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Common Questions

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Ketamine 101

WHAT IS KETAMINE?

Ketamine is a medicine historically used for anesthesia during surgeries and medical procedures. It was synthesized in the 1960s and is FDA-approved for procedural sedation and anesthesia. It is widely used in hospitals and ERs and is on the World Health Organization’s “List of Essential Medicines.” Ketamine is now being .used “off-label” to treat depression, as well as anxiety, post-traumatic stress disorder (PTSD), and some chronic pain disorders. This medication has a long track record for its safety when used appropriately.

HOW DOES KETAMINE WORK?

While ketamine is the most researched psychedelic medication, how it exactly works is still being discovered. Studies have shown that it has a multilayered effect that targets dozens of systems in the brain and has a psychological and spiritual impact on clients. This creates a “reboot,” resetting the mind’s innate ability to heal itself. We do know that ketamine works on the NMDA receptor to block the glutamate neurotransmitter. Scientific study shows ketamine improves the health of the neurons (brain cells) by increasing the connection between the neurons involved in determining mood and improving the brain’s ability to adapt (aka neuroplasticity). Furthermore, ketamine decreases activity in the Default Mode Network (DMN) of the brain, which is more active in depression, anxiety, and chronic pain.

HOW DO I KNOW IF KETAMINE IS FOR ME?

Ketamine infusions may be for you if you suffer from depression, anxiety, PTSD (post-traumatic stress disorder), some pain disorders, or other mental health and stress issues that are keeping you from living your best life. Many who have not found relief from traditional medications and therapies often benefit from ketamine infusions. If you want to avoid the side effects of more conventional treatments or current treatments are not working for you, this may be for you. Ketamine therapy can also be helpful for high-functioning people who are looking for a new tool to deal with the stress of living in today’s world. Even if you haven’t been professionally diagnosed with a mental health condition, you can still find clarity, confidence, and creativity with ketamine therapy.

IS KETAMINE SAFE?

​​Ketamine has been proven safe and effective over decades of widespread use. The drug has minimal breathing, blood pressure, or heart rate, making it an ideal anesthetic. It was first FDA-approved for anesthesia in 1970. During an infusion for mental health treatment, the amount given is just a fraction of the dose safely used in sedation during surgery. But ketamine’s mental health applications are still considered “off-label” uses of the drug, meaning they are emerging treatments that the FDA hasn’t yet formally approved. Research on ketamine for depression and other mental health conditions is extensive and ongoing.

While the medication is extremely safe, there are recommended standards for administration. Therapy should be done by a licensed physician who can administer a DEA schedule III medication. ACLS certification is recommended and meets the American Society of Anesthesiologists’ requirements for delivering moderate sedation. It is also recommended that the outpatient environment where these services are performed can monitor vital signs every 15 minutes. Additionally, when patients have a pre-existing history of cardiovascular or respiratory problems, they may receive additional support and monitoring with oxygen therapy and continuous end-tidal CO2 monitoring during their infusions.

IS KETAMINE ADDICTIVE?

Ketamine has a long proven track record of being a safe FDA-approved anesthetic since 1970. It is part of the List of Essential Medications the World Health Organization (WHO) recommends to have in every hospital. Addiction has not been found in individuals who receive ketamine infusion therapy at the dosing, treatment, and schedule in the appropriate setting with a medical professional. Ketamine treats addiction by allowing clients to work through the root cause of trauma, which triggers their unhealthy use of substances.

IS KETAMINE SCARY?

During your infusion, it’s important to remember that you are safe and under the care of a highly trained ketamine specialist. You chose this therapy for its transformative effects. Powerful experiences lead to meaningful changes. Our goal is to expose you only to experiences you feel ready to handle. It’s counterproductive to push you into an overwhelming experience that will prevent you from exploring further. This treatment typically works best in a series of infusions. If the experience becomes too intense or uncomfortable, we will adjust your overall dose or slow down the infusion drip-rate. This is what we call “titrating to effect.” And when you feel ready to challenge yourself, we can help you with that, too.

