What is ketamine?
Ketamine has traditionally been used as an anesthetic for years. It has recently emerged as a rapid-acting and effective treatment for mood disorders at doses lower than those used in anesthesia.
How does ketamine work?
While the mechanism by which ketamine exerts its antidepressant effects remains controversial, it is likely through the modulation of the glutamate system. This is important as ketamine’s antidepressant effects occur via a different mechanism than traditional antidepressants and can potentially provide benefits to individuals who have failed previous treatments.
For what psychiatric disorders is ketamine best proven to be effective for?
At the Braxia Health we treat Major Depressive Disorder, and Bipolar Depression. Individuals Post Traumatic Stress Disorder (PTSD) or Obsessive-Compulsive Disorder (OCD) will be considered on a case-by-case basis for potential investigational use of intravenous ketamine.
How long will the effects of ketamine last?
The long-term efficacies of ketamine in individuals who have responded to this treatment modality are not yet fully known. Emerging evidence indicates that some individuals remains well for several months. Undoubtedly, there will be some individuals who remain well for longer periods of time. It’s also known that other individuals will require booster sessions to maintain their feelings of wellness. The booster sessions are typically administered approximately once per month.
Are there any contraindications for ketamine?
- Any individual who has a primary diagnosis is anything other than MDD or BD. As noted above, individual consideration will be given on a case-by-case basis for adults with either PTSD or OCD.
- Individuals who meet DSM-5 criteria for a substance use and or alcohol use disorder
- Any individual who has met DSM-5 criteria for a Substance Use Disorder and/or alcohol use disorder in the past 3 months.
- All individuals who use illicit substances (but do not meet criteria for Substance Use Disorder according to the DSM-5 criteria) must refrain from using substances for a minimum of one month prior to their first infusion at Braxia Health.
- Individuals who are experiencing psychotic symptoms as part of an MDE (mood congruent/mood incongruent)
- Individuals with a dementing disorder (e.g., Alzheimer’s disease)
- Individuals who are unable to provide written consent to the treatment
- Individuals who are unable to adhere to the protocol in its totality (i.e., remain in the clinic post infusion for a minimum of 20 minutes or as advised by the medical team for observation).
- Individuals who are unable to identify a person to assure their safe transport to home post infusion
- Individuals with symptomatic traumatic brain injury
- Uncontrolled medical disorders (i.e., uncontrolled and/or insufficiently treated hypertension, allergies to ketamine and/or previous intolerability of ketamine)
- Medical contraindications to ketamine (e.g. epilepsy)
- Patients that are over 275 lbs.
- Patients who do not adhere to Braxia Health protocol with respect to chaperoning during visit and post-discharge
- Individuals will be ineligible for ketamine treatment if they are not a Canadian resident
- Any patient who does not have a community MRP will not be accepted for assessment or any procedure at Braxia Health.
- Any individual who exhibits aggressive or intimidating behaviour towards Braxia Health staff or other patients will not be eligible for treatment at Braxia Health.
- Any patient who does not adhere to all pre-procedure recommendations (e.g., food fasting) is not eligible for treatment at Braxia Health.
- Patients feeling acutely unwell for any reason (e.g. symptoms of infection) and/or have come into direct contact with someone acutely ill from a transmissible infection.
Treatments at Braxia Health
What formulations of ketamine are available at Braxia Health?
Ketamine is delivered through intravenous infusion or sublingual lozenge.
How long do ketamine treatments take and how long do I need to stay at the clinic?
IV Ketamine infusions are given over 40 minutes. Post infusion patients will be required to stay up to 30 minutes of recovery time. Patients who receive intranasal ketamine are required to stay 2 hours at the clinic. Patients who receive sublingual ketamine are required to stay 1 hour however usually require 1.5 – 2 hours to recover post dose.
How many treatments of ketamine will I require?
For IV Ketamine the acute treatment phase consists of 4 to 6 infusions over a course of 2 weeks. For sublingual ketamine the acute treatment phase consists of 6 doses over a course of 4 weeks.
How many infusions do I need?
Typically patients who will need to come back for maintenance therapy is every 2-6 weeks.
