Ketamine Infusion Therapy

Everything you need to know about Ketamine Infusion Therapy at Take Care Clinic
  • What is Ketamine?
  • Ketamine and mental health
  • What does the infusion cost?

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Ketamine Infusion Therapy

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What is ketamine?

Ketamine is an anaesthetic agent commonly used by doctors and veterinarians to induce anaesthesia or for procedures requiring sedation. It has potent analgesic (anti-pain) properties and is commonly used to treat painful conditions such as burn dressing changes. It is listed on the World Health Organisation’s (WHO) list of essential medicines. This list contains the medications considered to be most effective and safe to meet the most important needs in a health system.

Ketamine and mental health

Ketamine has more recently been used to treat depression, anxiety and PTSD, chronic pain conditions and stress related disorders in conjunction with best medical therapy and psychotherapy.

The best results have been obtained in patients with treatment resistant depression. Further evidence is emerging for ketamine use for OCD and substance abuse disorders such as alcoholism.

Several other conditions may benefit from ketamine therapy and can be discussed with your GP, psychiatrist or psychologist.

How is Ketamine administered?

How is ketamine administered?
Ketamine can be administered intravenously (through a drip), intranasally, intramuscularly and orally.

Ketamine therapy for mental health is usually conducted intravenously or intranasally and is patient dependent or condition dependent.

With a background in anaesthesia, Dr Sean Thornley is most comfortable administering ketamine intravenously via a drip in the arm where the dosing, onset and offset of action and side effects can be controlled.

How does ketamine work?

Ketamine works primarily by blocking NMDA receptors in the brain. It has been shown to increase a protein called brain-derived neurotrophic factor (BDNF). This is roughly equated to fertilizer for brain cells and causes neurogenesis (new brain cell formation) as well as synaptogenesis (new connections between existing brain cells).

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Who cannot be given Ketamine?

Ketamine must be used with caution in patients with poorly controlled blood pressure or heart disease. Patients with any history of psychotic disorders such as schizophrenia should not be given ketamine.

Caution should be used in patients with bipolar mood disorder although success has been seen with patients in the depressive phase of bipolar disorder.

Patients with raised pressure inside the eye should first be seen by an eye specialist. Pregnant women should not be given ketamine.

What dose of ketamine is given during infusion therapy?

The dose is individualized for every patient. This depends on:

  • Baseline cardiovascular status
  • Mental status
  • Physiological status according to physical examination and blood tests.

In general a lower dose is used for the first infusion to reduce side effects and can subsequently be increased if needed. In general a range between 0.4mg/kg and 1mg/kg is used (roughly half your weight in total). This is administered over 40-60 minutes.

What do you need to do before having Ketamine infusion therapy?

Intention is very important with a ketamine infusion. It is good to prepare yourself physically and mentally beforehand. Do not consume any alcohol or take any illicit substances the night before the infusion. Try and get a good night’s rest. Chronic medications should still be taken the night before and the morning of the infusion unless instructed otherwise.

We suggest seeing a therapist such as a psychologist beforehand in order to map out your intentions on a single double-sided A4 page.

Music plays an important part of the experience, we suggest using Meditation music or music for deep sleep for the first infusion. An alternative is to prepare a 60 minute playlist of songs that have significant meaning to you or are relevant to your intentions.

Bring along a comfortable pair of headphones (preferably noise cancelling) and an eye mask if you have one. If you do not have earphones or an eye mask a pair will be provided for you. Please wear comfortable clothes for the infusion and ensure that you have emptied your bladder when you arrive at the practice.

What does the process itself entail?

Upon arrival in the rooms you should empty your bladder. You will be counseled as to the procedure and any concerns or queries addressed.

Your intentions for what you want to achieve out of the process should be voiced with the doctor. You will then be taken to the infusion room whereby an IV line (drip) will be inserted in your hand or arm. You should have an eye mask and headphones available with music ready to play and volume adjusted to a comfortable level.

Monitors including blood pressure, saturation monitoring, ECG, pulse rate as well as oxygen will be on hand. Supplemental oxygen will be administered via a nasal cannula if required. This is seldom necessary.

