How do I make an appointment?
3) Patients who are taking benzodiazepines (alprazolam, lorazepam, clonazepam, et al.) should know that these medications may interfere either with the efficacy of ketamine or the duration of relief provided by ketamine treatment. Patients may opt to work with their prescribers to lower their intake or wean off these medications prior to beginning ketamine infusion therapy in order to maximize the treatment's efficacy. If this is not possible, the dose prior to each infusion should be held. Self-weaning can be dangerous and is strongly discouraged.
Lamotrigine (Lamictal) appears to have mixed / unpredictable interactions with ketamine in terms of efficacy.
4) The first appointment consists of a mental health evaluation and question-and-answer consultation by our staff psychologist. A medical review with one of our physicians will occur either at this evaluation or at the start of your first infusion appointment. Appointments for infusions take place after the full consultation process is complete. We encourage patients to plan for a series of six infusions over two to three weeks. All appointments are scheduled for 90 minutes.
5) To schedule your first visit, please call (781) 538-6555.
What is your cancellation policy?
Please notify us within 48 hours of your appointment if you need to cancel it for any reason. If you cancel your initial appointment, Boston MindCare reserves the right to re-assign the remainder of your reserved treatment appointments to a patient on the waiting list. Our goal is to keep the waiting list for treatment at Boston MindCare to a minimum and serve those patients who are ready for treatment as soon as possible.
What are the costs of the initial consultation and the infusions?The
mental health evaluation / initial pre-infusion consultation costs $350. Each infusion costs $550. Insurance companies currently are not likely to cover ketamine infusion therapy for depression, but we encourage you to apply for reimbursement.
Do I really need a whole psychological evaluation and medical
consultation before starting my infusions?Ketamine infusion therapy can be challenging, both physically and mentally. It is absolutely essential to be prepared and to have a team of health providers who know you involved in your care and able to tailor it to your individual needs. We believe a holistic approach enables patients to get the most out of this treatment process and feel strongly that the treatment team here at Boston MindCare, in collaboration with your primary treatment team (psychopharmacologist, therapist, and primary care physician) can provide the safest and most comprehensive, hands-on care during this intense process.
What exactly is an infusion?
An infusion is administration of a substance, in this case a medication, intravenously over a certain period of time. All our infusions take approximately 45 minutes to an hour to administer.
How many infusions do I need?
The optimal regimen for ketamine therapy has not been established and may vary among individuals. We do know the following from various studies and from clinical experience:
1) Serial infusions have been shown to be more effective than single infusions;
2) Closely spacing infusions in the initial treatment phase (two to three infusions per week), then fine-tuning an individual's regimen with well-timed maintenance infusions, appears to confer the best hope of success.
Typically we offer four to six infusions within a two-week period, with subsequent infusions as needed to relieve symptoms. Most patients require “maintenance” infusions every few weeks. The response of individual patients varies and is impossible to predict with current available resources. In keeping with the standards and best traditions of the practice of anesthesia, wherein each anesthetic plan is designed according to the particular needs of any given patient, we are dedicated to getting to know each patient's needs and responses and tailoring therapy to the individual.
What side effects can I expect during and after an infusion? Will I be anesthetized / unconscious during the infusion? Will I be groggy afterward?
Responses to ketamine vary from individual to individual. You will be awake and most likely continue to be able to interact with those around you, listen to music, or just close your eyes and relax during the infusion. Some people may experience transient dizziness, nausea, mild visual hallucinations, a sense of disconnection from the body, and mild distortions of space and time perception. The infusion is generally a tolerable experience for most people, though is commonly described as "weird." It can also leave some people feeling emotionally raw or vunerable, while others may feel a sense of well-being or opennness. You will be back to your baseline about fifteen to thirty minutes after the infusion ends and will be monitored for twenty to sixty minutes before you are discharged. Some people become extremely fatigued after infusions and/or may develop headache, a feeling of "heaviness," or some nausea. While you may not be groggy after the infusion, we strongly advise that you avoid driving, operating machinery, or participating in challenging mental work or decision-making for at least twelve hours after the infusion, and we require that someone drive you home.
