Ketamine for Chronic Pain & Depression

by | Apr 6, 2018 | Articles, Chronic pain, Conditions, Intravenous therapies, Mental health

Intravenous (IV) Ketamine is proving to be a tremendous treatment for intractable depression as well as chronic pain.  About half the patients treated respond positively with results lasting up to a week in most of the responders.

It has emerged as a treatment option for a variety of chronic pain conditions including fibromyalgia, small fiber neuropathy, Complex Regional Pain Syndrome (CRPS), Reflex Sympathetic Dystrophy (RSD) and psychiatric conditions including depression, Post Traumatic Stress Disorder (PTSD), suicidal ideation, and Obsessive-Compulsive Disorder (OCD).

Ketamine IV Treatments

There are many questions along with ongoing research about the long term dosing and effects of ketamine.  From our review of current research there are some general guidelines to consider:

  1. Dosing is typically 0.1-0.5mg/kg/hour via IV infusion
  2. Longer infusions from 4 to 100 hours have shown mixed results on providing longer relief
  3. Repeated 1 hour infusions, e.g. 3x/wk for 6 infusions, have shown longer symptom relief
  4. Positive responders will know if ketamine is going to work within 4 hours
  5. Positive responders are likely to get long lasting relief as well
  6. 50-70% of patients are positive responders
  7. 70% of positive responders report symptom relief up to 1 week after infusion
  8. Ketamine has a short half life, meaning it clears from the patients system quickly
  9. There is much to learn about non-IV administration and chronic use of ketamine

Ketamine Nasal Spray

We also offer in-office, medically supervised, self-administration of ketamine nasal spray which is less expensive and less invasive than IV ketamine therapy.  Ketamine nasal is absorbed very quickly, much as with IV administration.  We monitor patients for 1-2 hours after dosing of ketamine spray and they are not permitted to drive or operate machinery for the remainder of the treatment day.

Our Ketamine Treatment Protocols

Ketamine administration should be overseen by qualified personnel skilled in monitoring vitals and ACLS protocols.  We have medications available to treat possible side effects, such as mental agitation or high blood pressure.  We monitor patients continuously during the infusions and for 1-2 hours after the infusion ends.

Initial IV infusions are 1 hour only and started at a slower infusion rate to monitor tolerance to the ketamine.   If tolerating well, the infusion is increased to the standard flow rate of 0.5mg/kg/hr.    Based on the research and our clinical experience, we recommend subsequent infusions of 1 to 4 hours, repeated as often as 3x/week.

Our protocol varies a bit depending on patient response, but in general we start with treatments 1-2x/week for a month then drop to 2-4x/month.  Many patients experience prolonged improvement in symptoms for months and return for therapy only as needed.

Ketamine in the News

Remarkable secrets of ketamine’s antidepressant effect unlocked by scientists

Could Party Drug Ketamine Be a Treatment for Depression?

‘The fog is gone’: How ketamine could help lift hard-to-treat depression

Ketamine Research

Ketamine for Depression, 1: Clinical Summary of Issues Related to Efficacy, Adverse Effects, and Mechanism of Action.

Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms

The use of ketamine as an antidepressant: a systematic review and meta-analysis.

Ketamine safety and tolerability in clinical trials for treatment-resistant depression.

Low-dose ketamine for treatment resistant depression in an academic clinical practice setting.

Rapid and longer-term antidepressant effects of repeated ketamine infusions in treatment-resistant major depression.

Symptomatology and predictors of antidepressant efficacy in extended responders to a single ketamine infusion.

How does ketamine elicit a rapid antidepressant response?

Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial.

Do the dissociative side effects of ketamine mediate its antidepressant effects?

Ninety-six hour ketamine infusion with co-administered clonidine for treatment-resistant depression: a pilot randomized controlled trial.

Ketamine IV Brochure


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