The History of Ketamine
In 1962, ketamine was first synthesized by a chemistry professor at Wayne State University. It is a fast-acting, quickly metabolized, non-opioid anesthetic. It was approved by the FDA for this purpose in 1970. For decades, ketamine has been used in hospitals, by first responders and combat medics for safe, effective pain control. It is the most commonly used anesthetic in third world countries. For these reasons, The World Health Organization has judged ketamine to be an essential medication.
In the United States, ketamine is routinely administered (in much higher doses) by civilian and military first responders, emergency room physicians, and anesthesiologists for acute pain relief and anesthesia. In the last twenty years, low dose ketamine therapy has been studied as an innovative treatment for psychological disorders and chronic pain.
Biochemistry
Repeated scientific studies show that stress, both acute and chronic, adversely affect the number and functionality of certain brain cells called neurons. Events that produce fear or physical and/or emotional pain (stressors) stimulate chemical reactions that alter the communication between these cells.
The discomforts we identify as anxiety and depression are the results of the body’s attempt to adapt to stress. Over time, stress affects neurons; shrinking them in size and diminishing their function. The good news is the human brain exhibits “neuroplasticity,” which is the ability to alter routes by which thought, emotions, and memories are regulated. Ketamine enhances neuroplasticity, helping to repair cellular connections damaged by stress exposure.
The glutamatergic system (part of the brain affected by ketamine) appears to play a role in the development of migraines and several chronic pain syndromes as well. We provide treatments focused on facilitating relief from these debilitating conditions.
With your active participation, we will design an individualized treatment plan to address your specific issues and reduce the possibility of symptom recurrence. Summit Ketamine Innovations offers a safe, professional, open, and accepting environment to address the issues preventing wellness.
Treatment Modalities
Ketamine is administered in several forms. Oral, intranasal (nasal spray), intramuscular (injected into the muscle), sublingual (dissolved under the tongue) and intravenous (injected into a vein) have all been studied. Intravenous (IV), continues to be most effective, although other delivery methods have shown moderate success. At our clinic, depending upon each individual’s specific circumstance, we administer ketamine intravenously and intramuscularly.Our small group program utilizes intramuscular injection as part of an 8 week treatment program that includes weekly integration sessions. We encourage you to contact us to discuss individualized options.
Intravenous (IV)
Infusion therapy is administered by a licensed physician, specialized in Anesthesia, who adheres to the American Society of Anesthesiologists (ASA) guidelines for moderate sedation. Anesthesia specialists are trained in administering, monitoring, and managing the dynamic continuum associated with IV sedation and treatment. At Summit Ketamine Innovations, patients are continuously monitored through the treatment process by our doctor and critical care trained, registered nurses. Vigilance and detailed attention to safety are the cornerstones of our practice.
Infusion therapy has advantages over other forms. IV administrations provide the highest bioavailability (amount of medication that can be used by the body). Research shows that 70-75% of patients respond with IV infusion. Other forms of administration have less predictable results. Infusion therapy is closely monitored to provide us the greatest opportunity to individualize treatment, based upon your body’s response and under the safest conditions possible.
Intramuscular (IM)
Intramuscular injections are frequently used with decent response rates. Ketamine is ~95% bioavailable in this form. Patients must still undergo a comprehensive evaluation, require supervision and measurement of vital signs. Doses can be adjusted between treatments, however it is less precise than with IV.
Sublingual
Ketamine is administered as a dissolvable medication that is placed under the tongue. Response rates to sublingual administration are less than infusion, as absorption rates are significantly lower than IV/IM. Risk of side effects from ketamine appear to be higher with sublingual administration, therefore we do not recommend this form as a method for ketamine treatment by itself.
Sublingual administration is a valuable tool that can enhance progress in therapy. This method is very low dose and is used at the time of therapy, in the presence of a trained ketamine assisted therapy provider. We provide medical supervision for this modality and coordinate with the therapist.
Oral
Oral ketamine is widely used in Europe, primarily for cost savings. Similar to sublingual, response rates to oral ketamine are not as effective. While oral ketamine may be effective in certain situations, we rarely find it to be of significant enough benefit to outweigh the risks.
Intranasal
Early in 2019, the FDA approved a new medication for treatment-resistant depression used in conjunction with an oral antidepressant. Spravato, or esketamine, is a close chemical relative of ketamine, administered as a nasal spray. Recently, they have removed the requirement that patients also be taking an antidepressant. Currently, we do not provide Spravato in our clinic. As insurance carriers begin to cover this service, we are monitoring how this evolves for patients and clinics to determine if it is a reliable option. Stay tuned…