Questions about Ketamine Treatments?

A CRNA is a Certified Registered Nurse Anesthetist. We are professionals who have a Master’s Degree or Doctorate in Nurse Anesthesia. Nurse Anesthetists may practice independently in 38 states. Minnesota and Wisconsin are two of these states. Nurse Anesthetists complete a bachelor’s degree in nursing, work in an intensive care unit for an average of 3 years, and then complete a Master’s program between 2.5 to 3 years in length. Traditionally we provide all inpatient anesthesia services including preoperative and postoperative evaluations, plan of care, general anesthetics, sedation, and regional anesthesia. CRNAs are credentialed and nationally recognized as experts in anesthesia. CRNAs are well educated in the effects and adverse effects of medications and are highly qualified to administer them in an outpatient setting as well as possess the skills to evaluate and intervene should potential or life-threatening events occur.

We are NOT psychiatrists or psychologists and do NOT specialize in the clinical treatment of depression or other mental health illnesses. You will receive the highest level of expertise in our professional field and we will work alongside your primary care provider/Therapist to determine if you are eligible for the treatments we offer. Beth Maki, Co-owner and Operator, is the CRNA here at Bloom and she has over 20 years of experience in administering anesthetic agents and is highly skilled in providing you with a safe and comfortable, private environment.

Intravenous (IV) ketamine therapy is a treatment option for people who have been diagnosed with treatment-resistant mood disorders. The treatment is administered via a small IV catheter, in low to moderate doses, and in a comfortable, safe outpatient setting. Currently, there is an overwhelming amount of evidence-based clinical data and research that has revealed results that are dramatic in relation to the treatment of depression and other mood disorders. It is a new option to explore and it is making a lasting impression on clients and practitioners who have embraced it. It is providing an attainable goal, (remission) from these chronic conditions.

Ketamine is an FDA approved medication that was synthesized in 1962 and was approved for use as an anesthetic medication in 1970. It is a blocker of the cellular NMDA receptor, a neural receptor for glutamate that has proved to play a significant role in major depression, chronic pain syndromes, fibromyalgia, and other ailments. It is also known to have potent anti-inflammatory properties and is known to stimulate neuronal growth, synaptogenesis, and neuroplasticity. It is a Schedule III drug and should only be used and administered by a skilled licensed anesthesiologist, nurse anesthetist, or trained physician.

Ketamine is a non-competitive NMDA glutamate receptor antagonist with additional effects on dopamine and mu-opiod receptors. While it does stimulate opiate receptors, much like morphine, its NMDA receptor antagonism at subanesthetic doses is thought to be much more important in the treatment of chronic pain and psychiatric disorders. It is this low dose of intravenous ketamine that has been found to cause a glutamate surge, which appears to play a critical role in the rapid and robust effects of ketamine.

Ketamine is largely different from that of typical FDA-approved antidepressants and pain medications because it works more broadly by reducing NMDA receptor function therefore modulating or preventing the brain’s glutamate transmission. This leads to a rapid increase in glutamatergic activity causing regeneration of synaptic connections between brain cells that have been chronically damaged by stress, anxiety, depression, and pain. It is a sort of “rebooting” for the communication system between areas of the brain and body that have previously been damaged by these chronic conditions.

Recently performed and published studies have shown that a low dose of ketamine infused over 40 minutes has had a dramatic positive effect on clinical depression, especially towards suicidal feelings and in cases that don’t respond to standard treatment. The results indicate an immediate resolution of depression and the relief from a single infusion can last for as little as a few hours to as much as a few weeks.

There is current anecdotal evidence that moderate doses of ketamine can increase remission rates- each infusion is customized to your specific needs.

Ketamine is a very safe drug when administered for anesthesia or as a treatment for depression as we do at Bloom Neurotherapy. The effects wear off within an hour or so afterward. We carefully assess your medical history and medication list before the treatment and will consult your primary care physician or mental health professional as needed.

The side effects of the low dose ketamine infusions in our protocols are minimal and will only last about an hour or two, but may include mild drowsiness, nausea, and increased blood pressure. We routinely administer medication for the prevention of nausea. Less common side effects include vivid dreams or agitation and these can be controlled by adjusting the dosage. Most clients don’t mind the relaxed and free feeling they experience during the infusion.

In past years, Ketamine has received the stigma of being a “party drug” or “street drug” and some may be concerned about the potential for abuse or addiction. Academic research and clinical experience have shown that the low to moderate dosing and adherence to protocols dismiss the risk of addiction. Again, access to ketamine is limited and difficult to attain outside of the controlled atmosphere that we provide so there is virtually no concern for abuse. We do not write prescriptions for ketamine use outside the clinic.

Remission is defined as a complete disappearance or elimination of symptoms. The goal in ketamine treatment is to achieve a period of time when you are free of symptoms of Depression, Anxiety, PTSD, and Suicidality. Every person is different as to the extent and/or length of remission. The average length of remission from symptoms with ketamine is 5 weeks. Boosters (1 infusion) are given at the point when you feel your symptoms have returned or become unmanageable. Bloom uses mood monitoring to help assist in deciding when to come back in. Some patients feel that the initial infusions are enough to stabilize mood and help them maintain other health practices to keep them healthy, others come in on a regular schedule for boosters.

