KETAMINE TREATMENT INFORMATION SHEET
Indications
Ketamine is a schedule III FDA-approved medication for anesthesia. At lower doses, ketamine can be used off-label for treatment-resistant depression and PTSD, but it is not FDA-approved for this indication. Treatment-resistant depression means a patient has failed 2 adequate trials of 2 different FDA-approved antidepressant medications.
Ketamine may improve PTSD and depressive symptoms including sadness, suicidality, and helplessness.
Ketamine alters a chemical called glutamate by blocking NDMA receptors in the brain and may produce a more rapid effect compared with usual antidepressant/anti-anxiety medications that work on serotonin, dopamine, or norepinephrine.
Patients should start to receive benefits from a single dose within 30-90 minutes. This is unique because most other antidepressants require 4-6 weeks before taking full effect.
The duration is specific to each patient, but most patients have an effect that lasts 3-7 days from a single first dose, and subsequent doses can provide even longer relief.
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Procedure
Ketamine is weight based at 0.5mg/kg; higher doses are associated with more side-effects.
The injection is given as an intramuscular (IM) injection into the deltoid muscle (upper arm). This administration has fewer adverse effects as compared to IV administration, but is more effective than intra-nasal and sublingual forms.
You will be periodically observed for 1-2 hours, monitoring your cognitive function and vital signs.
You will need to pre-arrange a ride home; Uber, Lyft, family-member, or friend are all acceptable.
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Side Effects & Risks
Common (1-10% of patients):
-Temporary increase in heart rate and/or blood pressure
-Slowed respirations
-Blurry vision
-Dizziness
-Nausea/vomiting
-Reduced coordination/concentration
-Pain at injection site
Rare (0.1-1% of patients):
-Jerky muscle movements or tremor
-Hallucinations
-Dissaciation (“out of body” experience)
-Confusion/altered mental status
-Laryngospasm (spasm of vocal chords leading to difficulty speaking or breathing)
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Who Should Not Receive Ketamine?
You should NOT receive ketamine if you…
-have a history of psychosis or schizophrenia (even if stable and controlled with medication)
-are actively using alcohol, marijuana, or illicit drugs on the day of the procedure
-have uncontrolled high blood pressure are pregnant or breastfeeding
-have a history of liver disease, liver transplant, or significantly abnormal liver blood tests
-have a history of untreated coronary artery disease (CAD)
-had a prior negative reactive to ketamine
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Medications That Can Interact with Ketamine
-MAO inhibitors (MAOIs): can cause elevated blood pressure
-Lamotrigine (Lamictal) and Naltrexone (Vivitrol): reduce effectiveness of ketamine
-Opioids and clonidine (Catapres): can cause increased chance of side effects
-Do not take these medications on the day of treatment: Stimulants, benzodiazepines, marijuana, opioids, alcohol, and other illicit drugs
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Patient Instructions:
1) Take your usual medications, including blood pressure medications, on the day of treatment.
2) Do not take opiods, clonidine, stimulants, benzodiazepines, marijuana, alcohol, or other illicit drugs on the day of treatment, and for 24 hours after the injection.
3) Arrange for transportation from the visit. You may not drive for the remainder of the day after receiving ketamine.
4) Avoid making any important decisions for the remainder of the day after the ketamine treatment.
5) Call 911 or go immediately to the emergency room with any concerning or serious symptoms after you leave our care.