The infusion itself will last anywhere between 40 and 60 minutes and varies between patients according to individual response. Once the medication has finished running through the IV line you will slowly start to feel the effects wear off as you return to normal cognition. You may feel dizzy during this period and it is a gradual process from removing the eye mask, adjusting to the ambient light, sitting up and then standing.

Who should come along to the infusion and can you drive afterwards?
Please bring along a chaperone that can sit alongside you during the infusion. This should be a family member or friend that you trust. If you are unable to bring someone along the infusion may be recorded for the safety of the patient and doctor.

You should treat the infusion as any general anaesthetic and you may not drive yourself home afterwards. It is best to have a family member or friend drive you home and not e-hailing services such as Uber.

You should not make any important personal or financial decisions or operate any heavy machinery or motorized vehicle for 24 hours following the infusion.

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How will I feel after the infusion?

Dizziness and instability on feet is very common following the infusion.

A small percentage of patients may experience nausea for a few days afterwards. This is usually counteracted with anti-nausea medication during the infusion and oral nausea medication such as valoid once at home.

A mild headache is common for 24-48hours and can be mitigated by staying hydrated or taking a painkiller such as paracetamol or ibuprofen.

Avoid alcohol or stimulants such as caffeine following the infusion. Sleep may be affected for a few days following the infusion. Positive effects of the infusion are usually noted within the first 72 hours although maximal effects can take up to a week.

What should I do in the days and weeks after the infusion?

Integration is an important part of the process. A follow up session with the person who referred you for the infusion should be considered. This gives you an opportunity to discuss the infusion and what you hope to achieve out of the process. We can refer you to a psychologist or psychiatrist with experience in ketamine therapy should you wish to speak to another healthcare professional.

Integration may also involve performing hobbies or tasks that you enjoy. If you enjoy painting, DIY, or physical activity then plan this into your diary in the first few days after the infusion.

Exercise is a great way to build up natural endorphins. 30-40 minutes of cardiovascular exercise 3-4 times a week should be the goal. Start slowly and build this up. Mindfulness and meditation are wonderful tools to assist you in creating the best version of yourself. There are many apps and tools one can download to assist in this regard.

How many infusions do I require?
This decision is individualized. Most patients require 2-3 infusions in total separated by a 7-10 day interval. We recommend at least two infusions for the majority of patients. Maintenance infusions may be considered every 3-6 months in select cases.
What does the infusion cost?
The cost for the treatment is R2 960 per infusion.

This takes into account the duration of time spent with the doctor (60 – 90 minutes) as well as the cost of the infusion materials and medication. This amount is only partially covered by certain medical aids on specific plans. There are other options available as well as other facilities available that administer ketamine infusions. These options can be discussed prior to your first infusion.

Patients reviews

“I have been depressed for about 40 years. I saw phycologists, psychiatrists and have been on medication for more than 15 years. None of this helped me. About 18 months ago, I went to a mindfulness coach. At first, I felt better, but then I had a total breakdown. I lost all hope, could not set foot out of bed, and was on a total downward spiral (to put it mildly). My mindfulness coach told me that I needed Ketamine treatment and referred me to Dr Sean Thornley.

I was very sceptical but decided to give it a try as a last resort. I arrived at Dr Sean’s room with no hope but found this wonderful kind man. He immediately set me at ease, examined and spoke to me to determine whether I was a candidate for the Ketamine treatment. He explained the treatment and sent me home with more reading to make an informed decision. For me, it was a no-brainer. I had to undergo Ketamine treatment. I started with the treatment the very next week. Again, Dr Sean put me at ease. He monitored me during the entire session (as he did with all the sessions) by checking my blood pressure, oxygen levels, and heart rate. I felt an improvement after each session. I have completed my treatment, and I cannot describe to you what a difference the Ketamine treatments made to my life! I cannot remember when last I felt this good: I can tackle life’s obstacles with ease.

Apart from being very grateful to my mindfulness coach for referring me, the Ketamine treatment itself, I am so grateful to Dr Sean for his kindness during this process. WOW! He is one of a kind.”

Marie Janse van Rensburg

Patient

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