Medical conditions that are not well managed would disqualify you from any infusion treatment. Uncontrolled high blood pressure, any serious cardiac or respiratory condition, untreated thyroid disease, a current manic phase of bipolar need to be discussed with your clinician to avoid any potential complications. Adequate pain control in issues of chronic pain needs to be addressed before receiving ketamine for mental health. Ketamine is a very effective treatment for pain at higher doses, however, we do not treat pain at Bloom. We are happy to refer you to a ketamine clinic that does. Active psychosis (hallucinations/delusions) or a diagnosis of schizophrenia is a disqualifier for ketamine therapy.

We will review your medical history, contact your primary provider, and perform a brief physical assessment to ensure this line of treatment has little to no risk to your physical or mental health.

We will review your medications with you. Some medications have been shown to interfere or dampen the effectiveness of the infusion. These medications include benzodiazepines (such as Xanax, Ativan, Versed, Valium, and Clonazepam), risperidone (Risperdal), olanzapine (Zyprexa), and Lamotrigine (Lamictal). We will work with your primary provider in those cases. We do not do medication management at Bloom.

Infusion therapy is typically well-tolerated, however, as with any medical procedure or administration of medication, there is always a potential risk of complications or adverse events. The symptoms or side effects will diminish once the infusion is completed, discontinued, or slowed down. We are prepared for all potential side effects and have the necessary skills and equipment to manage the potential complications of all treatments we offer here at Bloom.

Resolution of symptoms after a series of infusions may last anywhere from 2 weeks to 3 months and sometimes up to a year. Remission is variable and individualized. Completion of a full course of treatment is encouraged to maximize the effects of the treatment. After completion of an initial series of treatment subsequent “booster” infusions may be required to substantiate the longevity of remission. The highest chance of success is to ensure proper diagnosis and to utilize this treatment as an adjunct to your ongoing program by your primary care or mental health provider.

Prior to beginning an infusion series, you will complete some brief questionnaires that will provide us with a baseline to compare progress. Upon completion of each infusion, we will follow up with you to determine your response. At that time, we can assess whether we need to adjust your treatment program accordingly to maximize benefits and minimize side effects. It is not uncommon to notice positive effects as soon as 30 minutes post-infusion but typically improvements begin several hours post-infusion.  Using a daily mood monitor, such as the one provided as part of your treatment, will provide insight into when you might want to return for a booster.

Each day of treatment will be similar in expectations and we ask that you adhere to our guidelines to keep you and others safe. Prior to your infusions, we will require a government-issued photo ID, completion of a questionnaire regarding your illness as well as consent forms acknowledging that you understand the rules, risks and that there is no guarantee and that this treatment is not a cure but an adjunct to your current therapy regimen. As you get deeper into the infusion process it may be difficult to carry on a conversation with those around you, so we encourage you to focus on getting comfortable, relax and pay attention to what you are feeling.

Please do not eat  4 hours prior to your appointment. You are encouraged to drink water prior to your appointment. Once your infusion is over, there are no dietary restrictions.

Although the effects of these infusions wear off quickly once the infusion has stopped, we ask that you refrain from driving for 24 hours after your infusion. Please plan on arriving with or arranging a responsible friend or relative who can drive you home safely after your infusion. Choosing to drive any earlier than 24 hours after your infusion is considered to be driving under the influence and can be punishable by law.

Although IV ketamine is now nationally recognized as a substantial and legitimate treatment for mental health it remains “off-label.” Therefore, insurance has not covered the treatment series in the past. Just in this past year, we are starting to see insurance companies recognize the value of ketamine, sometimes covering a portion of expenses. For this reason, we have started offering “SuperBills”, which is a bill you submit to your insurance company for reimbursement of your expenses. The percentage of coverage varies by state and insurance company. We can also work with you to use your Health Savings Plans and Flex Benefits.

We prefer a formal referral from your primary care or mental health provider. We strongly believe that to achieve the greatest success it is best for Bloom and your treating provider to communicate throughout the infusion series to ensure this treatment is working toward substantial remission. If you do not feel comfortable or do not know how to start the conversation about ketamine with your provider, we are happy to help with that. We will also need to obtain your medical history and recent treatment history from your treating provider.

Infusions are $2700 (pre-paid) for the entire series of six infusions. Boosters are $450 each. This is the standard price in the US for ketamine. Personal checks are not accepted, however, cash, credit/debit cards, and cashiers checks are acceptable forms of payment. If you are a veteran, please let us know for special pricing ($2200/six infusions, paid in full, $350 for boosters). We now offer financing available with interest free for a year. For more information on cost and financial responsibility please call. We do not want to turn anyone away for purely financial reasons, and will try to work with you!

The ketamine fund donates 400 free treatments to veterans in 2019
https://apnews.com/press-release/pr-prnewswire/9e1d2d1d2a2dc037c7b3d81b0ee17a8b

Financing available through Advance Care.