What is ketamine? Is it safe?
Ketamine is an NMDA receptor antagonist and an AMPA receptor stimulator. Its is also a general anesthetic and can be used as sedation. Its effects on the brain are multi-factorial and this effects many of the neurotransmitter processes. One significant effect is preventing serotonin from being exhausted by re-uptake. Serotonin and similar neurotransmitters are responsible for many functions such as mood, pain and the like. The biochemistry of Ketamine and its neural-interactions is very complex and is only partially known. Yet we do know that it does affect the neurotransmitter system differently than opioids or standard anti-depressive medications. That is why Ketamine is truly a new treatment for pain, depression and PTSD.
How long has Ketamine been in use?
Ketamine is a drug that has been used for over a half a century as an anesthetic for surgical procedures. It is, approved by the FDA for anesthesia. Off-label it is used to treat patients with chronic pain, depression and PTSD. This is becoming more common at Ketamine clinics around the world. Off label use of medication by physicians is a accepted practice and is allowed. Botox for example was used to treat wrinkles when its only FDA approval was for Blepharospasm.
What about results with the Ketamine infusions?
This limited studies have resulted in surprisingly good results, but this is judged by the physicians who use this therapy. Formal studies are underway and what we know so far is that these studies appear extremely promising. In our practice we have seen about 50% of our patients benefit extremely well to the point that they could stop narcotic use, other cases did find various degrees of improvement and were able to lower their narcotic use. There are some patients that felt there was no improvement. In none of the cases that we have used Ketamine has there been any persistent side effects.
Again, here we believe the science follows the art of medicine, but will catch up soon.
What is the best Ketamine protocol?
The main unknown issue with Ketamine infusion for pain, depression and PTSD is to know exactly what is the best protocol. There are about thirty different protocols ranging from outpatient in-office settings to hospitalized settings.
Various treatment regimens include high rates of infusions for some. There are others with lower rates of infusion. Other variables are if the drug is administered daily, every day or intermittent and how long the infusion is carried out, be it an hour, 4 hours or even 24 hours. To know the best protocol will take time to sort out. It is simply not known yet.
Safety of Ketamine
Ketamine is safe when given in a monitored environment. Mandatory heart rate, heart rhythm vital signs and oxygen level is required. An experienced physician with Ketamine should be in attendance along with nursing personnel. Though side effects are rare, one must observe for heart rhythm disturbances, heart rate changes and blood pressure changes. These side effects when they rarely occur can be treated easily, but one should be experienced specifically with Ketamine. Our physician has been using Ketamine for over thirty years in the surgical environment and for about a year with this new treatment. He is very familiar with the side effects of the treatment. Your safety is our number one concern.
