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Frequently Asked Questions
How does ketamine work?
The nervous system is a communication system that functions through individual connections between nerve cells. The abnormal functioning in different psychiatric or pain conditions can be caused by damage to these connections. Persistent stress, traumatic events, or untreated mental health problems can lead to this damage and make it worse over time. Ketamine has a variety of effects on the nervous system and the various mechanisms are still being researched, though the evidence of it's efficacy is undeniable. Currently, the primary effects are attributed to ketamine being an N-Methyl D-Aspartate (NMDA) receptor antagonist, meaning it blocks the receptor sites of the excitatory neurotransmitter glutamate. This causes a cascading effect that leads to an increase in Brain-Derived Neurotrophic Factor (BDNF). BDNF works by encouraging the growth of new nerve cells and nerve cell connections, known as neuroplasticity, with the neurons in the central nervous system.
Is ketamine treatment safe? Is it addictive?
Ketamine has been shown to have a robust safety profile over the last 50 years of use in anesthesia, which is as exponentially higher doses than is needed for treatment of mood and pain disorders. Side effects can occur, but are generally limited to right after a session and resolve quickly. These can include mild nausea, dizziness, and drowsiness, or sometimes distress from the psychoactive effects. We provide ketamine in IV infusions as our preferred route as it provides much higher control over the rate the medication is received, allowing us to slow or stop the infusion if any discomfort occurs. We also have other medications and interventions we will utilize to ease any discomfort. Ketamine studies have shown no evidence of physiologic addictiveness, though it can, like any other positive experience, create a psychologic dependence when used inappropriately and must be used cautiously and respectfully.
How long does treatment take? How long until I see improvement?
Our ketamine infusions are run over about 40 minutes with the total infusion session usually lasting around 90 minutes. The psychoactive effects of the infusion begin minutes after the infusion starts and are strongest during the infusion and for around 15 minutes after the infusion ends. The effects then quickly fade, though some residual effects may last from around 1-12 hours. The length of time depends upon many factors including dose, individual response, recovery time, and other factors that are discussed during your intake session.
The therapeutic benefits also vary for each person. The large majority of individuals experience immediate benefit after their first treatment, though this first infusion may not produce robust and sustained improvement. Some patients with treatment-resistant conditions may take several treatments before having persistent effect. For maximum efficacy and duration of treatment response, we recommend a series of six infusions given twice weekly for three weeks. After this series, most patients find their symptoms to be in total remission and their lives drastically improved. Maintenance doses are usually required about once a month for patients after a treatment series to maintain benefits, so we recommend planning to have a treatment monthly, but some patients may prefer to wait and schedule when they feel their symptoms begin to return.
Do you take walk-ins?
Treatments are by appointment only. We are always happy to talk with anyone curious about ketamine infusions to discuss which of our treatment options is right for you. Give us a call and we will fit you in for a same day infusion as our schedule allows. No formal consultation visit is required as there are very few contraindications to ketamine therapy. Once we have a patient scheduled, we will send out intake paperwork to be completed prior to the first appointment. Please expect the first treatment to take a bit more time as we will review all pertinent physical and mental health considerations before beginning treatment, as well as discussing treatment goals and expectations. We know that this treatment is of the utmost importance for those who need it and will accommodate you to the best of our ability. If you are interested in ketamine-assisted psychotherapy, we recommend an appointment with one of our therapists to establish therapeutic rapport and identify goals for treatment prior to receiving ketamine treatments during a session.
Is ketamine treatment covered by insurance?
Ketamine treatments when used for mental health are considered "off-label" and are currently not covered by insurance. For this reason, our ketamine-assisted therapy sessions will have the ketamine treatment and the therapy session billed separately. This helps reduce financial burden by ensuring that coverage for therapy sessions are unaffected. As we continue to see profound psychiatric benefits by patients receiving ketamine infusions, we will persist in advocating for wider acceptance and financial coverage for this treatment.
Does ketamine treatment have to be an IV infusion?
Ketamine may be administered via several different routes such as intravenous (IV), intramuscular (IM), orally (PO), sublingually (SL), and intranasally (IN). IV infusion is the optimal route for administration and offers several advantages over other routes of administration such as 100% bioavailability and the ability to control the rate of administration. The ability to control the flow rate allows us to increase or decrease the intensity of the experience or even stop the flow completely if needed.
