What is ketamine infusion therapy? Ketamine infusion therapy is a safe series of IV infusions that can rapidly and effectively address a number of conditions in about 75% of otherwise treatment resistant patients. Ketamine is effective when other medications commonly used are not since it effects neurotransmitters and receptor site levels in an area of the brain other medications are incapable of. Ketamine effects the levels of glutamate in your brain and causes upregulation of the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPAR) leading to a cascade of downstream synaptogenic signaling pathways with the increased release of Brain-Derived Neurotrophic Factor (BDNF) and the mechanistic Target of Rapamycin Compound 1(mTORC1). This activation of downstream synaptogenic signaling pathways leads to increased neuroplasticity and the growth of neurons and new synapses (connections) which was previously thought to be impossible. This downstream cascade is primarily responsible for the rapid and powerful effects that usually manifest within 2-4 hours.

How does ketamine work? Prolonged depression, anxiety, pain, inflammation, and other forms of stress damage the communication system areas of the brain responsible for memory, learning, and higher-order thinking. Ketamine can promote the neurotransmitters and receptor site materials necessary to make repairs to this damage within hours, even enhancing neuroplasticity of the neurons within the central nervous system. Ketamine increases glutamate, norepinephrine, and dopamine levels as well as other neurotransmitters. The proposed mechanisms include N-Methyl D-Aspartate (NMDA) receptor antagonism, resulting in pyramidal cell disinhibition and a surge of glutamate levels precipitating the acute activation and upregulation of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPAR) that leads to activation of downstream synaptogenic signaling pathways with the increased release of brain-derived neurotrophic factor (BDNF) and the mechanistic target of rapamycin Compound 1(mTORC1). This activation of downstream synaptogenic signaling pathways results in neuroplasticity and the growth of neurons and new synapses (connections) which was previously thought to be impossible. Therefore, ketamine is a rapid and powerful effects usually manifest within 2-4 hours an infusion

Is ketamine safe? Since the 1960s, ketamine has been used as an anesthetic and for pain management in operating and emergency rooms across the US & UK. In the right hands, ketamine is a safe depression treatment that can effectively improve depressive symptoms in upwards of 75% of patients. Anesthesia providers are the most highly trained individuals when it comes to safely administering ketamine due to their extensive training in both administering the ketamine as well as highly specialized training in airway management, rescue, and crisis management. When ketamine is used for treatment resistant depression, anxiety, PTSD, psychiatric disorders, and chronic pain, it is administered at sub-anesthetic levels or ketamine doses below levels that induce general anesthesia.

Can ketamine relieve Depression, PTSD, Suicidal thoughts, bi-polar or OCD? About 75% of patients with treatment-resistant depression (including bipolar patients), experience rapid relief after a low-dose ketamine infusion. Similar success rates have been seen in returning combat veterans suffering from PTSD. These PTSD patients’ cases are the most resistant to conventional treatment, lasting years or even decades, without response to various types of medication & treatment. Many veterans with PTSD have hovered on the verge of suicide for years, many attempt suicides, and most have endured a very poor quality of life. Before ketamine therapy, there was virtually no way to substantially improve the PTSD of veterans like these. The fact that ketamine works rapidly on more than 70% of those suffering from PTSD is astonishing. The actions of ketamine have profoundly changed depression research, and our understanding of the very nature of depression, neuroplasticity and regeneration of damaged neurons and synaptic pathways. It is important to keep in mind, however, that the degree of relief can vary. While most patients experience rapid relief of their symptoms, some experience only partial relief, others do not experience relief until a second or third infusion, and some do not respond to ketamine at all. There are medical conditions and medications when accompanied by depression that can reduce ketamine’s effectiveness.

What are mood disorders? Mood disorders are psychological disorders that affect the way you act and think. If you have a mood disorder, you will experience serious, repeated changes in mood. Mood disorders may increase your risk of suicide. There are numerous types of mood disorders with varying symptoms.

Which mood disorders can ketamine help?

  • Treatment-Resistant Depression (TRD)
  • Major Depressive Disorder (MDD)
  • Bipolar depression (the depressed phase of bipolar disorder)
  • Post-partum depression
  • Post-traumatic stress disorder (PTSD)
  • Suicidal Thoughts (Suicidal Ideation)
  • Anxiety disorders
  • Obsessive-compulsive disorder (OCD)
  • Addiction
  • Sexual Abuse Trauma

