The Science - Integration Healthcare

[vc_section full_width=”stretch_row” content_placement=”top” parallax=”content-moving” css=”.vc_custom_1599848875987{margin-top: 0px !important;margin-bottom: 0px !important;padding-top: 0px !important;padding-bottom: 0px !important;background-image: url(https://smithfamilymd.com/wp-content/uploads/2020/09/new-cloud-header.png?id=152) !important;}”][vc_row][vc_column][la_divider height=”xlg:420px;lg:400px;md:350px;sm:350px;xs:300px;mb:300px;”][/vc_column][/vc_row][/vc_section][vc_section css=”.vc_custom_1580500545466{margin-top: -180px !important;margin-bottom: 0px !important;padding-bottom: 0px !important;}”][vc_row full_width=”stretch_row” content_placement=”middle” css=”.vc_custom_1580500131181{padding-bottom: 0px !important;}”][vc_column width=”3/5″ la_animation_name=”slideInLeft” la_animation_duration=”1″ la_animation_delay=”0″ la_animation_iteration_count=”1″ css=”.vc_custom_1583507246138{margin-bottom: -55px !important;padding-bottom: 0px !important;}” offset=”vc_col-lg-2/5 vc_col-md-6 vc_col-xs-8″][la_heading tag=”h1″ alignment=”right” use_gfont_title=”yes” title=”The Science Behind Ketamine Treatment” title_class=”spaced-3″ title_font=”font_family:Vollkorn%3Aregular%2Citalic%2C700%2C700italic|font_style:400%20regular%3A400%3Anormal” title_color=”#ffffff” css=”.vc_custom_1597929935140{margin-top: -15px !important;margin-left: -1000px !important;padding-top: 25px !important;padding-right: 40px !important;padding-bottom: 17px !important;padding-left: 1000px !important;background-color: #196b99 !important;}” el_class=”rounded” title_fz=”xlg:45px;lg:35px;md:30px;sm:30px;xs:30px;mb:30px;”][/la_heading][/vc_column][vc_column width=”2/5″ la_animation_name=”slideInRight” la_animation_duration=”1″ la_animation_delay=”0″ la_animation_iteration_count=”1″ offset=”vc_col-lg-3/5 vc_col-md-6 vc_col-xs-4″][la_parallax_row direction=”left” background_repeat=”no-repeat” background_position=”bottom” image=”53″][/vc_column][/vc_row][/vc_section][vc_section css=”.vc_custom_1583510158652{margin-top: 20px !important;padding-right: 50px !important;padding-bottom: 50px !important;padding-left: 50px !important;}”][vc_row gap=”35″ content_placement=”top”][vc_column width=”1/2″ la_animation_duration=”1″ la_animation_delay=”0″ la_animation_iteration_count=”1″ css=”.vc_custom_1597930076515{padding-right: 10px !important;padding-left: 10px !important;}”][vc_column_text css=”.vc_custom_1597929736589{margin-top: 0px !important;margin-bottom: 0px !important;border-right-width: 0px !important;border-left-width: 0px !important;padding-top: 0px !important;padding-bottom: 20px !important;padding-left: 0px !important;}”]

Medical Applications of Ketamine

[/vc_column_text][vc_separator color=”custom” align=”align_left” border_width=”2″ el_width=”50″ accent_color=”#e6e7e8″ css=”.vc_custom_1583513596001{margin-bottom: 20px !important;}”][vc_column_text css=”.vc_custom_1599847794220{margin-top: 0px !important;margin-bottom: 30px !important;border-right-width: 0px !important;border-left-width: 0px !important;padding-top: 0px !important;padding-right: 0px !important;padding-bottom: 20px !important;padding-left: 0px !important;}”]Ketamine (ketamine hydrochloride) has been approved for use in general anesthesia either alone or in combination with other medications. It is a superb drug for use in short-term medical procedures that do not require skeletal muscle relaxation, and it has approval for the induction of general anesthesia as a pre-anesthetic to other general anesthetic agents.

