Few pharmacotherapies have demonstrated sufficient efficacy in the treatment of posttraumatic stress disorder (PTSD), a chronic and disabling condition.
To test the efficacy and safety of a single intravenous subanesthetic dose of ketamine for the treatment of PTSD and associated depressive symptoms in patients with chronic PTSD.
Proof-of-concept, randomized, double-blind, crossover trial comparing ketamine with an active placebo control, midazolam, conducted at a single site (Icahn School of Medicine at Mount Sinai, New York, New York). Forty-one patients with chronic PTSD related to a range of trauma exposures were recruited via advertisements.
Intravenous infusion of ketamine hydrochloride (0.5 mg/kg) and midazolam (0.045 mg/kg).
The primary outcome measure was change in PTSD symptom severity, measured using the Impact of Event Scale-Revised. Secondary outcome measures included the Montgomery-Asberg Depression Rating Scale, the Clinical Global Impression-Severity and -Improvement scales, and adverse effect measures, including the Clinician-Administered Dissociative States Scale, the Brief Psychiatric Rating Scale, and the Young Mania Rating Scale.
Ketamine infusion was associated with significant and rapid reduction in PTSD symptom severity, compared with midazolam, when assessed 24 hours after infusion (mean difference in Impact of Event Scale-Revised score, 12.7 [95% CI, 2.5-22.8]; P = .02). Greater reduction of PTSD symptoms following treatment with ketamine was evident in both crossover and first-period analyses, and remained significant after adjusting for baseline and 24-hour depressive symptom severity. Ketamine was also associated with reduction in comorbid depressive symptoms and with improvement in overall clinical presentation. Ketamine was generally well tolerated without clinically significant persistent dissociative symptoms.
This study provides the first evidence for rapid reduction in symptom severity following ketamine infusion in patients with chronic PTSD. If replicated, these findings may lead to novel approaches to the pharmacologic treatment of patients with this disabling condition.
clinicaltrials.gov Identifier: NCT00749203.
Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial.Feder A, Parides MK, Murrough JW, Perez AM, Morgan JE, Saxena S, Kirkwood K, Aan Het Rot M, Lapidus KA, Wan LB, Iosifescu D, Charney DS – JAMA Psychiatry – June 1, 2014; 71 (6); 681-8
etamine treatments can be an effective tool to treatments PTSD – with the possibility of immediate and lasting effects.
[A] single dose of IV ketamine was associated with rapid reduction of core PTSD symptoms– Feder Et Al. 2014
PTSD is often associated with veterans of the armed forces or emergency services personnel, but it also affects men and women and children of all kinds and from all walks of life – with an estimated lifetime prevalence of around 7% of all adult Americans. PTSD can result from car accidents, abuse, or traumatic incidents of any kind. Experiencing trauma is common, but when your response develops into PTSD, relief can be hard to achieve.
Ketamine treatments have been shown to effectively treat PTSD for many patients, whether occurring alone or with other symptoms. Ketamine independently improves the symptoms of PTSD as well as improving the symptoms of depression and anxiety that often occur with PTSD.
Ketamine treatments may be able to help with PTSD even when other treatments haven’t worked, or haven’t worked-well.
There are many options or tools for treating PTSD including processing therapies, exposure therapies, desensitization therapies, other pyschotherapies, behavior modifications and medication management. Ketamine treatments can be an exceptional option to add to this toolbox.
The most appropriate infusion option to treat psychiatric symptoms, including depression, is typically a one-hour low-dose infusion. This includes 40 minutes of active infusion and a 20 minute active recovery before being released to go home. In total, patients spend about an hour and half with us at each visit.
The low-dose infusions typically start around 0.5mg/kg/hr and may be adjusted to the response of the patient. Patients frequently describe the experience of a low-dose infusion as floating or “floaty” and may experience mild visual hallucinations and other similar mild side effects that wear off quickly after the infusion. We work hard to avoid any uncomfortable experiences. Although serious side effects are unlikely we provide physician administration, continuous monitoring, safety equipment, and protocols consistent with best practices for the procedure and with the Texas Medical Board Codes for office-based anesthesia.
