Treat Pain and Depression With Ketamine Therapy

What is Ketamine

Ketamine is a commonly used anesthetic in operating rooms around the world. The dosage for treating depression and chronic pain is well below what is typically used in the operating room. Dr. Malek will discuss specific risks, side effects and alternatives during your initial consultation.

Breakthrough Therapy for Pain and Depression in Pasadena

Although ketamine has been used as anesthesia in operating rooms for many years, ketamine IV infusion therapy is one of the newest, most advanced pain, depression and mood disorder therapies. (Psychiatrists swear by it, and it was featured in a special edition of TIME magazine in August 2017.) Here at our Interventional Anesthesia & Pain Management Clinic’s ketamine clinic, we have had great success with ketamine infusion therapy. IV ketamine depression treatment has been called the most important breakthrough in antidepressant therapy in decades. We have saved the lives of many people who otherwise had no hope for a decent life. We have even saved people from committing suicide!



Ketamine infusion is also effective for chronic pain syndromes, especially those with a neuropathic component such as complex regional pain syndrome (CRPS), post-herpetic neuralgia and neuropathic pain from peripheral nerve damage, it is also great therapy for fibromyalgia, it is a sure shot and a life saver for depression and fibromyalgia since they very commonly combine together . Ketamine is an anesthetic drug used in general anesthesia, in operating rooms and in war zones by active-duty US Army officers for many years. Dr. Malek knows firsthand since his days as an Army officer. Since then, he has been providing safe, effective ketamine infusion therapy from his own ketamine clinic at Interventional Anesthesia & Pain Management Clinic. His ketamine clinic patients have experienced amazing success and great results.

Ketamine FAQs:

1. Will ketamine infusions help me if I have treatment resistant depression?

Although we cannot guarantee any particular outcome, we have administered over 5,000 IV Ketamine Infusions since opening in 2014 and over 80% of our patients have received significant relief. Many clinical trials have shown that Ketamine Infusions produce results for about 70% of those involved. Our treatment is tailored, in terms of frequency and dosage, to each person. We believe it offers your best possible chance of success at over 80%.

2. How many ketamine infusions will I receive?

For our mood disorder patients, we provide a series of 6 infusions over 2-3 weeks. Most patients see some improvement the day after their 2nd or 3rd infusion, but it is crucial to complete the whole series. For those who don’t see benefit after the 2nd or 3rd infusion, we may attempt a longer and/or higher dose infusion. If there is still no response, we generally stop further treatment. If ketamine does improve your mood, outlook, and functionality, we suggest that you complete your series to maximize ketamine’s brain-repairing abilities.
For our CRPS/RSD and other pain patients, we provide five 4-hour long infusions, generally done on five consecutive days. Because pain conditions require more substantial dosing, we cannot determine whether or not a patient is responding after their 2nd infusion. Results can be seen very quickly, in as little as one infusion, but are often not seen until several days after the full course of treatment is complete.

3. What happens after my series of ketamine infusions?

Our commitment to you and your recovery remains long after your last infusion. We know how vital it is that ketamine therapy be part of a bigger treatment plan for our patients, and that’s why we combine our program with an extensive aftercare plan including: regular availability to you for any resources or referrals you may need, always available to answer questions and address concerns, daily text messaging to check-in for patients who want closer monitoring, bi-weekly depression assessments sent straight to your phone through an encrypted and HIPAA compliant server, a detailed list of lifestyle changes to support your recovery, regular follow up from our medical team, and more. Some patients are more receptive to conventional oral anti-depressants after treatment and most are encouraged to be involved in talking therapy with a trusted, licensed, mental health professional. We also work with patients on modifying their lifestyle choices to help maintain their good results. For pain patients, the aforementioned treatment plan applies as well. Physical therapy, exercise, and stretching are also beneficial in some cases, depending on what the cause of the pain is and their condition.

For both types of patients, following the initial series of infusions, some patients begin an infusion maintenance program; returning for additional infusions, “boosters”, as needed. In most cases, 1-2 boosters is all that is necessary to restore patients and significantly extend their results. The interval between maintenance infusions will vary from patient to patient. Some patients may have 1-2 boosters per month starting 3 months post treatment while others have gone over 2 years before needing to come back. There is no way to predict if or how often you will require booster infusions. The level of involvement with the above listed aftercare plan may impact the need and frequency of follow-up infusions.

4. If ketamine therapy works for me, how soon will I begin to feel better?

For mood disorder patients, some will begin to feel better within 1 hour of their first infusion. Patients with thoughts of self-harm or suicidal ideation often notice those thoughts and feelings dissipate first, and almost immediately. There is often a dramatic relief of dread and hopelessness. Other patients may not notice any improvement in mood until the day after their 2nd or 3rd infusion. Some patients will require more infusions and more time following their infusions before feeling significantly better. It is important to note that the results of ketamine can be sudden and dramatic, but they are not always. It is more common for patients to see gradual, subtle improvement. Sometimes function improves before mood does.
For pain patients, it is uncommon to see substantial relief after 1-2 infusions. It is possible, and we do have patients leave the clinic pain free after one infusion, but that is uncommon. Most of the time, pain patients need to complete the full series of five infusions before they see substantial and lasting relief.

