Frequently Asked Questions

Who Should have Ketamine therapy?

If you have tried numerous therapies including medication, TMS (transcranial magnetic stimulation), or even ECT, ketamine may be right for you. Even if you want to consider ketamine to boost your current treatment outcomes or minimize your medications, consider this treatment option. For CRPS and pain syndromes, Ketamine has been extremely helpful as add-on therapy.

What is ketamine?

Ketamine is a medical agent used for over 50 years as an anesthetic agent in surgery and sedation. It has a proven safety record and was even utilized on the battle fields during the Vietnam War to transport patients off the field. In the Emergency Department it has been an effective medication for procedural sedation, allowing the patient to maintain all their vital signs and breathing even at high doses. The side effect profile is very low when monitored appropriately. In the early 2000’s , the anti-depressant properties of Ketamine were more formerly evaluated, with Carlos Zarate, the Chief of Neurobiology at the National Institute of Mental Health, characterized the positive impact of ketamine in the successful therapy of Treatment Resistant Depression. This was showcased in a JAMA 2017 Interview Article { https://jamanetwork.com/journals/jama/article-abstract/2662752 } in which he describes the effective use of ketamine in mood disorders that other treatments had failed to relieve.

How is Ketamine Administered?

Dr. Sendi uses precision-medicine to treat each condition and evidenced based plans to maximize outcomes. Each disorder has a different protocol which can be discussed in consultation. Generally, the depression treatment will be a series of 6 infusions over 2-3 weeks, with the decision of continuation based on the improvement rated after the second infusion. For PTSD, Dr. Sendi uses a two infusion approach a week apart. Pain management may require higher dosing over several hours.

  • IV infusions of Ketamine over 45 minutes for depression and mood related disorders
  •  IV Infusions of Ketamine for Pain | CRPS , generally over several hours at a setting.
  • Nebulized Ketamine for patients with a fear of needles
  • Intranasal Ketamine for follow up home treatments after completion of initial treatment
  • Periodic infusions as needed for patients with breakthrough symptoms
  • Oral Troches (lozenges) of Ketamine with additional treatment for some depressive and anxiety states.
  • Trigger point injections offered for fibromyalgia and pain management infusions of Ketamine
  • IV High dose Vitamin therapy offered as an add-on to Ketamine treatments for the benefit of boosting energy, mood, and health. This includes high dose Vitamin C, B-complex, methyl-cobalamins, Magnesium, calcium, zinc and trace minerals that are frequently low in pain states, mood disorders, addiction, and excess weight.
  •  Ketamine with NAD therapy for addiction treatment including alcohol and opioid use disorders.
What are the success rates in treatment?

For depression treatment, Dr. Sendi sees more than a 50% improvement in 85% of the patient, most of whom have had limited success on multiple other medications and treatments. For CRPS, this is a treatment of choice.

How Fast are the results?

Ketamine is a rapidly acting anti-depressant, with patients showing improvement of mood within the first 24 hours. Suicidal thoughts can be diminished within hours after the first infusion. Results for responders is within days. We use the Beck Depression Inventory score to assess response for our patients within depression so we can get a consistent scoring of improvement to pass on to your therapist.

How Long do results Last?

Outcomes are variable for length of results, but in our experience, patient with continued psychiatric and medical care can have excellent responses for several months before needing any further treatments. We do provide intranasal ketamine prescriptions for selected patients to extend responses even longer.

What does Ketamine therapy feel like?

The experience most patients have during treatment is a mood-elevating state that is generally pleasant. Insightful thoughts and understanding of complex problems are frequently gained by many patients as they focus on internal turmoil. Some patient will bring their therapist to work out solutions to their problems. Others will focus on evocative musical scores that guide them through the experience. Guided imagery with the assistance of a therapist is an option for treatment for many patients as this helps them cope with and understand problems they may be facing. For some patients, they have described vivid dreams which they can control, while others have had a synesthetic experience in which they can hear colors and see sounds. You will be awake for the infusion, which is generally a lower dose for mood disorders. You are in control of the infusion and can stop it at any time. Every infusion is a different experience, and for some patients, there can be some dysphoria (bad feelings) during the infusion. These experiences do not impact the outcome of treatment, but rather we look for the mood alterations as studies have demonstrated better outcomes in patients who get mood elevations during the infusion.

Are There side Effects of Ketamine?

During the infusion, some patient can have bad dreams, nausea, vomiting, and dizziness. Some can get anxious during higher doses, which can be adjusted immediately. We provide anti-nausea medications and even sedatives for maximum comfort. After the infusion, you will be unable to drive for 8 hours as your motor skills will be impaired.

Is Ketamine addictive?

Ketamine has been abused, primarily in Southeast Asia, but it is very rare in the United States for this situation. If anything, we primarily see tolerance to the effects of ketamine with few withdrawal symptoms in that population. As far as medical uses of ketamine, the dosing is low and with minimal risk of addiction. In fact, there are studies demonstrating effectiveness in Ketamine for cocaine, heroin, and alcohol addiction. These protocols are available in NOVA Health Recovery for selected patients.

How do I prepare for my infusion?

We request that you have someone drive you to and from the appointment on the day of the infusion. You will be unable to drive for 8 hours after the appointment. Bring a headset and music of your choice on you iphone/android/ipad, but it is best to play evocative, calming music during the infusion. Music that reminds you of happy, special times can be helpful in guiding your experience. Don’t eat any food for two hours before the infusion, but water is fine to drink. We provide bottles of water at the office during the infusion. Be relaxed. The experience is controlled by you and doses can be adjusted to comfort.

Do you use Ketamine Psychotherapy?

If you have a therapist who can come to the office during your infusion, that would be fine to have them provide guided imagery or therapy during a session. Many patients open up to discussion and insight during infusions and the experience can result in much psychological gain.

Do you provide further therapy and medication support?

For patients without active psychiatric providers, we can connect you with available counselors, for CBT, DBT, and other therapies. I can initiate anti-depressants and other aids in the office, but generally with the continuing care of a mental health counselor. For other patients, we will work closely with your psychiatrist to keep them informed of your progress. As mentioned earlier, Dr. Sendi can offer guidance on dietary choices that impact your mental health and well-being. The choices can be based off pharmacogenomics and nutrigenomic studies and advanced lab testing (hormones, inflammatory markers, advanced lipid and cardiac panels, vitamin levels) that can direct us in nutritional and vitamin supplementation that can allow you to maintain wellness and produce the necessary serotonin and dopamine that drives your mood and memory. We do provide IV Vitamin support for chronic diseases, mental health, addiction, cancer, weight loss, auto-immunity, hair loss, and other conditions. We prefer to look into root causes of your medical condition and not just the symptoms.

What to do with your other treatments:

We will work closely with your therapists. We recommend that you have continued psychiatric visits as before and continue your other medications as before. In fact, the optimal time to make changes in your therapy may be during your period of infusion. Do this on consultation with your therapist. There are few drug interactions with ketamine, but we will need a full list of your medications, allergies, and medical history.