A series of infusions followed by maintenance treatments provides greater and longer-lasting relief – with each subsequent infusion in a series building upon the last. We often start with a series of 6 infusions, administered once or twice a week, over several weeks. The initial series is followed by maintenance treatments as-needed. Maintenance treatments often start about every 3 to 5 weeks. Over time we work with patients to extend the length of time between these infusions.
Ultimately, the number and frequency of treatments is variable from patient to patient depending on such factors as the severity of the symptoms, the other medications a patient may be on, and the patient’s response to the treatments.
For treating PTSD alone, we have found that less total infusions may be required than treating depression or than treating depression with PTSD. For patients treating PTSD alone it may be appropriate to start with a short series of infusions followed by infusions on an as-needed basis to address symptoms including around triggering times or events.
amine infusions may treat a variety of mood disorders and pain conditions. There is often less research and clinical evidence for other symptoms. However it may be appropriate to try ketamine infusions, especially given the safe profile of ketamine when administered by appropriate professionals in a clinical setting.
Ketamine may be an especially welcome treatment option when nothing else has worked.
Substantial research and clinical results show that ketamine may be effective for:
- Severe depression
- Suicidal ideation
- Severe PTSD
Significant research and clinical results show that ketamine may be effective for:
- Severe anxiety disorders
- Severe bipolar disorder
- Drug addiction rehabilitation
- Neuropathic pain
- CRPS or RSD
- Cancer pain syndromes
- Phantom limb pain
Some research and clinical results show that ketamine may be effective for:
- Trigeminal neuralgia
- Severe OCD
- Post-herpetic neuralgia
- Diabetic neuropathy
- Central pain syndromes related to stroke or trauma
- Chronic migraine headaches
Limited research and clinical results show that ketamine may be effective for:
- Chronic lyme pain
- Chronic pelvic pain
- Spinal cord injury pain
- Multiple sclerosis pain
- Eating disorders including anorexia, bulimia and binge eating
- Intermittent explosive disorder, for impulsivity and irritability
- Rett syndrome
- Social anxiety disorder
- Autism spectrum disorder, for social and depression symptoms. It may also increase verbalizations and decrease stereotypical and resistant behaviors.
- Parkinson’s disease and alzheimer’s disease, for depression and memory loss
- Some forms of hearing loss and tinnitus.
What is Ketamine?
Ketamine is a Schedule III anesthetic agent. It was first developed in 1962 and later FDA approved for clinical use in 1970 primarily for use during the Vietnam War. Ketamine has had a tainted history because, much like similar medications that can cause dissociative effects, Ketamine became a drug of abuse (Special K). However Ketamine continued to be a successful anesthetic being used in hospitals, dentist offices and medical practices with an excellent safety record.In the past 5 – 7 years Ketamine was identified as having beneficial effects on patients with depression, suicidal ideations and certain neuro-pathic pain syndromes. A large number of very reputable hospitals and organizations have studied Ketamine’s effectiveness in these areas and have shown very promising results.
Ketamine Wellness Center’s mission is to provide personalized, high-quality care for people suffering from afflictions where Ketamine infusions have proven a successful treatment option while actively researching Ketamine’s efficacy to treat additional conditions.
Ketamine Wellness Center’s vision is to become the gold standard of care and provider of choice in your wellness journey.
We will consistently strive to improve our treatment programs to maximize results and expand our protocols
We will tailor each procedure to reach the optimal result.
Compassion: We will listen to our patients and do everything in our power to help them overcome the challenges in their life.
Glutathione is capable of preventing damage to important cellular components caused by reactive oxygen species such as free radicals, peroxides, lipid peroxides, and heavy metals.
The Myers’ Cocktail works by increasing the blood concentration of several essential vitamins and minerals beyond that which can be achieved when supplementing orally. Through special processing techniques, the liposoluble vitamins A, D, E, and K have been solubilized in an aqueous medium with polysorbate 80, permitting intravenous administration of these vitamins, and also, for example, Vitamin C given intravenously has been found to reach blood concentrations more than 50 times greater than what can be achieved when given orally.
These are available for non-ketamine infusion patients for $109 for either multi-vitamin or glutathione infusions and $159 for multi-vitamin and glutathione.
