ketamine though may be infused only after proper detoxification from the drugs you are addicted to. Mixing drugs may have unpredictable effects that may also be life-threatening.

4. Am I pregnant?

Rationale: Does this mean that ketamine can cause potential adverse effects on the fetus? A recent study suggested possible neurotoxicity to the brains of developing fetuses. More studies have yet to determine the cause of ketamine to unborn children in the womb. It’s best not to expose pregnant women to ketamine, which may potentially harm the baby. 

5. Am I breastfeeding?

Rationale: More data have yet to surface regarding the effects of ketamine on breastmilk. It’s also best to refrain from KAP while breastfeeding to ensure the safety of your baby.

3 Routes of ketamine administration

Ketamine can be administered sub-lingual (SL), intramuscular injection (IM), and intravenous infusion (IV). These are thoroughly discussed in a Ketamine-Assisted Psychotherapy Informed Consent form:

1. SL ketamine lozenges

SL ketamine lozenges are dissolvable tablets to be taken under the tongue. It has a lower dose compared to IM and IV. This aims to uplift you from your depression or other mood disorders. It allows you to experience psychological healing. Full benefits may be achieved through repeated administration of lozenges. 

2. IM

IM ketamine is given either in the hip or shoulder. It has a rapid onset that creates a dissociative experience. This aims for an altered state of consciousness for a deep transpersonal experience. 

A mental healthcare clinician or therapist guides you through the process of KAP. At this state of consciousness, you may be able to resolve existing worries and speed up your spiritual growth. This will lead to your deep personal transformation and an improvement in your general lifestyle. 

This is also why you have to be honest and trusting of your mental healthcare clinician or therapist. Because all the information you will give out will help in overcoming your issues and struggles during KAP.

3. IV

You will receive ketamine through an intravenous line for about 40 minutes to an hour. This depends on your dose and preference on the rate infusion. This provides the best means for a profound KAP experience compared with SL and IM. 

A study shows that a low dose of 0.5mg per kg of ketamine IV has a response rate of 50-70% among people with treatment-resistant depression. Relapse may occur in the third weekup to 18 days. This may require you to get additional sessions. KAP though may enhance these response rates.

3 Roles in ketamine assisted psychotherapy

The Ketamine Research Institute or KRIYA released Guidelines for Therapeutic Ketamine Clinicians. The three roles of a therapeutic ketamine treatment are the following:

1. Medical practitioner: The medical practitioner or healthcare provider assesses the client’s physical status before the therapy. Monitoring the client’s status is a major responsibility. This includes ensuring safety protocols are in place and addressing potential adverse reactions during the therapy.
2. Mental healthcare clinician: During preparation, the clinician conducts the client’s initial interview/assessment and plans for the integrative treatment. The clinician also provides psychological support and manages psychological emergencies throughout the therapy.
3. Client: The client should be honest in giving all the needed information during the interview/assessment. This enables the clinician to come up with a good plan for the integrative therapy. Honesty and open communication are also important. This will let the clinician and medical practitioner know about the client’s condition during the therapy. Most of all, the client is expected to participate in the integrative treatment plan.

3 Phases in ketamine assisted psychotherapy

There are three phases of KAP according to McInnes and Yu’s presentation on Ketamine-Assisted Psychotherapy: A Practical Guide for Medical Providers. They presented the stages of preparation, administration, and integration during the 2020 Psych Congress Virtual Experience. These stages originated from a recent study on ketamine psychedelic psychotherapy.

The authors noted that psychotherapeutic interventions are provided during the administration and integration stages. A mental healthcare clinician also monitors the person undergoing KAP throughout the whole session.

1. Preparation

You will undergo a liver function test and urine test for pregnancy, and drug use. Your vital signs will be checked. This includes your exact height and weight as these are needed in calculating your ketamine dose. You will then sign a consent form. You will be oriented about ketamine and what to expect during KAP.

2. Administration

You may sit or lie down in a comfortable position as ketamine will be administered either SL, IM, or IV.  The Injection and Infusion Clinic of ABQ provides the IV route. In the case of the authors, they chose the SL route as an example. Instrumental music may be provided as you go through KAP. You may or may not experience side effects at this phase.  Some potential side effects may include anxiety, headache, irritability, dissociation, and increased blood pressure or heart rate.

3. Integration

The integration phase happens after the ketamine infusion session. Therapeutic techniques offered are cognitive behavior therapy, dialectical behavioral therapy, emotion modulation therapy, guided imagery, mindfulness, and mindful compassion. The most vital aspect of KAP is a personal narration of your profound and healing experience. 

McInnes and Yu discussed evidence-based cases on KAP. One, a 65-year old man with TRD reported interpersonal and physical improvements, as well as a renewed sense of purpose in life. Another, a 39-year old female with TRD reported a feeling of a sense of unity and that “everything will be okay.” 

Your thoughts about Ketamine-Assisted Psychotherapy matters

KAP is gradually gaining traction as a new intervention coupled with ketamine IV infusion. Although, KAP may not be for everyone due to its medical restrictions. Share your thoughts about KAP with us, so we know how better to serve you. You may visit us in Albuquerque, Santa Fe, Rio Rancho, Tijeras, Edgewood. Or, we’d appreciate it if you’d leave a comment and we’ll get back to you as soon as we can.

Have you been prescribed a cocktail of antidepressants or experienced ECT or TMS yet nothing seems to work?

For many years, ketamine IV infusion has been widely used for Treatment-Resistant Depression (TRD). Recently, the FDA recently approved Spravato esketamine intranasal spray for TRD, too. In light of this latest development, medical practitioners have started to prescribe Spravato, a tradename of esketamine. Like Ketamine IV, Spravato can only be used under the supervision of a clinician in a medical facility. Should you have questions about esketamine and Ketamine IV infusion therapy, you may contact the Injection and Infusion Clinic of ABQ – 505 455 4300. Many studies have been published about the safety and efficacy of ketamine IV. Esketamine is a partial form of ketamine IV known as an isomer. This version has also been researched. The latest study shows long-term esketamine nasal spray coupled with an oral antidepressant appeared to be safe. Depressive symptoms continued to improve among the 603 participants. 

Here are the 5 differences between Ketamine IV and Nasal Spray:

1. Pros and cons on the administration of Ketamine

Ketamine IV: The infusion takes about 40 minutes to an hour. The IV form is 100% bioavailable.

Nasal spray: It takes a few minutes to administer the nasal spray. There is some loss as some may drip out of your nose or down your throat. This makes it less bioavailable. The FDA requires that you be observed for 2hours after administration of the nasal spray.

2. Efficacy and scope of therapy

Ketamine IV: It has a proven track record as a therapy for TRD (Please link to any blog that presents benefits etc.). It has rapid effects as ketamine is injected directly into the bloodstream. It has long-lasting results with intermittent or booster infusions. Studies have shown that Ketamine IV is also effective for other mood disorders such as anxiety, postpartum depression, bipolar disorder, suicidal ideation, and post-traumatic stress disorder (Please link to any blog about the following disorders). 

Nasal spray: It has to pass layers of tissues before it takes effect. But it has a rapid antidepressant effect. Moreover, esketamine plus antidepressants showed to be effective in preventing relapse of TRD. It performs better than oral antidepressants with placebo.

3. Dosage and schedule of therapy

The dosage and schedule of therapy may vary slightly depending on the healthcare provider. For details on ketamine IV infusion therapy, call us at Injection and Infusion Clinic of ABQ – 505 455 4300.

Ketamine IV: Dose 0.5mg-1mg per kilogram, 5-6 infusions over 2-3 weeks, and boosters every 4-6 weeks. Some long-time ketamine infusion patients are able to prolong the time between their boosters.

Nasal spray: Dose 56 mg or 84 mg, 2 times a week for 4 weeks, and maintenance every 1-2 weeks 

4. Cost

The price of Ketamine IV and esketamine depends on the brand and frequency of use. The Institute for Clinical and Economic Review conducted a cost-analysis comparison between ketamine and esketamine for the treatment of TRD. The results show that esketamine is more costly than ketamine.

In a more recent study, researchers at McClean Hospital conducted a cost-effective analysis of esketamine nasal spray. The result also showed that esketamine nasal spray is too expensive.

5. Health insurance coverage

Ketamine IV and nasal spray are not yet covered by health insurance.Other than differences, Ketamine IV and nasal spray share some commonalities. Ketamine IV infusion has potential side effects and risks.For ketamine nasal spray, there are reported cases of treatment-emergent adverse events (TEAE). The researchers noted dissociation, nausea, and headache during a 60-week study. They further reported 6.9% of participants with serious TEAEs.Ketamine nasal spray like IV is safe and tolerated by the body. You still have to be aware of its potential risks. The FDA listed warnings on the use of Spravato. Here are the more common 7 warnings or potential side effects or risks.