ISN’T KETAMINE A STREET DRUG?

Ketamine, also called “Special K,” Kit Kat,” or “K,” has been used as a recreational drug and, like many pharmaceuticals, can be dangerous if not appropriately administered under the care of trained medical professionals. Ketamine IV therapy at Illumma is carefully dosed with a set duration in a soothing setting under medical observation to prevent any risks associated with overuse or abuse.

WHAT’S THE DIFFERENCE BETWEEN IV KETAMINE AND KETAMINE NASAL SPRAY (ESKETAMINE - SPRAVATO)?

IV ketamine therapy uses ketamine, an anesthetic that’s been FDA-approved for use in surgery since the 1970s. The nasal spray contains esketamine, a drug approved by the FDA in March 2019 under the brand name Spravato. The two drugs are closely related. Ketamine is a generic drug. Esketamine is a slightly different form of ketamine, allowing it to be patented and monetized as a novel treatment for depression.

Although the two forms of the drug work similarly to treat depression and other mental health conditions, Spravato effectiveness rate is significantly lower than IV therapy. Also, the studies that have shown a higher success rate have been in combination with SSRIs. It’s required to be given under the supervision of a psychiatrist over a matter of months instead of weeks with ketamine infusion therapy.

The only benefit of the nasal spray is that it doesn’t require a needle poke in the arm. But it only comes in two doses—low and high. In contrast, IV administration of ketamine allows the physician to tailor the dose to the patients’ individual needs, based on weight and treatment goals, and adjust the amount and rate of the drip during the treatment as necessary. IV delivery is also the most effective method for absorption and accuracy of dose.

WILL I CONTINUE TO FOLLOW UP WITH MY DOCTOR, PSYCHIATRIST, PSYCHOLOGIST, AND/OR THERAPIST?

Yes. We are serving in a consulting capacity to provide this infusion and recommend continuing to continue seeing your physician and mental health support professional. Illumma also believes in collaborative care and can share important information about your care plan with your team if approved.

IF KETAMINE INFUSIONS ARE SO GREAT, WHY AREN’T ALL DOCTORS PROVIDING THIS SERVICE?

Three main reasons:
1. Comfort with administering the medication
Outside of ER doctors and anesthesiologists, few other medical specialists are trained in administering ketamine.
2. Awareness of this alternative uses
While ketamine is widely known for its effectiveness in the operating room, many doctors are simply not educated on its success with mental illness and pain management.
3. Acceptance of this treatment
In addition to the doctors being unaware of the full spectrum of ketamine’s benefits, others are bound to the traditional pharmacology model and are unwilling to consider alternatives despite the growing evidence.

DO I NEED A REFERRAL?

We do not require a referral. Over 70% of Illumma’s clients are self-referred, meaning they were struggling and searching for an alternative tool for healing. Before scheduling your clinical consultation, we ask you to start by filling out our short intake paperwork. This is to help us ensure ketamine therapy will be a beneficial step in your wellness journey and give us the information we need to work with your current health care provider to design an individualized treatment plan. If you’re currently working with a mental health professional, PCP, or other referring physician, we’ll request the release of your medical records. If you do not have a current provider, we can refer you to one. While there are minimal risks with ketamine treatment, we value a team approach to medicine. We require that you remain under the care of another medical or mental health professional through the course of treatment.

WHY ISN’T KETAMINE THERAPY FDA APPROVED?

Before a drug can be approved, a pharmaceutical company must submit clinical data and other information to the Food and Drug Administration (FDA) for review. The company must show that the drug is safe and effective for its intended uses. “Safe” does not mean that the drug has no side effects. Instead, it means the FDA has determined the benefits of using the medicine for a particular use outweigh the potential risks. Once the FDA has approved a treatment for one purpose, healthcare providers may prescribe that drug for other purposes when they judge that it is medically appropriate for their patient. Prescribing a drug for a purpose other than its approval is known as “off-label” use. Off-label use of medications is legal and common. About one in five prescriptions written in the US today is off-label.