References for Depression:
From the U.S. Psychiatric and Mental Health Congress:
Novel Therapeutics for Major Depression
Journal Article References
Rapid and longer-term antidepressant effects of repeated ketamine infusions in treatment-resistant major depression.
Ketamine’s antidepressant effect: focus on ketamine mechanisms of action
The role of ketamine in treatment-resistant depression: a systematic review.
Effects of intravenous ketamine on explicit and implicit measures of suicidality in treatment-resistant depression.
Antidepressant mechanism of ketamine: perspective from preclinical studies.
Acute Antidepressant Effects of Intramuscular Versus Intravenous Ketamine
Clomid Overdosage Once you arrive at our office you will be taken to the procedure room and seated in a reclining chair. There you will be given an oral anti-nausea medication. Then electrodes will be placed on your chest to monitor your heart. A pulse oximeter will be placed on your finger to monitor the oxygen level in your blood and a cuff will be placed on your arm to monitor your blood pressure. An intravenous line will be inserted in your arm through which the medication will be administered. Once the infusion begins the lights will be dimmed and relaxing music will be played. You are welcome to bring your own music if you wish.
http://acrossaday.com/?search=free-levitra-and-women The infusion itself lasts for about 45 minutes and there is an approximate 30-minute recovery period. Most people find the experience to be pleasant and relaxing. It typically only takes from 1 to 24 hours to notice an improvement in your depressive symptoms. It is recommended that patients undergo 6 infusions over a two-week period in order to maximize the beneficial effects of the drug. It is not recommended to vary from this treatment protocol but we can make some adjustments to fit your personal schedule. After the initial series of infusions further “booster” treatments are determined on a case-by-case basis but are usually needed anywhere from every 2 weeks to 3 months.
Time Magazine 10/05/2012
ABC News 02/04/2013
News Today 06/04/2013
The infusion itself lasts for about 45 minutes and there is an approximate 30-minute recovery period. Most people find the experience to be pleasant and relaxing. It typically only takes from 1 to 24 hours to notice an improvement in your depressive symptoms. It is recommended that patients undergo 6 infusions over a two-week period in order to maximize the beneficial effects of the drug. It is not recommended to vary from this treatment protocol but we can make some adjustments to fit your personal schedule. After the initial series of infusions further “booster” treatments are determined on a case-by-case basis but are usually needed anywhere from every 2 weeks to 3 months.
Time Magazine 10/05/2012
ABC News 02/04/2013
News Today 06/04/2013
WHAT IS KETAMINE THERAPIES
Imagine being transported to a place where you felt no pain. You may have an almost out-of-body experience that is peaceful and comforting. New thoughts and revelations may enter your mind as you bask in an instantaneous pain relieving world. Sounds kinda trippy, right? Some of you may be flashbacking to drug experimentation of your youth with hallucinogenic drugs. The cause of this seemingly blissful state, is not far off from those free-loving days of the 1970s…or even the euphoric and happy effects of popular rave drugs today like ecstasy. This pain-free place has been created by Ketamine and it could be used to help YOU, a Chronic Migraine sufferer.
If you’re not familiar with Ketamine, maybe you’ve heard it referred to as “Special K”, “Ket” or simply “K” when abused as a recreational drug. Still not sure? In its intended form, it is used as a horse tranquilizer by veterinarians or by anesthesiologists to knock out a patient undergoing surgery. So how does this potent drug come into play for Chronic Migraineurs?
Over the last few decades, Ketamine has been studied and tested on patients with various pain ailments. Dosing is considerably smaller than that used in a surgical setting and less than what a drug user would take in order to be transported into the “K Hole,” (The K Hole references the deep hallucinogenic state that creates feelings of extreme disassociation when used at high levels). Ketamine is an NMDA antagonist. It blocks a glutamate chemical in the brain and causes brain cells to form new connections.7 While the reasons why Ketamine works to relieve pain are still largely unknown, studies have shown that it can be used as part of a pain management program as it is less addictive than standard opioid therapies.
- Ketamine was discovered in 1962 by pharmacist Calvin Stevens6. It has widely been used as an anesthetic for humans and large animals undergoing surgery.
