Answers to Four Big Questions about Ketamine Therapy
About the Author Dr. Steven P. Levine is a board-certified psychiatrist internationally recognized for his contributions to advancements in mental health care. Though he is a psychiatrist who places great emphasis on the importance of psychotherapy, medication is often a necessary component of treatment, and he was dissatisfied with the relatively ineffective available options with burdensome side effects. Dr. Levine pioneered a protocol for the clinical use of ketamine infusions, has directly supervised many thousands of infusions and has helped establish similar programs across the country and around the world.
Ketamine therapy is gaining awareness as more physicians realize the astonishing number of patients in their practices suffering from treatment-resistant depression, anxiety and pain conditions. Physician attendees of the American Psychiatric Association’s National Convention in NY, NY, May 2018, participated in a survey that revealed 25% of their practice populations (patients) are comprised of treatment-resistant mood disorders. This data suggests there is a large portion of the population not currently receiving effective approaches to managing depression – don’t let this discourage you just yet. When talk therapy or lifestyle modification didn’t prove effective, you may have attempted other treatments such as anti-depressants, especially SSRIs. SSRI’s have about a 33 – 50% response rate.1 SSRI response data is taken from STAR*D study that can be read by clicking here. Per STAR*D, even those who have followed a best-practice treatment algorithm that includes SNRIs, tricyclic antidepressants, augmentation strategies, Cognitive Behavioral Therapy (CBT) and more, up to 1/3 of patients fail to achieve remission. Hence, the need for next-generation strategies such as ketamine, proven to be effective for treatment-resistant depression.
1. How Does Ketamine Therapy Enhance My Mental Health Care?
Actify augments talk therapy provided by patients’ current psychiatrist or therapist and helps in managing the most challenging and difficult-to-treat patients. We provide a high level of service to patients in a professional setting with a trained psychiatrist. The patient has an initial consult in which the referring provider is consulted for a review of the patient’s diagnosis and medical history. Depression and anxiety scale scores are measured prior to each treatment and immediately post-treatment to measure, record, and monitor progress and response. Pre-treatment screening and ongoing comprehensive evaluation by an Actify board-certified psychiatrist is important for a patient to receive optimal and safe care.
2. Who Is an Ideal Candidate for Ketamine Therapy?
Patients must be diagnosed by their primary care physician or referring psychiatrist with one of the mood disorders listed below and have not responded to first-line treatment strategies.
- major depressive disorder (MDD)
- bipolar depression,
- post-traumatic stress disorder (PTSD) or
- obsessive-compulsive disorder (OCD)
The patient cannot be presently abusing any substances, must have stable cardiovascular status, and must be in the depressive phase if diagnosed with bipolar disorder (no current mania). Finally, patients must not have a diagnosis of schizophrenia. Patients may remain on most medications while undergoing ketamine infusions as the drug has few relevant drug-to-drug interactions.
3.What is Actify’s Ketamine Therapy Protocol?
A typical treatment course consists of an acute phase of treatment, followed by maintenance, and on average, maintenance infusions are needed once per month. Administration of ketamine IV is completed by professional staff who are trained in infusion and life-saving emergency procedures. Patients are seen and treated in a controlled and supervised setting by a registered nurse, advanced practice nurse, and a psychiatrist. Private rooms that promote a calming and soothing environment are available for each patient. Patients are not allowed to undergo infusion if any of the criteria for ideal candidacy have not been met at the time of infusion.
4. How Effective is Ketamine Therapy?
Actify’s patients see a 70% positive response rate when ketamine therapy is administered according to the Actify treatment protocol, outcomes that can be further enhanced with complementary approaches such as cognitive behavioral therapy (CBT). Actify’s 70% response rate is based on our published research and feedback from patients. This is consistent with 50-80% response rates seen in clinical trials conducted by the National Institute of Mental Health, Yale University, Baylor University, Mt. Sinai University, The Mayo Clinic, and others. Additionally, Actify conducted a retrospective chart analysis of 740 patients over a two year time period and found similar results in clinical practice data.
Actify was among the first and is the national leader in providing treatment for treatment-resistant mood disorders with ketamine infusions. We have treated over 3,000 patients, have administered over 30,000 infusions and have seen a 70% positive response rate for MDD. With 9 locations nation-wide, Actify is available to assist patients in providing effective treatment for difficult to treat mood disorders with evidence-based, compassion-driven approaches. Watch an “A Tale of Overcoming Depression” to learn firsthand how ketamine has helped our patients improve their lives.
- Rush AJ, Trivedi MH, Wisniewski, SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006;163(11):1905-1917. doi:10.1176/ajp.2006.163.11.1905.