DR. MANDEL ANSWERS THE MOST FREQUENTLY ASKED QUESTIONS ABOUT KETAMINE TREATMENT
Pain patients often suffer from a process known as “central sensitization,” where pain signals increase in frequency and intensity over time. Ketamine acts to reset pain receptors and block signals of pain, restoring a healthier balance.
What is esketamine/Spravato and how is it different from the ketamine used in intravenous infusions?
- Lamotrigine, AKA Lamictal. Patients should allow 6 hours between taking Lamictal and the start of their infusion. They should wait 6 hours after their infusion before resuming Lamictal.
- Benzodiazepines. Patients taking large doses may have a reduced response to ketamine. This does not mean you can’t receive ketamine treatment while taking benzodiazepines or that you won’t benefit. It is perfectly safe to combine these medications. We want to ensure the best possible chances for your success though, so we may ask you to skip a dose six hours before the start of your infusion and wait six hours post-infusion before resuming your benzodiazepine. Some common brand names are Xanax (Alprazolam), Ativan (Lorazepam), Valium (Diazepam), and Klonopin (Clonazepam).
- SSRIs and tricyclics do not interfere with ketamine. There is no need to adjust dosing.
- If you are taking opiates, muscle relaxants, or anti-inflammatories, there is no need to adjust dosing.
In some cases, patients may benefit from reducing the dose or completely eliminating medications that don’t work and/or produce negative side effects. Ketamine can be helpful in this process, but you should not adjust your dose or frequency of use of any prescription medication without first consulting with your prescribing physician.
Pain patients receive a series of five, 4-hour long infusions, over five consecutive days. Afterwards, booster infusions may be provided on an as-needed basis for maintenance. Typically, booster infusions are 2 infusions, provided on consecutive days or sometimes one to two days apart. On average, patients enjoy around three months of relief before needing boosters. Sometimes, the results of the initial series do not last as long and in other cases, they last much longer. It is not unusual for patients to enjoy six months of relief, or longer.
For pain patients, ketamine is administered over a period of four hours. The amount given is higher than what mood disorder patients receive and can increase side effects such as dissociation. We use a number of adjuvants to decrease or eliminate the side effects that are associated with higher doses of ketamine. Patients generally take 60-90 minutes of rest following the infusion before they leave the clinic. There are no delayed “flashbacks” and aside from being tired or fatigued, most feel much like themselves. We require pain patients to be picked up inside our clinic by a responsible adult.
For pain patients, it is uncommon to see substantial relief before completing a full course of treatment, which is a series of five infusions.
Some patients achieve long-term relief after one series of infusions. Others find that infusions enhance the impact of antidepressants or provide initial relief that is then sustained by oral medicines, other therapies, and lifestyle changes. After the initial series of infusions restores the brain to a healthy balance, it is generally easier to maintain that balance than it was to attain it in the first place. Follow-up or “booster” infusions are provided on an as-needed basis for maintenance and are typically two infusions, provided one to two days apart.
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