7 Warnings

1. Sedation

You may feel sleepy or sedated. Sedation is one of the most commonly observed adverse reactions of Spravato. It also includes anxiety, dizziness, hypertension, hypoesthesia, lethargy, nausea, and vomiting. 49% to 61% of people treated with Spravato developed sedation based on clinical trials. Sedation, dizziness, dissociation, and increased blood pressure were also reported 2 hours after the use of Spravato. Sedation can worsen with drug-to-drug interactions. Central nervous system depressants include alcohol, benzodiazepines, and opioids.

2. Dissociation

You may feel disconnected from yourself – physically, psychologically, and environmentally. This is also called dissociation. Dissociative or perceptual changes are the most common psychological effect of Spravato. Its use should be seriously be avoided if a person is concurrently suffering from psychotic or other mental disorders. Spravato may aggravate the pre-existing mental condition.

3. Suicidal thoughts among teenagers and young adults

Spravato may be good for adults in the treatment of TRD with acute suicidal ideation or behavior. In fact, Spravato is a treatment for TRD with acute suicidal ideation or behavior.A study finds that suicidal thoughts decreased with a Spravato dose of 84 mg at 4 hours, but not at 24 hours or 25 days. Yet suicidal thoughts or behavior can be aggravated by Spravato among teenagers and young adults with depression and major depressive disorder. Based on placebo-trial studies on antidepressants, a review reveals that young people are at risk more than adults. Although, it is still unknown if the risk of suicidal thoughts and behaviors is long-term.There is an ongoing study to further test the efficacy and safety of Spravato to adolescents aged 12-18 years old who have major depressive disorder including suicidal ideation.

4. Increase in blood pressure

Based on the drug literature, Spravato may increase blood pressure by 40 mmHg systolic and 20 mmHg in all doses. This peaks at about 40 minutes after administration. Blood pressure will typically normalize prior to discharge home. Brief increases in blood pressure and heart rate have been observed in other studies as well. According to the FDA, other drugs that can induce hypertension are psychostimulants such as amphetamines and modafinil, and monoamine oxidase inhibitors such as phenelzine and selegiline.

5. Impaired cognitive ability

Spravato may affect your short-term more than your long-term cognitive or intellectual ability. A study reveals that Spravato affected the cognitive ability among healthy people 40 minutes after a single dose. The placebo group did better in a cognitive test. It took two hours post-dose before the Spravato group recovered to placebo-level performance. No long-term effect on cognition was described within a one-year open-label safety study. But it has been reported among people who repeatedly misused or abused ketamine.

6. Impaired ability to drive or use machinery

Twenty-four healthy people participated in a study to determine the effects of Spravato 84 mg on driving performance. The researchers found no marked difference in the driving performance 8 hours post-dose. You may still be at a risk of injury due to possible impaired motor coordination and mental alertness. Driving and operating machinery are examples of activities that are not allowed after Spravato therapy.

 7. Potential for abuse and misuse

Spravato belongs to Schedule III controlled substance (CII) due to its esketamine ingredient. Thus, it has the potential for abuse or misuse. The FDA differentiates abuse from misuse. Abuse is intentional and recreational or illicit drug use. People abuse a drug for their physical or psychological effects. Misuse is also deliberate but for medical or therapeutic purposes. But the person uses it in a way other than its main purpose. Or it may have been prescribed to someone else.Schedule III drugs means it may cause moderate or low physical dependence or high psychological dependence. The Comprehensive Drug Abuse Prevention Control Act of 1970, a federal drug policy defines Controlled Substance Act II. Spravato belongs to drugs that are regulated in terms of manufacturing, distribution, importation, possession, and use.Spravato has opioid properties that warrant further investigation in considering the best way to safely use it. This has also been an expert opinion of researchers who reviewed clinical trials on Spravato. They concluded that Spravato benefits people with TRD due to its rapid onset. But the main concern is safety with prolonged use.

• Abuse: A study assessed the potential abuse of Spravato at 84 mg doses compared with racemic ketamine IV infusion at 112 mg. The study also aimed to measure drug volume of distribution, maximum concentration, peak, half-life, and clearance. Thirty-four recreational polydrug users participated in the study. Results reveal that Spravato users showed higher scores for “detached,” “floating,” “hallucination,” and “spaced out” compared to IV ketamine users.  
• Dependence: The prolonged use of ketamine abuse may cause physical dependence according to reports. Physical dependence results from the body’s reaction to the repeated use of the drug. It can manifest as withdrawal symptoms when the drug is abruptly lowered or stopped. Unlike the abuse dosing, withdrawal symptoms were not observed up to four weeks after the use of Spravato. In over three years of providing ketamine IV, we have not observed withdrawal symptoms in our patients.

Which is better for you?

Ketamine IV and nasal spray are rapid-acting, safe, and effective for TRD. They have differences and similarities. And they have their respective pros and cons. Before deciding on any therapy, talk to us for a more detailed discussion on ketamine. Our Ketamine-certified clinicians have administered more than 2,000 ketamine infusions since 2017. You may visit us at the Injection and Infusion Clinic of ABQ in Albuquerque, Santa Fe, Rio Rancho, Tijeras, Edgewood. Or drop a comment below and we’ll get back to you.

Albuquerque, NM -- Your diet affects your mood. See the interlink between sugar, inflammation, and depression. And how it helps in ketamine therapy for TRD

Diet and Depression

Sugar as the culprit:  If you’re suffering from depression, you might want to drop soda from your diet. It does give you a momentary high because it increases the dopamine in your brain. Dopamine, a neurotransmitter gives you feelings of satisfaction and pleasure. But drinking sugar-sweetened beverages have been known to increase the risk of depression.This applies to all sugary foods and not just soda. Too much intake of sugar increases the glucose in the blood. It may manifest as blurred vision, dizziness, irritability, and depressive symptoms. Refined sugar as well as carbohydrates have these effects if taken excessively. Yes, this means you also have to cut down on your favorite pasta and chocolates, too. These foods have little nutrients and drain up the body’s B vitamins, which are mood enhancers. Moreover, sugar also affects chromium, another mood regulator that maintains your blood sugar level. In a nutshell, many studies suggest that added sugars may induce “depressogenic effects”. Reis and associates noted that excessive intake of sugars causes dopamine malfunction and oxidative stress. It also results in insulin resistance and the formation of advanced glycation end-products.These are the reasons why you should avoid sweets if you have treatment-resistant depression (TRD). If you have questions about ketamine IV infusion therapy for TRD, you may contact the Injection and Infusion Clinic of ABQ. The certified ketamine clinicians have done more than 2,000 infusion therapies since 2017. Now before we get into the ketamine diet, let’s take a closer look. In this article, we will deep dive into the following:

• The Link Between Inflammation and Depression
• The Link Between Inflammation and Sugar
• Why is Sugar Addictive?
• The Link Between Sugar and Depression
• How Significant is Your Diet?
• Ketamine Diet
• Special Dietary Tips for People Having Ketamine Infusion Therapy

The Link Between Inflammation and Depression

Depression is a mood disorder and not an inflammatory condition. Inflammation however increases depression and other mental disorders such as anxiety, bipolar, and schizophrenia. 

A study conducted by Timberlake and Dwivedi explains that unfolded protein response (UPR) is the body’s cellular reaction to stress. It has been directly linked to inflammatory cytokine production and toll-like receptor or TLR. 

TLR expression is the body’s immune response to bacteria, viruses, and trauma. In their study, TLRs have been shown to rise in depression. This established the link between inflammation and depression.In another study, researchers found out that inflammation contributed to causing some forms of fatigue and depression. They explained that antidepressants reduce inflammation.

However, people with higher levels of inflammation were predicted to be less responsive to treatments. These people responded more to therapies that targeted immune pathways. This was deemed effective in treating their depression and fatigue.Although a more recent study points out covariates play a role in the equation. Covariates are dependent variables such as age, sex, body mass index, and exercise. This includes lifestyle habits and a history of smoking, drinking, or chronic illnesses.

The researchers reveal that associations between depressive symptoms and inflammatory markers decreased when covariates were adjusted.

Further studies have to be conducted to further contribute to the growing evidence that links inflammation to depression. This brings us to the next topic.

How is inflammation linked to sugar, since sugar is the culprit of intensifying depression?

The Link Between Inflammation and Sugar

Participants in a study fasted overnight. On the following day, they ate three meals which contained 50 grams of carbohydrates such as pasta and white bread.

This may help explain the relationship between carbohydrates, their effect on blood-sugar levels, and the potential for chronic diseases. The results of the study show that high-glycemic diets, which causes blood sugar to rise, aggravated inflammatory process in lean and healthy young adults.

A related study determined a potential link between inflammatory disease and glycemic index. A study ran for over 13 years among 1,245 men and 1,490 women aged 49 and above. 

The researchers administered a food-frequency questionnaire throughout the study. They later noted that 86 men and 84 women died due to inflammatory disease. According to another researcher with the same idea, a high carbohydrate diet may promote inflammation in people with depression.

