What should you know about Ketamine therapy? Part 2: Patient Perspective

This is the second post in our two-part series that explores the experience of receiving a ketamine infusion.  Here’s a link to Part 1 in case you missed it.

The most frequently asked questions we receive from our patients and broader community revolve around the patient experience during a ketamine infusion.  In this post, we’ll answer questions such as: what is it like during the infusion?  How long will it take?   When will I feel better? Do you take insurance?

We believe ketamine is remarkable medicine that can ease pain and suffering.  After seeing all types of patients for all kinds of reasons, we know that for some patients, ketamine is the best fit to bring desperately needed relief to patients suffering from pain, depression and PTSD. *See comprehensive list below.

Every clinic does it a little differently.  Based upon current guidelines (see Part 1) and years of clinical practice, we’ve created a patient experience which flows like this.

Before visiting our clinic for a ketamine infusion

We encourage all of our patients work with the best provider(s) available to them.  For ketamine infusions, the American Medical Association offers the following recommendations as a baseline for quality care:

1. A comprehensive diagnostic assessment should be completed to establish current diagnosis and evaluate history of substance use and psychotic disorders.
2. Assessment of baseline symptom severity should be completed to allow later assessments of clinical change with treatment.
3. A thorough history of antidepressant treatment should be collected and documented to confirm previous adequate trials of antidepressant treatments.
4. A thorough review of systems should be performed to evaluate potential risk factors associated with ketamine treatment.
5. Decisions on the specific physical examination and laboratory screening assessments should be made according to established guidelines and advisories issued by the American College of Cardiology Foundation/American Heart Association and the American Society of Anesthesiologists and should be based on a patient’s individual clinical characteristics.
6. A careful review of past medical and psychiatric records and/or corroboration of the past history by family members are strongly encouraged; all current medications and allergies should be reviewed, including histories of opiate and benzodiazepine use; the use of a baseline urine toxicology screen is strongly encouraged to ensure the accuracy of the reported substance use and medication record.
7. An informed consent process, including discussion of the risks associated with the treatment, the limits of the available information pertaining to the potential benefits of the treatment, the fact that this is an off-label use of ketamine, and a discussion of alternative treatment options should be completed; this discussion should be complemented with written materials, and the patient should provide written informed consent before initiating treatment.

Full set of recommendations can be found here.

Patient care at our clinic is consistent with these recommendations.  Before visiting our clinic to receive a ketamine infusion, all patients take part in a comprehensive consultation with Dr. Stoner to review medical history, ensure ketamine is a good fit and in some cases receive additional recommendations (such as nutritional supplements, medication changes) if warranted.  If you are (or might be) pregnant, you must inform your provider.  It is essential to assess a different set of risks and benefits if pregnant.

During the consultation, patients receive an overview of their proposed treatment plan, including financial arrangements.  In our clinic, payment is required a week in advance of each visit – some patients pay in advance for several visits at a time.  Most clinics, including ours, do not accept insurance.  Depending upon your diagnosis and your insurance coverage, your insurance company may reimburse you for some of the costs.

For the day of the visit, we encourage our patients to prepare as follows:

1. Be well rested.
2. Don’t eat for 6 hours before your appointment. You may consume clear liquids up to 2 hours before your appointment.
3. Tell your provider about any changes in your health status or medications.
4. Do not consume alcohol prior to your treatment, or after.
5. Consult with your provider if you take benzodiazepines or naltrexone as these may impact your treatment.  Your provider may ask you to take them after your appointment rather than before.
6. Arrange for a driver to bring you home after your infusion is finished. If you wish to have your driver bring you to your appointment and stay with you during your infusion (in our waiting room or in the treatment room with you), that’s perfectly fine.
7. Plan your day to accommodate a 90 minute visit. This allows for some buffer time both before and after your infusion.
8. Set intentions for the session. Consider bringing music, ear buds and/or an eye shade to cultivate comfort and eliminate distractions.

During the ketamine infusion visit

1. Upon arrival, all patients and companions take part in a brief COVID-19 screening process.
2. Once settled in a private treatment room, an IV will be placed. This IV will not only deliver the ketamine, it will also be used to treat nausea or any other side effects.
3. Your provider will monitor your vital signs – heart rate, blood pressure, and oxygen levels – throughout the infusion.
4. Patients feel the effects of the infusion in highly individual ways, and most patients feel something. In fact, the mildly dissociated state induced by the ketamine is important for the therapy to be effective.  This is not necessarily a “trippy” feeling – in part due to the structure of the appointment and the professional environment (see our blog: Set and Setting: Patient/Practitioner Partnership in the Therapeutic Ketamine Experience).
5. Many patients report feeling better (relief of symptoms) immediately, some notice a change as quickly as 5-10 minutes into their appointment. Others notice improvements more gradually.  Sometimes family members notice significant improvements before the patient does.  Patient responses are highly individualized.
6. As the visit comes to a close and patients prepare to depart, many notice that their balance and depth perception might be a little off. Walking may require more attention than usual.

After the visit

1. Your driver will bring you home. No driving is permitted for the rest of the day after your infusion.
2. Take it as easy as possible for the rest of the day. We recommend you not go to work, enter into any situations which call for making important decisions, nor be solely responsible for another person for the remainder of that day.
3. The 48 hours immediately following is the most profound time for rebuilding connections in the brain. As such, this is the ideal time to schedule an appointment with your therapist and/or make time for mindfulness practices to help deepen the benefits of your infusion.
4. Over the next few days, be sure to drink plenty of water, eat nutrient-rich foods, get regular exercise and adequate sleep.

You’ll find more questions and answers on our FAQ – Frequently Asked Questions page.  We found the following video useful as well; it demonstrates one patient’s experience.

*Here is a comprehensive list of conditions we treat with ketamine infusions (following a comprehensive consultation to ensure it is a good fit and working in collaboration with patients’ care team):  major depression, the depressed phase of bipolar disorder (bipolar depression), postpartum depression, anxiety, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), pain syndromes such as fibromyalgia and complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD), and addiction. For depression specifically, it is one of the most effective major depressive disorder treatments, alleviating symptoms for up to 80% of patients…even those with treatment resistant depression.

In Glenwood Springs, CO, our integrative medicine clinic and ketamine treatment center offers ketamine infusions, integrative medicine, and acupuncture.  Dr. Stoner believes there are many paths to health. Her approach to integrative medicine is to work with the patient to choose the science-based tools from a full range of medical traditions and alternative/complementary modalities that optimize their individual mental and physical health. She will work with you and your other health and wellness providers to truly integrate your care.

We specialize in treatment for those suffering from major depression, the depressed phase of bipolar disorder (bipolar depression), postpartum depression, anxiety, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), pain syndromes such as fibromyalgia and complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD), and addiction.

We utilize conventional and alternative modalities to help our patients be the best they can be, given what they have and where they’re starting. If you or someone close to you would benefit from our services, please contact us today to schedule an appointment and/or learn how we can help you awaken to a new life.