American Society of Ketamine Physicians

Ketamine was first synthesized in 1962 and received FDA approval in 1970 for use as an anesthetic for general anesthesia induction and maintenance. It is classified by the DEA as a schedule 3 controlled substance. It is also used off-label for the treatment of Depression, Anxiety, PTSD, and chronic pain conditions such as fibromyalgia and complex regional pain syndrome (CRPS).

Multiple studies over the last decade have shown that ketamine can rapidly alleviate

symptoms of treatment resistant depression, within hours of treatment (references below).

Recent studies show that ketamine can also be helpful for PTSD and anxiety. Ketamine therapy has several advantages over traditional anti-depressant therapy. Rapid and robust response is a primary benefit. Depression symptoms can improve within minutes or hours, compared to 4-6 weeks for a trial of anti-depressants. And unlike most anti-depressants, ketamine does not cause sexual side effects or weight gain. Dr. Weinstock has been performing in-office ketamine treatments since 2015. He is one of only a very few Psychiatrists in the country that performs Intravenous Ketamine Infusions in an outpatient office setting. Most clinics offering this treatment are not staffed by Psychiatrists. Rather, they are run by Anesthesiologists or Emergency Medicine Doctors.

The reported national average success rate with ketamine infusions is approximately

70%. The national average length of treatment is a 40 minute infusion. Dr. Weinstock has

discovered that longer infusion times (approximately 60-75 minutes) produce much

greater success rates for Depression, Anxiety and PTSD. Additionally, most clinics

follow a simple dosing protocol of 0.5mg/kg of body weight, however, Dr. Weinstock

takes extra time to “titrate” each patient’s dose to the optimum level, further improving

the success rate. By combining longer infusion times with optimally titrated doses, Dr.

Weinstock has achieved an 85% success rate.

Ketamine is a “fast-in, fast-out” medication that is generally well tolerated and even safe

for use in children. The side effects are short sided (1-2 hours) and rare but include allergic reaction, elevation of blood pressure and heart rate, nausea, blurry vision, impaired balance and sedation. These risks require a companion to drive the patient home after the treatment (Uber is

okay too). Normal activities can be resumed after 3 hours.

Ultra-rapid relief of depression and anxiety symptoms. Symptoms can improve within minutes or hours, compared to 4-6 weeks for a trial of anti-depressants. And again unlike most anti depressants, ketamine does not cause sexual side effects or weight gain. When starting ketamine, it is not necessary to stop your current medication; however, after achieving a positive response, patients may be able to gradually wean off of their other depression medication under the careful guidance and supervision of Dr. Weinstock.

Patients commonly describe the treatment experience as a feeling of absolute tranquility, peaceful, floaty, relaxed, mildly euphoric, and similar to a meditative state of consciousness. The residual after-effects, which can last several days to several weeks after your treatment, include a greater sense of well-being and a much greater ability to cope with the daily stresses in your life.

Recent research has also discovered that ketamine increases the production and release of

BDNF (brain derived neurotrophic factor) in the brain. BDNF acts as a kind of “fertilizer” for neurons and other brain cells, leading to increased synaptic connections between neurons and the formation of new neuronal pathways. It is hypothesized that this is one of the mechanisms by which ketamine “heals” the brain.

Dr. Weinstock offers both Ketamine IV Infusion Therapy and Ketamine Injection Therapy.

Ketamine IV Infusion Therapy is the gold standard of ketamine treatment and it is the most effective technique. It requires placement of a peripheral IV in the arm or hand. A carefully titrated Ketamine and Saline sterile solution is then slowly infused into the blood stream over the course of 60-75 minutes in a private room with continuous monitoring. Once the patient has completed the infusion, there is a 60 minute recovery period. The patient is then re-evaluated by Dr. Weinstock and cleared for discharge. Routine blood pressure and pulse oximetry readings are measured both before and after the procedure.

The Ketamine Injection Therapy consists of a very fine needle intramuscular injection of ketamine into the deltoid (shoulder) muscle. The patient will then relax in a private room for approximately one hour with periodic monitoring. The patient is then re-evaluated by Dr. Weinstock and then cleared for discharge. Routine blood pressure and pulse oximetry readings are measured both before and after the procedure.

Most studies of ketamine therapy for depression have utilized intravenous infusions. Therefore, we have more efficacy data for iv infusions compared to injections. IV Infusion patients get better results because the infusion can maintain a steady concentration of ketamine in the brain and achieve “continuous saturation” of the brain

NMDA receptors for the full 75 minute infusion. In contrast, a ketamine intramuscular injection usually provides only 10-15 minutes of “saturation” of the NMDA receptors. Another advantage of the IV Infusions is that they are much more “controllable” and can therefore provide a much smoother and safer experience. Infusions can be slowed down, sped up and even temporarily turned off, depending on the needs of the situation. In contrast, the injection is irreversible. Once you receive the injection, it can’t be slowed down or stopped.

The specific treatment regimen will be individually tailored to each patient but it will usually consists of 6-8 initial treatments, given once or twice per week. Once patients are experiencing sustained relief, the treatments can then be spaced farther apart. Eventually once per month or longer is sufficient to maintain stability.

All treatments are conducted in private rooms. You can bring one visitor with you to sit with you during the treatment, if you so desire. You will be laying down in a reclining “laz-e-boy” style chair. We provide soft, plush blankets, a “sleep” mask, head phones, pleasant music and a galaxy night sky light projector to give you the best possible experience.

Each room is equipped with a video camera so that we can visually monitor you the entire time, while still being able to give you privacy during your treatment. You will be wearing a pulse oximeter on your finger which will continuously measure your oxygen saturation and heart rate.

In addition to Dr. Weinstock, you will also be monitored by our Infusion Nurse, Nikki and our medical assistant Tiffany. You can relax and “let go” during your treatment, knowing that you are in the safe and experienced hands of Dr. Weinstock and his patient care team.

The majority of the cost can now be billed to in-network insurance plans (we are in network with United, Optum, Oscar, Aetna, Cigna, Evernorth, Humana and Medicare).  You are still responsible for paying your normal insurance co-pay and deductible (if applicable) for the office visit, procedure and monitoring charges billed to your insurance. 

There is also an out-of-pocket fee to cover expenses not covered by insurance such as the cost of the ketamine itself, nausea medicine, anxiety medicine, blood pressure medicine, disposables (needles, syringes, iv tubing/catheters/start kits, sterile saline bags), medical waste disposal, and the medical staff team.

Ketamine Therapy out-of-pocket cost per treatment:  $150

You may use your Health Savings Account (HSA) or Flexible Savings Account (FSA) to pay for all expenses.

Call or email our office to schedule a new patient visit to determine if ketamine is right

for you.

Office phone: 813-636-8300

Office email: help@ericweinstockmd.com

References:

From the U.S. Psychiatric and Mental Health Congress:

Novel Therapeutics for Major Depression

Journal Article References:

Rapid and longer-term antidepressant effects of repeated ketamine infusions in treatment-resistant major

depression.

Ketamine's antidepressant effect: focus on ketamine mechanisms of action

The role of ketamine in treatment-resistant depression: a systematic review.

Effects of intravenous ketamine on explicit and implicit measures of suicidality in treatment-resistant

depression.

Antidepressant mechanism of ketamine: perspective from preclinical studies.

Acute Antidepressant Effects of Intramuscular Versus Intravenous Ketamine