Elevated inflammation in the body is thus associated with the consumption of too many refined carbohydrates and sugars. This also results in insulin resistance and eventually weight gain or obesity.

Why is Sugar Addictive?

Why is sugar addictive in the first place? It has been revealed that sugar or intense sweetness is more addictive than cocaine. The researchers speculated that the compulsive wanting for sugar is caused by innate high sensitivity to the taste of sweets. 

Tastants are chemicals in the saliva that stimulates taste and makes you want to eat. The stimulation of these tastants due to sugar-rich foods generates a feel-good reward signal to the brain. Thus, the body craves more as the body gets satisfied.

The Link Between Sugar and Depression

Hence, as you eat more sweets, the more you crave it. This high sugar intake results in inflammation. And inflammation is linked to depression.

People who ate sweets were discovered to be more likely to suffer from depression compared to those who ate whole foods (Akbaralay et al., 2009). It’s not just sweets.

The diet consists of high-fat dairy products, fried foods, processed meats and foods, and refined grains. By whole foods, we mean fruits, vegetables, and fish. These were safer and did not show symptoms of depression among people who ate them.

In a large-scale study, researchers got the same results. Researchers assessed 23,245 people using random effects regression from a Whitehall II study. People were asked about their diet and mood using food frequency and validated questionnaires, respectively.

The researchers found out that sweet foods and beverages or sugar intake increased the incidence of mood disorders in men (Knüppel, et al., 2017). Sugar consumption was 2 to 3 times higher than the recommended intake.

The researchers further revealed that policies could support the prevention of depression by encouraging the reduction of sugar intake.

This echoes a more recent study that saturated fats and added sugars were somehow related to higher anxiety among 1,128 older adults living in Greece. 

The researchers recommended the promotion of healthy dietary habits to reduce the incidence of anxiety in older adults. 

How Significant is Your Diet?

SMILE. It’s the name of a controlled-trial that investigated the impact of dietary changes on people with major depression. Researchers assessed 166 participants in 12 weeks.

The results reveal that dietary improvement may be effective as a treatment strategy in the management of mental disorders. This brings us to the topic of the appropriate food or proper diet for depression.

Ketamine Diet

There is no ideal diet for people undergoing ketamine IV infusion. Let’s just say the “ketamine diet” may prevent aggravating your TRD symptoms.

A study reviewed 20 scientific articles and identified eating habits as beneficial for people with depression (Ljungbeng, et al., 2020).

These are the consumption of fish and various fatty acids and avoidance of processed foods. The researchers also included the intake of an anti-inflammatory diet, magnesium, and folic acid. 

Another group of researchers also found out that the Mediterranean diet along with vegetables, fruits, and fish have been linked to a lower risk of depression. 

While Western diets that are high in fats and sugary beverages have been linked to an increased risk of depression. They also noted antioxidants such as green tea can be good for you.

Are you having problems with your medications or procedures? The researchers suggest a healthy diet and proper nutrition as an alternative therapy. 

Special Dietary Tips for People Having Ketamine Infusion Therapy

To prevent depression, a study identified five key dietary components:

• Stick with “traditional” diets like Japanese, Mediterranean, and Norwegian
• Eat plenty of fruits, legumes, nuts, seeds, vegetables, and whole grains, which are high in selenium
• Consume foods rich in omega-3 polyunsaturated fatty acids
• Pick wholesome nutritious foods or plant-based over unhealthy foods or those that are processed
• Limit eating fast foods, bakery goodies, and sweets

A study suggests taking Vitamin D. Vitamin D may alleviate depressive symptoms. It also improves your long-term health and general well-being. Many clinicians actually call Vitamin D a ‘brain hormone’. 

Almost all people need to supplement Vitamin D to achieve optimal levels. Our modern lifestyle of working indoors, wearing sunscreen, and showering all decrease our Vitamin D levels.

Another study suggests stop eating foods with refined and saturated fats that affect brain function and worsens depressive symptoms (Fernandes et al., 2017).

If you are already getting ketamine IV infusion, avoid grapefruit because it increases plasma drug concentration.

In 2017, a study reveals that St. John’s Wort is as effective as selective serotonin reuptake inhibitors (SSRIs) for people with mild to moderate depression.

But, refrain from ingesting this herb because it is known to breakdown ketamine, which decreases the efficacy. Drinking alcoholic beverages or taking illicit drugs are also disallowed.

The Story

The complex interlinking of inflammation, sugar, and ketamine shows the dynamic prevention and management or therapy for TRD. Based on the studies, diet, eating habits, and nutrition play an important role in its prevention. Share this information to help others. Let them know how poor eating habits and nutritional deficiencies can worsen depressive symptoms. Give us a call at the Injection and Infusion Clinic of ABQ – 505 455 4300.

Send us your feedback or talk to us about your ketamine therapy. You may visit us in Albuquerque. We serve the Greater Albuquerque Area, Santa Fe, Rio Rancho, Tijeras, Edgewood, Los Lunas, and other surrounding areas. 

Albuquerque, NM -- Ketamine IV Therapy can be coupled with mindful meditation. Understand how a holistic approach eases severe depression

Holistic Approaches to Severe Depression

Have you heard of Cognitive Behavior Therapy (CBT), Ketamine Assisted Psychotherapy (KAP), or Ketamine Psychedelic Psychotherapy (KPP)?

Whether you are currently getting ketamine infusions or just thinking about them, it is important to think about other techniques that can enhance your experience and results. There have been studies conducted about interventions that could enhance your healing experience. These are other therapies that go well with your ketamine therapy. CBT, KAP, or KPP concentrate on your psychological state as you go through the psychedelic sensation during your ketamine IV infusion therapy. We recommend a mental health professional who will supervise and guide you on these activities. Relaxation and breathing techniques, too, are also used during depression therapy. A study narrates a report of a nurse’s experience with a patient who’s suffering from depression and chronic pain. The nursing care implemented relaxation, music, and biofeedback techniques. Relaxation techniques included meditation and abdominal breathing. The sessions ran for 45 minutes to an hour. The nurse observed that the patient was motivated, active, and aware of the psychosomatic symptoms. The patient also gained self-control and had a marked improvement in resolving problems.There’s a simple breathing technique though you can do on your own before and during your ketamine IV infusion therapy. This can be coupled with mindfulness meditation (MM).

Before your Ketamine IV Infusion Therapy

It’s best to arrive at least 15 minutes before your therapy so you can settle down. The goal is to be in a grounded state with a calm and open mind. This will prepare you for whatever you will go through during your ketamine infusion. You can achieve this through the 4:7:8 breathing technique to reduce your anxiety. This is also used in MM, which will be discussed later.Dr. Andrew Weil developed the 4-7-8 breathing technique. He is the founder and director of the University of Arizona Center for Integrative Medicine. You focus on the following deep and rhythmic breathing pattern as you perform the technique.

You will have time for this at the Injection and Infusion Clinic of ABQ. We start your IV and get you settled into your comfortable chair. We then prepare your infusion, giving you an opportunity to settle in and mentally prepare for your ketamine infusion

DURING your Ketamine IV Infusion therapy

Breath normally and just let go. Practice mindfulness by being aware of your thoughts, feelings, and bodily sensations in the present moment to achieve calmness. Focus your attention on the sound of your breathing. Accept any sensation you may feel during the ketamine infusion. Receive the experience without expectation or judgment.

10 Benefits of Mindful Meditation (MM)

• Sharpens your mental function
• Boosts your immune system
• Increases your energy level
• Strengthens your resilience
• Aids your body in managing pain
• Induces relaxation
• Regulates your mood
• Reduces your stress and anxiety
• Induces relaxation
• Improves the quality of your sleep

The National Center for Complementary and Integrative Health and the National Institutes of Health endorse meditation and mindfulness for general well-being. Moreover, the Canadian Agency for Drugs and Technologies in Health (CADTH) recommends mindfulness intervention to decrease the recurrence of depression.CADTH further extends this practice during the treatment phase of people who are at risk of relapse. And it also applies to people with major depression who are at the second-line therapy or maintenance phase.MM with Mindfulness-Based Cognitive Therapy (MBCT): A study revealed that therapeutic change or “coming to terms” can be achieved through MM’s concept of “living in the moment”. The researchers noted how MM skills had a vital role in the development of change. This continued practice offered support to MBCT in reducing the relapse of people with mood disorders.MM as effective as non-mindful physical exercises for depression: Researchers surveyed five electronic databases that tested this idea. It turned out that both MM and non-mindful physical exercises were effective in reducing depression on a short- and long-term basis.They suggested a larger sample size and well-controlled studies since they only came up with 12 randomized control trials.Mindfulness interventions stabilize attention and improve mental ability: A review of related literature from electronic databases was performed by researchers. They found out that meditation-inspired interventions presented a promising solution in preventing and rehabilitating cognitive problems.The researchers also suggested the creation of neuropsychological tools with seven attitudinal foundations of mindfulness practice. This was originally promoted by Jon Kabat-Zinn. This will serve as a guide to people in coping with their psychiatric issues. This includes depression among others.MM for depression, anxiety, and spiritual well-being: Twenty-eight Japanese patients undergoing cancer treatment participated in a study. The MM activities included breathing and yoga. They were trained in these techniques in the first session and they did the rest of the sessions in their homes. They answered a preintervention questionnaire, then after two weeks, they answered a postintervention questionnaire. The questions were about depression and anxiety. The results reveal that MM may be an effective therapy for anxiety and depression in Japanese cancer patients. They further said that spiritual well-being was linked to depression, anxiety, pain, and growth.

