Ketamine Infusion is one of the latest modalities currently researched for use in Psychiatric disorders. Although traditionally used as an anaesthetic, Ketamine is now gaining popularity for use in Treatment Resistant Depression and Post Traumatic Stress Disorder (PTSD). Ketamine infusion is not currently FDA approved for treatment, although it is now widely used as an off label treatment.
Ketamine infusion is commonly used for patients with Clinical Depression and Post Traumatic Stress Disorder (PTSD). It is most suitable for those who have not responded to other treatments for the indications listed above.
How Does Ketamine Infusion Work?
Ketamine exerts an antidepressant effect through a completely different mechanism from traditional antidepressants. This is why Ketamine may be able to help people successfully manage depression when other treatments have not worked.
One target for ketamine is NMDA receptors in the brain. By binding to these receptors, ketamine appears to increase the amount of a neurotransmitter called glutamate in the spaces between neurons. Glutamate then activates connections in another receptor, called the AMPA receptor. Together, the initial blockade of NMDA receptors and activation of AMPA receptors lead to the release of other molecules that help neurons communicate with each other along new pathways. Known as synaptogenesis, this process occurs through a process called gene expression, and likely affects mood, thought patterns, and cognition.
Ketamine also may influence depression in other ways. For example, it might reduce signals involved in inflammation, which has been linked to mood disorders, or facilitate communication within specific areas in the brain. Most likely, ketamine works in several ways at the same time, many of which are being studied.
Because of its effects on receptors that a are part of the “pleasure pathway”, Ketamine is also being researched for use opioid, alcohol, and more recently, cocaine dependence.
What Do I have To Do During And After The Session?
Make sure you have cleared your bladder
Lie down in a relaxed position
On the day of your session, you’ll meet with one of your care providers who will walk you through the treatment process. When you are at treatment facility, it’s time to relax. You can use your mobile phone and headphones while you receive your treatment. Each infusion session last 45-60 minutes and is closely monitored.
After your session is complete, the medical staff will assess you before you’re clear to go home. You will typically go home 1-2 hours after the infusion session is over.
Note that you are cautioned against driving or using any intoxicants like alcohol or drugs for 12 hours after each treatment.
Will It Have Any Side Effects?
You can expect the following side effects during the course of the treatment:
>10% of patients
Nausea and vomiting
Hypertension
Increased cardiac output
Tachycardia or increased heart beat
Visual hallucinations
Vivid dreams (dream like experience)
Dissociative anaesthesia (out of body sensation)
1-10% of patients
Bradycardia
Diplopia
Hypotension
Increased Intraocular pressure
Injection-site pain
Nystagmus
<1% of patients
Anaphylaxis
Cardiac arrhythmia
Depressed cough reflex
Fasciculations
Hypersalivation
Increased metabolic rate
Hypertonia
Laryngospasm
Respiratory depression or apnea
Are There Any Conditions In Which Ketamine Infusion Is not Administered?
Ketamine infusion is used with caution in the following conditions:
Allergy to Ketamine
Alcohol intoxication
Illicit drug use
Decreased lung function
Delirium
Elevated intracranial pressure and space-occupying lesions in the brain
Recent myocardial infarction (within the last 3 months)
Severe arterial hypertension
Narcotic intolerance
Any Metallic Brain Implant/Cardiac Pacemaker
Intracranial lesions including infarction, haemorrhage, aneurysms, trauma, tumours like angioma and dementia
Cochlear implant in situ
History of post ECT delirium
Recent brain injury, infection, stroke or haemorrhage
Organic brain lesions, cerebral space occupying lesions but without raised intracranial pressure
Unstable angina
Poorly compensated heart failure
Valvular disease
Bradycardia or heart block
Epilepsy—risk of inducing status epilepticus
Retinal detachment and glaucoma
Asthma and chronic obstructive pulmonary disease
Thrombo-embolic disease and pulmonary embolus.
Pregnancy
How Often Do I Need To Attend Sessions?
Ketamine infusion sessions can be scheduled according to your availability and preference. Presently, guidelines recommend a minimum of 2-3 sessions per week, for a maximum of 6 weeks, in order to see therapeutic benefit.
When Will I See The Benefits?
Some people report feeling some positive effects as early as 1 or 2 sessions, but for most people it tends to take longer. A review of your symptoms is done after every 5 sessions or earlier, to see objective and subjective signs of improvement.
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