IV Ketamine Infusions

Traditional antidepressant medication modulates neuron messaging by preventing the re-absorption of serotonin and norepinephrine.  This can result in improved communication between nerve cells and stronger circuits that regulate mood.  Unfortunately, these medications don’t work for everyone.

BDNF (brain-derived neurotrophic factor) is a protein that supports the survival of existing neurons and encourages the growth of dendrites and synapses.  Life stressors and past traumas can inhibit the production of BDNF and predispose people to serious mood and anxiety disorders.

Ketamine acts as an antagonist at the NMDA receptor and blocks the receptor from reabsorbing glutamate.  This causes the release of BDNF which helps promote neuronal connectivity. It is believed that this is one of the mechanisms of ketamine’s antidepressant effects.

In summary, ketamine helps create and ‘turn on’ new neural pathways in the brain that are believed to improve mood regulation and create healthier thought patterns.

IV ketamine infusion therapy is an option for adult patients with unipolar depression, bipolar depression, or PTSD who have not responded to 2 or more first line agents. It is contraindicated in patients with unstable cardiovascular disease, psychosis, or a history of ketamine abuse.

Please see our Pricing page for current pricing of our services. At this time, IV ketamine infusion therapy for mental health is not covered by provincial health care plans at private clinics. Third party insurance agencies may cover a portion of the cost. We do not direct bill insurance companies but will gladly provide an invoice, cost breakdown and drug identification number (DIN) to submit your claim.

Your first appointment is a consultation with a Psychiatrist.  They will assess your mental and physical health history and answer any questions you have.  The psychiatrist will determine if you are an appropriate candidate for IV Ketamine therapy.

We require an initial screening consult to ensure ketamine is appropriate for your case.  This is normally done at one of our offices, but if you have a long distance to travel, this can be a video consult.  For video consults, we’ll need your email address, and you’ll need access to a device or computer with a camera.  At your appointment time, simply follow the link in your email, and click on the button that says “join on the web instead”.  There is no need to install software on your device.

When you arrive for your infusion, an RN will bring you to a private treatment room. You will meet the physician trained in conscious sedation (ER/anesthesia) who will be administering the medication and monitoring your blood pressure, heart rate and oxygen saturation. An intravenous line (IV) will be started in an extremity and you will be given a weight-based, sub-anesthetic dose of ketamine by continuous infusion over 40 minutes. Depending upon your response to the first infusion, the dose of ketamine or the duration of the infusion may be changed to maximize your response.

Our treatment rooms have blankets, pillows and dimmable lighting for your comfort.  You can bring a mobile device to listen to music with earbuds or use our Bluetooth speaker.  Family members or friends are welcome to stay with you during the infusion.

The initial course is a set of 6 infusions.  Our clinic recommends 2 infusions per week for 3 weeks for a total of 6 treatments.  Required maintenance treatments vary by patient, and can range from weekly to every 6 months.

The length of symptom remission varies but the average is 3-4 weeks.  We recommend returning for a single infusion booster 4 weeks after your initial treatment course.  Some patients find that over time they can go longer between booster treatments.

The most common side effect of ketamine is dissociation, which is when images appear somewhat distorted. Dissociation affects up to a third of people during the first infusion. The number of people who experience dissociation decreases with each subsequent infusion.

Other common side effects include headache, nausea, dizziness, blurred vision, drowsiness, elevated mood, anxiety, and elevations in blood pressure and heart rate.  All the side effects are transient and resolve quickly post-infusion.

An uncommon side effect of ketamine is cystitis or hematuria.  This is typically associated with prolonged ketamine abuse but please inform us if you experience bladder pain or blood in your urine.

Any time a medication is administered via IV there are risks such as discomfort from the needle stick, bruising, and infection at the IV site.  Dosing errors, or drug interactions that require medical intervention such as intubation or hospitalization could also occur. Our non-hospital surgical designation means that we are required to have a specific team of medical professionals who are all trained to respond to these very rare risks.

The other risk is that ketamine may not help your depression, PTSD, or suicidal ideation.

For the remainder of the day after each infusion:

• You must not drive a car, operate hazardous equipment, or engage in hazardous activities.
• Plan to not conduct business or make any critical decisions
• You must refrain from consuming alcohol or other recreational drugs for 24 hours before and 24 hours after an infusion.
• You must inform The Linden Medical Centre of all prescription medications, and over the counter supplements you are taking.

First, let’s define these acronyms. IV stands for intravenous, which means a medication is given straight into the bloodstream. IN stands for intranasal, which means a medication is given in a mist via a spray into the nasal cavity. SL means sublingual and means the medication is given by a lozenge in the mouth under the tongue. Lastly, IM means intramuscular, which means a medication is given with a needle into the arm, thigh or buttock muscle.

The CANMAT guidelines list IN Spravato (esketamine) and IV ketamine as second line treatments for difficult-to-treat depression. We choose to administer ketamine via IV because it has the highest level of evidence and for the following reasons:

• Administering ketamine via IV has the highest bioavailability (100% compared to 25-55% for IN and 30% for SL). Because of that, the effects are more predictable, and the dose is easier to titrate.
• IV ketamine takes effect quickly (1 minute) and has a 1–2-hour recovery time whereas IN/SL/IM can require 3-4 hours of recovery time. Note: You are not allowed to drive after a ketamine infusion until the following day.
• If an emergency occurs, staff can stop the IV drip and the medication will be out of your system very quickly.
• The nature of IN and IM require more time for the client to receive the effects and recover after treatment. This can increase costs to the client.

If you have any questions about which route of Ketamine is right for you, ask your doctor or psychiatrist.