May I eat or take anything before coming in for treatment?
Please do not consume solid food, orange juice, pulp-filled juices, or non-clear broths or soups in the six hours preceding your appointment. You may have transparent liquids such as water, clear broth, apple juice, white grape juice (not dark), black coffee (NO DAIRY OR CREAMER), or clear tea (no milk or leaves) up to two hours prior to your appointment.
PLEASE REFRAIN FROM CONSUMING ALCOHOL, SMOKING OR INGESTING MARIJUANA, OR USING COCAINE, HEROIN, OR OTHER ILLICIT SUBSTANCES. Not only can they pose a safety risk when combined with ketamine treatment but also they can interfere with the effectiveness of ketamine therapy.
Is ketamine dangerous?
Ketamine is an anesthetic that has been widely used for decades. It was synthesized by Calvin Stevens at Parke Davis Laboratories in 1962 and has been used as an anesthetic in both children and adults since the 1970’s.
Ketamine has been used illegally under the street names K, Special K, Vitamin K, Kit Kat, Cat Valium, Special LA Coke, Super Acid, Super C, Green, Purple, Honey Oil, Bump, and Jet. Boston MindCare does not endorse the recreational use of ketamine. Abuse of ketamine can be very dangerous and potentially lethal, as is the case with alcohol and narcotic medications.
In the hands of clinicians specially trained to provide ketamine as an anesthetic or analgesic, however, ketamine has a wide safety margin. In fact, in some cases when other anesthetics are unsafe to use because of a patient’s unstable condition, many anesthesiologists will choose to use ketamine for the patient’s protection. The doses used for treatment of depression are “subanesthetic”: they are well below what anesthesiologists use to anesthetize patients for surgery.
Is there research to show that ketamine helps with depression?
Studies at the National Institutes of Mental Health, Mayo Clinic, Mt. Sinai School of Medicine, and Yale have shown significant benefit with the use of low-dose ketamine infusions for depression. To read more about this research, please click on the "Articles" tab.
Does ketamine help people with bipolar disorder? What about other psychiatric illnesses?
Research supports the use of ketamine for bipolar disorder. Various studies suggest it shows some promise for chronic posttraumatic stress disorder, obsessive-compulsive disorder, substance addiction, and even traumatic brain injury as well. It has also been used for chronic pain conditions such as CRPS. Its cognitive protection / ability to attenuate post-operative delirium has been observed by anesthesia providers for a number of years now and may hold promise for individuals with chronic conditions in which cognitive protection / synaptic regeneration is desirable (see "How does ketamine work?" below).
Ketamine is not useful and may in fact be harmful or exacerbate symptoms in schizophrenia. Its use for a variety of medical / neuropsychiatric problems has generated considerable interest and is being actively explored.
Will ketamine work for me? What is the success rate of ketamine infusions for depression?
Ketamine has shown significant promise in the studies that have been published within the last eight to ten years. On average, three out of four people experience some benefit from ketamine treatment for depression. It is important to remember that ketamine may produce no improvement in some, and in a small subset of patients may even worsen symptoms. Your response to ketamine cannot be predicted with our current resources. There may be certain elements of your health history that may affect your body's ability to respond well to ketamine.
There is some evidence suggesting that even if an individual's response to ketamine is imperfect or incomplete, it may still be of benefit for certain symptoms of depression. One study (Murrough et al, 2013) reported, "Of particular note, suicidal ideation (SI) rapidly decreased across the total study sample, even among study non-responders. While preliminary, this result suggests that ketamine may exert a unique anti-SI effect even in the absence of a full response and is consistent with previous reports highlighting the potential anti-SI effects of ketamine in depressed populations.”
Practitioners across the country are reporting positive results for their patients. For a list of ketamine infusion providers in the U.S., please see the directory on the Ketamine Advocacy Network website.
