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What is Ketamine?

 Ketamine was first synthesized in 1962 and it was not until 1966 that Corssen and Domino published the first clinical study of ketamine as a human anesthetic . It was first reported to have antidepressant properties in 2000 when it was demonstrated that an intravenous (IV) administration of a sub-anesthetic ketamine dose resulted in a reduction of MDD symptoms rapidly and continuing to 72 h after treatment. Recent studies have shown beneficial results in the treatment of depression, PTSD, and bipolar disorder patients. Also, patients suffering from alcohol abuse, and other elicit drug dependency may benefit from ketamine treatment. 

 

Initial free consultation 

During your first encounter, you will consult with the nurse for an evaluation and assessment where information about medication regimen history, health history, baseline weight (kg), and vital signs will be acquired.  Information about the benefits, side effects, adverse effects, and precautions to take before and after treatment will be discussed.  We will also answer any questions that may arise during the consult at this time.  The nurse will also provide you with educational material to take home and encourage you to read in order to reach a better understanding of the process and reasoning behind the ketamine infusion treatment for you. 

 

 

Consultation with the psychiatrist 

Dr. Monica Robles will perform a complete psychiatric evaluation where your past medical and psychiatric history will be discussed. Your current symptoms will be assessed and you will talk about your expectations and goals from the ketamine treatments  A comprehensive social and substance abuse history also will be collected. After this thorough evaluation, Dr. Robles will  decide if you are an eligible candidate for ketamine treatment and will discuss different options available to you. Your initial dosage will be calculated and discussed with you. The initial dose will be based on the acquired weight with minor adjustments.  Subsequent dosing will be based on your reaction to the initial infusion.  The infusion will last approximately 40 to 45 minutes and you will be monitored by our nurse the entire time.  Vital sign monitoring throughout, while providing a calm and comfortable environment, in order to facilitate the best experience during your treatment. 

 

 

Procedure

Upon your arrival, you will be guided to our ketamine room and will be met by the nurse who will obtain again your weight, baseline vital signs, and will ask you about the medications you have taken in the last 24 hours.  The next step in your treatment will be the medication infusion.  At this time the nurse will connect the monitoring devices (wrist blood pressure cuff, finger oxygenation monitor).  An intravenous catheter will be inserted into your hand, wrist, or arm and secured to your skin with adhesive dressing and paper tape.  This catheter will be attached to intravenous solution tubing which will help infuse the medication into your bloodstream.  

During the procedure, we will monitor your vital signs with non-invasive equipment which will remain in place throughout, while displaying values on a small tablet screen at the nurse’s desk.  We will also assess your response to the medication during the treatment and will ensure the infusion rate is adequate for your best experience. In order to provide a calm and peaceful environment, we will provide you with noise cancelation headphones through which we play pleasant music at a volume level of your preference.  Also, we have the capability of dimming the lights down, while you comfortably sit in our reclining chair set to a position comfortable for you.  Furthermore, we can provide you with blankets and blindfolds to make sure you reach the best level of comfort during your treatment.   After about (40-45) minutes we will remove the tubing and catheter and allow you to relax in the room until you feel ready to leave. 

 Once the infusion ends, you will regain your full faculties within minutes and will be able to relax in the infusion room until you feel prepared to walk safely.  The effects are often completely gone after approximately 15-20 minutes, some patients will feel fatigued after the treatment, while others are able to resume their daily activities.  You will have the option to meet with one of our therapists right after the infusion or in the following 48 hours following the infusion which have been found by other experienced practitioners to be when the mind is more 

"open " and receptive to understanding and processing blocked material and working on cognitive restructuring. 

 

Experience

The experience during ketamine infusions is set to be a pleasant one.  Most of our patients experience a peaceful and comfortable state during their infusion treatment.    You will experience the effects of ketamine within minutes of the initiation of the infusion.  In some cases, you will be able to carry out a coherent and intelligible conversation, though some prefer to simply relax quietly and enjoy the music and follow the path of their mind and thoughts.   

 

It is possible that you may experience moments of fear and anxiety during the treatment, especially if you are in a state of high anxiety at the beginning of the infusion.  We encourage our patients to think positive thoughts and try to ground themselves prior to the infusion. Our staff will closely monitor every step of the way during your treatment and will provide reassurance when needed. If at any time you feel  extremely uncomfortable the infusion will be stopped 

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