Ketamine Therapy

In recent years, the utilization of psychedelics has emerged as a novel approach to treating mental health conditions. These compounds offer individuals distinctive insights, emotions, or experiences that may shed light on the underlying reasons for their current state. While typically classified as a psychedelic, ketamine operates through a distinct biochemical pathway that facilitates a gentle lifting of users' negative emotional states. As ketamine's advantages are becoming increasingly evident in reputable psychiatric journals, Hendricks Therapy is now offering ketamine therapy at our new Plainfield facility. Our aim is not to replicate other ketamine clinics, but rather to enhance ketamine treatment’s effectiveness, convenience, affordability, time efficiency, and monitoring.

In 1962, Ketamine was created and subsequently approved by the FDA in 1970 as an anesthetic. During the Vietnam War, first responders administering treatment to wounded soldiers noticed its antidepressant and anti-suicidal properties. This observation prompted researchers from Yale School of Medicine to conduct the first randomized control trial on Ketamine's efficacy in 2000. Since then, the use of Ketamine for depression has grown significantly, culminating in the FDA's approval of a variant known as (S)ketamine for treatment-resistant depression in 2019 called Spravato.

Ketamine is not a replacement for medication or psychotherapy, but rather serves to complement them. Its antidepressant effects manifest within hours to days, in contrast to conventional antidepressants which can take weeks to show an effect. While traditional antidepressants increase levels of serotonin, norepinephrine, and dopamine, ketamine functions in part by enhancing nerve cell communication through the glutamate/NMDA system. Of particular interest is ketamine's ability to repair neuronal damage and inflammation associated with depression, anxiety, post-traumatic stress disorder and other mental illnesses. This neuroplasticity can also occur through healthy thinking and behaviors. Research is finding that the days and weeks after receiving ketamine treatment are an opportune time for neuronal repair through psychotherapy, positive thinking, and behavioral modifications.

Our understanding of the brain has changed over the years. We used to think that the brain was a static organ and couldn't change, but we now know that it adapts and evolves throughout our lives. This process is called neuroplasticity. Our genes, environment, stress, thoughts, and actions can all affect the structure and function of our brain. This is why trauma, negative thoughts and actions, and stress can lead to mental health problems. In early childhood, when the brain is rapidly developing, adverse childhood events (ACE) can be especially harmful due to the brain's high level of neuroplasticity during this time.

Fortunately, we can positively impact the structure and function of our brain through changes in our environment, thoughts, and actions. Ketamine can also be a valuable tool in this process. Ketamine works by increasing levels of the neurotransmitter glutamate and reducing inflammation, which can help restore normal brain function. Ketamine also opens a window of opportunity where our brain is more receptive to change i.e., a higher level of neuroplasticity. The question we must ask ourselves is whether we want to influence our brain in a positive or negative direction.

We mustn't waste this opportunity or engage in negative behaviors that could harm our brain development. Therefore, we ask individuals receiving ketamine therapy to actively restructure their neural connections in a positive way by engaging in our neuroplasticity program. While simple and effective, these therapies demand significant effort and courage to enact changes in one's life.

Enantiomers are a pair of mirror images that make up many molecules. Despite having identical chemical structures, they reflect one another, similar to the left and right hands. Ketamine is comprised of two enantiomers, a left-handed one called (S)-ketamine and a right-handed one called (R)-ketamine. Spravato consists of the left-handed (S) molecule, while ketamine is a racemic mixture of both molecules.

As Ketamine has been FDA approved for anesthesia for more than half a century, it cannot be patented as a treatment for depression; but ketamine ins not unusual in this regard as roughly 70% of medications are used for conditions outside their FDA-approved indications. However, if a pharmaceutical company can demonstrate the effectiveness of a compound's enantiomers in treating a particular illness, they can receive FDA approval. Consequently, (S)-ketamine was introduced to the market as a new agent for treating depression.

Obtaining FDA approval for a medication is a costly endeavor for pharmaceutical companies, resulting in a price range of $590 to $885 per session for (S)-ketamine, exclusive of office visit expenses. Despite this, many find comfort in using an FDA-approved drug and insurance companies may cover a significant portion of the cost. To comply with FDA regulations, (S)-ketamine must be administered in fixed doses of either 56 mg or 84 mg, and patients must be monitored for at least two hours. The only available form of (S)-ketamine is intranasal (IN), while ketamine can be administered through multiple routes, each having differing levels of bioavailability.

When considering a medication, it is necessary to understand its bioavailability. Bioavailability is the amount of a substance that can enter the bloodstream and have a positive effect on the body after it has been administered through a certain method. It's a measure of how well the body can absorb and use a drug or nutrient after it has been taken in by a particular route such as swallowing a pill or getting a shot. The amount of substance that enters the bloodstream can be influenced by different factors such as the form and amount of the substance, how it's given, and the person's own physical state.

IV ketamine has a bioavailability of 100%, while IM ketamine has a bioavailability of 93%. Intranasal administration of ketamine, including (S)-ketamine, has a range of 35% to 50% bioavailability. In contrast, oral ketamine has a bioavailability of approximately 20%. Although there are only a few studies, subcutaneous ketamine presents an intriguing alternative.

Efficacy: When it comes to efficacy, numerous studies have demonstrated the superiority of IV ketamine over intranasal (IN) (S)-ketamine. On the other hand, studies have found that IM and IV ketamine exhibit similar efficacy. While there is little difference in the bioavailability of IV and IM ketamine, the bioavailability of (IN) (S)-ketamine is significantly lower. We also incorporate neuroplasticity therapy to enhance ketamine’s efficacy.

Safety: When it comes to safety, administering ketamine is generally considered safe. However, in theory, IM ketamine could have more side effects than (IN) due to its higher bioavailability and the ability to administer higher doses. It may also theoretically lead to more side effects compared to a continuous infusion of IV ketamine. To reduce the risk of potential side effects, when doses exceed 0.5mg/kg, we give ketamine in two separate doses 15 minutes apart. Additionally, we closely monitor blood pressure, heart rate, oxygen saturation levels, as well as levels of dissociation and alertness.

Cost: Insurance network members can utilize coverage for the initial psychiatric visit as well as psychiatric supervision occurring during each treatment. However, the expenses related to ketamine and ketamine monitoring, which amount to $205, are not included in the insurance coverage. Despite this significant cost, it remains considerably lower than what is typically charged by most ketamine clinics.

Time: Due to our improved monitoring and protocols, our objective is to enable patients to be discharged earlier than the standard two-hour observation period for IV and (S)-ketamine treatments, provided they meet the discharge criteria. According to their own research, most patients receiving Spravato have been found to have completely recovered from treatment well before the mandatory two-hour observation period.

Convenience: Patients only need to arrange transportation to the appointment, as we will arrange and cover the cost (up to $30) of the Uber ride back home. Therefore, there is no need to have a companion wait during the recovery period.