How many ketamine infusions will I receive? For our mood disorder patients, we provide a series of six infusions over two weeks. Most patients see some improvement the day after their 4th or 5th infusion, but it is crucial to complete the whole series. For those who do not see benefit after the 4th or 5th infusion, we may attempt a longer and/or higher dose infusion adding in magnesium or oxytocin. Magnesium or oxytocin may be added in at any stage of infusions. If ketamine does improve your mood, outlook, and functionality, we suggest that you complete your series to maximize ketamine’s brain-repairing abilities. For our Complex Regional Pain Syndrome (CRPS), Reflex Sympathetic Dystrophy (RSD) and other pain patients, we provide a series of six 1-4 hour long, high-dose ketamine infusion. After the infusion, our Certified Registered Nurse Anesthesiologist (CRNA) will assess several parameters to determine if the treatment has been effective. These may include functional status, pain scores, opioid use, quality of sleep and emotional well-being. We will usually recommend a series of six infusions over two weeks and maintenance treatments as needed, most pain patients receive three to six weeks of relief from a single series of infusions before needing a booster infusion to maintain their pain control . Ketamine is effective at relieving the mood disorders such as depression and anxiety that are commonly associated with chronic pain as well.

What chronic pain is ketamine infusion therapy effective for?

  • Neuropathic pain such as neuralgia
  • Complex Regional Pain Syndrome (CRPS)
  • Reflex Sympathetic Dystrophy (RSD)
  • Fibromyalgia
  • New-Onset Daily Headache (NODH)
  • Chronic Migraines
  • Trigeminal Neuropathic Pain
  • Cancer pain syndromes
  • Chemotherapy-Induced Neuropathy
  • Breakthrough Non-Cancer Pain
  • Post-Herpetic Neuralgia (Shingles, Herpes)
  • Chronic pelvic pain
  • Chronic Sickle Cell Pain
  • Phantom limb pain & Painful Limb Ischemia
  • Central Neuropathic pain syndromes from stroke or trauma
  • Lyme Disease pain
  • Multiple sclerosis pain
  • Spinal cord injury pain
  • Crohn’s Disease Pain

If ketamine therapy works for me, how soon will I begin to feel better? For mood disorder patients, some will begin to feel better within hours of their 3rd or 4th infusion. Patients with thoughts of self-harm or suicidal ideation often notice those thoughts and feelings dissipate first. There is often a dramatic relief of dread and hopelessness, anxiety, dysphoria, physical fatigue, insomnia and much more. Many patients report the increased ability to function and be productive immediately. Other patients may not notice any improvement in mood until after their 5th or 6th infusion. Some patients will require more infusions and more time following their infusions before feeling significantly better. It is important to note that the results of ketamine can be sudden and dramatic, but they are not always. It is more common for patients to see gradual, subtle improvement. Sometimes function improves before mood does.

Will I require ketamine therapy for the rest of my life? Some patients achieve long-term relief after one series of infusions. Others find that infusions enhance the impact of antidepressants or provide initial relief that is then sustained by oral medicines, other therapies, and lifestyle choices. If ketamine therapy is the only solution that works for you, you may be able to space your infusions apart by 1-3 months. After the initial series of infusions restores the brain to a healthy balance, it is generally easier to maintain that balance than it was to attain it in the first place. Follow-up or “booster” infusions are provided on an as-needed basis for maintenance.

How long will the relief last? The research shows that a series of 6 treatments over 2 weeks can provide relief lasting months. Some patients can go 3-6 months before needing another single treatment while some may need one treatment every 1-2 months.

What should I expect from ketamine IV Infusion therapy? You will have a medical history and exam to determine if ketamine infusion therapy will reduce your pain or mood disorder. The team at Vancouver Ketamine Infusions then draws up a treatment plan tailored specifically to you for maximum results. Depending on the severity of your condition and other medications you are on, you may be offered Six to ten consecutive or alternating sessions of either high or low dose ketamine therapy. Based on the treatment plan devised for you, you will relax from one to four hours per session while having the infusion, and then spend 20 minutes to one hour recovering afterwards. Our team works hard to ensure you experience no more than minimal discomfort and side effects using best practice standards. If you want to learn more about ketamine infusion therapy and how it will reduce the symptoms of your mood disorder or your chronic pain, call us at 360-360-2244.

What should I expect during my ketamine treatments?

