FREQUENTLY ASKED QUESTIONS
What is Ketamine?
Ketamine was developed in 1962 by Parke-Davis. It has been used safely as an effective anesthetic since the 70’s for a variety of medical purposes for both children and adults. It works primarily as an NMDA receptor antagonist, commonly described as a ‘dissociative’ anesthetic. Recently, it has been touted as the most significant breakthrough as a treatment option for treatment-resistant depression, anxiety, PTSD, chronic pain and other mood disorders. Unlike traditional psychotropic medications, which can take weeks to months to take effect, Ketamine works within hours of administration. This can be especially useful for severely depressed individuals with suicidal thoughts. The immediate relief could be life-saving.
What happens in Depression and How does Ketamine work?
When we experience persistent high levels of social, environmental, and work-related stressors, the neuronal connections in our brain, called synapses, dwindle and atrophy. Depression causes a disruption of these neuronal connections particularly in the cortical and limbic regions of the brain which control cognition, mood, and emotion. This, in turn, affects how we think, and thus affects our motivation and emotion. The longer we experience these stressors, the more connections we lose; and, the more severe the neuronal atrophy.
In contrast to the effects of stress and depression, chronic treatment of antidepressants produce a slow increase in neuroplasticity, and allows for the neural connections to reform. The response rate to a first line antidepressant, however, is less than 50% and takes weeks to months to start taking effect.
As an NMDA receptor blocker
Ketamine works by a different mechanism. It causes a surge in glutamate, a major excitatory neurotransmitter in the brain. Through an elaborate pathway, there is a subsequent increase in BDNF (Brain-Derived Neurotrophic Factor), a neurotrophin that promotes neuronal growth and connections in the brain. A single Ketamine treatment alleviates depressive symptoms within hours in patients who have failed to respond to conventional antidepressants. It is therefore very effective in significantly decreasing suicidal ideations. Ketamine rapidly reestablishes the neuronal connections in the brain that were once lost due to chronic persistent depression.
The fast and efficacious mechanism by which Ketamine treats symptomatology is an exciting new advancement in the management of depression.
How likely is it to work?
Our experience, along with several clinical studies, have shown a 70-80% response rate.
Can Ketamine complement other treatments?
Ketamine for depression may be administered coupled with other treatments which may include the non-drug, non-systemic Transcranial Magnetic Stimulation or TMS.
In fact, we recommend Ketamine treatments to complement other treatments.
How do you know if it is working?
Most report a noticeable feeling of hope, calmness, lightness and increased functionality. It could be as subtle as being able to do daily chores and self-grooming, to being able to be more social and meet up with friends. The effects could happen hours after treatment, but generally it could take two (2) to three (3) days to be noticeable.
How many treatments will I need?
We will schedule you for a series of 6 to 8 treatment sessions over 3 to 4 weeks. Most patients will feel their mood start to improve after 2 to 3 treatments. After the initial six to eight treatments, some patients may require maintenance treatments or booster sessions which will be adjusted in its frequency based on your clinical responses.
Are there any side effects?
Occasionally, some patients feel nausea during or after the treatment. Your heart rate and blood pressure may increase with Ketamine. We can give you medications to counter these, should they happen. Tiredness is also not uncommon after treatments. There are no reported long-term side effects with low dose Ketamine therapy.
Will I be asleep?
At this low dosage, Ketamine will not cause you to be unconscious. Although some patients will feel fully calm and relaxed that they may doze off on their own.
How will I feel after the treatment?
You may feel a bit groggy right after the treatment, but you will quickly be back to baseline shortly after. We recommend that you do not engage in any physically taxing activities, avoid driving and using any machinery, and avoid making important decisions for the rest of the day.
Will it cause hypomanic/manic episodes in Bipolar patients?
Ketamine therapy can treat the depressive phase of bipolar disorder. We are not aware of any reports of Ketamine treatment causing mania.
Will these treatments cause bladder damage?
