Ketamine & Spravato Treatments

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Ketamine, Spravato, & Ketamine Assisted Psychotherapy

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What is Ketamine and How Does It Work?

Ketamine is a medication that can potentially help those struggling with depression that has not responded to other types of medication. This is because most antidepressant agents we have used in the past work within the monoamine (serotonin, dopamine and/or norepinephrine) neurotransmitter systems of the brain. Rebalancing monoamines is helpful for some people suffering with depression, but not all. Ketamine works on different neurotransmitters (primarily the glutamate system), to aid depression. Individuals who respond to ketamine treatments often find their depressive symptoms improve in hours to weeks, as opposed to weeks to months like monoamine antidepressants can often take.

Another exciting change in the nervous system that occurs with ketamine treatments is something called neurogenesis. In some ways, the circuitry of the brain is akin to all the roads and highways connecting all the parts of a big city. When someone is depressed, we see that many of these connections diminish, making it harder for the brain to function cohesively. During a ketamine treatment, there is a burst of a substance our brains make called brain derived neurotrophic factor (BDNF). Dr. Scargle colloquially refers to BDNF as “fertilizer for the brain,” because it causes the brain cells to sprout and grow new neuronal connections, allowing the brain networks to start functioning better as a collaborative whole.

Ketamine treatments are done in our office, and can be received by either intramuscular injection, intranasal spray, or by oral lozenge. We are not delivering IV infusions at this point, as intramuscular injection (like getting an immunization shot) has proven in our office to be very effective and allows us to keep the cost of the ketamine treatments to a more affordable rate. Intramuscular ketamine injections also allow the ketamine to get to the nervous system the most rapidly of all means of delivery, which some researchers feel can possibly increase the antidepressant quality of the ketamine.

Use of ketamine to treat depression is off label, as it was originally developed to be used at much higher doses as an anesthesia. In recent years, the benefit of using ketamine in sub-anesthetic doses to treat depression via the glutamate system has been discovered and put into clinical practice. Many medications are used off label, when new uses of the chemical compounds are found to help in different conditions than they were originally invented for.

What is a Ketamine Journey Like?

During a ketamine journey, people have different experiences depending on what dose of the medication they take, and how the medication is delivered (oral lozenges, intramuscular injection, etc). Lower doses of ketamine can feel similar to being mildly intoxicated, as if you have had a glass of wine, but are still fully present in the treatment room.

With higher doses, patients report feeling like they are having a wakeful dream. Some people see abstract colors. Others have more distinct visuals such as storylines or being present in other environments such as space or the ocean.

There is a sense of movement during these higher dose/inwardly focused journeys. Ketamine is what is called a dissociative medication. This means that during the higher dose journey, patients will feel like it’s the “essence of themselves” having the experience without the awareness of the body. This is because the experience is occurring entirely in your own mind.

We take pride in tailoring the ketamine treatment for each patient. The initial dose of ketamine is determined with a rubric based on body weight. If this dose is not sufficient, or if you are a rapid metabolizer and come out of the journey too quickly, a booster dose of ketamine can be administered.

We are often asked, “What happens if I have a bad trip?!” This is not common, but if someone is having a challenging journey, we are able to give you some additional medication (a calming medicine called midazolam) to move you past the problem. Even in a high dose journey, you are able to still hear us talking with you, giving you guidance to move into a different thought space.

Spravato Treatment

Spravato, also known as Esketamine, is the right-handed isomer of the ketamine molecule.

Spravato has also been very helpful for some people suffering with depression and does have an FDA indication for treatment of refractory depression, or depression with suicidality. It is administered via a nasal spray in our office.

Depending on your health insurance coverage and history non-response to other antidepressant medication, Spravato treatments may be covered by your health insurance.

For more information, visit the Spravato website.

How do I Know if Ketamine or Spravato Treatments Could be Right For Me?

If you are interested in learning more about the potential use of ketamine to treat your depression, one of our clinicians can meet with you for an hour-long assessment to obtain more information about your mental and physical health, discuss the process of the ketamine treatments, show you our ketamine treatment center and answer any questions you might have.

If you feel ketamine may not be the best fit after the initial evaluation, we will work with you to provide other treatment options for your depression.

Often we are able to bill this initial evaluation with your health insurance.

How Much Do Ketamine or Spravato Treatments Cost?