3 Ways to Practice Mindful Meditation

It can be a stand-alone therapy that is effective for depression and other mood disorders. There are three ways you can practice MM. You may perform it under the tutelage of an expert, do-it-yourself (DIY) with an instruction guide, or with the aid of a video or smartphone application.

1. You may practice mindfulness with a meditation guru, therapist, or life coach who will guide you through it.

A good reference is the “7 Attitudinal Foundations of Mindfulness.” Jon Kabat-Zin wrote about this in a book, entitled “Full Catastrophe Living.” Just to give you an idea, the eight attitudes are the following:

• Acceptance
• Non-judging
• Beginner’s Mind
• Trust
• Non-striving
• Letting go
• Patience
• Self-compassion

2. Do-It-Yourself

Here’s a simple way of starting your mindfulness meditation practice. You can perform this during your ketamine IV infusion therapy with the modification of your sitting position. Or you can do it at home in between your ketamine IV infusion therapy sessions. It can be anywhere during your work breaks or any time of the day. In performing MM, the key is to focus on your breathing.

• Sit down comfortably on a stable chair, bench, cushion or mat on the floor, or firm bed.
• Observe the position of your legs. You may cross your legs while seated on the floor. If you’re seated on a chair or bed, place your foot firmly on the floor at a 45-degree angle.
• Your head and shoulders are relaxed with your back straight following the natural curve of your spine.
• Let your arms rest on your sides, parallel to your body.
• Slightly lower your chin and gaze downward. You don’t have to close your eyes. If your eyes are open, let it be and see whatever appears before you.
• Relax and just breathe. Focus your attention on the feel and sound of your breathing. Be aware of the sensations in your body.
• Be there at the moment. Breathe in and breathe out. If your mind wanders, let it be. But let your attention go back to the rhythm of your breathing.
• Practice the pause. If you need to reposition yourself, do so.
• Go back to breathing even at times you may experience distractions from your environment or your mind. Be free from expectations and judgments.
• Slowly emerge from your mindfulness meditation as you open your eyes to your environment.

3. If you’re tech-savvy and into gadgets, you may opt for a smartphone application.

A 12-minute smartphone-based mindful breathing technique is currently being studied. The researchers want to find out if it affects the heart rate of students with depression, anxiety, and chronic pain. The random controlled study aims to evaluate the psychological and physical effects of the MM application. The study has yet to be completed by the end of 2020. The researchers are hoping that through this study, MM training tools delivered through applications and web platforms will be developed to benefit people with depression, anxiety, and chronic pain.

There are a lot of mindfulness videos online. There’s a cool compilation of these at the David S. Rosenthal Center for Wellness and Health Promotion, Harvard University Health Services you may want to check out.

A holistic approach to your severe/TRD

A holistic approach in treating severe/TRD can incorporate 4-7-8 breathing technique and MM in the routine. Both practices have been shown as safe and effective therapeutic adjuncts to major depressive disorder. These can go well with your ketamine IV infusion therapy. Both practices help you cope with your TRD symptoms in-between ketamine sessions, too. 

For more information about Ketamine IV Infusion therapy, you may visit or call our friendly and caring staff at 505 455 4300 in the Injection and Infusion Clinic of ABQ serving Albuquerque, Santa Fe, Rio Rancho, Tijeras, Edgewood.

Albuquerque, NM - The Injection and Infusion Clinic shares practical tips for your ketamine infusion therapy. See what it’s like after your first session

Ketamine Infusion Therapy

Ketamine infusion therapy has become one of the most popular and promising adjunct therapies today. It has been discovered in studies that it is effective in addressing issues related to treatment-resistant depression, substance abuse, chronic pain, and post-traumatic stress disorder - among others. The Injection and Infusion Clinic of ABQ is one of the most outstanding clinics offering expert management in terms of ketamine infusion therapy. Its highly experienced team of healthcare providers are more than willing to assist every patient who wishes to achieve a better quality of life and mental health through ketamine infusions. After all, if we get to have more than a glimmer of hope in the battle against depression, why should we forego the chance? Depression is not an easy foe, but it is not unbeatable either.The good news is, Ketamine has already helped a lot of individuals with depression, and it continues to do so despite not being FDA-approved yet for this purpose. Ketamine is used primarily as an anesthetic drug, however its action as an NMDA antagonist makes it a potential medication against depression - more so in individuals with treatment-resistant depression.

Depression, if measured in terms of total years wasted due to incapacity, is accordingly the leading cause of disability globally.1 It has a broad spectrum of symptoms, and the diagnosis is as challenging as finding a cure. The complexity of the disease coupled with difficulty in diagnosis, and failures of many clinical trials – serve as a huge obstacle to many clinicians. Depression does not look the same in everyone – it affects individuals in a multitude of ways, resulting in different manifestations of the illness.However, the ultimate challenge in treating depression, and most psychiatric problems, is that there is never one such thing as a “boxed management” for everyone. Every person has a unique story and a unique experience that had ultimately predisposed him or her towards developing such a condition. Even though we already have a lot of treatment options available for these psychiatric disorders, there will never be a “one-size-fits-all” treatment in the world of psychiatry (or even in medicine, for that matter). Doctors can go only as far as creating tenets of management protocols mostly involving selective serotonin reuptake inhibitors (SSRIs) coupled with psychotherapy. Some cases require employing brain stimulation therapies as well. But since every person is different, there will always be a possibility of a treatment failure. In fact, most medical practitioners are faced with the challenge of how to avoid treatment failures in any kind of therapy. Depression is already a crippling, debilitating condition – treatment resistant depression (TRD), on another note, can be twice as paralyzing and agonizing, and frustrating. And surprisingly, 10-20% of individuals diagnosed with depression, meet the criteria for TRD.People who are living with treatment resistant depression have often lost quite a great deal of hope that they can recover from the illness. And yet, ketamine infusions have proven to be very promising in addressing TRD. It is fast-acting, has proven to be effective in most patients, and even researchers are continually studying it due to the promise that it offers.

However, despite overwhelmingly testimonials from patients, there are indeed reports of ketamine infusions not living up to expectation, especially among the elderly. Yes, these things can happen. Treatment failure happens. In both TRD patients and non-TRD patients. One research study discovered that failure to respond to ketamine infusion therapy was common in people who had late-onset depression. It was hypothesized that aging significantly changes the sensitivity to ketamine hence the occurrence of more intense side-effects in the elderly patients than those in younger patients.

It was further postulated that N-methyl-D-aspartate (NMDA) receptors appear to be significantly affected compared to glutamate receptors as individuals age, resulting in an overall decline in its number and functionality.

And since ketamine works as an NMDA antagonist, it explains the lack of efficacy towards the geriatric population due to either of two things: (1) lack of NMDA receptors (probably due to degenerative changes), or (2) structural changes in the existing NMDA receptors rendering it nonfunctional.

Another study further disclosed that in the geriatric population, there was a documented inability to maintain an antidepressant response after a range of eight to 22 maintenance infusions. Although the study emphasized that there were only mild, transient, adverse effects noted, the population in the study specifically failed to show a sustained response towards the ketamine maintenance infusions. These treatment failures are not enough to dismiss the highly documented myriad of positive responses of patients towards ketamine infusions. There are more studies documenting the efficacy of ketamine infusions in addressing treatment-resistant depression than studies documenting failure of response to therapy. 

Ketamine infusions are a promising solution for treatment-resistant depression and its rapid onset of action continues to spark interest among medical practitioners to know more about all of its mechanisms of action. To date, there are only two known pathways accounting for the effects of ketamine resulting in rapid onset of action against depression and suicidal ideation.

Researchers believe there must be more pathways responsible for its effect. Continuing studies, ongoing positive feedback from these studies, and multiple success stories have cemented ketamine’s place in the medical world as part of a therapeutic plan for people with treatment-resistant depression.

To avoid unnecessary anxiety and worry whether to process with ketamine infusions or not (even when you are already advised by your physician to consider the therapy), here are a few things to consider:

Ketamine is not a simple fix for all your depressive symptoms, despite how promising most patient testimonials are.

