What is Ketamine?
Ketamine is a legal anesthetic. In breakthrough research, it was also found to provide fast-acting and potentially life-saving relief for many patients who have major depression resistant to treatment, or suicidal thoughts. Research is also showing promise for other mood disorders or chronic mental-health conditions that have not been helped by traditional treatments when administered off-label under clinical, controlled settings using dosages different from its use as an anesthetic. Ketamine is used illegally and in higher doses as a recreational drug, which can cause dissociation with hallucinations.
How does IV ketamine work on severe conditions, such as major depression?
When stressed, which includes periods of severe mood disorders, such as major depression, changes happen in the brain. The hormone cortisol is released. Cortisol can damage neural connections and ketamine appears to act to restore some of the connections that have been lost. As well, ketamine acts on the neurotransmitter glutamate, in contrast to traditional antidepressants, which increase neurotransmitters like serotonin but they either take a long time to work, or for some people, don’t work at all. Studies are ongoing on the complex ways ketamine may work in the brain. Clinical trials have shown that 60% to 70% of patients with treatment-resistant depression have been responsive to ketamine.
How long do the effects of ketamine last?
The long-term effects of ketamine are not known at this time. Current evidence suggests that most patients stay well for a couple of months with others staying well for longer periods of time. It is recommended to take booster shots as needed. Theses are typically administered once every 1-2 months.
Can IV ketamine treat anxiety disorders, PTSD, OCD, bipolar disorder and suicidality?
Ketamine has shown promise in several studies at prestigious universities and hospitals in providing relief for anxiety disorders, PTSD, OCD, bipolar disorder and suicidality, as well as treatment-resistant depression. Because of its rapid effects in many patients, it is given to patients with suicidality in some emergency departments. At this time, protocol only calls for ketamine therapy for treatment-resistant depression, but as more research is conducted, the promise is high for ketamine to treat other mental-health conditions.
Why IV ketamine infusions?
We have chosen intravenous (IV) delivery of therapeutic doses of ketamine in order to provide the most accurate, efficient, safe and fast-acting treatment. IV infusions mean 100% of the medication is getting to your bloodstream, and can begin to act quickly. IV delivery also allows for precision dosing, and carefully controlled delivery by a doctor.
How quickly does IV ketamine treatment begin to work?
Some patients experience relief within hours, while others may see relief in days. A full treatment protocol is 6 infusions. Some patients may require repeated treatments. Our staff have specific expertise in ketamine treatment for mood disorders and chronic mental-health conditions and will monitor and adjust your treatment to give you the treatment plan that best matches your needs.
Is IV ketamine safe?
The infusion of IV ketamine in a medical clinic supervised by an anesthesiologist is safe. Treatment at a therapeutic dose is non-addictive. One of the most common side effects during treatment is a sense of dissociation (or disconnection from yourself or your surroundings), which disappears soon after the infusion.
Is IV ketamine right for me?
Are ketamine infusions covered by OHIP?
At this time, public insurance such as OHIP does not cover IV ketamine treatments.
Are there any contraindications for ketamine?
Currently there is a contraindication to ketamine for those suffering from psychotic disorders. This would include those who suffer from conditions that include hallucinations and delusions.
How much do ketamine infusions cost?
$750 per infusion, with the typical protocol being 6 infusions.
Do I need a doctor to refer me for IV ketamine infusions?
Yes you need a referral to access treatment at TKC. If you have been treated for depression with at least 2 trials of antidepressant medication and have for a period of 4-6 weeks each at a therapeutic dose and have not seen relief you can ask your doctor for a referral to TKC.
What can I expect IV ketamine infusion treatment to be like?
If you are a candidate for IV ketamine treatments, you will be scheduled for a series of 45-minute sessions of intravenous infusions in our Toronto clinic. You will be offered a recovery period after your treatment, which depends on your individual response, and you will need a companion to accompany you home after treatment. You will be scheduled for three weeks of 2-times-a-week infusions. Follow-up visits for booster infusions are available as needed, and would typically be in 2-3 months, depending on individual needs.
Do I need to stop my current treatments?
You don’t need to stop your current treatments. Your doctor at Toronto Ketamine Clinic will review your medical history and potentially consult with your doctor to determine the best course of treatment.
When can I start ketamine infusion treatments?
Once you have been approved by the clinic psychiatrist, you can book your first treatment.
What is Spravato?
Spravato is an intranasal antidepressant. It is the first ketamine/esketamine antidepressant that has been approved by Health Canada. It must be prescribed and monitored by health-care professionals who have undergone training by the manufacturer, in a clinical setting.
How is Spravato different than traditional antidepressants?
Most of the current antidepressants target certain chemicals in the brain, such as serotonin, norepinephrine or dopamine. Ketamine/esketamine is a novel therapy targeting receptors for a different neurotransmitter: glutamate. Though researchers are still investigating the mechanism of how Spravato works, among other things, the medication is thought to increase synaptic connections between brain cells. People with depression are thought to have fewer synaptic connections. Currently, esketamine is taken together with traditional antidepressants and begins bringing relief to many patients with treatment-resistant depression or major depressive disorder much faster than traditional antidepressants used on their own.