How long does it take before ketamine begins to work?
Based on the available evidence, individuals receiving ketamine begin to report relief of depression within one day of administration of the first infusion. Others may take longer but overall the majority of people who are going to benefit from ketamine benefit from 1-2 weeks.
What is the usual dose of ketamine administered for treatment resistant mood disorders?
Generally speaking, the dose of ketamine administered through intravenous infusion is 0.5mg/kg to 0.75mg/kg. This dose results in a blood concentration of ketamine of about 10%-20% of what is usually used in anesthesia. Intranasal ketamine doses vary from 28mg to 84mg. Sublingual ketamine doses vary from 100mg to 400mg.
Can I eat during an infusion?
You’ll be asked not to eat or drink during treatment. Fasting is required pre-treatment with the length varying based on the route of administration. For intravenous infusions, patients are required to fast approximately 6-8 hours before the treatment. For sublingual and intranasal doses, patients are asked to fast for 2 hours before treatment.
What are common side effects?
The most common side effects of ketamine are dissociation, which is when images appear somewhat distorted. Dissociation can affect up to a third of people during the first infusion. The overall number of people who experience dissociation decreases with each subsequent infusion. It is also noted that some people may have an increase in blood pressure or heart rate during infusion therapy. That will be monitored closely during by your health care team. Although it is rare, some people may experience changes in liver or kidney function, and/or notice blood in their urine. These are considered rare events and more typically associated with much higher doses of ketamine for longer periods of time and/or people who abuse ketamine.
Is it safe for me to drive home after ketamine treatments?
No. You’ll need to be accompanied on your way home following the infusion of ketamine treatment.
Are there any medications that interfere?
Drugs that may interfere with ketamine treatments may be determined by your health care team at the Braxia Health during assessment.
Will there be research studies conducted at the Braxia Health that I may be able to participate in?
Yes, at times research studies will be conducted at Braxia Health. If eligible, patient’s of Braxia Health will be contacted regarding potential participation.
How much do treatments cost at the Braxia Health?
Depending on the ketamine formulation (eg, IV ketamine versus sublingual ketamine) prices range from $200 to $1000 per dose. The number of doses for an acute course of treatment also varies from 4-8 treatments.
How can I be assessed for eligibility for ketamine therapy?
A referral can be made by your healthcare provider at our referral page. Staff at the Braxia Health will conduct a comprehensive assessment of your psychiatric history, medical history and family history. Moreover, a full list of all previous treatments taken will need to be determined to ensure you have a treatment resistant disorder. Once you have been determined to be eligible for ketamine therapy, an appointment time will be scheduled for you at the Braxia Health.
Who can make the referral and how can they make the referral?
Any one of your doctors may be able to submit a referral for an assessment to our clinic. To submit a referral, your doctor can visit https://braixahealth.com/refer-a-patient-en
How quickly can I be seen?
Your referral will be assessed by the treatment team at the Braxia Health within 2-3 business days. Subsequent to that, if eligible, an appointment for an initial assessment will be made for you within 2-6 weeks.
Does the initial assessment at the Braxia Health cost money?
No. Your initial assessment at the Braxia Health would be covered by OHIP. The overarching aim of your referral of the initial assessment is to clarify and confirm what your diagnosis is to determine the appropriateness of your current and past treatments, as well as to consider appropriate treatment avenues for you. It is fully expected that many individuals may not be considered appropriate candidates for ketamine and/or will be recommended alternative treatments to ketamine.
What is the age eligibility for ketamine?
The age eligibility for ketamine at the Braxia Health is 18+ years of age.
Price and Costs
Is ketamine treatment for depression paid for by the public health plan of Ontario (i.e. Ontario Health Insurance Plan, OHIP)?
At this time OHIP does not cover costs for Ketamine treatment.
Will my insurance company cover my treatment?
Some insurers will cover ketamine treatments. Existing patients are encouraged to speak with clinic staff for assistance in submitting requests for insurance coverage.
Still Need Help?
Contact the clinic via email, telephone or in person. Visit our contact page to learn more.