Despite an ever-growing body of research supporting ketamine therapy for depression, anxiety, PTSD, OCD, and chronic pain, they remain off-label uses of the drug. Because ketamine has been administered for over 50 years as an anesthetic, its patent has expired, making it a generic drug. Without a patent, there isn’t much profit potential. That means there’s no financial incentive for any pharmaceutical company to sponsor the kind of large, costly clinical trials of ketamine for mood and pain disorders that are required for FDA approval.

WHO SHOULDN’T TAKE KETAMINE, I.E., ARE THERE CONDITIONS THAT MAKE KETAMINE DANGEROUS OR INEFFECTIVE?

Yes. If you are experiencing the following: Diagnosed or potential schizophrenia, Uncontrolled high blood pressure (hypertension); Unstable heart disease (arrhythmias, congestive heart failure, chest pain, etc.); Untreated thyroid disease; Active manic phase of bipolar disorder; Active delusions and hallucination symptoms (not on medications or while taking street drugs). If you have any of the above on the day of your infusions, you, unfortunately, will not be able to receive your infusion.

WHAT IS THE RESPONSE RATE?

Research suggests improvement in 70-80% of patients who are treated with ketamine for depression. At Illumma, about 82% of clients see a significant (>30%) reduction in their mental health scores over the initial six infusion series.

WHERE CAN I GET MORE INFORMATION ABOUT KETAMINE?

Go to our Resources page and www.askp.org for more information.

Your Ketamine Experience

HOW LONG IS THE APPOINTMENT FOR THE KETAMINE INFUSION?

The medication is delivered over one hour for mental health infusions, and the appointment is booked for 2 hours. This allows for infusion prep, the actual ketamine infusion, and then recovery time. Most clients are in and out of the clinic in around 90 minutes.

HOW AM I GOING TO FEEL DURING THE INFUSION?

Some patients report feeling like they are in a dream or they feel sedated. Some feel like they have changes in thought processes, vision, and or speech. Remember, a healthcare professional will always be close by, ensuring you are safe and well taken care of during your infusion. For a more detailed description of please see our Ketamine Infusions Therapy page(link to page).

HOW AM I GOING TO FEEL AFTER THE INFUSION?

Many patients recover 20-30 minutes after the infusion. You may feel a little tired, notice a mild difficulty talking, or even “cloudy thinking” for a few hours later. Since you need to arrive fast, most clients are hungry post-infusion, it’s best to get something to eat and rest for at least 1-2 hours after. We also advise you to take it easy and have a relaxing day following the infusion. We will make sure you are ready and safe after your infusion before we let you go home!

WHAT SIDE EFFECTS DOES KETAMINE HAVE?

The main side effects that ketamine can cause are nausea, vomiting, fatigue, brain fog, and emotional sensitivity afterward. These are typically mild and short-acting. We will pre-treat you with nausea medication and can increase your nausea protocol throughout your series if needed. If the physical recovery issue lasts longer than 24 hours, we suggest adding a vitamin IV post-infusion to support a quicker recovery. Ketamine also raises blood pressure and pulse, so our ketamine specialist will monitor you closely at all times. One long-term side effect that is only known to occur at the abuse level of ketamine is bladder irritation (AKA cystitis). The risk with monitored ketamine infusions is extremely low, and we have never observed it with our protocols.

HOW LONG WILL THE RESULTS LAST?

A single infusion typically lasts anywhere from a few days to a month. A standard mental health series of 6 infusions may last anywhere from weeks to months. Most clients find that a single booster infusion when effects are wearing off can restore and extend response. Every patient responds differently, and some patients get several months of relief with just a few infusions.

HOW MANY TREATMENTS WILL I NEED?