Always remember that results for every patient vary: every patient is, after all, unique, and hence responses are also unique. The therapy must be viewed as something collective – the sum of all the parts – in order to fully realize what it has to offer. Although a lot of patients report the absence of depressive symptoms right after the first ketamine infusion session, this might not be the same case with yours. Follow your own personal therapeutic management plan given by your health provider, and be honest and cooperative enough to comply with all the monitoring and follow-up sessions that they encourage.

Ketamine Infusion therapy is not the primary choice of therapy for patients with depression.

First and foremost – ketamine is an adjunct to treatment, an aid, a support mechanism on top of currently prescribed therapy. It is not a standalone cure to your depression. Second, ketamine infusions are given as an alternative to patients who have refractory depression – patients who have not responded to initial modes of therapy such as antidepressants, psychosocial counseling sessions, and even electroconvulsive therapy. It is vitally important to recognize that these other modes of management exist, and they are prioritized before a patient is advised to receive ketamine infusion therapy. There are studies showing that ketamine infusions have a very robust effect, and full remission was noted specifically in TRD patients in just one to two hours.4 Therefore, patients with TRD should be the main target of therapy for ketamine infusions, as compared to non-TRD patients.

Ketamine infusions can have a significant impact on your budget, so be prepared.

There is a big possibility that your health insurance does not cover ketamine IV infusions. If covered, coverage and reimbursement may vary from company to company. Also, most patients require four to six infusions over a period of two to three weeks as part of the initial therapy, depending on the severity of your condition. The number of maintenance therapy sessions and the dosing will depend on your response, so make sure you comply with all the monitoring questionnaires and follow-ups recommended by the clinicians at The Injection and Infusion Clinic of ABQ.

Make sure you choose a Ketamine clinic that gives you assurance and peace of mind.

Clinics are not all equal. Many clinics are new and not yet well-established. Many clinics are only open part-time. Go for a clinic that is open most days, has already established its name and protocols in terms of ketamine IV infusions and look up reviews online. The Injection and Infusion Clinic of ABQ is proud to offer infusion therapy four days per week. It also has full-time staff working Mon-Fri.

Ongoing ketamine infusion therapy research.

This explains the numerous ongoing research studies and case studies for ketamine infusions, especially regarding the long-term effects of ketamine infusions among different populations. The lack of sufficient data on the specific subject might be the only thing hindering the full approval of ketamine for the treatment of depression.

Patient cooperation makes a big difference.

Always be honest with yourself, even though it can be challenging at times for a patient with depression. At the first sign of treatment failure, inform the staff at the clinic. In the same manner, if you have experienced improvement in your symptoms, notify us as well. Also be sure to keep your mental health provider updated. We recommend against discontinuing other antidepressants, but lower doses are often effective. Our thousands of infusions and over three years of experience has taught us that discontinuing other medications too soon, often leads to a relapse. This type of experience is one of the many reasons you want an experienced clinic. Be open about any symptom that might be bothering you. Comply with the questionnaires and follow-ups. The acknowledgement of your role in the solution of your problem is one of the many ways to keep your head above the water. Not only does it help your clinic assess whether they are on the right track or not, it also makes you feel good about yourself. You can write down in a journal your thoughts while having your sessions; reviewing it from time to time can give you a glimpse of how you are doing as a patient. We also recommend this because journaling at your best, helps you journey back on your dark days.

The Injection & Infusion Clinic of ABQ

It is incredibly important that ketamine infusions be viewed by its mechanism of action as a neuroregenerative agent, or as something that is continuously improving connections within the brain. Viewing it as such will spare patients from the expectation of getting a “quick fix” just by having a single infusion. Understanding it from that perspective enables the patient to acknowledge that recovery is a collaborative effort. Ketamine infusions serve as an adjunct therapy. And that healing takes time, and timelines vary from patient to patient. Treatment failure can happen. But maybe, it is just part of the battle that needs to be won. A battle that many have overcome and while fighting this battle against depression, make sure you or your loved one is given the best care. Book an appointment with Us.

Meta description: Albuquerque, NM -- Read more about these critical FAQs on Ketamine – safety, contraindications, and side effects. Get a pre-ketamine consult today!

FAQs on Ketamine Infusions

What’s the last resort when other antidepressants don’t work for severe depression?Ketamine intravenous (IV) infusion is a breakthrough therapy for people with severe or treatment-resistant depression (TRD). TRD is a condition where at least two adequate antidepressant treatments didn’t work. Ketamine infusion is fast-acting and safe. A single low dose infusion can have long term effects of up to 15 days. It’s also effective for people with TRD who exhibit symptoms of suicidal ideation.Depression is one of the most common psychiatric disorders in the world. It affects people of all communities. If left untreated, depressive symptoms can become chronic and disabling. It hinders a person from doing day to day tasks efficiently.A variety of medicines and psychosocial therapies are available to ease symptoms of depression. But treatment resistance was noted in about one-third of people who fail to achieve full recovery. Thus, there’s ketamine infusion therapy for TRD.The Injection and Infusion Clinic of ABQ offers Ketamine infusions for a better quality of life. If you qualify for IV ketamine therapy, or you are considering ketamine IV infusions, here are some frequently answered questions (FAQs) that we have for you:

What is Ketamine?

Ketamine is a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist mainly used in the field of anesthesiology. It works by blocking sensory perception in the patient and has been approved for use in anesthesia since the 1970s.

What are the uses of Ketamine?

Ketamine was originally used in veterinary medicine and for pediatric sedation. Aside from pain management, Ketamine has been noted to have bronchodilator effects (studied in the management of asthma exacerbations in children) and observed to be useful in cases of status epilepticus.The classification of ketamine as a dissociative agent makes it very effective as an analgesic Ketamine has been widely used to provide analgesia in burn dressing changes, during excision and grafting and for sedation, and even in prehospital or battlefield settings where resources are limited. It has been used off-label in the management of chronic pain and neuropathic pain.

Is Ketamine safe?

Yes. Ketamine has been used for more than 50 years as a potent analgesic with a safe anesthetic profile. Administering it in the right doses does not affect the airway reflexes nor does cause respiratory depression, making it a preferred drug for pediatric analgesia. It also does not lower blood pressure like most anesthetics.

How does Ketamine work in patients with depression?

In simple terms, depression results from imbalances in communication systems in the brain. Ketamine works bystimulating growth of neurons within the brain, allowing the different systems to communicate effectively with one another. Biochemically, ketamine is a non-competitive, glutamate N-methyl-d-aspartate (NMDA) receptor antagonist. NMDA-receptor antagonism is linked to the potentiation of glutamate transmission at α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptors and increased brain-derived neurotrophic factor (BDNF) levels, which are associated with antidepressant properties.It has been speculated though, that there are still other mechanisms that remain to be discovered regarding ketamine and TRD - such that studies are still being conducted further to hopefully uncover the exact mechanism responsible for the strong and sustained effect of ketamine infusions against depression.

New Ketamine Patients!

First-time patients must book a Pre-Ketamine Consult prior to your first infusion. This consult reviews your history and determines whether Ketamine is an appropriate treatment option.  Referrals are not required*, but you must be established with a mental health or primary care provider prior to starting treatment.

What medications interfere or interact with Ketamine?

Ketamine is very safe, but fortunately the drug interactions are only a few. Ketamine is noted to have synergistic effects on some drugs and may decrease the effectiveness of other drugs. People who are suffering from substance abuse or alcohol abuse are often prescribed benzodiazepines – which are known to decrease the effectiveness of ketamine. Specific examples of benzodiazepines are Ativan, Klonopin, and Xanax.Medical practitioners prescribe these drugs for anxiety, muscle spasms, and sleep disorders. However, benzodiazepines can delay and decrease the effects of ketamine if used in conjunction.On another note, people with epilepsy and bipolar disorders are often prescribed lamotrigine. Lamotrigine 150 mg or higher doses for bipolar disorder and seizures decreases the effectiveness of ketamine. Hence, lamotrigine decreases glutamate while ketamine increases it.Lithium stabilizes the mood of people with bipolar disorder. Unlike benzodiazepine and lamotrigine, lithium enhances the antidepressant effects of ketamine.

Should I stop taking my prescribed medications once on Ketamine therapy?

No. You should continue taking your medications as prescribed by your psychiatrist or mental health provider. After your consultation, we will guide on which medications may need to be adjusted and you can report these recommendations to your mental health provider.

If I have other medical conditions, can I still get ketamine infusion?

People diagnosed with psychosis are not allowed to undergo ketamine IV infusion. Ketamine may increase the possibility of dissociative episodes which may aggravate the symptoms of people with psychiatric disorders. Some medical conditions like arrhythmias make ketamine unsafe. Untreated glaucoma and untreated high blood pressure, must be corrected prior to starting ketamine infusions. If in doubt, schedule a free consult with one of our practitioners and they will guide you based on your individual circumstances.

Ketamine for Depression

Clinically-proven Depression treatment! The symptoms of Depression can place a massive burden on a patient and their family. Ketamine infusions offer hope for a major reduction in your depression symptoms.

