Ketamine was unveiled as one of the 10 medical innovations by Cleveland Clinic in 2017 due to

its beneficial effects in mental health illnesses. S-ketamine nasal spray was approved by FDA

for use in treatment resistant severe depression in 2019. More and more clinical evidence has

been emerging in last couple of years to support ketamine use in alcohol and substance use

disorder. All of this has led to exponential increase in outpatient ketamine clinics and

outpatient ketamine infusions.

As a patient or family member, sometimes it becomes overwhelming and even scary to decide

whether ketamine is right for you and if yes, which practice you should go to get it. No worries,

we have assembled a list of important questions you should ask prior to committing to a

specific ketamine practice.

Who is administering the ketamine?

In New state, any board-certified MD/DO can provide ketamine infusion if he/she can

demonstrate competence in the ketamine administration. In general, emergency medical

physicians, critical care providers, anesthesiologists and hospitalists with ICU patient

management experience have enough exposure to the ketamine administration during their

training. Hospitalists (internal medicine) have added advantage of better knowledge of mental

health illnesses as compared to other specialists

Who is supervising the ketamine administration?

Ketamine is a category 3 controlled substance. Its administration must be supervised closely by

ACLS certified medical professional preferably MD/DO in stead of nursing staff.

What should be monitored?

As ketamine is known to increase blood pressure and heart rate, patient should be monitored

for blood pressure, heart rate, heart rhythm, oxygenation continuously (preferably every 10

minutes) during each ketamine infusion session.

How is ketamine administered?

Ketamine can be administered through oral, sublingual, nasal spray, lozenges, intramuscular

and intravenously. Intravenous route is the easily titratable and most effective way of

administering any medication that provide 100% drug bioavailability in the blood and same is

true for ketamine. Other routes of administration might be less expensive but have higher risks

of side effects and less effective.

What intravenous ketamine administration protocol is being followed?

No large randomized clinical trial has been done so far to demonstrate that one protocol is

better than the other. Several small studies have shown that six (0.5 mg/kg) ketamine infusions

given over 2 weeks period provide the best possible outcome.

Does practice offer personalized treatment?

Although six ketamine infusions of 0.5mg/Kg given over 2 weeks provide the best possible

outcome, but sometimes one size does not fit all. Some patients do need higher titratable

ketamine dose. This is where an experienced ketamine specialist can make a significant

difference.

When to stop the ketamine treatment?

Ketamine can provide safe, rapid, and amazing results in patients with treatment resistant

depression, severe anxiety, PTSD, migraines and OCDs. But it is not effective in 100% of the

patients. If patient and/or family don’t notice any signs of improvement after 4or 5 intravenous

ketamine sessions, it is likely that ketamine might not work for you. Clinics which offer package

deals should therefore be avoided. You should not receive any medication unnecessarily just

because you have paid for it already. Ketamine is safe but not immune to side effects.

Ketamine is a wonderful, relative safe and rapid acting psychedelic category 3 controlled drug

that have shown tremendous potential in improving mental health illnesses such severe

depression, treatment resistant depression, bipolar disorder type 2 with depression,

postpartum depression, generalized anxiety, OCD, PTSD, chronic refractory pain, and alcohol

use disorder. However as with any other medication, ketamine is not everyone and must be

avoided in some circumstances.

If you have any further questions, please feel free to contact our ketamine specialist at

(516)280-3842 or email at contact@ketamine-wellness.com