  • For mood disorder patients, ketamine is administered over a period of 40 minutes.
  • The infusion is administered in a very pleasant private outpatient setting, not in the hospital.
  • No solid food should be eaten within 6 hours of the infusion, liquids are ok up to 2 hours before the infusion.
  • Most medications should be taken at their regular times, particularly blood pressure medicine. Diabetic medicine generally should not be taken that morning. There are a few medications that may conflict with your treatment. This will be discussed before infusion day.
  • You should bring a friend, family member or trusted person with you. They will need to take you home. They are welcome to stay with you for the entire infusion.
  • There is no need to disrobe. The infusion is done with your clothes on in a plush reclining chair.
  • A very small gauge IV is started, and the infusion will be started immediately.
  • A Nationally Board-Certified Registered Nurse Anesthesiologist (NBCRNA) will be with you to monitor the infusion and ensure your safety and comfort. Your blood pressure, EKG and pulse oximetry will be monitored.
  • Many patients like to bring music, earbuds, or headphones. We suggest calming, soft music.
  • Mental Health Mood Infusions are 40 minuetes in duration with a 20-to-30-minute recovery period.
  • You will leave the clinic under your own power and your trusted person will take you home (no driving the day of treatment).
  • The amount of ketamine given will not cause you to lose consciousness. Most patients find the infusion experience to be very pleasant. It is quite common to have a floating or body tingling sensation, accompanied by a mild dissociative experience with an increased sensitivity to light, sound and an altered perception of time and/or color. This is temporary and will end shortly after the infusion is complete. Most patients tolerate these experiences without discomfort and many people find them to be pleasant. In the rare case these side effects are perceived as unpleasant, other rapid acting medications can be used to relieve or eliminate side effects considered unpleasant or uncomfortable.
  • Once the infusion is complete, the dissociative effects of the drug rapidly dissipate and are often mostly gone within 20-30 minutes. There are no aftereffects or “flashbacks” and patients generally leave our clinic within 30 minutes following the infusion and aside from mild fatigue, feel much like themselves.
  • For pain patients, ketamine is administered over a one-four hour period with a Certified Registered Nurse Anesthesiologist (CRNA) monitoring you during your infusion to ensure your safety and comfort. Your blood pressure, EKG, pulse oximetry and ETCO2 will be monitored during these infusions. The amount given is higher than what mood disorder patients receive and can increase side effects such as dissociation. We use several adjuvants to decrease or eliminate undesired side effects sometimes associated with higher doses of ketamine. Patients generally take 30-60 minutes of rest following the infusion before they feel comfortable leaving our clinic. There are no aftereffects or “flashbacks” and aside from being tired or fatigued, most feel much like themselves. We require pain patients to be picked up inside our clinic by a responsible adult.

Are there any other side effects I should be concerned about? Patients commonly feel tired following an infusion. On rare occasion, some patients experience nausea after an infusion. If so, we have anti-nausea medication that can relieve this. If you are prone to nausea, we can administer anti-nausea medicine prophylactically before the infusion to help prevent it. Side effects usually dissipate within a few hours and are completely gone by the following day. There are no known long-term or permanent side effects of low dose IV Ketamine Infusion Therapy when administered by a responsible clinician in a medical setting.

I am bi-polar, will ketamine make me hypomanic? Although hypomania is possible, it would be very rare.

What is Neuropathic Pain? Neuropathic pain, also known as nerve pain, is a type of chronic pain that occurs when nerves in the central or peripheral (or both) nervous systems become injured or damaged. It is a complex chronic pain state that usually is accompanied by tissue injury. Neuropathic pain can be a result of dysfunctional, injured, or damaged nerve fibers themselves. Damaged nerve fibers can send incorrect signals to the brains other pain centers. The impact of a nerve fiber injury includes a change in nerve function both at the site of injury and areas around the injury. If you or someone you care about has nerve pain, you know that it can erode quality of life.

What are some of the causes of Neuropathic Pain?

This is a partial list of causes:

  • Alcoholism
  • Amputation
  • Chemotherapy
  • Diabetes
  • Facial nerve problems
  • Multiple myeloma
  • Multiple sclerosis
  • Nerve or spinal cord compression from herniated discs or from arthritis in the spine
  • Shingles
  • Spine surgery
  • Thyroid problems
  • Trauma

Can Ketamine infusions relieve the agony of severe chronic nerve pain? Yes. Just like the success seen with mood disorders, scientific research has demonstrated ketamine to be a remarkably effective treatment with a similar efficacy of about 70%. The mechanism of action is different than the medications used for acute pain such as Dilaudid, Percocet, Vicodin, morphine, and others. Ketamine blocks the NMDA receptors in the brain from receiving a constant barrage of input from pain receptors. Results are often seen in 2-3 treatments. Long term relief will require a series of infusions.

Will Ketamine reduce my intake of opioid medicine? Ketamine can reduce opioid intake by as much as 50% or more through an opioid sparing effect (mu opioid sparing and opioid potentiation) for many patients. Some patients are able to permanently eliminate opioids.

Why should Ketamine be administered by an Anesthesia Professional? Ketamine is an anesthetic medication. For maximum safety it should only be administered by a healthcare professional educated and highly experienced in delivery of ketamine and general anesthesia. Our Certified Registered Nurse Anesthesiologists are the highest trained and experienced experts in emergency airway and crisis management. The FDA package insert, and label information clearly states that Ketamine should only be administered by someone experienced in the delivery of anesthesia. Vancouver Ketamine Infusions offers Ketamine Infusion Therapy provided by:

  • Karl Hare CRNA MSA — A Nationally Board-Certified Registered Nurse Anesthesiologist (NBCRNA) has over 21 years of anesthesia experience and ongoing specialized training with 30 years of experience in direct patient care.