What are the current routes of administration of Ketamine?

Aside from intravenous infusions, there are other routes of ketamine administration. These are intramuscular, nasal, oral, rectal, subcutaneous, and sublingual administrations.The most rapid method to deliver Ketamine is through the intravenous route. This also helps effectively regulate the delivery of the drug in its proper dose. Ketamine IV infusions have the fastest onset and recovery. They are also easiest to adjust the dose/rate throughout the infusion. Ketamine can also be given intramuscularly, however, higher doses are required as compared to IV infusions and the procedure can cause localized bruising at the IM site. The intramuscular route is well studied largely through its role and application in pediatric sedation, where intravenous access is usually difficult.8The most recent route of administration is through the intranasal route, which is the route of choice for esketamine, its enantiomer, in the treatment of TRD.

What should I expect during my Ketamine IV Infusion session?

Upon arrival at the clinic, you will be asked to do some standard paperwork. After processing payment, you are then ushered to the back of the clinic to start IV therapy. Once done, the nurse addresses your concerns, starts your IV and takes you to your infusion chair. Once you are settled comfortably, you will be set-up on the monitors and your ketamine infusion will be initiated. Please do not be afraid to raise any concern to the staff , especially your expectations on what you will be going through on your first session. During the infusion, most patients are noted to dissociate. This is entirely normal, and the staff will be there to monitor and guide you throughout the process. You will feel dreamy or light after several minutes, a mood that some call a “reflective state”. Please do not hesitate to call the staff’s attention once you feel uncomfortable during your infusion. Once the infusion is complete, you will be given time to rest and recover for 30 minutes. In the absence of any untoward effects, your IV line is then removed, and you will be discharged. The day following your infusion, expect to receive a text from us asking you how you are doing. Kindly respond as this is extremely important to monitor your response to the infusion. So, there you go! It will be so easy, and you can breeze your way through it! For a more detailed description, check out this video below so you can have an idea what to expect during your first ketamine infusion appointment at The Injection and Infusion Clinic of ABQ.

What are the possible side effects after getting Ketamine infusions?

Patients often report feeling “strange or loopy” within minutes of the start of the ketamine infusion, and resolves within two hours. There were also reports involving minor and temporary effects such as nausea, vomiting, dizziness, double-vision, drowsiness, restlessness, and confusion. When this happens, kindly call the attention of the staff assigned to you to assist you with your needs. Other than that, there were no serious drug-related adverse effects noted, no reports for dependency and tendency for recreational use, no significant cognitive or memory deficits noted within a three-month period of monitoring and follow-up. Thus, the best way to get your Ketamine IV infusion is through a professional clinic where you can be monitored by a healthcare professional, and you are given the right dose for your therapy. The Injection and Infusion Clinic of ABQ assures you that you are monitored well and given the safe dose, hence quality of care is not compromised.

Ketamine for Postpartum Depression

Postpartum depression affects up to 15% of mothers. The negative effects on child development are well-established. THANKFULLY, there is now a FAST-ACTING option.

Ketamine is also known as a club drug. Can frequent Ketamine infusion sessions get me addicted to Ketamine?

Ketamine as a recreational drug was first reported in the 1970s. “K-hole”, “Super K”, or “kai-jai” are some of the terms associated with ketamine. The misuse of ketamine as a club drug increased at the turn of the century.As a therapeutic substance, you will be unlikely to get addicted to it since the dosage and frequency of infusion is controlled at low and specific doses. Moreover, chances of addiction are nil unless you are self-medicating. 

Ketamine is FDA-approved (for anesthesia) but is used off-label for depression. What does this mean?

Ketamine has been approved since the 1970s for anesthesia purposes. However, it does not mean that because it is “off-label’ for depression, it can’t be used safely for this indication. It only means that the drug manufacturer can’t advertise for its use in depression.Take for example, aspirin is FDA-approved for fever and pain, but is widely used off-label for preeclampsia, emergency management of stroke or a heart attack, and even prevention of blood clots in people who have atrial fibrillation. Off-label only indicates that it is not FDA approved for depression, but a significant amount of research and data already shows that it is effective and safe, and has already been used widely by doctors and medical health professionals as an adjunct to current therapeutic methods

How long will each ketamine IV infusion session last?

The standard regimen followed at The Injection and Infusion Clinic of ABQ is six infusions spread over two to three weeks. Adjustments are made based on individual response. Though randomized controlled studies have documented responses even on the first day of infusion. Our experience in the clinic is that most patients have a response by the fourth infusion. When this occurs, remaining infusions are then spaced out a bit longer (e.g. instead of the 5th infusion occurring in two-three days, we postpone it to five or even seven days). Take note however that the number of sessions for each patient are extremely variable and is based on patient response and preference. We highly encourage you schedule counseling in between sessions, so you can unpack your experiences. Here at The Injection and Infusion Clinic of ABQ, we are highly committed to give you the best experience.

Ketamine for Post-Traumatic Stress Disorder (PTSD)

Studies has shown that a single 45-minute Ketamine Infusion can produce rapid reductions in PTSD symptoms as measured by the Clinician-Administered PTSD Scale to increase the duration of effect a series of 6 infusions.

How long will each Ketamine IV Infusion session last?

Ketamine infusions for mental health are administered over forty minutes. The approximate recovery time is about thirty minutes (this is on a case to case basis – some patients take longer time to recover). All in all, most patients can expect to spend almost two hours in the clinic from the start to the end of the infusion session.

Do I need to bring someone with me to my sessions?

You can come on your own. And most of our patients prefer this. However, you may bring someone to sit with you. Since we encourage “letting go” during a ketamine infusion, we have observed that having a friend or family member can interfere with that process. You are not advised to drive right after a session for safety reasons. You need to plan for your ride prior to the start of your ketamine session. Most of our patients have us call their ride once they enter recovery. Uber or Lyft is also allowed. Kindly inform the staff of your after-recovery plan before the start of the session.

Can I eat prior to a Ketamine IV infusion session?

You will be advised to not eat six hours before your scheduled therapy. Nausea and vomiting happens in about 50% of patients during and after the therapy. You can however drink clear liquids up to two hours before the session. If nausea or vomiting happens, you will be given Ondansetron (Zofran) IV as needed. Ondansetron is also given prophylactically if a particular patient is known to experience nausea.

Schedule a FREE Ketamine Consult now!

Your comfort is our utmost priority at The Injection and Infusion Clinic of ABQ. We hope this helped. If you are ready to start or if you have questions, schedule a free consult with The Injection and Infusion Clinic of ABQ.

Ketamine in History

Ketamine has been used for years now as a therapeutic substance for Treatment-Resistant Depression (TRD). ​

The National Institute of Mental Health reported an estimated 11 million US adults suffered at least one major depressive episode in 2017 alone. Depression is real and it won’t go away on its own. 

Pharmaceutical companies have developed antidepressants and medical procedures over the years. Medicines though react differently with each person. Some get relief from their symptoms, while others do not.

10 Historical Facts About Ketamine

• 1956: The pharmaceutical company Parke-Davis in Detroit, Michigan, USA synthesized phencyclidine (PCP) as a general anesthetic (Maddox et al., 2013). Its trade name Sernyl was a powerful anesthesia. Its production was later discontinued due to its many side effects.
• 1962: The original form of ketamine or CI-581 was synthesized as a short half-life derivative of PCP or (R, S)-ketamine (Domino, 2010)
• 1964: Dr. Edward Domino and Dr. Guenter Corssen performed the first study of (R, S)-ketamine in humans. They studied the anesthetic effects of CI-581 on healthy volunteer-prisoners. The prisoners reported feeling disconnected from their bodies. They felt as if they were floating. Later, Ketamine was dubbed as a dissociative anesthetic because of this sensation.
• 1965: Ketamine was confirmed as an effective anesthetic and analgesic (Domino et al, 29165)
• 1970: The U.S. FDA approved ketamine as an anesthetic and analgesic. It was used as a field anesthetic by Vietnam soldiers during the US-Vietnam war. During this decade, studies explored the properties and anesthetic and analgesic effects of ketamine for therapeutic purposes (Tyler et al., 2017)
• 1978: Starting in 1978 and onwards, ketamine became a Class III substance of the US Controlled Substances Act.
• 1983: Ketamine was confirmed as an N-Methyl-D-aspartate receptor (NMDAR) antagonist (Anis et al., 1983). NMDAR antagonists are used as anesthetics for animals and humans. It causes a trance-like state. A study pointed out that ketamine had pain relief and sedation properties.
• 1985: The World Health Organization included ketamine as a safe intravenous anesthetic in the Model List of Essential Medicines
• 2000: Researchers conducted the first double-blind placebo control study of (R, S)-ketamine as an anti-depressant. It showed rapid-acting and sustained anti-depressant effects in a patient suffering from major depressive disorder (Berman et al., 2000)
• 2019: The U.S. FDA and European Commission approved (S)-ketamine nasal spray for TRD

Ketamine 101: What It Is, Best Uses and Applications

How exactly does Ketamine work? What are these mental health disorders and how can ketamine administration help? Get to know Ketamine better!