Initial Evaluation:

If our practice is a contracted provider for your health insurance company, we are able to bill the initial evaluation through your insurance. Please see the insurance providers section of our website for more details.

If we are not providers for your insurance, or if you don’t have health insurance, the cost of the hour long initial evaluation is $300.

Ketamine:

Ketamine treatments are $300 per treatment. This includes the cost of the medication as well as the medical supervision and support provided by our treatment team.

To achieve the best possible response for depression, a typical index course of treatment would be 6 treatments over 3-6 weeks. This is the average number of recommended treatments to achieve response. Some people respond to fewer than 6 treatments, some people need more.

We don’t ask patients to “buy a package” of treatments; you pay for each individual treatment as you receive them.

Spravato:

Depending on your health insurance coverage and history non-response to other antidepressant medication, Spravato treatments may be covered by your health insurance.

Ketamine Assisted Psychotherapy (KAPS)

While ketamine treatments alone can be largely beneficial, research indicates that combining ketamine and psychotherapy may provide even greater healing. This is especially true for individuals with complex trauma or PTSD. This Ketamine Assisted Psychotherapy (KAP) model essentially works to expedite therapy, with ketamine as a catalyst, and allow individuals to better integrate what they discover in therapy.

If you are working with a therapist to treat issues related to trauma, depression and/or anxiety, having a ketamine treatment 1-3 days prior to your appointment with your therapist could potentially hasten or intensify the benefit of your work with your therapist.

For patients interested in ketamine assisted psychotherapy who do not have a therapist, we can help to establish you with a KAPS trained therapist.

Why Should I Choose Concord Health for my Ketamine or Spravato Treatments?

We genuinely want you to feel better!

Our clinical staff has extensive training in providing ketamine.

Dr. Scargle completed a year long fellowship in ketamine treatment for physicians through Integrative Psychiatry Institute. She is an active member of the American Society of Ketamine Physicians, Psychotherapists and Prescribers (ASKP3) and is part of a national peer supervision group for ketamine providers.

Treatment is provided in a safe environment.

All of our clinical staff in the ketamine clinic are ACLS certified.

We want you to feel comfortable and cared for.

We make every effort to make the experience of receiving ketamine/spravato as relaxing and supportive as possible.

This includes:

  • Individual treatment suites to accommodate the patient and family member or friend if desired.
  • Comfy zero gravity chairs
  • Weighted blankets
  • Option of treatment room with a window for those that prefer natural light

What To Expect

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Before Treatment

Those interested in a possible trial of ketamine to aid with their depression or as an adjunct to their psychotherapy are seen by one of our clinical staff for an hour long overview appointment to make sure ketamine or esketamine is medically a good fit, and to explain what it’s like to have a ketamine treatment.

Medical contraindications include a known history of vascular aneurysm, unstable cardiac conditions or active seizure disorder, uncontrolled hypertension, as well as active mania or psychosis. We make sure to answer any questions that might arise.

Day of Treatment

On the day of the ketamine “journey” or Spravato treatment, each patient has a private room with a zero gravity recliner. Headphones with special playlists designed for psychedelic work are provided as well as a weighted blanket and eye mask (if desired). Our staff will be present to answer any additional questions as well as to monitor vitals.

After the medication is administered, a dissociative experience akin to having a “lucid dream” typically follows. Come to the process with the intent of finding healing, but without expectation beyond that, because everyone’s experience is a little different. Some people have storylines like a dream, other people see lights with abstract colors and textures. Emotional journeys without visuals at all also occur.

No matter what kind of journey is experienced, the biological benefit of the ketamine treatment is conveyed and healing can occur. Our clinical staff is with the patient throughout the entirety of their experience to make sure they feel safe and well cared for.

Once the treatment has ended, our staff will monitor vitals a second time and clear patients to go home. Patients are free to wait in our recovery room for their ride.

**Patients cannot drive themselves home after treatment so it is important that they have a ride secured. Uber/Lyft are acceptable but a family member or friend is preferred.

**Patients should not eat/drink 2 hours before treatment

After Treatment

We recommend that patients take the remainder of the day to rest following their ketamine treatment. Patients are able to eat and drink as they normally would once they leave our office.

Patients are not permitted to drive themselves home from their ketamine treatment so they should plan to have a friend or family member pick them up. Ride services such as Uber and Lyft are permitted as well.  We recommend that patients do not drive until they have had a full nights sleep as reaction time may be slowed.