Ketamine FAQs

FREQUENTLY ASKED QUESTIONS

Will ketamine therapy help my treatment-resistant depression?  Based on searches of major medical centers over the past 15 years and in our clinic’s experience, up to 70% of all patients may experience significant and rapid relief.  While we cannot predict any individual’s response, a significant number of people report improvement of their symptoms and functioning.

Do I need to be referred by a psychiatrist?  If you are not currently a patient of Dr. Amato’s, she will meet with you to discuss your diagnosis and treatment history to determine if ketamine treatment is appropriate for you.  Patients who are already seeing Dr. Amato will work with her to determine readiness for ketamine treatment.

Where is the treatment performed?  All treatments are performed at Montana Psychiatry on an outpatient basis in our relaxing and comfortable location.

How many ketamine infusions will I receive?  That will depend on your response.  Most responsive patients receive a series of six infusions.  Dr. Amato will work with you to customize your treatment plan for the best chance of success.

Will I require ketamine infusions for the rest of my life?  Some patients achieve long-term relief after a series of infusions.  Some patients may return for “maintenance” treatments if ketamine has been effective to help maintain their response, especially if they have tried antidepressant treatments in the past that either haven’t worked or haven’t been tolerated.

If ketamine therapy works for me how soon will I begin to feel better?  Some patients begin to feel better within hours of the first infusion.  Patients with thoughts of self-harm often notice those thoughts dissipating first.  There can be a dramatic relief of dread and hopelessness.  Other patients may not notice any mood improvement until the next day.  Some patients will require more infusions before feeling better.

Are there any long-term side effects with ketamine therapy?  Traditional medications often produce side effects such as sexual dysfunction and weight gain.  However, ketamine therapy has not shown any long-term side effects when administered at the small doses used to treat mental health conditions.

I am bi-polar.  Will ketamine make me hypomanic?  Hypomania or mania have not been reported following ketamine therapy.  Ketamine therapy is not appropriate for people currently experiencing a manic episode.

What conditions could keep me from receiving ketamine?  There are very few but these can include uncontrolled high blood pressure, severe kidney function problems, psychotic disorders, or mania.  Women who are pregnant should not have treatment with ketamine.  Dr. Amato will discuss contraindications with you before you receive your first infusion.

Are ketamine infusions addictive?  No.  While ketamine is sometimes abused as the club drug known as “Special K,” there is minimal risk of addiction when administered in small doses in a controlled clinical setting.  In fact, ketamine has been shown to be helpful when people are trying to overcome addiction disorders that are commonly accompanied by depression or other mental health conditions.  Dr. Amato will discuss any history of substance abuse problems to determine the appropriateness of ketamine therapy for you.

Will my current psychiatric medications interfere with ketamine therapy?  Anti-depressant medications (SSRIs, MAOIs, and tricyclics) do not interfere with ketamine, and there is no need to stop them.  Patients taking large doses of benzodiazepines (Ativan, Xanax and Klonipin) may have a reduced response to ketamine, but taking these medications at lower doses does not mean that ketamine cannot help you.  There are some reports that Lamictal in doses over 100mg/day may blunt the ketamine response, but this is still considered controversial.  Your medication history will be discussed with Dr. Amato at the time of your evaluation and any recommended medication changes to optimize your response to ketamine will be discussed at that time.  Important: You should not decrease or stop taking any prescribed medication without first consulting your prescribing physician.

What should I expect during ketamine therapy?  Ketamine is administered over a period of 40-60 minutes.  The dose is determined by your weight and by your response to previous infusions.  The amount of ketamine administered is not enough to cause a loss of consciousness, so you will remain awake, but relaxed.  Blood pressure and heart rate are measured at the beginning of treatment and at a few intervals during the infusion.  During the infusion, some patients experience odd perceptions – like seeing bright colors, sounds sounding amplified or far away, or feeling a distortion of the passage of time.  Some report what is referred to as “dissociative” or “out of body” experience.  These are effects of ketamine that may be important for ketamine’s ultimate effectiveness.  Most patients tolerate the experiences with no trouble, and many people find them pleasant.  Our highly experienced RN is on hand throughout the treatment to provide support and to make sure the experience is tailored to your needs.  Once the infusion is complete, the dissociative effects of the drug rapidly dissipate.  There are no delayed “flashbacks” and patients generally leave the office within 30 minutes following the infusion and feel quite normal.

Are there other side effects that I would experience during or after my therapy?  Occasionally patients experience some nausea during or following an infusion.  If so, we have medication that will help.  More rarely, a patient may experience a transient headache.  Patients can expect to be tired following the infusion.  Very, very rarely, patients already at risk for seizure have reportedly experienced one.  If you have a seizure disorder, please be sure to share that information with Dr. Amato prior to your therapy.

What happens after my series of ketamine infusions? If you have had a positive response to ketamine following the initial series of infusions, you will work with Dr. Amato and her team to plan a maintenance program, which involves intermittently returning for single infusions. The interval between maintenance infusions varies from patient to patient.