Eligibility for Ketamine Treatment
Before participating in ketamine treatment, you will be screened to determine if you are eligible for ketamine therapy, including medical, physical, and psychiatric history.
Pregnant women must not participate in ketamine treatment. Ask your primary care physician if you would like to discuss birth control options. If you become pregnant while participating in this program, you should notify your provider immediately as the effects of ketamine on the unborn child are undetermined.
Overview of Subanesthetic Ketamine Therapy
The length of the ketamine session will be approximately 60 minutes, and we recommend you remain in the recovery area for at least 15 minutes following the appointment. For IV treatment, an intravenous catheter will be placed, and ketamine is infused over the next 30-40 minutes. Alternatively, ketamine will be given as an intramuscular injection into your shoulder. If nauseous, you may be offered oral or Intravenous ondansetron (Zofran) or oral or Intramuscular promethazine (Phenergan).
You will be provided with a bed, blanket, pillow and music to make this time more comfortable. Eye masks available at request. At any time, you may ask the medical staff any questions you may have concerning the procedure or the effects of ketamine. Your consent to receive ketamine may be withdrawn, and you may discontinue your participation at any time up until the actual medication has been administered.
Estimate of Expected Recovery Time
The non-ordinary state of consciousness produced by ketamine usually lasts about 45 to 50 minutes, but can last for one to two hours. For some, a reduced sense of balance with dizziness and possible nausea may occur, and will gradually subsides over two to six hours. Occasionally patients experience emotional volatility and hypersensitivity to stimuli but these symptoms should resolve within 24 hours.
Potential Risks of Subanesthetic Ketamine Therapy
You will be asked to lie down during the ketamine administration because your sense of balance and coordination will be very poor until the effect has worn off. Participants have also reported blurred vision, slurred speech, mental confusion, delirium, dreamlike state, excitability, inability to see things that are actually present, hallucinations, vivid imagery, inability to hear or feel objects or one’s body, irrational behavior, anxiety, nausea, and vomiting.
To minimize the likelihood of nausea and vomiting, you should not eat a meal during the 4 hours preceding the session.
The administration of ketamine may also cause the following adverse reactions: tachycardia (elevation of pulse), diplopia (double vision), nystagmus (rapid eye movements), elevation of intraocular pressure (feeling pressure in the eyes), and anorexia (loss of appetite). The above reactions occurred after rapid intravenous administration of ketamine or intramuscular administration of high doses of ketamine.
Very rare: Bradycardia, cardiac arrhythmia, hypotension, increased blood pressure, increased pulse, hypertonia (tonic-clonic movements sometimes resembling seizures), increased cerebrospinal fluid pressure, Erythema (transient), morbilliform rash (transient), rash at injection site, Central diabetes insipidus, Anorexia, nausea, sialorrhea, vomiting, Bladder dysfunction (reduced capacity), cystitis (including cystitis noninfective, cystitis interstitial, cystitis ulcerative, cystitis erosive, cystitis hemorrhagic), dysuria, hematuria, urinary frequency, urinary incontinence, urinary urgency, Hypersensitivity: Anaphylaxis, Pain at injection site, Laryngospasm, Diplopia, increased intraocular pressure, nystagmus, Hydronephrosis, Airway obstruction, apnea, respiratory depression
Safety risks while working under the influence of ketamine- Ketamine decreases reaction time, cloud judgment, and causes drowsiness and tolerance. It could be dangerous for you to operate heavy equipment or drive while under the influence of Ketamine.
Driving an automobile , engaging in hazardous activities, or operating machinery should not be undertaken until after your first night's sleep following treatment with ketamine. A driver is REQUIRED to pick you up to continue treatment at our facility. This can be public transportation, Uber/Lyft, friends or family members, etc.
In terms of physical risks, ketamine should not be taken if you have unmanaged hyperthyroidism. It does raise blood pressure, so you should have the approval of your doctor to take ketamine if you have high blood pressure. For high blood pressure, you may be offered oral Clonidine to aid in bringing down the high blood pressure. However, it has been used for many years as a general anesthetic for children, the elderly, and those with severe physical illnesses because it is considered safer than most general anesthetics.
In terms of psychological risk, ketamine-induced experience has been shown to worsen certain psychotic symptoms in people who suffer from schizophrenia or other serious mental disorders. It also may worsen underlying psychological problems in people with severe personality disorders.
Potential for Ketamine Abuse and Physical Dependence
Ketamine is a controlled substance and is subject to Schedule III. With regard to the potential for misuse of ketamine, “cravings” have been reported by individuals with a history of heavy use of ketamine and other “psychedelic” drugs. In addition, ketamine can have effects on mood (feelings), cognition (thinking), and perception (imagery) that may make some people want to use it repeatedly. Therefore, ketamine should never be used except under the direct supervision of a licensed medical provider..
Injuries and/or Illness
If you become ill or sustain an injury during your participation in ketamine therapy, immediately contact your medical personnel, and, if emergency care is needed, you will be transferred to the nearest local hospital.
Voluntary Nature of Participation
Ketamine therapy is a new treatment for depression and is not a mainstream treatment, though there are multiple research studies that demonstrate it can be an effective treatment, it is still considered “off-label use”. The effect generally occurs after several treatments and does not permanently relieve the depression.
If the depressive symptoms respond to ketamine, you will still be treated with medications to try to reduce the rate of relapse. You may also need additional ketamine treatments or other therapies to maintain remission.
Ketamine infusions generally must be repeated and/or paired with therapy as well in order to maintain response. Sometimes ketamine taken by mouth or intranasally has been used for maintenance dosing. Ketamine is not generally a first-line treatment for pain as well, and is usually used along with other pain medications that must be continued, and does not produce permanent pain relief.
Your decision to undertake ketamine therapy is completely voluntary. Before you make your decision about participating in ketamine therapy, your medical personnel will give you a chance to ask any questions you may have about the procedure.
Patient Behavior and Safety Agreement
By signing this consent form, you acknowledge and agree to uphold a safe and respectful environment during your treatment. Any behavior that is violent, threatening, or sexually inappropriate will not be permitted. This includes, but is not limited to, physical aggression or sexual misconduct.
Please understand that if such behavior occurs, it may result in the discontinuation of your treatment, removal from the premises, and, if necessary, involvement of law enforcement. These measures are in place to protect the safety, dignity, and well-being of all patients and staff, and to maintain a professional and supportive healing space.
