Exploring Ketamine Therapy with Dr. Bankole Johnson: A Comprehensive Insight into Innovative Depression Treatment

Ketamine is safe and effective for the treatment of refractory (i.e., resistant to traditional treatments) depression. Also, most individuals with refractory depression are at high risk for suicide. Ketamine appears particularly useful for the prevention of suicidal ideation. Ketamine offers an additional medical tool to treat depression over and above traditional treatments with antidepressants. 

Ketamine’s method of action is not well understood but its effect is thought to be due to the modulation of excitatory glutaminergic neurons in specific parts of the brain, the MGLU-2 receptor. An important advantage of ketamine over other methods to alleviate depression is that the response is rapid, and responders are out of danger from suicide quickly. Ketamine also has a mild side-effect profile, and its half-life is only 3-4 hours, and is, therefore, mostly eliminated in a day following acute dosing. 

Pre-screening for ketamine use requires the establishment of a diagnosis of severe depression, anxiety, or post-traumatic stress disorder. This diagnosis is best made by a psychiatrist or certified clinical psychologist. Intravenous ketamine administration is the most efficient method of administration because it allows accurate dosing. Individuals sit in a comfortable chair, and an IV is started with the required dose of ketamine - typically 0.5 mg/kg but can be higher depending on patient response. Patients have a choice to receive ketamine undisturbed in a quiet room, usually with a blindfold or eye protector, or even a device with imagery and/or music that is soothing or provides motivation to reduce depressive thoughts.  At Casa Privée, there also is the option of a therapist to provide “guidance” during the session.  During the ketamine session, the patient’s vital signs - blood pressure, pulse, and cardiac tracing are monitored at short individuals - usually every 10 min until the end of the session.  Intranasal ketamine administration is mostly used for home dosing. The doses are relatively smaller than intravenous but because this is not monitored, the cumulative dose administered can be much higher than for intravenous administration, and the risk of developing dependence, especially when taken in a recreational environment may be higher.  At Casa Privée, we do not advocate unsupervised home use of intranasal ketamine as this can be associated with unexpected dangers to physical and mental health.

Monitoring procedures were described above. Ketamine administration is safe in a medical environment and the typical side effects can include a rise in blood pressure and pulse. Disorientation, loss of consciousness, dizziness, nausea, and vomiting also can occur.  A dissociative experience also can occur as well as hallucinations.  The critical element of ketamine dosing is getting the dose “correct”. That means not exceeding a dose whereby the patient achieves relief without producing a prolonged “high”. Starting at relatively small doses and building up slowly is a sensible approach. In a medical setting, all tools to resuscitate an individual who experiences acute toxic effects of ketamine are usually present, and safety measures and protocols can be delivered speedily. Notably, adverse events are typically mild and in a medical setting, intravenous ketamine is safe. 

At Casa Privée, we have innovated our use of ketamine therapy by combining it with TMS (trans-cranial magnetic stimulation), which delivers small electromagnetic pulses to a specific region of the left side of the brain. TMS is a useful and effective tool for treating depression and combined with ketamine therapy seems to have a magnified effect. Additionally, it allows for the therapeutic response to depression treatment to be prolonged over weeks and months rather than days. 

Ketamine treatment is available at medical facilities such as ours in the Miami area. 

The cost of ketamine treatment can vary widely. The cost of ketamine treatment is associated with the resources deployed to ensure medical safety. So, cheaper is not often the best way to avail oneself of the best treatment. It is important to research the facility and ensure that a doctor or nurse practitioner will be available at all times during the treatment and that the clinic has modern apparatus for the constant monitoring of vital signs and cardiac function. Typically, the cost of a single dose of ketamine is in the range of $500-$900 but some clinics may offer a package to reduce the overall cost. Be suspicious of clinics that offer cheap rates for ketamine infusions because they might be skimping on safety.

Depression treatment has improved mark over the last decade. Multiple methods to treat depression exist. The best centers offer a combination of potential treatments that can include ketamine therapy. Depression is common, with about 20.4% and 36.7% of men and women, respectively having meeting criteria for treatment in a lifetime. The risk of depression increases with age; however, individuals in their early 30s to 40s can have high risks due to the pressures of work or being a homemaker.  An important message is that most people recover from depression with proper medical treatment, which combines pharmacological, technological, and psycho-social approaches. 

Medical use of ketamine in therapy in a medical setting supervised by an experienced doctor or nurse practitioner is safe and effective.  Taking ketamine at home, in recreational settings, and any unsupervised environment is not safe and risks the potential for acute toxicity and longer-term mental health problems including dependence. 

Recreational ketamine use is associated with the risk of dependence. This usually takes the form of an increased drive or propensity to seek ketamine but also can lead to dependence with withdrawal symptoms (typically mild to moderate) on cessation. Ketamine withdrawal in those with physical dependence can be associated with a “rebound” of depression and/or anxiety, sluggishness or sleepiness.

The best advice is always to seek the help of a certified psychiatrist or mental health worker if in need of mental health care. Importantly, recreational use of ketamine or its use in an unsupervised setting (even if provided by a health professional) is not safe.  Ketamine must be administered in a medical setting under proper medical monitoring procedures.