It also has indications for supplementing low-potency agents such as nitrous oxide. Ketamine is used for short-term procedural sedation, rapid sequence intubation, and is very useful in the emergency department setting for these conditions. It is the medication of choice for patients with bronchospasm because of its bronchodilatory properties. It can be utilized for procedures requiring short-term sedation/anesthesia, such as the reduction of fractures and dislocations, as well as in wound repair in uncooperative patients, especially children. It can be safely used in a wide age range, beginning at three months. Because children metabolize ketamine faster than adults, higher dosing is required than in the adult population. Elderly patients, on the other hand, need lower dosing since they are slow metabolizers of this agent.[/vc_column_text][vc_btn title=”Learn More About Ketamine Treatments” shape=”square” color=”turquoise” align=”left” link=”url:https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fbooks%2FNBK470357%2F||target:%20_blank|”][/vc_column][vc_column width=”1/2″ la_animation_duration=”1″ la_animation_delay=”0″ la_animation_iteration_count=”1″ css=”.vc_custom_1597930080871{margin-top: 25px !important;padding-top: 0px !important;padding-right: 20px !important;padding-bottom: 30px !important;padding-left: 20px !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}”][vc_column_text css=”.vc_custom_1597929752946{margin-top: 0px !important;margin-bottom: 0px !important;border-right-width: 0px !important;border-left-width: 0px !important;padding-top: 0px !important;padding-bottom: 20px !important;padding-left: 0px !important;}”]

Ketamine Works Quickly

Ketamine, has shown considerable promise as a fast-acting antidepressant in patients with Treatment Resistant Depression, alleviating depressive symptoms and reversing suicidal ideation within hours following a single, low-dose (0.5 mg/kg) intravenous (i.v.) infusion, and having effects lasting up to one week, on average (Ballard et al., 2014; Berman et al., 2000; Phelps et al., 2009; Zarate et al., 2006).

[/vc_column_text][vc_column_text css=”.vc_custom_1597929789532{margin-top: 0px !important;margin-bottom: 0px !important;border-right-width: 0px !important;border-left-width: 0px !important;padding-top: 0px !important;padding-bottom: 20px !important;padding-left: 0px !important;}”]

Ketamine is Safe

Ketamine generally maintains normal pharyngeal and laryngeal reflexes and, therefore, permits spontaneous respiration. It slightly enhances or maintains normal skeletal muscle tone and is associated with cardiovascular and respiratory stimulation. Blood pressure elevation of 10-15mm Hg is a possible side effect.

[/vc_column_text][vc_column_text css=”.vc_custom_1597929815318{margin-top: 0px !important;margin-bottom: 0px !important;border-right-width: 0px !important;border-left-width: 0px !important;padding-top: 0px !important;padding-bottom: 20px !important;padding-left: 0px !important;}”]

Ketamine is Affordable

50mg of ketamine for IM injection costs $1.10

The major cost associated with initiating treatment is due to the necessity of administering it in a medical setting with cardiac monitoring for 60-90minutes.

Ketamine lozenges for home treatment are $50/month.

[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_separator color=”custom” border_width=”4″ accent_color=”#fcf995″ css=”.vc_custom_1597930016325{margin-bottom: 20px !important;}”][/vc_column][/vc_row][/vc_section][vc_section css=”.vc_custom_1583510158652{margin-top: 20px !important;padding-right: 50px !important;padding-bottom: 50px !important;padding-left: 50px !important;}”][vc_row gap=”35″ content_placement=”top”][vc_column la_animation_duration=”1″ la_animation_delay=”0″ la_animation_iteration_count=”1″ css=”.vc_custom_1597930076515{padding-right: 10px !important;padding-left: 10px !important;}”][vc_column_text css=”.vc_custom_1599848595171{margin-top: 0px !important;margin-bottom: 30px !important;border-right-width: 0px !important;border-left-width: 0px !important;padding-top: 0px !important;padding-right: 0px !important;padding-bottom: 20px !important;padding-left: 0px !important;}”][/vc_column_text][/vc_column][/vc_row][vc_row gap=”35″ content_placement=”top”][vc_column la_animation_duration=”1″ la_animation_delay=”0″ la_animation_iteration_count=”1″ css=”.vc_custom_1597930076515{padding-right: 10px !important;padding-left: 10px !important;}”][vc_column_text css=”.vc_custom_1597930234007{margin-top: 0px !important;margin-bottom: 30px !important;border-right-width: 0px !important;border-left-width: 0px !important;padding-top: 0px !important;padding-right: 0px !important;padding-bottom: 20px !important;padding-left: 0px !important;}”][/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_separator color=”custom” border_width=”4″ accent_color=”#fcf995″ css=”.vc_custom_1597930016325{margin-bottom: 20px !important;}”][/vc_column][/vc_row][/vc_section][vc_section css=”.vc_custom_1583510158652{margin-top: 20px !important;padding-right: 50px !important;padding-bottom: 50px !important;padding-left: 50px !important;}”][vc_row gap=”35″ content_placement=”top”][vc_column width=”1/2″ la_animation_duration=”1″ la_animation_delay=”0″ la_animation_iteration_count=”1″ css=”.vc_custom_1597930076515{padding-right: 10px !important;padding-left: 10px !important;}”][vc_column_text css=”.vc_custom_1597930306077{margin-top: 0px !important;margin-bottom: 0px !important;border-right-width: 0px !important;border-left-width: 0px !important;padding-top: 0px !important;padding-bottom: 20px !important;padding-left: 0px !important;}”]

