Although my general psychiatric practice is often full, I can also see patients for ketamine treatments as a consulting psychiatrist. In these cases, patients come to me for ketamine treatment only and continue with their psychiatric clinician.
Before starting ketamine treatment, I meet with patients to evaluate whether ketamine is appropriate. I have done over two thousand IM and IV treatments over the last few years and now am much more able to predict who will benefit.
Predictors of a positive response include severity of depressive symptoms (more severe symptoms = greater probability of improvement), depression with hypersomnia (oversleeping), bipolar and mixed depressive episodes, seasonal worsening, and suicidality.
Patients with hypertension, sleep apnea, or cardiac issues are often not good candidates for ketamine. Patients taking daily opioids or Suboxone/buprenorphine are not as likely to benefit from ketamine treatment.
Unlike many ketamine clinics which use a protocol of six low dose IVs over two or three weeks, I have found that I can usually get very significant improvement with two higher dose treatments within a one week period. I start patients with an IV or IM treatment at the dissociative threshold, followed by a higher dose fully dissociative treatment within the next week. This two treatment model is much less expensive and faster acting than the six IV/low dose model and more quickly reveals whether ketamine is going to be effective.
Ketamine responders appear to fall into three groups:
- Some patients will need 2-3 treatments and then return to their usual outpatient treatment.
- Those in the bipolar spectrum will typically complete 2-4 treatments in the fall/winter transition.
- A final group with chronic treatment resistant depression or PTSD will often benefit from monthly maintenance treatments.
After treatment, patients often say things like:
“Life doesn’t seem so hard. I can walk the dog. It feels like a weight has been lifted.”
“My mind feels cleaner, power washed; the darkness is gone.”
“The cobwebs in my brain aren’t there anymore. I can think, I can handle things.”
“The suicidal thoughts have moved way back. Quieted. I want to live.”
KETAMINE: 7 QUESTIONS
This mini-episode of my podcast, Back From the Abyss, explores some of the most frequently asked questions about ketamine:
What is ketamine?
How does it work?
Who responds best to ketamine?
What is the ketamine experience like?
What is the best way to do ketamine treatments?
What are the side effects and risks?
Who definitely shouldn't do ketamine?
Ketamine IV (90min) — $425