970.778.3753

Ketamine for Depression and Pain   

PROTOCOL

After receiving the diagnosis of treatment-resistant, major depressive disorder from a qualified practitioner, the patient will be scheduled for ketamine infusion therapy under the direct supervision of a physician anesthesiologist.
 
Depression therapy is twice weekly for 3 weeks.

• Patients will receive a History and Physical examination  within 30 days of their infusion therapy with the goal of that one examination to encompass the entirety of their treatment.
• Patients will be examined and assessed for appropriate  physical and cognitive condition immediately prior to  therapy per the standard ASA (American Society of  Anesthesiologists) guidelines.

Prior to each infusion:

• Patients will complete a survey assessing side effects of  the treatment to determine tolerance.
• Patients will complete a depression self-assessment questionnaire based upon PHQ-9 criteria for their clinical response to ketamine therapy.  This will be used to determine efficacy.   
• In the unusual circumstance of a patient not responding to ketamine infusion therapy by the 3rd infusion, we will recommend discontinuing treatment.

Infusion Therapy

• Patients will undergo therapy in a private room.  We encourage bringing a comfortable blanket, music, support person, etc to use during the infusion.
• We advise patients to eat a very light meal or drink a carbohydrate beverage (Gatorade, apple juice) within 2 hours of treatment.
• Dose: 0.5mg/kg of intravenous ketamine administered over 45 minutes.  This dose is often adjusted based on the patient's response to therapy.
• Patients will be monitored using ASA guidelines for pulse oximetry, heart rate and non- invasive blood pressure. 
• Medications to treat possible but transient elevations in  blood pressure and heart rate will be immediately available.
• Patients will be monitored for recovery for approximately 20-30 minutes following the infusion.  
• Patients will be discharged with an appropriate caregiver who will provide transportation for them.

REFERRALS

To refer patients, please call our office at 970.778.3753 or fax us at 970.778.3754 with your patient’s contact information. Our office will then call the patient to schedule their appointment.

REFERENCES

Sanacora, Gerard et al.;  A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders; JAMA Psychiatry; March, 2017; pp E1-E6