IV & IM KETAMINE
We have found that certain patients prefer the security of knowing that the IV route has been more studied or offers greater control over the amount or rate of ketamine administered since an IV infusion can be slowed down or stopped. Other patients prefer the simplicity of a single injection over a 40-minute infusion. Since our experience has been that patients who receive IV and IM tend to fare similarly, we offer the choice of route of administration to the patient to decide for themselves.
Most research on ketamine for mental health issues has been on the intravenous (IV) route of administration. As a result, if we are to practice evidence-based medicine, we would recommend most patients receive ketamine in the way it was studied via IV infusion. However, some psychiatrists developed a method of administering ketamine via intramuscular (IM) injection, citing its simplicity and no burden of maintaining IV access that some find uncomfortable or distracting. They also cite the bioavailability, the amount of medication administered that actually enters the bloodstream, of IV and IM are quite similar: 99 vs. 95%, respectively. Because these two methods have not been compared in a head-to-head study, no one can definitively state that IV is superior or that IM is inferior, but it cannot be argued that IV has more evidence supporting its use for now.
THE KETAMINE THERAPY EXPERIENCE AT THE MENTAL HEALTH CENTER
We pride ourselves on facilitating the highest quality psychiatric care for various issues, including depression, anxiety, post-traumatic stress disorder, bipolar depression, obsessive-compulsive disorder, thoughts of self-harm, and addiction. Unlike most other clinics that offer ketamine treatment, we work with subspecialty fellowship-trained psychiatrists. This means in addition to general adult psychiatry, psychiatrists affiliated with us are trained in subspecialties such as mood disorders, child & adolescent psychiatry, geriatric psychiatry, or addiction psychiatry. Psychotherapists affiliated with us are trained in Ketamine Assisted Psychotherapy (KAP) and many other modalities, are available to help our patients get the most insight and psychological benefit out of the non-ordinary state of consciousness (NOSC) that ketamine therapy creates.
Your first appointment will always begin with a comprehensive psychiatric evaluation via telehealth. Psychiatrists will discuss various treatment options during the assessment, including psychotherapy, traditional antidepressants or other oral medications, or ketamine therapy. Psychiatrists will also review your medical and psychiatric history, determine a diagnosis, and develop a treatment plan. If you have a history of a recent heart attack, stroke, psychosis (hallucinations, delusions), or bladder inflammation (cystitis), you may not be a candidate for ketamine treatment, or you may require clearance from your physician.
If you and your doctor mutually agree to proceed with ketamine treatment, you will schedule the ketamine treatment sessions, which require up to two hours in our office.
WAYS WE CAN GIVE KETAMINE:
- Infusion - an intravenous (IV) drip providing medication directly into the bloodstream over a period of 40 minutes
- Intramuscular (IM) Injection - a shot administered with a needle into one of your muscles (usually the shoulder)
- Spravato(R)/esketamine (nasal spray) - a mist absorbed through the nasal sinuses
The effects of ketamine vary with the route of administration and dose. Initial effects may include feelings of relaxation, warmth, openness, lowered defensiveness, empathy, and increased capability for introspection; this state is most conducive to Ketamine Assisted Psychotherapy (KAP). With higher doses, patients may experience an increasing disconnection from one’s body, which may even feel like an out-of-body experience or ego dissolution (loss of individual identity), with simultaneous deep feelings of love, peace, and joy. Research is being conducted to determine if feelings of dissociation predict whether a patient’s depressive symptoms will respond to ketamine therapy. Despite the “non-ordinary state” one enters with ketamine treatment, patients most often describe it as a positive and pleasant experience. The majority of these subjective effects of the medication, for all routes of administration, last 40-60 minutes, though the beneficial effects on mood persist from 1 week to several months. Since the greatest and longest-lasting benefit of ketamine comes with 6 treatments over a 2-3 week period, we ask patients to commit to at least 2 but preferably 6 administrations and then plan to return for periodic booster sessions every few weeks or months to prevent depression from returning. Driving after a treatment is not allowed until the next day since ketamine temporarily impairs coordination and balance. Please plan to get a ride home after your treatments from family, a friend, or a taxi or ride-sharing company.