IM injection is another good option for patients as it offers 93% bioavailability and is simple to administer. We offer this route for those who prefer IM to IV, but we prefer to do IV for everyone's first treatment to determine individual response. This is because IM ketamine tends to have a longer duration and once the injection is administered there is no way to reduce the dose and the patient is fully committed to the entire experience.
Other routes such as PO/SL/IN have unpredictable absorption, onset, and duration, as well as a low bioavailability ranging anywhere from 25-50%. For these reasons, we do not routinely offer these routes at this time.
Can you prescribe ketamine to use at home?
Ketamine treatment is ideally performed via IV infusion under the supervision of a licensed medical professional and in a comfortable, controlled environment for maximum efficacy and safety. As discussed above, the unpredictability of routes such as PO/SL/IN offer a variety of downsides. Ketamine is also a controlled substance and home use creates additional risks such as medication diversion, overdose, unforeseen side effects, frightening/dangerous experiences, and abuse, though research shows ketamine is not likely to be physiologically addictive. Due to these additional risks, we do not routinely prescribe ketamine for use at home. If we do consider home-use ketamine, it is only after a patient has done a series of treatments at our clinic and we have determined they are a sound candidate for home-use ketamine. Each person is different and the criteria are frequently changing, so there is not rubric on how to qualify for home-use ketamine. We go case by case and tread those waters very carefully. Our primary concern is for the safety of our patients. A patient will not be considered for home use ketamine until after they have tried optimal methods. If we get a good response but not a durable response, and if all other factors point to possible home-use success, we may consider home use when people need a more frequent dose of ketamine in order to get a robust effect. Because the risks are higher with home use ketamine, we do not prescribe it for any of these reasons: fear of needles, desire to save money, or convenience. We want each patient to have the most optimal experience. In our experience, that almost always includes coming in to the clinic. On rare occasions and only for people who have a deep fear of needles, we may offer a troche (by mouth) experience in the clinic where we can monitor the patient. The cost of this experience is the same as the cost for an IM injection due to the use of the clinical space and the time spent monitoring the patient. Again, this is at the discretion of Thomas (Dr. Swahn).
Is ketamine legal? What if I am drug tested?
Ketamine treatment at our clinic is perfectly legal. Ketamine is a Schedule III controlled substance under the U.S. Controlled Substances Act. It is illegal to use without a prescription just like any other controlled substance such as prescription pain killers. When you receive a treatment with us, we are prescribing you the treatment as licensed medical practitioners with controlled substance prescriptive authority. This would be the same as any other instance of your healthcare provider ordering a controlled medication for you in office and is not documented anywhere other than in our medical records.
Ketamine infusions pose no risk to patients on a drug test for several reasons. First, ketamine is not tested for in any of the currently used routine drug screens including the standard 10-panel as well as more extensive screens. Second, ketamine's half-life is 2.5 hours. This means that the active ketamine is effectively cleared from the body in about 10-12.5 hours (4-5 half-lives). Some studies, however, found that ketamine and its metabolites could be detected in the urine for up to 14 days and in the hair for up to 4 months. Last, on the rare chance that one of our patients is specifically tested for ketamine and accused of illicit use, simply contact the clinic and we'd be happy to provide proof of your medical treatment here with us which is no more illicit than if you were given ketamine during surgery or an ER visit.
Does having a medical cannabis card put my professional license at risk?
Though legal to use under Utah law, federal law continues to consider cannabis use illegal and provides no employee protections for medical use. This enables employers to drug test employees for THC and fire employees found to have it in their system without further reason. This causes many individuals who benefit from cannabis to use it illicitly for fear that a medical card puts them at risk for their employer finding out about their use. In the state of Utah, having a medical cannabis card is considered protected health information and is only accessible by those involved in your care using cannabis such as your Qualified Medical Provider or those involved in providing products at the Dispensaries. Cannabis use by a cardholder is considered a prescription medication by the Department of Occupational and Professional Licensing, subject to the same rules and protections as any other prescription medication. Due to this view by DOPL, it is much safer for an individual who chooses to use cannabis to do so using a medical cannabis card. The risk of an employer finding out and firing the employee remains the same, yet if fired for having prescription cannabis in their system they are protected from any risk to their professional license, therefore the total risk to their livelihood is greatly decreased as their license is protected.
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