What conditions is Spravato best used to treat?
Spravato is used to treat people with treatment-resistant Major Depressive Disorder.
You can find more information about Spravato treatment on the manufacturer’s website. (Please note that some of the information on this American site does not apply to Canadian patients.)
For adults with treatment-resistant depression, click here.
For depressive symptoms in adults with major depressive disorder with suicidal thoughts or actions, click here.
Do I need to go off my current antidepressants in order to take Spravato
No. Spravato is taken in combination with your current antidepressant medication.
When is Spravato not a good option?
This list of contraindications for taking Spravato may not include specific concerns our clinical psychiatrist may have.
· Anyone who is under 18 or over 65.
· Anyone who has a primary diagnosis other than Major Depressive Disorder or Bipolar Disorder (though individual consideration will be given on a case-by-case basis for adults with either PTSD or OCD)
· People who meet DSM-5 criteria for a substance use and or alcohol use disorder
· Anyone who has met DSM-5 criteria for a substance use disorder and/or alcohol use disorder in the past 3 months
· Anyone who uses illegal substances but does not meet criteria for substance use disorder according to the DSM-5 criteria must stop using those substances for at least one month before their first treatment at TKC
· People who are experiencing psychotic symptoms as part of a major depressive episode (mood congruent/mood incongruent) or other psychotic disorders such as schizophrenia.
· People with a dementing disorder (e.g. Alzheimer’s disease)
· People who are unable to provide written consent to the treatment
· Anyone who does not adhere to all pre-procedure recommendations (e.g. food fasting)
· People who are unable to remain in the clinic for 2 hours for treatment and monitoring
· People who are unable to commit to the full course of 8 treatments
· People who are unable to identify someone before treatment who can assure their safe transport home after treatment
· People with symptomatic traumatic brain injury
· People with uncontrolled medical disorders (e.g. uncontrolled and/or insufficiently treated hypertension or recent cardiodvascular event, or allergies to ketamine and/or previous intolerability of ketamine)
· People who have medical contraindications to ketamine (e.g. epilepsy)
· People who are not Canadian residents
· Anyone who does not have a community MRP (primary care physician) will not be accepted for assessment or any procedure at Toronto Ketamine Clinic (TKC)
· Anyone who is aggressive or intimidating towards TKC staff or other patients will not be eligible for treatment at TKC
· Patients feeling acutely unwell for any reason (e.g. have symptoms of infection such as fever) and/or have come into direct contact with someone acutely ill from a transmissible infection will not be eligible for treatment at TKC
How do I take Spravato?
Spravato is a nasal spray that must be taken in a clinic setting. Patients are monitored by trained health-care professionals. The whole process, including monitoring after treatment, takes about 2 hours in the clinic. Patients must arrange to be picked up by an adult at the end of their procedure, otherwise treatment cannot go forward.
How long before I start feeling results?
It varies from patient to patient. Some may feel results after a few treatments. Others may respond more toward the end of their full recommended course of treatment.
How long will I stay well?
Many people can stay well for several months and some even longer than that. But it is anticipated that you will need to do booster treatments to maintain wellness, which varies for each patient. After the month of acute treatment, patients will decide with their TKC psychiatrist on the schedule of ongoing treatments.
Does this work for everyone?
Research suggests that about 70% of people with treatment resistant depression who have not had success with traditional treatments get results with ketamine/esketamine treatment within a month.
What are the risks?
Risks include nausea and elevation in blood pressure and intracranial pressure during treatment, and dissociation or sedation immediately after treatment (patients cannot drive until the next day after treatment). You will be monitored closely by TKC’s healthcare professionals.
What is the cost of Spravato?
The cost is dependent on the dose required, as determined by our clinical psychiatrist. The range is between $550 and $1,250 per session. There are no additional fees.
Is Spravato covered by OHIP?
At this time, OHIP does not cover Spravato treatments.
Is Spravato covered by health insurance?
Each insurer is different. Some are beginning to partially cover treatments. Check with your insurer.
How can I be assessed for Spravato treatment?
The first step is having your primary healthcare practitioner fill out the referral form that can be found our website. The staff at Toronto Ketamine Clinic (TKC) will conduct a detailed assessment of your health and psychiatric history. We will also look at a full list of previous treatments to ensure you fit the criteria for a treatment resistant disorder. Once this has been done, we will book an assessment appointment at TKC.
Can I get treatment without an assessment?
The main reason for the initial assessment is to clarify and confirm your diagnosis and to determine whether ketamine/esketamine treatments are appropriate for you. Unfortunately, ketamine/esketamine treatments will not be deemed appropriate for some people.
Does the assessment cost money?
No. The assessment is covered by OHIP and is free to patients.