10 Myths on Ketamine Busted

Myth 1: Treatment-Resistant Depression (TRD) is a hopeless case

There are various therapies for TRD. Mental health clinicians prescribe antidepressant medications for TRD. These medications are divided into groups or classes. These are selective serotonin reuptake inhibitors or SSRIs, serotonin-norepinephrine reuptake inhibitors or SNRIs, norepinephrine, and dopamine reuptake inhibitors, tetracycline antidepressants, tricyclic antidepressants, and monoamine oxidase inhibitors.You may be prescribed a medication in one of these classes. If it doesn’t work, you may be given another medication from a different class. If this still doesn’t work you will be given a combination of medications from other classes. Your mental health clinician can also recommend a combination of an antidepressant with a different kind of medication. This is called augmentation therapy. These medications are lithium, antipsychotics, and dopamine. Other than medications, Cognitive Behavioral Therapy (CBT) has been studied as an effective adjunct to medications. The Mayo Clinic also listed psychotherapy, dialectic behavioral therapy, and psychodynamic treatment to name a few (Mayo Clinic, n.d.). Medical procedures are also an option. These are vagus nerve stimulation (VNS), electroconvulsive therapy (ECT), and repetitive transcranial magnetic stimulation (rTMS). Ketamine intravenous infusion therapy has become the last resort when medications and procedures fail. Why is this so? Read Myth no. 2 for answers.

Myth 2: Ketamine doesn’t work for TRD since it’s just an anesthetic

Yes, Ketamine is an anesthetic and pain reliever. It’s an off-label drug for TRD. Ketamine is made up of two enantiomers or a pair of molecules These are R- and S-ketamine. A study found out that both enantiomers showed rapid and long-lasting effects. R-ketamine appeared to be potent and safe relative to S-ketamine because it exhibited no psychomimetic side effects.Spravato is an S-ketamine nasal spray that was recently approved by the FDA for TRD. Ketamine used for infusion is an off-label use of racemic ketamine, meaning it has both the left and right isomer of the drug. There have been a lot of studies conducted on the efficacy and safety of ketamine IV infusion therapy.It has been shown that ketamine had rapid antidepressant effects even for ultra-resistant depressed people. Researchers found out ketamine is safe and well-tolerated.It is effective as a maintenance therapy, too. Researchers revealed that repeated once-a-week infusions of ketamine had cumulative and continued antidepressant effects.

Myth 3: Ketamine is a horse tranquilizer not suitable for people.

Veterinarians sedated horses and other animals with ketamine. It goes way back to the 1960s. It’s also suitable for people since for so many years, it has been used as an anesthesia and pain reliever. For animals, veterinarians may inject higher doses to reach a desired effect. Horses are infused with 2.2 mg ketamine/kg bodyweight.Ketamine infusion for people with TRD comes in small doses at 0.5 mg ketamine/kg body weight.

Myth 4: Ketamine is just a party drug

In the 70s, ketamine became popular as a club drug in Europe and the US due to its psychedelic or euphoric effects (Wolff, 2016). One of its popular street names is “K”. In large doses, users of ketamine abusers reported a sensation of falling into a deep and dark hole. Ketamine as a recreational drug is illegal. It is considered a regulated drug by the Drug Enforcement Agency.Its medical use is legal. The government allows ketamine therapy for TRD under the strict supervision of certified healthcare professionals. Ketamine is given to people with an appropriate controlled dosage in a healthcare facility, such as the Injection and Infusion Clinic of ABQ. Its ketamine-certified staff has administered more than 2,000 Ketamine infusions since 2017. 

Myth 5: Ketamine mixed with alcohol produces better results

Ketamine with alcohol does NOT maximize the desired effect. Mixing ketamine and alcohol is dangerous. A study showed that combining ketamine and alcohol may result in over-intoxication. The potential overdose can lead to memory loss, coma, and even death. The combination of both substances causes impairment of your motor coordination and reflexes. This can lead to minor to serious injuries.

Myth 6: Ketamine makes you crazy or psychotic!

FALSE. Ketamine will not make you crazy or psychotic unless you have a pre-existing psychiatric disorder. This is why people with psychiatric disorders are not allowed to undergo ketamine therapy. Because there is a possibility that ketamine may aggravate the present mental disorder. In typical circumstances, it may induce momentary hallucinations that are within safe limits and reversible. Healthy participants in a study reported hearing voices and music as hallucinations at a moderate dosage. These visual and auditory perceptions are temporary and don’t persist after the therapy. No valid basis has been reported about ketamine as a cause of mental illness.

Myth 7: Ketamine leads to addiction

Any drug has the potential for addiction, not just ketamine. The key here is responsible usage. According to the United Nations Office of Drugs and Crime in 2014, PCP derivatives or new psychoactive substance such as ketamine misuse is only at 1%.Ketamine creates feelings of calm and detachment. It becomes pleasurable for some people to the extent of seeking a repeat experience. This makes it a potential for psychological dependence or abuse. This happens at higher doses, which is unlikely in a medical setting or under a controlled environment. Addiction can exist if you take ketamine without medical supervision, which is illicit. Ketamine does NOT cause physical dependence, like opiates or benzodiazepines

Myth 8: Ketamine is for adults only

Adults 18 years and above have undergone ketamine IV infusion therapy. They have been subjects of many studies that resulted in positive outcomes. There’s only a little information about the efficacy of ketamine to adolescents with TRD. But these are promising.There’s a study conducted among 12-18 teenagers with TRD who were administered six doses of 0.5 mg/kg of ketamine. Ketamine infusions were tolerated with fleeting dissociative symptoms. The researchers concluded that ketamine may have a potential role in treating adolescents with TRD. They recommended further studies would be helpful to validate the dosage and long-term effects. A more recent pilot study used ketamine to see if there are any behavioral or neural changes among adolescents with TRD. And to find out if these changes are related to the improvement of symptoms. The study reveals that behavioral and neural findings were related to clinical improvement in adolescents with TRD.

Myth 9: Ketamine should not be used since there’s Electroconvulsive Therapy (ECT)

According to Dr. Amit Anand, Electroconvulsive Therapy (ECT) has been considered as one of the best therapies for TRD. Across the Life Span program in Cleveland Clinic, Ohio. He is the head of an ongoing study to compare ECT and ketamine in treating major depression among people who have not responded to antidepressant medications.ECT is known to cause memory loss. This is not a side effect of ketamine, making it a more attractive option to many patients suffering from TRD.Ketamine for TRD has been acknowledged and is an accepted healthcare practice. Each therapy has its pros and cons. The fact is, individuals react differently to medicines and procedures. The best therapy for one may not be the best for another. 

Myth 10: Ketamine is a stand-alone therapy for TRD

Not really. A study of 16 participants with TRD showed that Cognitive Behavioral Therapy (CBT) may bolster ketamine’s antidepressant effects.CBT is a psychological method deemed effective for depression and other mood and substance dependency disorders. It may be combined with ketamine IV infusion therapy. Its goal is to change thinking patterns through various strategies. It enables a person to recognize biases and rethink them in a more rationally. It allows the person to use problem-solving skills in difficult situations and learn ways of boosting one’s confidence. CBT is performed by a certified therapist just like ketamine is administered by a certified clinician.

Want to Know More About Ketamine Infusion?

At the Injection and Infusion Clinic of ABQ, we have noted that patients have the best outcomes with regular boosters AND at least one other medication. Since ketamine is so different than SSRIs or SNRIs, this makes sense that two classes of medication would have synergistic effects.

Visit us or give us a call at 505-445-4300. Our certified ketamine clinicians are happy to answer your questions. 

Albuquerque, NM -- Check out these Ketamine benefits and how it works for depression, anxiety, and post-traumatic stress disorder. Get a Pre-Ketamine Consult now!

What is Ketamine?

Ketamine was first introduced in the 1960s as an anesthetic. Known to produce dissociative general anesthesia, it is commonly used in surgical and obstetric procedures.

As ketamine does not compromise the functions of the heart and lungs, it is widely used in the field of critical care and pain medicine.Besides it’s use in treating medical patients, it is also sought out for it’s psychedelic effects. Users who take ketamine at low doses experience hallucinations, sedation and an “out of body experience”.

Those who are familiar with ketamine recreationally may also know it as “Special K”, “Cat Vallium” & “Super Acid”. Consequently, people who take ketamine in high doses are prone to develop bladder problems, loss of consciousness and schizophrenia-like symptoms. The recreational use of ketamine, does not negate its medical usefulness.

How exactly does Ketamine work?