5. Will I require ketamine therapy for the rest of my life?

No. 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 choices. If ketamine therapy is the only solution for you, you may be able to space your infusions apart by 3-6 months. 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.

6. What should I expect during my ketamine treatments?

For mood disorder patients, ketamine is administered over a period of 40 minutes. The amount given will not cause you to lose consciousness. During the infusion, most patients have a mild dissociative experience, with an increased sensitivity to light and sound and an altered perception of time and color. Most patients tolerate these experiences without discomfort and many people find them to be pleasant. In the rare case these side effects are considered unpleasant, other rapid acting medications can be used to relieve or eliminate this discomfort. Once the infusion is complete, the dissociative effects of the drug rapidly dissipate and are often mostly gone within 20-30 minutes. There are no delayed “flashbacks” and patients generally leave our clinic within 30 minutes following the infusion and aside from mild fatigue, feel much like themselves.
For pain patients, ketamine is administered over a period of 2 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 30 minutes of rest following the infusion before they feel comfortable leaving our 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.

7. Are there any other side effects I should be concerned about?

Patients commonly feel tired following an infusion. On rare occasion, some patients experience nausea after an infusion. If so, we have medication that can relieve this. If you are prone to nausea, we can administer a prophylactic before the infusion to help prevent it. Side effects usually dissipate within a few hours and are completely gone by the following day. There are zero long-term or permanent side effects of IV Ketamine Infusion Therapy when administered by a responsible clinician in a medical setting.

8. Do ketamine treatments cause bladder damage?

No. There has been zero link between therapeutic ketamine use and bladder damage, also known as cystitis. The only known reports of bladder damage caused by ketamine are based on the abuse of street ketamine at doses 10-20 times the amount we administer, taken daily, over the course of years. There is only one study we are aware of on this topic, but bladder cells were exposed to ketamine for 72 hours at concentrations several thousand times greater than the peak serum levels achieved in patients undergoing subanesthetic infusions of ketamine.

9. I am bi-polar, will ketamine make me hypomanic?

Although hypomania is possible, we have not seen one single case in over 700+ patients.

10. Is ketamine infusion therapy addictive?

No. Not one of our patients has displayed or reported any symptoms of addiction.

11. Do I need to bring someone with me to my ketamine treatments?

You do not need to have someone bring you or remain with you during the infusion, but someone must bring you home. We advise you not to drive a car, operate heavy/dangerous machinery, sign any contracts, or partake in other potentially risky activities until the following morning.

12. Can I eat or drink before my appointment?

You cannot eat 4 hours prior to your scheduled appointment. You may have clear liquids up to two hours before your appointment.

13. I don’t have a psychiatrist, is that a problem?

You do not need a referral from a psychiatrist or therapist, but we do require pre and post treatment evaluations by a mental health professional in order to verify the efficacy of the treatment for you, monitor your progress, and ensure a successful treatment plan.

14. Will my current medications interfere with my ketamine infusions?

Please inform us of any and all medications you are taking. We are particularly interested in learning if you are taking:
§ Lamictal (generic name Lamotrigine). 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
§ Patients taking large doses of benzodiazepines may have a reduced response to ketamine. This does not mean you can’t receive ketamine treatment while taking benzodiazepines. It is perfectly safe. We want to ensure the best possible chances for your success though, so we may ask you to skip a dose 12 hours before the start of your infusion and wait until 6 hours after 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 stop them.
§ If you are taking opiates, muscle relaxants, or anti-inflammatories, there is no need to adjust your dose.
We can assist you in reducing or tapering off of any medications that are contraindicated, cause a reduced response to ketamine, or that you would like to stop taking due to negative side effects, ineffectiveness, or price. You should not adjust your dose or frequency of use of any prescribed medication without first consulting with your prescribing physician.

15. Will my insurance company pay for ketamine therapy?

Reimbursement policies vary widely among insurance companies. Some providers offer reimbursement for ketamine therapy. We can assist you in finding out whether or not your provider is one of them prior to your having treatment and will provide you with the necessary documents to submit to your insurer for reimbursement. We require payment at the time of treatment.

16. Is there an age requirement to have IV ketamine infusions?

There are no formal age limitations.

17. What is esketamine/Spravato and how is it different from the ketamine used in intravenous infusions?

We infuse the racemic mixture of ketamine, which contains 50% R-Ketamine and 50% S-Ketamine, left and right shaped molecules. Esketamine (s-ketamine) is only the left shaped of the pair. They appear to be comparable, but some studies have shown R-ketamine to be slightly more effective. The more significant differences between ketamine and Spravato are not the molecules themselves, but the route of administration or ROA. Esketamine is only approved for nasal administration.

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