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A New Treatment for Depression: Ketamine

01-06-2017

Do you suffer from severe depression and feel like you’ve exhausted all options for treatment? There is new hope for treating your depression, and it may come in the form of a medication that’s been used for more than 50 years as an anesthetic in emergency and operating rooms.

It’s called ketamine infusion therapy, and experts are calling it one of the most significant advances in mental health. Research has shown that ketamine not only produces a rapid and robust antidepressant effect; it also can put a quick end to suicidal thinking.

Antidepressants can take weeks or even months to reach therapeutic levels and only half of all patients get relief from their symptoms. Some have tried everything from psychotherapy, to an endless number of medications, to transcranial magnetic stimulation (TMS) and even electroconvulsive therapy (ECT) with no relief.

In traditional doses, ketamine is a reliable anesthetic used to sedate adults and children. Recent studies now show a low dose intravenous ketamine infusion can lift depression in many patients within hours. Ketamine has become a promising treatment option for many chronic diseases, including:

  • Depression (including postpartum depression)
  • Obsessive-compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)
  • Generalized anxiety disorder (GAD)
  • Bipolar disorder (manic with refractory depression)
  • Fibromyalgia
  • Complex regional pain syndrome (CRPS), also called reflex sympathetic dystrophy (RSD)


A Unique Collaboration With a Hospital
A team of dedicated caregivers at Mission Hospital are collaborating with the Ketamine Wellness Clinic of Orange County to offer this treatment option at Mission Hospital in Laguna Beach. Patients experience a spa-like environment, complete with reclining chairs, eye covers, calm lighting and relaxing music as board-certified anesthesiologists administer the infusion treatment to patients.

“This is a unique collaboration between a hospital system and a ketamine clinic during a time when mental health is one of the most challenging issues facing our communities today,” says Dan Hancock, MD, medical director of the Ketamine Wellness Clinic of Orange County. “We’re able to provide another avenue to treat the patient population that is traditionally resistant to other forms of treatment. It’s a safe, effective, fast-acting medication with very few side effects.”

The clinic opened in Mission Hospital Laguna Beach in October 2016. The physicians and clinicians say they’re already seeing people’s lives rapidly improve with this therapy.

“We have one patient who has suffered from depression for decades, and this was looked at as her ‘last resort’,” said Deanna Koschel, RN, clinical coordinator of the clinic. “When she came to us, she admitted to thinking about suicide daily and continuously, and since we’ve been treating her with ketamine infusion therapy, we’ve seen a profound change in her mood. She is lighter, talkative, happier, and her husband sees these changes as well.”

There’s a huge benefit to having the clinic within hospital walls, staffed with behavioral health experts who can identify and de-escalate patients who may be a risk or need additional medical care, says Koschel.

“Having our clinic in a hospital allows us to have every resource and support system available,” she says. “For example, we may have a suicidal patient, and the staff can work with the patient to get through it or get other hospital staff, departments and resources to assist, if necessary.”

If you have a mental health disease and feel you’ve exhausted all treatment options, talk to your primary care provider today about whether ketamine infusion therapy may be the next step in your care.

Learn more about the Ketamine Clinic at Mission Hospital: www.mission4health.com/ketamine.

The Ins and Outs of Ketamine Infusion Therapy

Dr. Dan Hancock, MD, is medical director of the Ketamine Wellness Clinic of Orange County, a clinic that is collaborating with Mission Hospital Laguna Beach. He recently sat down to answer more questions about this new treatment option to improve the mental and physical health of patients suffering from chronic diseases such as depression.

What is Ketamine?
Ketamine was developed more than 50 years ago as an anesthetic. Ketamine is a safe, effective and fast acting medication with few side effects. Physicians regularly use this medication on both pediatric and adult patients. More recently, intravenous (IV) ketamine has been proven to be a highly effective medication for the treatment of depression, anxiety, post-traumatic stress disorder and certain pain syndromes.

What is the Usual Course of Treatment?
Initially, patients begin with two successive infusions scheduled 48-72 hours apart. The majority of the patients see some mood elevation and symptomatic relief between the first and second infusion. If the infusions are effective, a series of four additional infusions are scheduled over the following 10 days. After that, maintenance “booster” infusions may be scheduled weeks/months later to maintain a positive response. Each patient is unique, so the total length of treatment can vary.

What are the Risks and Side Effects of the Infusions?
Ketamine is a very safe drug. The anesthesiologists at the clinic regularly administer this medication, and there are very few side effects. Patients commonly admit to feeling tired following an infusion. Occasionally patients experience nausea, which is often relieved by administering an anti-nausea medication. There are no long term reported side effects with ketamine infusions.

Are Ketamine Infusions Addictive?
Current studies do not demonstrate an addictive potential for ketamine. “One of the factors in addiction is access to the medication. By providing ketamine in a clinic environment instead of sending patients home with oral medications, we’re controlling the access, amount, and frequency of the medication, which minimizes the potential for addictiveness,” says Dr. Hancock.

Will Ketamine Infusion Therapy Work for Everyone?
Although all patients are unique, more than 70 percent of patients with treatment-resistant depression have experienced significant relief with ketamine infusion therapy. We customize each patient’s infusion dosage and frequency to maximize the most effective response.

Will my Insurance Cover This Treatment?

Ketamine infusions for the treatment of mood disorders are an off-label use of the medication, and insurance companies have not advertised their direct reimbursement for these infusions. However, we are finding that our patients are able to recuperate a significant portion of their out-of-pocket expenses, some up to 80 percent of the cost. Each patient is responsible for submitting these claims to their insurance company, and the clinic facilitates this process by providing all patients with a detailed super bill receipt. The FDA has indicated that it is fast-tracking the approval process for ketamine infusions for mood disorders, and we optimistically believe the insurance companies will follow suit in covering this important breakthrough treatment protocol.

How do I Explore Ketamine Infusion Therapy as a Treatment Option?
If you have a mental health disease and feel you’ve exhausted all treatment options, talk to your primary care provider today about whether ketamine infusion therapy may be the next step in your care.

Categories: Mental Health