If I do respond to ketamine, how quickly will it work, and how long will relief last? Can ketamine cure me?
Some patients begin to feel a difference by the evening or day after their first infusion. Even for "responders," periods of sadness or depressed mood may still occur between infusions, but the overall trajectory of mood symptoms should be one of improvement. Responders may also find urges to self harm and suicidal thoughts diminished and ability to cope with stress improved.
Patients may find that functional improvements - getting a to-do list done, socializing more easily, etc. - occur before improvements in mood. Family and friends thus sometimes observe that a patient "seems better" even though the patient still feels the same. Changes can be gradual.
Some patients find that the positive effects of ketamine may wear off with time. There is research to suggest that in order for the effects of ketamine to be sustained, a maintenance regimen is advisable. The response of individual patients varies. There have been rare cases of remission after ketamine infusion therapy, but these should be considered the exception rather than the norm.
Ketamine should not at this time be thought of as a cure for depression but rather as an adjunct to ongoing treatment that can help reset a person's baseline, relieve some of the suffering and hopelessness of major depression, and give other therapies such as oral medication and psychotherapy a chance to progress.
How does ketamine work?
Ketamine's anesthetic effects are mediated by interactions with a member of the glutamate receptor family, the NMDA receptor. It interacts with other receptors as well, including
- opioid receptors;
- dopamine receptors - it appears to reduce dopamine deficits in a brain circuit involving the hippocampus and the nucleus accumbens; and
- a receptor known as the AMPA receptor, thought to be an important component of its antidepressant effects.
Rather than targeting neurotransmitters in the brain, ketamine is thought to target gene expression and protein manufacture in certain important brain pathways or circuits. It rapidly activates a biochemical pathway associated with synaptic plasticity, the mTOR pathway, by increasing expression of a gene encoding the protein BDNF, which gets the m-TOR pathway going. Activation of the protein-making machinery of this pathway in brain cells leads to an increased number of new synapses in the prefrontal cortex and the increased formation of synaptic signaling proteins. Put simply, ketamine appears to restore brain synapses, both structurally and functionally, that have been damaged by the disease of depression.
As one NPR article reported, describing a discussion with researcher Carlos Zarate, “[Zarate] says depression not only weakens connections between neurons; it affects the neurons themselves. ‘A healthy neuron will look like a tree in spring: you have branches, you have leaves.’ (Zarate says the leaves are synapses.) ‘What happens in depression is there’s a shriveling in these branches, these leaves, and it looks like a tree in winter. And a drug like ketamine does make the tree look like one back in spring.’ Zarate says the change is obvious and almost immediate.”
Can I get addicted to ketamine?
Because it is abused as a "party drug" or "club drug," there are legitimate concerns about ketamine addiction. It currently does not meet criteria for being physically addictive, though tolerance to its effects may occur with prolonged exposure. It may pose a risk of being psychologically addictive for some.
Will ketamine interact with my other medications?
Patients do not have to stop their antidepressant medications to receive ketamine. Ketamine can be used safely with most medications including SSRIs, SNRIs, lithium, Wellbutrin, and tricyclics (with caution). Patients taking aminophylline for asthma or COPD may be at greater risk for developing seizures if they receive ketamine. Patients who are taking benzodiazepines (alprazolam, lorazepam, clonazepam, et al.) or lamotrigine (Lamictal) may see a weaker effect from ketamine (see above).
Is there anyone who should avoid ketamine treatment?
Ketamine infusion therapy can benefit patients with severe depression or bipolar disorder. It is not for patients with schizophrenia, psychosis, or seizures. As mentioned above, those taking aminophylline for asthma or COPD should avoid receiving ketamine. Patients who have serious medical problems such as uncontrolled high blood pressure, cardiac disease, or pulmonary problems need to have their conditions optimized and to obtain clearance from their primary care physicians before undergoing even low-risk medical or anesthetic procedures, including ketamine infusion. Patients with schizophrenia or other psychotic disorders should avoid ketamine.