Ketamine infusion therapy is an innovative treatment that targets the symptoms of chronic pain conditions, depression, and even post-traumatic stress disorder (PTSD). At his office in the West Ashley community of Charleston, South Carolina, Stephen Gibert, MD, offers ketamine infusions to treat a variety of pain conditions and mood disorders. To schedule an appointment with an experienced pain management specialist, call Stephen Gibert, MD, or book a visit online now.
Ketamine is a drug developed in the 1950s which is used as an anesthetic for surgery. When used as an anesthetic, ketamine is administered in high doses, providing profound pain control and deep anesthesia.
Ketamine infusion is an entirely different procedure in which a very low dose of ketamine is infused by IV over an extended period, usually 40 minutes to an hour. The patient remains conscious, and in fact, awareness is usually increased.
Ketamine infusion is effective for what is known as treatment-resistant depression (TRP). Treatment-resistant depression is defined as depression that has not responded to the usual treatment consisting of selective serotonin reuptake inhibitors (SSRIs) along with talk therapy. In the past, when depression persisted despite an adequate trial of these treatments, the only option was electroshock treatment. Many studies have now shown that ketamine infusion is as effective as electroshock without all the associated side effects. It is well-known that electroshock therapy can result in amnesia even for well-established memories as well as inhibit the development of new memories. Ketamine infusion does not suffer from this problem. There are other more subtle cognitive impairments associated with electroshock, which limits its use to the most extreme cases. Because ketamine infusion is not associated with cognitive impairment, and because it is easier to administer and less costly, it can be used to treat people in whom electroshock would be undesirable. Experience shows that it may even be the majority of cases that are treatment-resistant and at the same time too mild to warrant electroshock. Thus ketamine is likely to change the treatment of depression dramatically. The many people for whom standard therapy does not work but who do not want to undergo electroshock therapy now have an option.
Ketamine infusions have been successfully used to treat persistent PTSD symptoms.
In some patients, ketamine infusions are effective in treating CRPS, although lidocaine infusions have shown more consistent results.
Pain from nerve injury or disease has responded to ketamine infusions when other treatments have failed.
Fibromyalgia leads to widespread pain in your muscles, joints, and bones. While health experts don’t fully understand what causes the condition, they believe that changes in the peripheral and central nervous system lead to a hyperresponsiveness of pain sensation.
Ketamine infusion can be done in the doctor’s office with basic monitoring equipment. An IV is started and ketamine is infused over a period of about 40 minutes in a quiet environment. The patient remains conscious and able to converse. Blood pressure, heart rate, ECG, and oxygen saturation are monitored. The patient is observed for a short time following the infusion and is driven home by a companion. Patients generally find the experience very pleasant and there is usually the dramatic improvement of depression symptoms the same afternoon. It has been found that the antidepressant effects wear off in about a week for most people and for that reason the infusion is repeated after one week’s time, usually for six weeks. After that in many cases, patients achieve long-term relief.
During the infusion itself, many people experience a kind of transcendental state. Many people feel as though they have realized a greater connection with other people. The antidepressant effects are almost immediate. There is some evidence that patients must achieve what is called a dissociative state in which they have a kind of out-of-body experience in order to get the full anti-depressant effects. There is controversy concerning this point; some studies show that the dissociative state is important for the antidepressant effects and some do not. In contrast to electroshock, there is good evidence that ketamine infusion actually improves cognitive performance. Because depression can interfere with cognitive performance it is not clear whether it is the ketamine infusion itself that has improved cognitive performance or the improvement of depression.
Because insurance companies are motivated primarily by the profit they have an incentive to resist paying for any new treatment. They justify this by calling the new treatment “investigational”. Most insurance companies have classified ketamine infusion as investigational and therefore do not pay for it. While ketamine infusion is less expensive than electroshock and has fewer side effects, unfortunately, it is the patient’s burden to pay for it. Another drawback is that the ketamine infusions have to do in a series, usually of six infusions, to have a prolonged effect. It is time-consuming in that the patient is not able to drive him or herself home after the infusions. Of course, electroshock has to be done in the hospital or a surgery center and also has to be repeated at varying intervals. Ketamine infusions should not be considered a one-time fix. It does require a commitment of time and money if good results are to be expected.
Many people require at least three ketamine infusions to reap the full benefits of this innovative treatment. During each treatment, Dr. Gibert administers low levels of ketamine through IV, while carefully monitoring signs and effects for your safety.
When compared to traditional treatments, such as antidepressants, and shock treatment, ketamine infusions have minor side effects. However, some people experience transient nausea, vomiting, loss of appetite, or vivid dreams on the day of infusions, but these are generally manageable.
Cognitive dysfunction, which is common following shock treatment, has not been demonstrated in studies, and in fact, some studies show improvement in clarity of thought.
Because ketamine infusions are safe and effective, you can resume your normal activities the day after treatment. You should avoid driving and operating heavy machinery until 24 hours after your treatment.