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Not All Ketamine Infusions Are The Same
Standard Ketamine Infusion or the RESTORE Ultra-Rapid Infusion
It may come as a surprise to find out that not all ketamine infusions are the same. Although people might say that ketamine is just ketamine, and that is generally true, there is a little more to it than that. Like anything else, depending upon how it is used, the effects can be altered very substantially
As a former Assistant Professor in the Department of Anesthesiology of Yale School of Medicine where the ketamine infusion for depression was first developed in 1994, I have had years of experience with ketamine therapy and developed RESTORE infusions to improve upon the basic ketamine infusion. Using RESTORE, we have successfully treated some of the most difficult cases that have not been helped with any other conventional or alternative medical therapy.
The RESTORE Infusions are very different from the usual ketamine infusion. It is the only ketamine-based infusion, for example, that can provide long-term remission of symptoms in just 3 days with 3 personalized/precision medicine treatments. Up to 85% of our patients with “treatment resistant” conditions including depression and anxiety see dramatic and long-lasting improvement, in many cases remission.
When patients fail to improve after multiple regular ketamine infusions from other providers, they are often referred to us. Even in these extreme cases, the RESTORE Infusion is very effective because it is a very precise and targeted therapy combined with an innovative treatment protocol that greatly improves its efficacy
How it works:
In basic terms, ketamine blocks a brain receptor known as the NMDA receptor (although it works at many other receptors simultaneously). By blocking specific NMDA receptors, the infusion stimulates a rapid release of the neurotransmitter known as glutamate. Glutamate is an “excitatory” neurotransmitter and this initial but relatively brief “glutamate burst” quickly helps to lessen symptoms of depression and anxiety for the first few days. But then what happens?
Why typical ketamine infusions only provide short term relief –
The good news is that if you are suffering with depression and anxiety, you may have a rapid response. Then, to make the ketamine effect last a little longer than just a few days, up to five or more additional infusions are necessary. Now the bad news; even with 6 or more repeated ketamine infusions the beneficial effects are only temporary, usually lasting 3-4 weeks before you need another infusion. So, while the standard ketamine infusion can be very effective initially, clearly it does not lead to long term relief or remission of symptoms. Still, if nothing has helped you in the past and this does then that is still a great benefit. However, we view this as a “band-aid” type of approach, requiring ongoing monthly infusions to keep feeling better but not providing any long-term benefits. Why doesn’t it last longer?
Why doesn’t it last longer?
There are several reasons why the effects of a ketamine infusion do not last very long. It is important to remember that the original ketamine infusion developed at Yale in 1994, which is now commonly used to treat some mood disorders, was never initially intend to treat depression or anxiety.
"All medications we use today come in different dosages – different conditions and different individuals respond best to certain amounts of medication but not others."
However, because of ketamine’s early reported success and the lack of experience of many physicians in using ketamine the original protocol, in which each patient is given 0.5 milligrams of ketamine for each kilogram of overall body weight, was quickly adopted by many without any thought as to the “optimal” or best dosage for that person or condition. After all, early reports suggested it worked better than any conventional medication that way and so it was adopted as “good enough”. But is it?
Making Ketamine Even Better!
After years of working with hundreds of patients with difficult to treat conditions, we have identified a number of factors which either contribute to the effects of an infusion or work against them. Often these issues are either not discovered or overlooked by many of those providing ketamine-based therapy. For example, many physicians are unaware of the very important effects and interactions of body mass, common medications and genetic metabolism on the primary and secondary metabolism of ketamine.
Body Composition and Ketamine:
Ketamine is a very “lipophilic” drug which means that it has a natural tendency to quickly and easily accumulate in fatty tissue as opposed to staying in blood stream where it can be delivered to the central nervous system. When ketamine is administered based upon someone’s total body weight and we do not consider body composition (amount of body fat) then under dosing or overdosing is more common than most believe. It goes without saying that this practice can lead to very different responses between individuals. Just look at the picture below – each of these women would receive the same amount of medication if we just considered total body weight:
Another important issue is the interaction between common medications and ketamine. Many are unaware that medications such as Vyvanse, Adderall, Chantix or Lamictal can have a significant impact on how ketamine works. Lamictal, for example, has been reported to completely block the effect of ketamine and we do not advise patients on that medication to have infusions for that reason.
Metabolic and Genetic Issues:
Also, very important to understand the effect of your metabolic profile and genetic makeup on the actions of ketamine. We have found that individuals who have low testosterone or carnitine levels, may not respond optimally and the infusion may not be as effective. That is one reason why we request blood work prior to considering someone for an infusion. If these issues are identified and corrected before the infusion, the beneficial results are greatly improved.
The newest approach to effective treatment is called Precision Medicine. We can use specialized genetic testing when necessary and have found that people with a “BDNF variant” or an “MTHFR variant” can have vastly different responses to ketamine. More than that, this type of testing can show individual differences in each individuals capacity to breakdown medications through what is know as the CYP450 system. Knowing this allows us to provide the best possible dosing strategy to obtain the greatest chance for improvement.
Lastly, and in many ways the most important reason why the benefits of a ketamine infusion are temporary is due to the old protocol used to administer it and dose that is given. These factors together often do not allow for or actually prevent a second, very important step to occur. In order for new brain connections to sprout, grow, connect and finally stabilize, it is necessary that you have a factor to the sustained increase of another vital brain messenger known as “BDNF” or brain derived neurotrophic factor.
Realizing this, we have utilized it in many ways and through years of clinical use and research, developed different options to increase its remarkable benefits for your treatment that are unique. The Ketamine Research Institute is the only center in the United States that offers the Yale-National Institute of Mental Health ketamine infusion, also known as the “standard” ketamine infusion, as well as the advanced and more effective RESTORE Essential and the RESTORE Ultra-Rapid Infusions.
Let’s look more closely at some of the differences between the infusion options….
That is the RESTORE Essential and the RESTORE Ultra-Rapid Infusion difference.
“The most important breakthrough in antidepressant treatment in decades”....
Thomas Insel, MD - Former Director, National Institute of Mental Health