No. Bladder inflammation has been linked only to Ketamine abuse, which are at doses up to 20 times the amount used for our therapy and over the course of many years. There have been no reported cases of bladder damage with low dose, sub-anesthetic Ketamine therapy.
Do I need someone with me during my treatments?
Most people feel relaxed and calm during and after the treatment.. Feel free, however, to bring someone along in our Ketamine clinic if it makes you feel more comfortable.
Can I eat or drink before my treatments?
You do not need to fast. We recommend, however, that you refrain from eating, four (4) hours prior to your treatment. You may drink clear fluids up to two (2) hours prior.
Is this treatment FDA approved?
Even though Ketamine has been FDA approved since the 1970s as an anesthetic, it has not been FDA approved for this particular treatment and is considered “off label.” Ketamine has been safely used for the treatment of depression and other mood disorders, and chronic pain for almost a decade now by prominent university hospitals and private practices. It has been considered an important breakthrough in the treatment of depression and other mood disorders.
Will my insurance cover my treatments?
Because it is still considered an “off label” treatment, insurance companies will not cover the Ketamine treatment.
What happens after the initial series of treatments?
We will schedule you for ‘booster’ treatments for your continued recovery and to maintain the brain’s neuroplasticity. The timing is highly dependent on each patient and based on subjective reports and filled-out inventory scales.
What is the experience like during the treatment?
The Ketamine experience has been classically described as being “dissociated”. This means your mind will shift focus from your physical body to a more mentally active inward-directed reflectivity. Patients find this experience to be calming and pleasant — having thoughts and memories without their emotional burden. A calm environment is provided during treatment, with carefully selected music for your enjoyment. You may also choose to listen to your own playlist but we do recommend you play calming music during this time to avoid anxiety and allow for tranquility and deep relaxation.
Is this an outpatient procedure?
Yes. The treatment will be performed in a private, comfortable room, and will take approximately an hour.
Is it addictive?
While it is true that Ketamine has been abused as a party drug, it is not considered addictive. In the proper treatment of depression it is also imperative that the proper dosage is given based on weight, and carefully monitored by a medical personnel. One must also know that Ketamine has been used safely as a medication for decades and has been included on the World Health Organization’s Essential Medicines list since 1985.
Can I take my other antidepressant medications?
Yes. Ketamine is safe and can be taken with most medications including SSRIs (Celexa, Lexapro, Paxil, Prozac, Luvox, Zoloft, etc,), SNRIs (Pristiq, Cymbalta, Effexor, etc.), Lithium, Wellbutrin, tricyclics, and other psychiatric medications (Rexulti, Abilify, etc).
Are there medications that will interfere with my Ketamine treatment?
Yes. Lamictal (Lamotrigine), when taken at higher doses, may attenuate the effects of Ketamine. Benzodiazepines such as Xanax (Alprazolam), Ativan (Lorazepam), Valium (Diazepam), and Klonopin (Clonazepam), at higher doses may also reduce your response to Ketamine. Please contact us on how to schedule taking these medications around your Ketamine initiation and booster treatments. We want to ensure the best possible chance of success in your recovery.
Do I need a mental health referral?
While it is not required, we highly recommend it. We believe that in order to get the full benefits of Ketamine therapy and neuroplasticity, you should be monitored by a psychiatrist and fully engaged in talk therapy to solidify the new brain connections being made.
Are there any contraindications to treatments?
There are conditions and situations that will prevent treatments including unstable medical conditions, substance abuse, use of alcohol prior to the session, as well as pregnancy, among others. Please call us at 805-650-3880 for more information.
Get in touch for a comprehensive evaluation to see if Ketamine treatments are right for you.
Dr. Mendiola is Ventura's trusted hometown doctor, caring for its residents and neighboring counties’ since 2000.
He completed his psychiatry residency at the Cleveland Clinic Foundation in Ohio, his advanced TMS Fellowship at Duke University Medical Center, and is dual-certified by the American Board of Psychiatry and Neurology and the National Board of Medical Examiners.