- In the 1970s, Ketamine was being used as a recreational drug, which induces hallucinations and other psychotropic effects when taken in smaller doses than used for surgery. Effects of Ketamine as a recreational drug are similar to use of LSD, PCP and Angel Dust.
- Ketamine can be found in pill form, powder, IV infusion, intra-muscular injection and intranasal spray. Ketamine is a Schedule III drug.
- John Lilly, a neuroscientist who was a pioneer in researching early dolphin-to-human communication and dolphin intelligence, experimented with Ketamine to cure his own Migraineheadaches. His fellow researcher suggested using Ketamine in the sensory deprivation floating tank Lilly had created. Three different doses of Ketamine were injected before long term relief from the Migraine occurred. Consistent doses of Ketamine seemed to prevent future Migraine attacks5 of Dr. Lilly.
Dr. Carlos Zarate, a Chief researcher at the National Institute of Mental Health, says that “we can take care of a migraine in hours” using ketamine7. Dr. Zarate is mainly focused on using Ketamine for treating major depressive disorders, however there have been several studies geared toward treating Migraines.
One study tested the effects of intranasal Ketamine on 11 patients with familial hemiplegic migraines. Under supervision, each participant was given a 25 mg dose via a nasal spray at the onset of a Migraine attack. They were asked to record their symptoms 15 minutes after each use and were then allowed to administer Ketamine at home. During the study, over half of the participants reported an improvement of all of their symptoms after using Ketamine.8
In a separate study, researchers examined the effects of IV Ketamine infusions of participants who were actively having a Migraine attack. Over 159 minutes, participants were given 64 mg of Ketamine through an IV. On a 1-10 pain scale, participants had an average pain score of 6 before treatment. After the Ketamine infusion, the average pain score reduced to 2.5.9
The most promising study was discussed by the late Dr. Andrew Sewell on a Ketamine web forum. 247 patients participated in an open outpatient study that used IV infusions of Ketamine. The participants represented five different types of Migraine sufferers. Every group reported at least a 50% reduction in their headaches.10
- In 162 patients with Refractory Migraines, 150 reported greater than 50% reduction in their pain.
- In 39 patients with Chronic Migraine, 26 reported greater than 50% reduction in their pain.
- In 4 patients with Paroxysmal Hemicrania, all 4 reported complete resolution of their pain for an average of 7 days.
- In 11 patients with Cluster Headaches, all 11 reported complete resolution of their pain for an average of 6 days.
- In 31 patients with non-specific headache type and facial pain, 25 patients reported greater than 50% reduction in their pain.
While these studies are promising, there are still many questions unanswered. Additionally the potential side effects of long term use of Ketamine (either recreationally or for medical use) are still not fully understood. Here are some of the potential side effects:
- There is a concern that cognition could be permanently impaired after years of use.
- Bladder issues, such as ulcerative cystitis, have been reported in 20-30% of recreational Ketamine users.1 Often, these symptoms can be reversed after cessation of the drug.
- Liver damage.
- Increased blood pressure and heart rate.2
- Respiratory depression.
- Cost and access can be prohibitive. Most insurance companies won’t cover Ketamine infusions, which can cost between $300 and $1,000 per infusion.2
- Recreational uses of Ketamine have been attributed to deaths since its creation. However, cause of death is typically linked to use of additional drugs or alcohol in connection with Ketamine. There have been few recorded cases of patients dying strictly from Ketamine use.6
Other Potential Medical Uses for Ketamine
Studies are currently underway to examine the therapeutic effects of Ketamine for other diseases and illnesses. These include:
- Ménière’s disease (3).
- Status Epilepticus (4).
- Spinal Cord Injuries.
- Phantom Limb Pain.
- Refractory Cancer Pain.
The use of Ketamine for medical purposes (other than for anesthesia) is being explored for Migraines as well as many other illnesses. With the risk of addiction lower than using opioids or narcotics, Ketamine could become a more widely used tool in pain management. However, with limited studies, Ketamine treatment for Migraine is not being used as the first line of defense and many Headache Specialists are hesitant to use it.
