Our Protocol:
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The protocol at KlearMind was created to be consistent with the general agreement for infusions in the treatment of mental disorders that are resistant to medications. We understand that chronic pain and mood disorders are a spectrum, and each patient can respond differently. Hence each infusion is calculated to each patient and can change with each treatment.
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We recommend 6 infusions over two to three weeks which are what studies have been based on. Our dosing ranges from 0.5mg/kg to 0.7mg/kg and occasionally 1mg/kg and the infusion occurs over 40 to 60 minutes with continuous monitoring.
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The effect is often felt immediately, and most patients do feel better after the initial treatment. We always recommend that the series of 6 treatments are completed but understand when patients are hesitant or other concerns to proceed initially with all 6-up front. Hence why we suggest our patients to try one infusion and see if they respond to the treatment.
Many patients often do feel better within an hour or two after their first ketamine infusion and others do not until they have had at least three to four infusions. It is often difficult to predict the response.
We have patients who seemed resistant to the treatment until their third or fourth infusion when there is a notable improvement in symptoms. Ketamine can produce significant changes in one’s mental state, but the results are not always universal. Hence each treatment is tailored to each individuals’ needs and diagnosis. We do change infusion rates and dosing as needed through the course of the treatment, the price always stays the same.
IV Based treatment:
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We prefer intravenous (IV) infusion because the bioavailability of ketamine has been reported to be 100% following IV and intraosseous administration (bone), 93% intramuscular, 16% to 20% oral, 30% sublingual, 45% to 50% intranasal, and 25% to 30% rectal.14
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IV infusion allows many benefits that exceed intramuscular infusion. A team of anesthesiologists and a critical care nurse who are very comfortable in IV placement with a single placement rate over 95%. IV infusion also allows for a smoother onset and a smoother awakening. Intramuscular causes a rapid influx and efflux of ketamine’s effect.
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The benefit of an IV is allowing a patient to receive anti-nausea or headache medications and further a single stick allowing the patient to receive boluses if needed to maintain the infusions effect. If there is a mis-dosing with an intramuscular injection that will mean another poke for the patient. Importantly having access to an IV allows administration of emergency that can cease the effects of the infusion.
{Bonnet U. Long-term ketamine self-injections in major depressive disorder: focus on tolerance in ketamine’s antidepressant response and the development of addictions. J Psychoactive Drugs. 2015;47(4):276-285.}
