Ketamine

Ketamine for treatment of
depression, suicidal thoughts, PTSD and premenstrual dysphoric disorder

What Makes Ketamine Treatment Different?
Ketamine has a very rapid onset of action, which distinguishes it from other antidepressants. Most antidepressants take weeks or months to work, but ketamine can take only hours to days for its effects to be noticed. Ketamine is truly unique among the antidepressants in its rapid effect. Ketamine is also different than other antidepressants because it does not need to be taken daily, but rather it is administered intermittently by injection or nasal spray. 
 
Ketamine bypasses the slow molecular machinery that is required by conventional antidepressants before they get to a crucial aspect of recovery from depression. One of the main effects of ketamine is the regeneration of nerve endings (synaptogenesis) in the part of the brain called the hippocampus.  Ketamine also dampens a network in the brain (the “default mode network”) whose overactivity is responsible for ruminations and persistent negativity seen in depression and anxiety.
 
Ketamine was introduced into clinical practice in the 1970s as an anesthetic. The first human study in the treatment of depression were published in 2000.  Its use for depression started to expand in the mid-2010s and has been growing exponentially ever since.​  It is being used to treat many conditions in psychiatry now, including severe or chronic depression, suicidal thoughts, post-traumatic stress disorder (PTSD), and premenstrual mood symptoms (PMS,  PMDD), and others. 

Ketamine Treatment at the Point Loma Clinic (PLC)
Before your first ketamine treatment, you will receive a full psychiatric evaluation from Dr. Papp.  This is important to make sure that the treatment is right for you and to help make the experience safe and effective. 
 
Each ketamine treatment visit is scheduled for two hours.  It includes a thorough evaluation of how you are doing, which includes an assessment of the impact of the prior ketamine treatment, as well as deciding on the dose of ketamine for that treatment.  The ketamine effect itself (the “trip”) lasts for about 40-70 minutes. The visit concludes with a discussion of the experience and with a plan for the next treatment. 
 
Our treatment rooms are serene and comfortable, making the ketamine experience enjoyable.  While in the treatment room, you will be continuously monitored to assess your vital signs to assure your comfort and safety.  You will also be under remote video observation, so that at any time, your doctor can know how you are doing while under the medication’s effects.  You can be assured that your safety is our primary concern. 




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Why choose Ketamine?

After your ketamine treatment
After your treatment you must not drive, walk, or take public transportation from the Clinic to get home. You will need a family member, friend or ride share to take you home.  You may feel a little sedated after your session, so we advise that you rest for several hours and refrain from any potentially stressful activity for the rest of the day.
 
Improvement can be rapid. Some patients wake up from the “trip” feeling much better;  others it may take 12-24 hours.  However, patients would be advised to commit to 4 – 5 treatments, since it may take that long to notice a meaningful effect.
 
Studies have shown that the benefits of ketamine can be extended if it is combined with psychotherapy.   After 24-48 hours, the effects of the ketamine on brain growth (synaptogenesis) is at its peak, and if psychotherapy is conducted within that time frame, then not only the effects of the ketamine can be extended, but also a breakthrough in psychotherapy can occur.  If Dr. Myers is your psychotherapist, Drs Papp and Myers will coordinate the timing of the ketamine administration and psychotherapy accordingly.  Dr. Myers can also help prepare you for your next ketamine treatment, by helping you to formulate a specific goal for the experience. 


What type of ketamine is used?  

Ketamine can be administrated in a number of ways: Intramuscular, intravenous, subcutaneous, or intranasal. The absorption of ketamine is the most reliable when administered via the intramuscular, intravenous, or subcutaneous methods. Research has not found any difference in the effectiveness between these treatment methods.  Here at the Point Loma Clinic, we use the intramuscular route due to its simplicity. If you are interested in the recently approved intranasal spray formulation Spravato (esketamine), you may choose this method. You can learn more on the product’s website.

Is the Point Loma Clinic a Ketamine Clinic?

