Ketamine Infusions

What is Ketamine and Ketamine Infusions?

Ketamine is a prescription drug and a controlled substance, primarily used as a rapid-onset, short-acting pain-killing agent (anesthetic) during acute and emergency surgical procedures. Unlike other anesthetics drugs, Ketamine is less likely to cause breathing suppression, making it the drug of choice when reliable respiratory ventilating apparatus is not available. Ketamine infusions involve the release of Ketamine directly into the bloodstream

Ketamine was initially developed in 1963 as a veterinary anesthetic. Its promising results in animals triggered clinical trial in human prisoners, and led to a conclusion that it is as effective as it was in animals.

Ketamine is an effective pain-killer after a surgical procedure, if co-administered with a low-dose opioid drug (such as morphine). Ketamine infusions have shown effective control of acute pain, neuropathic pain (pain caused by decrease in blood supply in one area of the body), pain caused by cancer, and complex regional pain syndrome. Ketamine infusions are also being used in the treatment of bipolar depression, major depression, and for people with suicidal ideation.

Ketamine is known as a “dissociative anesthetic”, which means that this drug can induce general anesthesia (though when induced, the patient remains awake), catatonia (loss of control over voluntary movement), and transient amnesia (loss of memory). Ketamine can distort perception of sight and sound (auditory and visual hallucinations) and produces feeling of detachment from one’s self and the environment. Because of this, Ketamine has been placed on the list of controlled substances in the US because of its tendency to be used for recreation and potential for substance abuse. Ketamine can cause death in high, unsupervised doses.

Treating Severe Depression with Ketamine Infusions

A randomized controlled trial conducted by Murrough et al in 2013 concluded that Ketamine “demonstrated rapid antidepressant effects in an optimized study design, further supporting [that ketamine] as a novel mechanism for accelerated improvement in severe and chronic forms of depression.”

The rapid onset of action brought about by Ketamine is an advantage being used by clinicians in treating severe depression, particularly in patients with suicidal ideation. Ketamine has demonstrated improved mood in patients who are deemed unresponsive to conventional anti-depressant regimen (such as antidepressants, talk therapy, counseling, transcranial magnetic stimulation among others). Patients are thought to benefit from series of ketamine infusions, despite its ‘off-label’ usage (using a drug for a purpose other than its intended purpose).

Treating Obsessive-Compulsive Disorder (OCD) with Ketamine Infusions

In a small, open-label trial by Rodriguez from Columbia, it was thought that the “dysregulation of excitatory glutamate receptors appears to play a role in obsessive-compulsive disorder.” Ketamine was administered to 15 randomized patients, and demonstrated immediate and dramatic decreases in their obsessive-compulsive urges just after a 40-minute ketamine infusion. Although deemed effective, its exact mechanism of action on how it works in OCD is still not known.

Treating Chronic Pain with Ketamine Infusions

Ketamine infussions are used to treat therapy-resistant chronic pain syndromes. Blonk et al , through the European Journal of Pain, published an article about the “Use of Oral Ketamine in Chronic Pain Management.” They listed all available clinical data regarding the use of Ketamine Infusions in the therapeutic management of chronic pain in several disease conditions. These include the following:

  • Complex Regional Pain Syndrome (CRPS)
  • Peripheral Nerve Damage
  • Neuropathic pain
  • Chronic cancer pain
  • Trigeminal Neuralgia (facial pain)
  • Diabetic neuropathies
  • Post Herpetic Neuralgia
  • Fibromyalgia
  • Post-Amputation stump pain
  • Glossopharyngeal neuralgia

What are the possible side effects?

Ketamine may cause common and even serious side effects, depending on the dosage consumed, some of which do not require immediate medical attention. The most common side effects of the use of Ketamine are:

  • Nightmares of vivid-dreams
  • Double vision
  • Jerky muscle movements
  • Dizziness
  • Drowsiness
  • Nausea and vomiting
  • Loss of appetite
  • Sleep problems (insomnia)
  • Delirium
  • Euphoria (intense feeling of elation, happiness, excitement and joy)
  • Ketamine abuse, in high doses particularly with recreational and unsupervised use, may cause fatal side effects such as:
    • Severe respiratory depression
    • Heart failure
    • Coma
    • Elevated heart rate
    • Death (from overdose)

When to Consider Ketamine

A physician may consider ketamine infusions for therapy under certain conditions:

  • For diagnostic and surgical procedures that do not require skeletal muscle relaxation.
  • Induction of anesthesia prior to the administration of other general anesthetic agents.
  • Short-term pain relief following minor surgical procedures.
  • Off-label use of ketamine when conventional treatment for chronic pain, depression, obsessive-compulsive disorder, bipolar disorder, post traumatic stress disorder and other select psychiatric conditions fails to demonstrate positive improvement in symptoms.

How are Ketamine Infusions Given?

Ketamine infusions may be given within or outside the hospital setting.

  • Patients are required to stay inside the hospital for several days (around 5 days) for inpatient ketamine infusions. Ketamine is given through an intravenous (IV) line and started with a 20mg dose of ketamine per hour, which is then increased to a maximum of 40mg of ketamine per hour. Other medications may be used to treat nausea, vomiting and headache throughout the procedure. Fatigue may be common, and may be accompanied by transient periods of hallucinations. These symptoms will fade as the dose is tapered (lowered).
  • On the other hand, another option for giving ketamine is through its outpatient administration. Patients are given 70mg to maximum of 200mg daily for 10 days in tapered doses. Fatigue may also occur, but there are no reported long term side effects for outpatient ketamine administration.

How do we the Measure Success of Ketamine Infusion Therapy?

Several techniques are being used to measure efficacy of ketamine treatment. Pain and depression are both subjective phenomenon, and a qualitative and objective instrument must be used in order to assess therapeutic efficacy. The following are some of the pain scoring systems and depression evaluation methods that are routinely being used:

  • Pain assessment scales
    • Visual Analog Scale (VAS)
    • Wong-Baker FACES Pain Rating Scale
    • 0–10 Numeric Pain Rating Scale
    • Pain Quality Assessment Scale
  • Relief of depression
    • Beck Depression Inventory (BDI)
    • Montgomery-Asberg Depression Rating Scale (MADRS)
    • Zung Self-Rating Depression Scale
    • Hamilton Depression Rating Scale (HAM-D)

What are the Expected Results from Ketamine Infusion Therapy?

It is expected that patients who would receive ketamine infusion therapy would enjoy immediate pain relief and comfort that are not usually attained from traditional forms of pain treatment.

Ketamine’s rapid therapeutic effect also allows effective management of depression and obsessive-compulsive urges. This gives patients a more stable mood control and even save them from suicidal ideation.

Outcomes of both conditions treated with Ketamine infusions ultimately allow patients to receive cost-efficient plan of care and achieve a better quality of life.

Meet Our Neurologists

At Neurological Associates of West Los Angeles our neurologists specialize in using Ketamine, to treatment a variety of conditions that range from severe depression to chronic pain and peripheral neuropathy.  Dr. Jordan, Dr. Chang, Dr. Franc, and Dr. O’Connor all diagnose and treat patients with conditions where a Ketamine Infusion may be the best treatment for an individual patient. If you suffer from severe depression or major depressive disorder (MDD), chronic pain, CRPS, pelvic pain, obsessive compulsive disorder (OCD) or anxiety and need a specialist who is known for their expertise in using Ketamine to treat a variety of conditions contact one of them to schedule an appointment at 310-829-5968.