FAQs – Ketamine

Ketamine infusion can help people suffering from Treatment resistant depression, Anxiety Disorder, PTSD,  and Chronic pain, whose conditions have failed to improve with conventional treatment methods. The changes that Ketamine produce can be subtle, and it may take time for a patient to feel the full impact.  Some experience symptom improvement within hours; but, in the majority of cases, it may take up to 1 week to feel significant improvement. We expect to see a benefit in properly selected patients, however; it may not help everyone. The reality is that Ketamine allows patients to engage in healthy activities, which promote mental health and overall well being.

The mechanism behind how Ketamine works is still a matter of research, but current research demonstrates that it promotes growth of neural networks that were impaired due to resistant depression or chronic pain. Studies also show that it reduces inflammatory markers in the brain, leading to anti-inflammatory action throughout the brain. When pain persists for an extended amount of time, the brain begins to perceive that pain as more severe.  Ketamine works by preventing the pain stimulators in the brain and seems to decrease the amount of pain medication patients need to treat chronic pain symptoms.

Studies show ketamine infusions are safe and effective treatments for treatment resistant depression, PTSD and managing CRPS in both inpatient and outpatient settings.

Ketamine is administered in doses well below those necessary to anesthetize a patient.  There have not been any long-term side effects observed as a result of low dose intravenous Ketamine therapy.

Ketamine is a derivative of phencyclidine (PCP) and due to this property, it can cause hallucinations in some patients.  Patients will be given appropriate medication to control this dysphoria during infusion.  Other possible side effects can include nausea, blurry visual changes, effects of floating and in some, a headache and dizziness during an infusion.  You will be monitored closely and can be treated with other medications to make your infusion a pleasant experience. Patients are usually tired after a treatment and will need to be accompanied home by a responsible adult.

Side effects that may occur are limited to the time of the infusion, with no side effects between treatments.

Unlike opioids and other FDA approved analgesics, Ketamine is not a physically addictive drug.  As a street drug, it has been known to be psychologically addicting, but this can be attributed to higher doses and more frequent use than the clinic administers.

Historically, Ketamine has been abused as a recreational drug.  However, ketamine is used in much higher dosages recreationally than IV ketamine doses used to treat chronic pain, depression, anxiety, PTSD and psychiatric disorders.  Many other legal and safe anesthetic/pain management drugs are abused for recreational use; Ketamine is not unique in this manner.  As a highly trained professional, Dr. Chand administers individually tailored proper doses of Ketamine, under the proper conditions.

During your first appointment with Dr. Chand, you will discuss your medical and treatment history as well as the necessity of Ketamine infusion in your individual situation.  You will fill out depression and anxiety scales prior to the first treatment.  If it is determined that you are a good candidate for Ketamine infusions, we will order appropriate labs and schedule your first treatment session.

Any unmanaged medical condition could preclude you from Ketamine treatment.  These can include uncontrolled high blood pressure, any serious cardiac or respiratory conditions or pregnancy.

When you arrive for your infusion, your weight and vital signs will be recorded and used to determine the correct dosage of medication.  You may be given medications to minimize blood pressure changes and/or to treat anxiety or nausea.  An IV will be placed and the infusion, given over a 40-minute period, will begin.

Ketamine will not put you to sleep.  If you are already sleepy and are feeling calm and relaxed during the treatment, you might drift off to sleep.

Many find it helpful and relaxing to listen to music and to wear an eye-shade or sunglasses.  It can be difficult to carry on a conversation during the procedure; so, you are encouraged to sit back, relax and pay attention to what you are feeling.  Expectations coming into the treatment do affect the experience; so, it is helpful to decide ahead of time that you will be safe and will feel “weird” for a short time. Understand that these experiences are normal and will pass quickly, leaving you feeling much better.

The first 5 to 10 minutes are uneventful, with no noticeable effects.  Around 20 minutes into the infusion, people tend to notice some double vision and a feeling of lightness or floating.  There may be some numbness in the toes or around the mouth.  Other common experiences include euphoria, talkativeness, a disconnected feeling, heightened perceptions and a feeling that people often describe as “weird, odd, different, or interesting.” Some people may experience anxiety, a headache, nausea or sweating (towards the end).  These typically subside about 10-15 minutes after the infusion is complete and, in some cases, it may last for a total of 45-50 minutes.

You will be monitored post-infusion, for about 30 minutes, before you are released with a friend or relative who can safely drive you home.

You can expect to be with us for about 90 – 120 minutes from the time you arrive to when you leave, with no side effects at that point and none between treatments.  You will be provided with post procedure instructions and receive a call the day following your infusion to see how you are feeling.

On the day of your infusion, please do not eat solid foods, milk, pulp-filled juices or soup for at least six hours prior to your appointment.  You may have water and other clear liquids, Gatorade, apple juice, black coffee or tea up to two hours prior to your appointment.

Ketamine infusions produce a mental state which makes it unsafe for you to drive a car or operate heavy machinery for 48 hours after your infusion.  It is mandatory that a trusted friend or family member accompanies you to and from all your infusion appointments.

On average, 1 or 3 infusions are required to know if Ketamine will help, though sometimes a positive response may be delayed. Typically, a total of 6 infusion treatments are planned over a 2-week period; this frequency and duration can be altered to meet individual needs.

A typical treatment plan for CRPS/RSD includes a series of increasing Ketamine dose infusions over a 3-5-day schedule.  This is then repeated the following week.

More than one series of infusions may be required to achieve resolution of symptoms.

More days of Ketamine therapy in a row results in better symptom relief.  However, each patient is different; Dr. Chand will work with you to determine your individual treatment plan.  Some may do well with a less intensive treatment plan, while CRPS/RSD patients require a more intensive therapy.

Resolution of symptoms may last anywhere from 2 weeks to 3 months.

It is vital that Dr. Chand review your medication list prior to starting Ketamine infusion therapy.  Patients on MAOI’s should not take Ketamine and high doses of benzodiazepines will make Ketamine therapy ineffective.

Antidepressants and other psychotropic medications should be continued.

You should consult with your prescribing doctor prior to starting or stopping ANY medications.

Ketamine therapy is covered by Kaiser in Northern California, but mostly it is not a covered service by insurance currently.

Ketamine therapy is considered safe for OFF-LABEL use, as it was not originally used for these conditions.  Many medications have been discovered to be helpful in treating other diseases including Rogaine (Minoxidil), which was originally used to treat high blood pressure.  These, along with Ketamine, are not covered by insurance companies, Medicaid or Medicare.

• Evaluation/Screening/First Infusion – $400.00 ($800 for Chronic Pain)

• First Infusion: typical response in 4-24 hours, maximum effect at day 3 post infusion.

• Next five infusions: $2000 total, required for remission ($4000 for Chronic pain protocol).

• Maintenance infusion: $400 each($800 for chronic pain), not more than 1 per month, average every 4-8 weeks.

An 80% deposit is required when we schedule your infusion appointment.  The remainder of the balance is due on the day of your infusion.  All payments can be made by cash or credit card.  We accept Visa, MasterCard, Discover and American Express. We also accept CareCredit card. We cannot accept checks of any kind.

Our clinic is under no obligation to pursue reimbursement on the patient’s behalf from your insurance company.  We will provide you with documentation of your infusion visits, insurance codes and treatment plan.  It is between you and your insurance company how much, if any, will be reimbursed to you.