Unique Mechanism of Action

At higher doses, Ketamine hydrochloride is a nonbarbiturate dissociative anesthetic. This dissociation is a complete and temporary disconnection between a person’s thoughts, memories, feelings, actions and sense of who he or she is.

When used for pain management, sub-dissociative dosing, otherwise known as low dose ketamine (LDK) is used, either alone or as an adjunct to other medications for pain relief. It is safe and effective to use in combination with injectable nonsteroidal pain medications as well as opioids. It has gained greater acceptance as concern has grown regarding opioid use.

Ketamine’s effects in chronic pain, and as an antidepressant, far outlast the actual drug levels, and are probably mediated by a secondary increase in structural synaptic connectivity that is mediated by a neuronal response to the ketamine-induced hyper-glutamatergic state.” (Sleigh 2014).

Another reason ketamine has researchers excited is that it works differently than existing antidepressants. Rather than affecting one of the “monoamine” neurotransmitters (serotonin, norepinephrine and dopamine), as standard antidepressants do, it acts on glutamate, the most common chemical messenger in the brain. Glutamate plays an important role in the changes synapses undergo in response to experiences that underlie learning and memory. That is why researchers suspected such “neuroplasticity” would lie at the heart of ketamine’s antidepressant effects. Scientific American April 12, 2019

[/vc_column_text][/vc_column][vc_column width=”1/2″ la_animation_duration=”1″ la_animation_delay=”0″ la_animation_iteration_count=”1″ css=”.vc_custom_1597930080871{margin-top: 25px !important;padding-top: 0px !important;padding-right: 20px !important;padding-bottom: 30px !important;padding-left: 20px !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}”][vc_column_text css=”.vc_custom_1597930443056{margin-top: 0px !important;margin-bottom: 0px !important;border-right-width: 0px !important;border-left-width: 0px !important;padding-top: 0px !important;padding-bottom: 20px !important;padding-left: 0px !important;}”]

Additional Treatment Information

Some patients have dissociation with treatment accompanied by insightful thoughts that have life altering positive effects. This is a side effect of ketamine. It is not the therapeutic mechanism of action or a goal of treatment.

Treatment resistant depression
Medication assisted counselling (CBT) for anxiety
Addiction cravings, only med that helps with alcohol, benzos, cocaine, and marijuana
Ketamine treats suicidality quickly
- Ketamine, has shown considerable promise reversing suicidal ideation within hours following a single, low-dose (0.5 mg/kg) intravenous (i.v.) infusion, and having effects lasting up to one week, on average (Ballard et al., 2014; Berman et al., 2000; Phelps et al., 2009; Zarate et al., 2006).

2 IM treatments weekly for 3 weeks to assess efficacy

Ketamine administration every 2–3 days over a two-week period, maintains the antidepressant response, increases the percentage of patients responding to ketamine, and lengthens the duration of antidepressant response after cessation of treatment (aan het Rot et al., 2010; Murrough et al., 2013; Shiroma et al., 2014a).

When administered IM, the onset of action is approximately 4 minutes with a duration of action from 15 to 30 minutes. Ketamine Steven B. Rosenbaum; Vikas Gupta; Jorge L. Palacios.https://www.ncbi.nlm.nih.gov/

Sublingual Lozenges every 3-7 days for maintenance

Concurrent treatment with SSRI

Ongoing care with a Primary Care MD on site.