Ketamine infusion treatments occur in 2 steps: Initiation and Maintenance. At Illumma, we recognize each individual is unique. Thus, we tailor each treatment protocol to the individual based on your experience and reaction to the medication. In the standard mental health protocol, we have found that the maximum benefits occur from 6 infusions. The cadence of this can vary, but most clients come in over 4-6 weeks. If you are struggling significantly, your scheduling would be receiving two infusions the first two weeks and one infusion the third and fourth week. For higher functioning clients or those who have busy schedules, you may only need to come in once a week for six weeks. Studies have shown that cadence does not significantly affect the outcome, so we never want your appointments to add unnecessary stress to your life. A general guideline for infusion scheduling is at least one day between infusions and no more than 7-10 days apart.

CAN I DRINK OR EAT BEFORE MY INFUSION?

Please fast for 4 hours before the infusion to help prevent nausea. Continue to stay well hydrated but try not to drink a large number of fluid two hours before your appointment. Ketamine therapy often time increases urination drive, and this can be exacerbated with a full bladder. If you start to feel weak or faint, it is okay to have a light snack.

WHAT SHOULD I WEAR ON THE DAY OF MY INFUSION?

We suggest wearing loose, comfortable clothing. Feel free to bring cozy socks, a blanket, or anything that makes you feel relaxed at home.

CAN I DRIVE TO MY INFUSION APPOINTMENT?

No. Ketamine can impair your thinking for 12-24 hours after the infusion. You will need to coordinate a ride after your infusion from a trusted friend or family member or take a rideshare. We also recommend refraining from operating heavy machinery, avoiding watching small children, participating in strenuous activities, or signing or entering into any legal contracts for at least 24 hours after your infusion.

DO I NEED TO STOP ANY OF MY MEDS?

Most medication will be heald consistent during your infusion series. A few medications may need to be held the more of the infusion to not interact with the ketamine. These will be identified during your consultation with one of our Advanced Practice Providers. We do not recommend any changes to your medication routine just before. In recent years, researchers every day during ketamine therapy. The side effects of such changes can interfere with the effectiveness of ketamine therapy. After your series, if your symptoms have improved, you can work with your doctor to create a weening protocol. Illumma’s team can not help with this directly but can support the process in collaboration with your mental health team.

IF KETAMINE THERAPY WORKS FOR ME, HOW SOON WILL I BEGIN TO FEEL BETTER OR NOTICE A DIFFERENCE?

A small percentage of people can experience positive effects within an hour of finishing their first infusion. Most clients will not notice an effect until later in the series, around infusions three and four. Commonly, the effect is gradual and subtle, seeing thoughts of sadness and hopelessness begin to lift. Occasionally some people may have a dramatic impact. Function (going out, doing things you enjoy, work) improves before mood does. You can participate in your treatment plan more thoroughly with the improved function, thus improving your success rate!

 

Financing/Insurance

WHAT IS THE PRICE OF KETAMINE INFUSIONS?

Pricing is dependent on which healing protocol, self-guided ketamine infusion therapy, or ketamine-assisted treatment. You can find a detailed explanation of both on the Pricing page.

FINANCING

Our goal at Illumma is to make ketamine therapy available to as many people as possible and not allow financial barriers to stand in the way of anyone’s healing. We offer discounts for qualified groups and multiple financing options. To learn more about this, please check out our Pricing page.

DO YOU TAKE INSURANCE?

You want to use your insurance. We get it. We would like to. Since ketamine for mental health treatment is an off-label use, it is not covered by insurance. Also, like many physicians, we’ve decided not to take insurance because we want to make treatment decisions based on what will best serve each patient—not what their insurers will cover. Payment is collected at the time of treatment. And we’ll provide a superbill that you can submit to your insurance for reimbursement unless your insurer is Medicare. We are opting out of Medicare because its rules and regulations can provide the best possible care. For treatment at Illumma, you will sign an agreement not to submit treatment claims to Medicare for reimbursement.

We accept cash, ACH transfer, credit cards, debit cards, and HSA or FSA accounts. An FSA or HSA is a great way to utilize money from your paycheck to put into a specific account for healthcare expenditures before taxes are taken out. In other words, instead of paying for ketamine treatments with “after-tax” dollars, you’re using “pre-tax” dollars to pay for ketamine treatments, which will give most people about a 40 percent discount.