Frequently Asked Questions about Ketamine
Not yet. Over the past two decades dozens of studies in prestigious medical centers and The National Institute of Mental Health have proven ketamine’s safety and efficacy in treating major depressive disorders, anxiety, obsessive compulsive disorders and suicide ideation. Yet, without very large controlled studies generally required by the FDA to get approval for any psychiatric drug, approval has been delayed. Since ketamine is a generic drug, no pharmaceutical company will spend the hundreds of millions of dollars required for such a study. Efforts are being made to create a national registry of the outcomes of the thousands of patients treated by ketamine providers across the country to date. This data will be used to expedite FDA approval. In the meantime, ketamine is being used “off label,” as is true with many other medications prescribed by physicians.
****Update, Esketamine (Spravato) is now FDA approved! This is only the nasal spray version of Ketamine, and although this is a great step for those suffering from depression, it has significant restrictions, like it must be administered in the clinic and cannot be taken home. This is unfortunately extremely restrictive, but it is a start!****
Insurance doesn’t cover ketamine therapy because it’s not FDA-approved for use on depression. In order to obtain approval, the FDA requires extensive trials that are hugely expensive, costing millions of dollars. No one is willing to fund these trials, because the cost can never be recovered. Ketamine is a fairly inexpensive generic drug that creates only a small profit margin for manufacturers. FDA approval won’t change those economics. Since ketamine can’t produce blockbuster profits, no for-profit corporation is going to invest millions in FDA trials.
A total of 6 Ketamine infusions are recommended within a 14-day period. That will maximize the ketamine effect on new dendrite and synapse growth. Thereafter, patients are placed a maintenance program where they return when they feel it necessary for a single infusion booster (usually once a month). During the maintenance period, the duration of relief following the initial infusions and the first booster, and between subsequent single booster infusions varies between patients. The average duration of relief between booster infusions is 3 to 4 weeks. There is no way to predict what your needs will be.
We recommend everyone does at least 5 infusions before terminating. If you do not feel any effects after 5 infusions, we deem you a non-responder. This happens 15-20% of the time. It is frustrating both for you and Innovative.
No, right now ketamine infusion therapy is, perhaps, the most exciting and successful new treatment for severe depression. But there are large pharmaceutical companies developing ketamine-like drugs for more convenient nasal and oral administration. It may be a few years, but those drugs will become available. In the meantime, IV ketamine has been proven effective in most cases, and is available to you or your loved ones. Patients with debilitating severe depression with constant thoughts of self-harm cannot afford to wait. Please book a consultation to understand if it is the right treatment for you.
About an hour, with an additional half hour before discharge.
No. The dose of ketamine you will receive does not cause loss of consciousness.
Most patients experience a significant “dissociation” or inner reflective experience that is well tolerated. When Dr. Khare asks his first time patients to describe their infusion, the patients overwhelmingly say things like, “I was tripping” or “wow, that was beautiful” or “that was the strangest experience I have ever had” or “I was tripping by #$@# off.” The literature also states that the Ketamine dissociation is very similar to other psychedelics, such as mushrooms and LSD.
If you find it unpleasant we can slow down or stop the infusion. Of note, you are ALWAYS in control. If you want the infusion off, just call our name, and we will come in to evaluate you and will do whatever you tell us to do. Although we will stop the infusion, we will encourage that we re-start it after sitting with you and calming you down.
Within 15 minutes of ending the infusion your thinking will be clear. There are no delayed “flashbacks.”
Yes. The benzodiazepines, such as Klonopin, Xanax, Valium, and Ativan do interfere with ketamine if used daily and at higher doses. We recommend decreasing the dosage when getting Ketamine treatments. Usually, there is a natural decrease in usage after beginning the Ketamine infusions because the patients are less anxious. Lamictal (lamotrigine) in doses above 100mg/day also can block ketamine efficacy. We still recommend you continue your Lamictal, however. We will have a discussion about this at your first appointment. It is not a contraindication.
No, other antidepressant medications do not interfere with ketamine’s mechanism of action.
Yes, if you are on Lamotrigine (lamictal), we ask you to not take your daily dose until after the ketamine infusion. Patients on this medication need a significant amount more of ketamine to attain our goal of a dissociative state. So, while it is not life threatening, the ketamine infusion may not work as well. Click here for a great little article on this.
If you are on a benzodiazepine (Valium, Xanax, Ativan, Klonipin), we ask you to not take it the night before or the morning before your infusion. This is not an absolute, so if there is a reason to take it, then you can take it, just let us know about it.
These 2 types of medications are the only major medications that interfere with the Ketamine treatment outcomes. SSRIs should be taken regularly. Please do not stop any prescribed, daily medications because you are starting Ketamine infusions. Talk with our physician about your medications and we will advise you.
Almost none. Uncontrolled high blood pressure or heart failure need to be corrected.
No, ketamine has been proven safe in humans over five decades in and out of hospitals and battle fields for surgical anesthesia and trauma management. Those patients experience longer exposures and at much higher doses than those used to treat severe depression. Although it has been abused recreationally in high doses as a club drug, there is no evidence that ketamine is addictive.
For mood disorder patients, there are patients who report feeling better immediately after the infusion. These are usually patients who have ideas about self-harm, suicidal ideations, or other extreme feelings. Other patients may not notice any improvement until their 3rd or even 4th infusion. Yet others will feel better only after their 6th infusion. We encourage patients to do all 6 infusions because there are a subset of patients that are “late responders” and we have seen a switch in them late in their infusions.
For pain patients, it is uncommon to see a significant relief after the 1st or 2nd infusion. Usually, we see significant pain reduction after their 3rd infusion. We see significant and lasting relief when at least 3 infusions are done.
Hypomania or a manic state is always possible when helping patients out of the depressive state of bipolar disorder. However, in our experience, we have not seen this. We feel it is very safe in bipolar disorder.
You do not need to be referred to our clinic to be seen. If you have a psychiatrist or therapist and you would like us to share your experience with them, please let us know and we will call or send them your medical records. Usually, after your ketamine treatments and after you see them, they are extremely interested in Ketamine.
In early 2019, we opened up a brand new, state of the art, beautiful clinic on Belmont and Sheffield Avenue. Dr. Khare and his staff decided to decorate it in the most peaceful and delicate decor, to give our patients the relaxation and calmness they need while getting their Ketamine infusions. Thought was put into the entire patient experience, from check-in, sparkling water, comfortable couches, La-Z-Boy recliners, over-the-ear headphones with hand-picked, scientifically researched, relaxing music. Our staff are trained to be quiet, gentle, and patient to those seeking treatment with us. You get the personal email address of Dr. Khare for any issues that arise during or after the treatments. We are located at:
3221 N Sheffield Ave
Chicago, IL 60657
True emergencies can be seen within a day if the physician who administers ketamine is at the clinic. But, in general, 2 to 3 days are required to get you onto the schedule.