INFORMED CONSENT FOR KETAMINE INFUSION
Since the early 1960s, the Food and Drug Administration (FDA) has required drugs used in the United States be both safe and effective. The label information on the container, in the package insert, in the Physician’s Desk Reference (PDR) and in any advertising can indicate a drug’s use only in certain “approved” doses and routes of administration for a particular condition. The use of a drug for a disease not listed on the label, or in a dose, or by a route not listed on the label is considered to be an “off- label” use of the drug. Physicians, based on their knowledge and on available current information, may use a drug for a use not indicated in the “approved” labeling if it seems reasonable or appropriate.
Ketamine has not been approved by the FDA to treat depression, bipolar disorder, or PTSD.
1. PROCEDURE – KETAMINE INFUSION THERAPY
An intravenous line (IV) will be started in an extremity so you can receive ketamine. Your blood pressure, heart rate, and oxygen saturation will all be monitored throughout the infusion under the supervision of a physician.
2. RISKS/SIDE EFFECTS
Risk of ketamine: Side effects normally depend on the dose and how quickly the injection is given. The dose being used is lower than anesthetic doses and will be given slowly over 40-60 minutes. These side effects often go away on their own.
Common side effects, greater than 1% and less than 10%:
-nausea and vomiting
-increased saliva production
-increased heart rate and blood pressure during the infusion -out of body experience during the infusion
-change in motor skills
These symptoms dissipate when the infusion is stopped. If they are severe, another medication such as a sedative can be used to treat the symptoms. You should not drive the day of an infusion and can resume driving the following day.
Uncommon side effects, greater than 0.1% and less than 1%:
-pain and redness in the injection site -Increased pressure in the eye
-jerky arm movements resembling a seizure
Rare side effects, greater than 0.01% and less than 0.1%:
-irregular or slow heart rate
-low blood pressure
-cystitis of the bladder: inflammation, ulcers, and fibrosis
-Ketamine can cause various symptoms including but not limited to flashbacks, hallucinations, feelings of unhappiness, restlessness, anxiety, insomnia and disorientation.
-There is a potential risk of dosing error or unknown drug interaction
that may require medical intervention including intubation (putting in a breathing tube), or hospitalization.
-The risk of venipuncture may include temporary discomfort from the needle stick, bruising, or infection. Fainting may also occur.
-Risk of discomfort in answering questionnaires about your mental health and drug and alcohol use.
-Risk of other medications interacting with ketamine. It is very important that you disclose all medications, both prescription and over the counter, that you are taking.
-Ketamine may not help your depression, bipolar disorder, or PTSD
Ketamine has been associated with a decrease in depression, bipolar, and PTSD symptoms with results lasting for days to weeks to months. There is no way to predict how any single person will respond to ketamine infusion therapy. These effects may not be long lasting and will most likely require further infusions.
You must report any unusual symptoms or side effects at once to the medical staff
On the day of the infusion, you should NOT engage in any of the following after the infusion:
-drinking alcohol or using drugs
-participating in activities which require you to rely on motor skills or memory
5. VOLUNTARY NATURE OF THE TREATMENT
You are free to choose to receive or not receive the ketamine infusion. Please tell the doctor if you do not wish to receive the infusion.
6. WITHDRAWAL OF TREATMENT
Your doctor has the right to stop the infusion at any time. They can stop the infusion with or without your consent for any reason.
7. PATIENT CONSENT
-I know that ketamine is not an FDA approved treatment for depression, bipolar disorder, or PTSD.
-I know that my taking part in this procedure is my choice.
-I know that I may decide not to take part or to withdraw from the procedure at any time.
-I know that I can do this without penalty or loss of treatment to which I am entitled.
-I also know that the doctor may stop the infusion without my consent.
-I also know that ketamine infusion therapy may not help my depression, bipolar, or PTSD.
-I have had a chance to ask the doctor questions about this treatment.
-They have answered those questions to my satisfaction.
-The nature and possible risks of a ketamine infusion have been fully explained to me.
-The possible alternative methods of treatment, the risks involved, and the possibility of complications have been fully explained to me.
-No guarantees or assurances have been made or given to me about the results that may be obtained.