[/vc_column_text][/vc_column][/vc_row][vc_row gap=”35″ content_placement=”top”][vc_column width=”1/2″ la_animation_duration=”1″ la_animation_delay=”0″ la_animation_iteration_count=”1″ css=”.vc_custom_1597930076515{padding-right: 10px !important;padding-left: 10px !important;}”][vc_column_text css=”.vc_custom_1597930503990{margin-top: 0px !important;margin-bottom: 0px !important;border-right-width: 0px !important;border-left-width: 0px !important;padding-top: 0px !important;padding-bottom: 20px !important;padding-left: 0px !important;}”]

Monitoring

Monitor vital signs and cardiac function. Blood pressure, pulse, breathing, and oxygen saturation always need to be monitored when using ketamine.

Neuropsychiatric function always requires monitoring, and a patient must be at baseline before discharge from care. Even after a patient’s return to baseline, the patient discharge should be under the supervision of another responsible adult. Patients should not drive, use heavy machinery, or perform other potentially hazardous activities for 24 hours following ketamine administration.Ketamine Steven B. Rosenbaum; Vikas Gupta; Jorge L. Palacios. https://www.ncbi.nlm.nih.gov/

[/vc_column_text][vc_column_text css=”.vc_custom_1597930620237{margin-top: 0px !important;margin-bottom: 0px !important;border-right-width: 0px !important;border-left-width: 0px !important;padding-top: 0px !important;padding-bottom: 20px !important;padding-left: 0px !important;}”]

A Review of Nonanesthetic Uses of Ketamine

Abby Pribish, corresponding author 1 Nicole Wood, 2 and Arun Kalava 3

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152956/

[/vc_column_text][/vc_column][vc_column width=”1/2″ la_animation_duration=”1″ la_animation_delay=”0″ la_animation_iteration_count=”1″ css=”.vc_custom_1597930080871{margin-top: 25px !important;padding-top: 0px !important;padding-right: 20px !important;padding-bottom: 30px !important;padding-left: 20px !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}”][vc_column_text css=”.vc_custom_1597930548821{margin-top: 0px !important;margin-bottom: 0px !important;border-right-width: 0px !important;border-left-width: 0px !important;padding-top: 0px !important;padding-bottom: 20px !important;padding-left: 0px !important;}”]

Contraindications

Ketamine is contraindicated in those patients who have underlying conditions in which increased blood pressure would pose a risk of complications such as aortic dissection, uncontrolled hypertension, myocardial infarction, or aneurysms.

It is contraindicated in those who have shown prior hypersensitivity to the drug.
It is not recommended for use during obstetrics, pregnancy, or for women who are breastfeeding as it is unknown if this medication passes into breast milk.
Use in chronic alcoholics and the acutely alcohol-intoxicated patient may cause death.
It is contraindicated in patients with schizophrenia due to the potential for exacerbating the underlying condition.
Ketamine Steven B. Rosenbaum; Vikas Gupta; Jorge L. Palacios. https://www.ncbi.nlm.nih.gov/

Questions? Reach Out!

[/vc_column_text][elfsight_contact_form id=”1″][/vc_column][/vc_row][/vc_section][vc_section css=”.vc_custom_1583512713807{margin-top: -100px !important;margin-bottom: 0px !important;padding-bottom: 0px !important;}”][vc_row css=”.vc_custom_1583512622183{margin-bottom: 0px !important;padding-bottom: 0px !important;}”][vc_column la_animation_duration=”1″ la_animation_delay=”0″ la_animation_iteration_count=”1″ css=”.vc_custom_1583512626488{margin-bottom: 0px !important;padding-bottom: 0px !important;}”][vc_column_text css=”.vc_custom_1583512630472{margin-bottom: 0px !important;padding-bottom: 0px !important;}”]

Office Hours

MON || 8:00am – 4:00pm
TUE || 8:00am – 4:00pm
WED || 1:00pm – 4:00pm
THU || 8:00am – 4:00pm
FRI || 8:00am – 4:00pm
SAT || Closed
SUN || Closed

Quick Links

About Us
The Care We Provide
Our Office
Contact Us
Request Appointment

[/vc_column_text][/vc_column][/vc_row][/vc_section]