  • Marci Hare CRNA MSA -A Nationally Board-Certified Registered Nurse Anesthesiologist (NBCRNA) has over 20 years of anesthesia experience and ongoing specialized training with 30 years of experience in direct patient care.

I don’t have a psychiatrist, is that a problem? We encourage collaboration with your mental health provider or physician to assist us in monitoring your progress, efficacy of your treatment, and development of a successful treatment plan to ensure your ongoing care and wellbeing. If you do not already have a mental health provider, we can help refer you to one nearby if you wish.

We do require that you have been seen by a psychiatrist, MHP, CPP or PCP and have a diagnosis prior to ketamine infusion therapy.

Are there any conditions that may make ketamine dangerous? Uncontrolled blood pressure, unstable heart disease, untreated thyroid disease, active substance abuse, current manic phase of bipolar disorder, active psychotic (hallucinations or delusions) symptoms, severe liver disease or pregnancy may preclude you from having ketamine infusions. If you have questions about your specific medical conditions, give our office a call for more information. 360-360-2244

What are the risks of ketamine? The dose used for the treatment of mood and anxiety disorders is exceptionally low and safe. During ketamine treatments, blood pressure and heart rate may increase. This is monitored closely to ensure safety. The doses used to treat chronic pain are higher doses and sometimes require using other sedative medications to ensure patient comfort during the treatment. The team at Vancouver Ketamine Infusions is highly skilled in the practice of anesthesia and has been using ketamine in their daily practice for many years. They will ensure both patient comfort as well as safety during the treatments.

Is ketamine covered by insurance companies? Currently most insurance companies do not pay for ketamine treatments for mood disorders. Insurance companies view ketamine for these purposes as off-label, investigational, or experimental.

Do I need a referral? We prefer you have a referral. We prefer to work collaboratively with your current psychiatrist, mental health provider (MHP), chronic pain physician (CPP) or primary care physician (PCP). Alternatively, if you have never been seen or diagnosed with a mood disorder or chronic pain disorder by a MHP, CPP or PCP we can help refer you to one. A MHP, CPP or PCP will evaluate and diagnose your condition, a MHP, CPP or PCP may then be refer you or you can make your own appointment with your current medical records available to evaluate you for ketamine infusion therapy at Vancouver Ketamine Infusions. We do require that you have been seen by a psychiatrist, MHP, CPP or PCP and have a diagnosis prior to ketamine infusion therapy.

Can ketamine help me? Scientific studies performed since the early part of the century show a remarkable 75% effectiveness rate in intravenous ketamine for the treatment of depression and other mood disorders. While the benefits can be life-changing, they may manifest in ways that differ from some patients’ expectations. The changes produced by ketamine can be subtle, and though they occur rapidly, it may take time for a patient to feel the full impact. Some patients expect an immediate improvement after their ketamine treatments. But the reality is that ketamine improves depressive symptoms in a way that allows patients to engage in other healthy activities that promote mental health and overall well-being. With this in mind, we work closely with each patient to determine whether ketamine is a viable treatment option.

Is this real medicine? It seems too good to be true. The results are real and are being studied closely by some of the most prestigious medical institutions in the world. The National Institute of Health (NIH) has been studying ketamine as a treatment for depression for nearly ten years. Researchers at Yale University published the first major study in the year 2000. Since then, scientific controlled, double-blind, peer-reviewed research studies have been conducted around the world including institutions such as VA, Harvard, Oxford University, Mt Sinai Medical School, Johns Hopkins and many more. We believe it is only a matter of time until the FDA catches up with the research and recognizes ketamine for the treatment of depression, chronic pain, PTSD, and other problems.

Why does ketamine work when no other drugs have helped me? Ketamine works by a completely different mechanism than any of the other medications you have taken. It primarily blocks NMDA receptors in the brain and activates your (AMPA) receptors. It also works on numerous other neurotransmitter channels such as brain-derived neurotrophic factor (BDNF), mechanistic target of rapamycin (mTOR), HCN1, nitric oxide, cGMP, glutamate, and other as yet unknown areas. This cascade affects certain receptors and signaling pathways and produces a protein that triggers rapid growth of neural connections. This activation of downstream synaptogenic signaling pathways results in increased neuroplasticity and the growth of neurons and new synapses (connections) which was previously thought to be impossible. This is primarily responsible for the rapid and powerful anti-depressant effects that usually manifest within 2-4 hours. Ketamine metabolites such as hydroxynorketamine (HNK) are also neuroactive. Scientists have provided evidence that neurons and nerve channels are repaired and “re-wired” resulting in the lasting relief seen in so many patients.