Psychedelic therapy is making headlines across the nation, and ketamine is at the forefront of the conversation. Ketamine is rapidly distinguishing itself as a wonder drug, with benefits that apply to common and debilitating conditions like depression, post-traumatic stress disorder, chronic pain, and substance use. While ketamine is not considered a first-line intervention, as an adjunct to therapy, it’s producing increasingly positive results
The problem with ketamine is that its near-miraculous outcomes also lack hard science to back them up, and are therefore not completely understood. Regardless, the benefits of ketamine vs. its potential risks in the management of these types of patients has sufficiently impressed healthcare experts, precipitating the opening of numerous ketamine clinics across the nation.
As with any other trend in medicine, there is a call for healthcare providers and patients to be informed. The culture of psychedelic drug use in America has been historically experimental and pseudoscientific, and ketamine clinics can blur the lines between clinical and recreational use.
Legitimate, evidence-based information on ketamine clinics exists in resources like peer-reviewed journals and websites from reputable medical organizations. However, there is plenty of questionable information to be found in the media and online from providers seeking to financially benefit from the therapeutic buzz. It is crucial for medical providers to be well informed on the issues surrounding the use of ketamine, using reliable resources such as those offered by #1 Premiere Continuing Education.
Ketamine for Treatment-Resistant Depression
Patients who experience treatment-resistant depression (TRD) are those who, in spite of traditional treatment, never experience remission of their depression or fall into repetitive cycles of relapse. While the use of ketamine for treating behavioral and mood disorders is not necessarily new, the increased use of ketamine for treating TRD is shown to be an effective option for many, creating incentives for more research.
Depression can have a profound impact on a person’s quality of life, and Americans spend upwards of $71 billion on its treatment every year. Traditional therapies are 60-80% effective, but they can be extremely expensive and time-consuming. Combined with the inherent nature of depression, it’s estimated that only 66% of depression sufferers seek professional treatment.
Ketamine therapy, by contrast, can be as simple as a sublingual pill. It’s also competitively priced with traditional therapy, appears to have similar success rates, and offers minimal side effects.
However, there are many important considerations to take into account, especially in an absence of clear data. For instance, depression often presents with other underlying medical conditions. Because the administration of ketamine also carries with it physiologic implications, the complexities of a patient with multiple medical problems need to be fully appreciated when administering the drug.
What is a Ketamine Clinic?
While there are a few ketamine clinics associated with hospitals, ketamine clinics are often outpatient, and most likely independently owned and operated. In this format, clinics are marketing their fee-for-service resources in the management of disorders like depression and chronic pain. These businesses are often run by an interdisciplinary team of psychiatrists and anesthesia providers, with support from other healthcare professionals like registered nurses and social workers.
The most common form of ketamine therapy offered at a clinic is an IV infusion. The procedure takes between 45-90 minutes, but patients should expect to spend 90-120 minutes at the clinic for pre-procedure screening and post-procedure observation and care.
Clinics usually recommend a course of ketamine infusions—often 6—and typically suggest that results can be expected after 2-3 infusions. Infusions are given every other day, and after the initial course will probably require 1-2 injections a month on an ongoing basis.
Some patients report grogginess or lightheadedness after treatment, and these symptoms tend to clear up shortly after the procedure. However, it’s recommended that patients avoid operating heavy machinery on similar timelines to over-the-counter drugs that cause drowsiness.
The Challenges for Healthcare Providers
On one hand, the emerging trend in the growth of ketamine clinics represents the potential for accessibility to a promising resource that can improve the quality of life of many people. On the other, this resource comes with its fair share of potential concerns.
Off-label ketamine administration for the purpose of anything outside the realm of anesthesia is not FDA approved for insurance reimbursement. This means that if someone heads to a ketamine clinic they will be paying out of pocket, with a course of infusions costing anywhere from $400-$1200 each.
The challenge comes in considering the fair and equitable use of a resource like this for treating a debilitating disorder impacting millions of people across the country. Because it’s affordable for more affluent patients, ketamine therapy presents an obvious potential for disparity in care.
Side effects and their management are another serious concern in these non-traditional settings. There are hemodynamic and physiological implications that need to be considered when using this medication in an environment where the staff may not be comfortable managing emergency situations. Assuring the clinical staff is trained and competent in managing adverse reactions is crucial.
Improve Your Awareness of Ketamine Clinics
There doesn’t seem to be any sign of the increasing popularity of ketamine clinics slowing down anytime soon. The promising outcomes in patients who have long suffered from things like TRD and chronic pain create a sense of hope, but should not overshadow the need for healthcare providers to be well-informed.
Continuing education programs like The Latest on Ketamine and Esketamine for Treatment Resistant Depression, created by Kathy Gardner, DNP, APRN, FNP-BC, CNM, CNE
Faculty, Frontier Nursing University, and offered by #1 Premiere Continuing Education, represents a valuable tool for keeping healthcare professionals informed, up-to-date, and aware of the risks. Knowing who this treatment is most appropriate for, the pros and cons of ketamine use, and how to manage adverse events are just a few ways to safeguard your practice.