By Kevin Nicholson, COO of Delic and CEO of Ketamine Wellness Centers
Americans spent $225 billion on mental health treatments and services in 2019, but nearly half the people using antidepressants recorded a relapse in symptoms. During that time, ketamine has become an increasingly popular and effective breakthrough mental health treatment.The first clinical studies of ketamine as human anesthesia were published in 1966. Ketamine produced profound analgesic effects, but it could not avoid negative stigmas towards psychedelics created by the War on Drugs. In 1970 psychedelics were classified as a Schedule I substance through the US Controlled Substances Act, which significantly hindered ketamine clinical research and treatments.
Since 2019, ketamine has become a more popular treatment after the FDA approval of Spravato, an esketamine nasal spray, but it is not a “magic bullet” cure. Patients interested in pursuing this option should first understand that ketamine therapy is a long-term commitment. The average treatment calls for between 4 - 6 stabilization infusions over the first week with increasing intervals for maintenance infusions every 10 - 30 days. Infusions occur monthly for up to a year and then continue with occasional boosters to achieve long-lasting benefits.
Proper ketamine usage has the potential to uplift a patient on a Three-Legged Stool of wellness. The first leg, treatment, consists of receiving a prescribed ketamine dosage. Next, cognitive therapeutic support is required to monitor and boost successful patient outcomes. The third leg, emphasizing healthy living activities, is vital in combating depressive disorders and establishing healthy lifestyle habits for patients.
For potential patients to see the desired benefits of ketamine infusion treatments, it is vital to incorporate the three pillars of (1) Treatment, (2) Good Therapeutic Support, and (3) Prioritizing a Balanced Diet and Exercise. Patients preparing to embark on this journey should consider taking the following measures to ensure optimal outcomes.
WORK WITH A PROVIDER FOCUSED ON YOUR HOLISTIC HEALTH AND WELL-BEING
Finding the right provider can present challenges, but working with a clinic that puts patient safety and wellness first is imperative. Ketamine infusion must be the right treatment for the right patient, and it should be clear that these facilities are committed to upholding high safety standards instead of accepting patients to generate revenue. Responsible clinics will require a thorough screening process for potential patients. This is a critical step considering how ketamine can have adverse side effects in patients with certain preexisting conditions such as schizophrenia, hypertension, heart disease, liver conditions or kidney conditions .
Prospective clinics should also be staffed with licensed medical professionals experienced in personalizing treatments to fit each patient's specific needs. At KWC, ketamine is offered in the form of a nasal spray or intravenous (IV) treatment. NAD+ infusion therapy, a recent service
added to our clinic, is delivered into the bloodstream intravenously or intramuscularly. NAD+ (Nicotinamide adenine dinucleotide) is often taken for its natural holistic health benefits and may enhance the process of healing depression, PTSD, and anxiety.
Regardless of which option a patient chooses, it’s important for them to first consult with a provider that understands their goals and physiology. A single, low-dose ketamine infusion could have minimal side effects, including mild nausea or increased blood pressure, and can quickly relieve depressive symptoms within hours, whereas antidepressants take weeks or months to work. However, even when the ketamine treatment is effective, cognitive therapy and physical wellness are still vital components of a long-term treatment plan.
GOOD COGNITIVE THERAPEUTIC SUPPORT WITH A TRAINED MENTAL HEALTH PROFESSIONAL
Recent studies suggested that ketamine may enhance the effects of psychotherapy in treatment-resistant unipolar and bipolar depression. A ketamine infusion essentially assists in rewiring the brain, and cognitive therapy can help the patients solidify new pathways, challenge negative thoughts and encourage positive habits.
Consequently, it is essential for patients to have a dedicated care team to help them identify the most appropriate type of cognitive therapy. Current research indicates that Cognitive Behavioral Therapy can maximize outcomes in patients undergoing ketamine therapy for depression and anxiety disorders. Additionally, our own providers often recommend EMDR Therapy for trauma-based support and Dialectical Behavioral Therapy for patients with personality disorders. An established clinic will often provide a list of recommended mental health professionals to help streamline the process.
The efficacy of ketamine therapy is also impacted by what patients are doing to improve their quality of life in between sessions, such as attending support groups, receiving support from family and friends, and developing a healthier lifestyle.
Ketamine therapy does not happen in a vacuum–it’s important to build out a mental health support system that includes close friends and family that want to see you succeed. A trusted support group can play a key role in creating a healthy environment for the patient to return to. For these reasons, Ketamine Wellness Centers encourages patients to work with clinics that offer education and support programs for loved ones navigating this experience with the patient.
PRIORITIZING PHYSICAL WELLNESS
Diet and exercise are among the top lifestyle factors that impact the development and progression of depression. Exercise can not only reduce anxiety and improve cognitive function but often provides a safe emotional release for our patients who feel more emotionally stimulated after their initial ketamine infusions.
Additionally, many patients with major depressive disorders have been found to have unhealthy high carb, high sugar diets, which can worsen their existing symptoms, and a majority of them experience comorbidities, including obesity or anorexia. This is a particularly challenging matter for patients having trouble breaking out of sedentary lifestyles and feelings of tremendous malaise during the COVID-19 pandemic.
IS TREATMENT THE NEXT STEP?
For a patient to initiate their own ketamine therapy journey, it is crucial to have support from family and friends. Their loved ones can first discuss treatment expectations and ensure the patient is willing to make this long-term commitment before scheduling a consultation.
Ketamine therapy can be a meaningful experience with favorable outcomes for suitable candidates. Our internal data has shown 80% effectiveness when treating bipolar depression and 76% effectiveness recorded for major depressive disorders. Additionally, patients experiencing PTSD/anxiety and borderline personality disorder were treated with 65% and 50% effectiveness, respectively.
Regardless of these notable efficacy rates, patients must recognize that ketamine therapy is still a holistic treatment impacted by physical, emotional and environmental factors. If used correctly, along with the support of a trained mental health professional and proper physical upkeep, ketamine can be a very effective alternative to mainstream mental health therapeutics, such as prescription medications.
While Treatment Resistant Depression (TRD) used to be a required diagnosis for most providers to consider ketamine therapy, we have seen the life-changing benefits first hand after our many years of treating patients and administering tens of thousands of safe and effective treatments. Ketamine should be a first line of treatment similar to traditional medications anytime someone is considering medication therapy for depression, anxiety, PTSD and suicidality.