The Point Loma Clinic is not a “ketamine clinic”, although we do use ketamine.  “Ketamine clinics” are often run by non-psychiatrists and focus on giving ketamine only, typically to several people at the same time. No full scope mental health treatment is offered at most of these facilities, and patients must see other providers for psychiatric medication or psychotherapy treatments. 

We are a private mental health practice, where we use ketamine integrated into a well-rounded practice of general adult psychiatry and psychology, i.e., full psychiatric/psychological assessment, traditional psychiatric medication, psychotherapy (which may include virtual reality and  biofeedback), psychogenetic testing, and other treatments you may need. (Please see our page “Collaborative Care”)
Why choose Ketamine?
What is Ketamine?
Ketamine in Psychiatry
Other Uses of Ketamine
Ketamine Abuse
Ketamine is a small molecule that was developed in the 1970s as a medication used to anesthetize people for procedures, and it is still in widespread use for that purpose. Its use in psychiatry started to in the 2000s and has been expanding ever since.......

In addition to depression, studies with ketamine suggested effectiveness in PTSD, premenstrual disorders and bipolar depression. Psychiatric doses are very low compared to other uses.

Ketamine is also increasingly used for the treatment of severe chronic pain, and helping people get of high dose opiates. These are treatment provided by anesthesiologists and we do not offer them at PLC.  
Ketamine can be abused as a “party drug”, but it is not a frequent drug of abuse. People who self-inject or snort ketamine take much higher doses than used in medicine. Psychiatric use of ketamine is extremely unlikely to lead to abuse or dependence.

Learn more in this Q&A

Read about Dr. Papp at UC San Diego discussing the potential of ketamine as a remedy for depression when other treatments fail.
Learn More
Acute Antidepressant Effects Of Intramuscular Versus Intravenous Ketamine
Indian Journal of Psychological Medicine – 2014

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A Double-Blind, Randomized, Placebo-Controlled, Dose-Frequency Study of Intravenous Ketamine in Patients With Treatment-Resistant Depression
Post-publication peer review of the biomedical literature – 2017

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Cognitive Behavior Therapy May Sustain Antidepressant Effects of Intravenous Ketamine in Treatment-Resistant Depression
Psychotherapy and Psychosomatics – 2017



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Efficacy of Intravenous Ketamine for Treatment of Chronic Posttraumatic Stress Disorder 
JAMA Psychiatry – 2014

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Evidence that Subanesthetic Doses of Ketamine Cause Sustained Disruptions of NMDA and AMPA-Mediated Frontoparietal Connectivity in Humans
The Journal of Neuroscience – 2015
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Ketamine for Rapid Reduction of Suicidal Thoughts in Major Depression: A Midazolam-Controlled Randomized Clinical Trial
American Journal of Psychiatry – 2018

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Ketamine Treatment For Depression: Opportunities For Clinical Innovation And Ethical Foresight
Ilina Singh-Celia Morgan-Valerie Curran-David Nutt-Anne Schlag-Rupert Mcshane – The Lancet Psychiatry – 2017

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Replication of Ketamine’s Antidepressant Efficacy in Bipolar Depression: A Randomized Controlled Add-On Trial
Biological Psychiatry – 2012

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Long-Term Maintenance With Intramuscular Ketamine for Treatment-Resistant Bipolar II Depression
American Journal of Psychiatry – 2012

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Safety And Efficacy Of Maintenance Ketamine Treatment In Patients With Treatment-refractory Generalised Anxiety And Social Anxiety Disorders
Journal of Psychopharmacology – 2018

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Side-effects Associated With Ketamine Use In Depression: A Systematic Review
The Lancet Psychiatry – 2018

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Synaptic Potentiation Is Critical for Rapid Antidepressant Response to Ketamine in Treatment-Resistant Major Depression
Biological Psychiatry – 2012

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What Is The Mechanism Of Ketamine’s Rapid-onset Antidepressant Effect? A Concise Overview Of The Surprisingly Large Number Of Possibilities
Journal of Clinical Pharmacy and Therapeutics – 2017

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Ketamine Research
The below are selected research papers supporting the use of ketamine. Feel free to discuss any questions about these with Dr. Papp.