Studies show that ketamine works by binding to multiple receptors in the brain. One of these includes its ability to bind to opioid receptors, which provide pain relief.Ketamine also has an affinity for the NMDA receptor, where it functions as an antagonist. The excitatory neurotransmitter glutamate primarily binds to the NMDA receptor, which plays a role in stress management.Ketamine also binds to the AMPA receptor - a part of the glutamate neurotransmission which sends signals between nerve cells. It is unclear how ketamine provides antidepressant effects in addition to its anesthetic and pain relief properties.

Researchers postulate that it may be due to its ability to bind to many different receptors and affect many parts of the body. Imaging studies of the brain show that ketamine administration increases activity in the anterior cingulate cortex and signaling in the prefrontal cortex. These outcomes are correlated to ketamine’s rapid antidepressant properties.Ketamine has proven itself to be a valuable drug in the field of medicine. It’s use as an anesthetic agent and pain relief medication make it valuable in many various medical fields. In the past decade, studies consistently highlight its role in the treatment of mental health disorders.

What are these mental health disorders and how can ketamine administration help?

Ketamine for Depression

Depression is characterized by the following symptoms:

• A persistent loss of interest
• Depressed mood with sleep disturbances
• Fatigue
• Feelings of worthlessness
• Guilt
• Suicidal ideation (thoughts)

According to the National Institute of Mental Health (2019), in 2017, a major depressive episode affected approximately 17.3 million adults in the US. Only 65% of these people received professional medical treatment, while 35% did not receive any treatment at all. As the exact mechanisms of major depressive disorder are unknown, current available treatments are limited in its efficacy.Treatment-resistant depression is also increasing in incidence. In a clinical trial involving more than 2000 patients with depression, researchers monitored the symptoms and medication intake of participants for 6 weeks. The prevalence of patients with treatment-resistant depression was found to total 55%.Earlier studies have also shown promising results from IV infusion of ketamine. Patients with major depression were injected with 0.5mg/kg of ketamine, which resulted in significant improvement after only 3 days. The patients reported improvement in the two most prevalent symptoms of depression: loss of interest in activities and depressive mood.

Over the years, many studies have been conducted on the efficacy of ketamine as an antidepressant. In 2019, a single dose of IV ketamine was shown to improve severe depression and anxiety symptoms within 1 hour of administration. This effect was sustained when followed by 5 more doses in the course of 2 weeks. After a month of administration, the overall severity of depression also decreased.Researchers have also examined the effects of IV ketamine administration after childbirth. Postpartum depression - also known as “baby blues”, is characterized by feelings of emptiness, sadness and anxiety after pregnancy. In one study, a group of mothers was given a low dose of IV ketamine after childbirth. The prevalence of postpartum blues and depression was lower compared to the group that did not receive any.Perhaps the most significant effect of ketamine is its effect in suicidal ideation. Suicidal ideation is considered a psychiatric emergency, as there is currently no known medical treatment for it.

In a study involving more than 100 patients with treatment-resistant depression, one subanesthetic dose of ketamine was administered for 40 minutes. After 3 hours, the participants answered several questionnaires assessing their depression severity and suicidal ideation. The group that received the ketamine infusion showed less tendency towards suicidal ideation.Ketamine’s rapid and sustained properties have earned it the title of “miracle drug”. Despite its many benefits, it is important that patients do not attempt self-medication. As it is a potential drug of abuse, administration requires the supervision of an experienced professional in a clinical setting. For those that prefer to stay away from needles, the ideal therapy for depression also requires a multidisciplinary action involving a psychiatrist, in conjunction with other medications and cognitive behavioral therapy.

Ketamine for Anxiety

Generalized Anxiety Disorder (GAD) is a common chronic disorder that affects the adult population. It is defined as persistent, uncontrollable worrying and anxiety that causes notable distress and impairment in daily functioning. GAD affects all aspects of a person’s life - including their work and personal relationships. Standard treatment for GAD is a combination of cognitive behavior therapy and oral medications.

From initial studies that highlight the effects of ketamine for depression, researchers postulate that it may also benefit those with anxiety. This is due to the similarities in brain network activity for patients with depression and anxiety.One study involved 12 patients with treatment-resistant generalized anxiety disorders. Subcutaneous ketamine at low doses was administered to these patients at weekly intervals.

After just an hour of administration, the patients reported a reduction in anxiety that persisted until the end of the week. There were no adverse effects for this group of patients. Hence, the study concluded that ketamine can also be a potential medication for treatment-resistant anxiety disorders.

Another type of anxiety disorder ketamine can improve is Social Anxiety Disorder (SAD). SAD, or social phobia is characterized by uncontrolled fear of embarrassment, humiliation and scrutiny in public areas or situations. This fear is so excessive that it can lead to significant impairment in daily functioning. Researchers estimate that approximately 3-7% of adults in the US suffer from Social Anxiety Disorder.

Many patients with social anxiety disorder do not respond well to the current available treatments for anxiety. In one trial involving 18 adults diagnosed with SAD, researchers administered IV ketamine at 0.5mg/kg for 40 minutes. Compared to the control group, the social phobia and other anxiety-related symptoms of this group improved remarkably after 2 just weeks.

Ketamine for PTSD

Post-traumatic stress disorder (PTSD) is a disabling and chronic condition that often manifests after a traumatic incident. People with PTSD  are prone to re-experiencing traumatic events, as well as possess avoidance and hyperarousal symptoms. They can also exhibit combative and detachment symptoms when triggered by something related to the inciting event. PTSD often occurs concurrently with other psychiatric conditions such as depression, alcohol abuse and anxiety.Given the proven effects of ketamine in treating anxiety and depression, the possibility that it can also be used to treat PTSD was explored. In one study, 30 US army veterans with PTSD were given six 1-hour ketamine infusions.

Their depressive and PTSD symptoms were assessed using validated questionnaires. From the questionnaire, researchers discovered that the score for both depression and PTSD symptoms decreased after the ketamine infusions. They postulated that inducing a transpersonal dissociative experience alongside intravenous high-dose ketamine was what produced the desired effects.

In another study involving patients with both PTSD and major depressive disorder, researchers administered 6 ketamine infusions at 0.5mg/kg every Monday, Wednesday and Friday. After 8 weeks, data showed a remission rate of 80% for PTSD and a 93.3% response for treatment-resistant depression. The effect for PTSD was found to have been sustained for more than a month, with no adverse effects or worsening of symptoms in the participants during the study. As a result, researchers concluded that ketamine infusions administered in a clinical setting can be beneficial for patients with PTSD and treatment-resistant depression.Even today, the exact role of ketamine in PTSD is an active field of study. As researchers continue to study the effects of ketamine, we may discover more information regarding the optimal dose, administration and indications of Ketamine for PTSD.

Currently, the FDA approves the use of ketamine for the treatment of depression at a specific dose and route, under the supervision of a healthcare provider.

One aspect that is important is the method of ketamine administration. During clinical trials, researchers often used ketamine infusions or intravenous ketamine (inserting a needle into the vein). As you’ll soon discover, how ketamine is administered is just as important as what it is used for.

IV vs Oral Ketamine

Ketamine can be administered through an intravenous, intranasal, subcutaneous, or oral route. One study explored the effects of oral ketamine, and it’s ability to exert it’s same rapid and sustained antidepressant properties. After collating several studies that used oral ketamine, researchers came to the following conclusion:

1. The reduction in depressive symptoms manifested only after 2-6 weeks of taking oral ketamine, as compared to IV ketamine which only takes hours.
2. Oral ketamine does not decrease suicidal ideations.
3. Oral ketamine does not demonstrate improvement in treatment-resistant depression.

The authors of these studies claim that more relevant studies are needed for a robust conclusion. Omitting these claims, ketamine infusions are found to be more effective for treatment-resistant depression and reducing suicidal ideations, when compared to oral ketamine.

Some authors also add that oral ketamine is not palatable. It also has a much higher incidence of nausea. This is due to peak plasma levels not being as high as IV administered ketamine, as it would have to undergo hepatic metabolism if taken orally. Intranasal administration of ketamine can also pose several problems, as variations in the structure of the nasal cavity can affect the efficacy. Patients might also find it difficult to administer the medication themselves, which can affect the outcome.

Furthermore, because ketamine infusions are performed in a clinical setting, healthcare providers can monitor vital signs and respond as needed. This addresses complications immediately and allows the patient to focus on the experience.

Ketamine is regarded as a miracle drug in the field of healthcare. Studies have shown it to have a positive outcome on patients suffering from depression, anxiety, chronic pain, and PTSD. By binding to multiple receptors in the brain, ketamine’s effects are found to be long lasting and effective at treating mental health disorders.

The Injection and Infusion Clinic of ABQ can provide Ketamine infusions to patients!

Our team of clinicians are experienced in handling ketamine. We have completed over 2,000 infusions since 2017. We are active members of the American Society of Ketamine Physicians, Psychotherapists & Practitioners. If you’re thinking about using ketamine for medical treatment, visit us here to learn more about ketamine infusions and how it can benefit your mental health.