In my experience, the easiest way to learn about Ketamine and its use for depression is by reading the book: “Ketamine for Depression” by Dr. Stephen J. Hyde. If you are interested in this alternative form of treatment, I recommend you start there.
Ketamine For Depression: Our Protocol
I first came across Ketamine as a treatment for Depression at a conference in Las Vegas in January 2016. It was during a lunch break. A distinct looking man, in his late 60’s, sat down next to me and started an informal conversation. After a few minutes of a polite chitchat about the weather, he started telling me about his own experience with depression.
“I tried everything, I mean everything, and nothing was working. I couldn’t even take certain medications for more than few days because of the terrible side effects, and I was really about to end it all–I started seriously thinking about suicide. Then, I came across that book, and here I am… back to myself again and working again. Ketamine saved my life”.
The story impressed me mostly because I had heard it from a physician: someone who didn’t have any financial interest or questionable incentive to promote Ketamine. The book itself was easy to read. It was full of positive examples, showing the effectiveness and safety of Ketamine for depression– particularly in instances where other antidepressants simply wouldn’t work. I must admit, however, that many stories featured in the book sounded “too positive” to me. I needed to find a book with a more “balanced view” on Ketamine before I considered using it in my practice. After a little research, I chose a book that based on its title seemed like”the one”. It was a book written by another physician - Karl Jansen, and it was titled “Ketamine: Dreams and Realities” (2004). I expected to find “all the bad things” about the drug in this book, but instead, I found that among its other effects–Dr. Jensen was mostly discussing Ketamine as an antidepressant and its safe effects.
For these reasons and others, I have chosen to integrate a ketamine protocol into my clinic.
This protocol is as follows:
1. If you are new patient specifically seeking Ketamine treatment, you will need to be registered and interviewed as a new patient to make sure you meet the criteria for this treatment.
2. If selected, the prescription for Ketamine will be given to you, which is then refilled in a “Compounding Pharmacy”. Your prescription will be for 30 ml of Ketamine: this is a 100 mg/ml solution for sublingual use. The pharmacy will charge you $40.00 for this prescription, and the bottle will be delivered directly to our office.
3. Your treatment will start in the office under the direct supervision of our psychiatrist to ensure that you have no side effects or allergic reactions to the medication. Depending on your body weight, anything from 0.3 to 0.6 ml of Ketamine may be administered sublingually during each session.
4. In most of the cases, only the first 2-3 sessions are undergone in the office, and when no adverse reactions to Ketamine are observed– the medication is released to the patient for home self-administration.
We also prescribe and administer intranasal form of Ketamine - FDA approved Spravato (esketamine is the s-enantiomer of ketamine) nasal spray, in conjunction with antidepressants for the treatment of depression in adults with treatment-resistant depression. It's expensive, but the majority of the insurances cover for it.