Ketamine Boost Infusions Combined with Infrastructure Changes May Help You Sustain Remission
What do you do when the symptoms return?
You spent years in that condition. The sadness, the hopelessness…the numbness. That terrible shame. Unable to participate. Shut down. Withdrawn.
Or, maybe the symptoms were reactions to sudden noises…smells…darkness… or touch.
They may even have been obsessive thoughts…and compulsive actions that follow.
Or the old dreaded cravings…and relapse close behind.
You even wondered if you could go on much longer.
Then, you heard about ketamine treatment, and you found a way to pay for the treatment series of 6+ infusions. Afterwards, you came alive and felt so much better.
For once, you had hope, motivation, initiative. There was energy to live, invest 
your effort, build healthy relationships. You enjoyed your job and began to really excel. You actually felt happy. It was exhilarating to not just barely hang on.
Then it happened. …out of nowhere…those old symptoms began to return.
Maybe your job performance led to more responsibility. And the higher level of stress began wearing down your synapses…those connections between the cells in your brain. It’s possible that after awhile those cells in your lateral habenula began bursting too much and too often.
Plus all those G proteins that had slid off the lipid rafts in your cell membranes may have started piling back up on those rafts. The numbness that had gone away, came back.
Why?
Could it be because your wife’s cousin is living with you, taking advantage of your hospitality, rather than trying to find a job or her own place. And you keep stuffing your feelings…you don’t want to upset your wife.
Or maybe your boss takes credit for every innovation your create. But you? You keep working long hours and your husband is fed up that you’re never home.
Stress.
You’re so mad at yourself for not accomplishing more, so you carry your feelings on your sleeve, and jump down the throat of anyone who crosses you. You KNOW they don’t deserve this treatment…but you’re too ashamed to apologize.
Or, perhaps you got a little cocky with your sobriety, and began hanging out with friends who still use the substances you’ve broken away from… ? Any type of hard and stressful situation can make you think back to the old days…
It also might even be that this disorder is in your genes…that your whole family fights depression and it’s like a heavy gray blanket covering everyone around you. It could be to get better you might have to purposefully surround yourself with more positive, uplifting people …?
Or separate yourself from obligatory situations…
Sometimes we can’t see the nose on our proverbial face. We need someone to point it out and help us see specifics like these in our own complicated lives.
And we need to take action.
Tell your spouse what you really feel. Stand up to your boss even at the risk of getting fired. Because your self respect is too important to just silently bow to his abuse and dismissal of your value. That might reduce your stress.
Sometimes it doesn’t take much…just a step… to stand for what’s right. But when you do, the chains fall off.
And your own personal infrastructure – the things that make your life yours – is freed up to support your well-being.
So back to the causes. All of the mechanisms associated with stress can go into play, and undo some of the work the ketamine treatment had accomplished.
This is why it’s important to find ways to improve the “infrastructure” in your life,
to reduce stressors that wear down your resilience.
Without making healthy changes in the areas most critical to your wellbeing, the same stressors that caused you to need ketamine treatment in the first place may cause you to need it again.
But…let’s be clear: there are no published studies about “booster” infusions
Can you believe that?
None.
But in all fairness, it can take years to gather data on recurrence of symptoms and how to best treat them.
Still. We need research!
Meanwhile, what do we do? The best we know to do is to use our clinical judgment if symptoms try to creep back in. We collaborate with you, and your treatment team, about the best way to proceed.
Lifestyle changes? Any improvement in the stressors in your life that you can make…well, that can be a big help.
A medication change perhaps? Some people continue their medications while receiving ketamine infusions. A change in medication might help…
Or is an additional ketamine boost infusion what’s called for? Perhaps so. If nothing has ever worked for you before to control your symptoms, you may know that ketamine infusions are your “go-to” solution.
Those of us in clinical practice have learned that additional infusions down the road can help refresh the work ketamine began.
Many patients…and their doctors…take a shortcut straight to ketamine because of their experience that it worked so beautifully after all those failed rounds of 
antidepressants and other treatments.
But we still don’t have research to show us in those cases how often we should prescribe a booster infusion or whether maintenance is inevitable for the foreseeable future.
My experience says that ongoing maintenance doses really aren’t required in many, if not most, cases. There is no research to guide us at this point. I do wonder why? …and hope that changes soon.
For now, I think it’s premature to make a blanket recommendation for ongoing maintenance “booster” infusions every few months indefinitely.
There are too many cases of patients who only need one or two or three after the initial series… then no more for a year or more. Psychiatrists need to work with their patients and the health care team to guide the best recourse for each individual patient.
But remission is the goal. Helping you feel truly good and able to live productively.
One or two ketamine boost infusions at a time can support and sustain remission. Especially if the patient’s infrastructure is in place and strong.
So…maybe you still feel better than you did before you knew about ketamine…but you don’t feel as good as you did a few weeks ago.
What do you do?
When you feel better, but not better enough, you may need a ketamine boost infusion to get your brain working well again and get you back on track.
Kick It Up a Notch!
Every brain is different, just as every person is different. Dosage and frequency can vary.
Another point… for the purpose of rebuilding and strengthening your personal “infrastructure,” you might benefit from therapy with a skilled therapist after each of your ketamine infusions.
This is when the neuroplasticity in your brain is very high, and it’s easiest to consider new ways of thinking, of reacting, of decisions…that make your life more functional, less stressful, and more rewarding.
Some people don’t need additional infusions at all. When you feel better, really so much better you’re empowered to build the life you want, there’s no need for boosters. And there’s no need to schedule them in advance.
But when you feel better but not better enough, you need to take action and find ways to get completely better. Start with another ketamine infusion. And take an inventory of your daily life. What do you need to change to make it better?
It might be taking action to change something. Or it might be taking action to change your attitude about something. But use those extra ketamine infusions to explore your life, your heart, your attitudes. And with the help of your therapist, make some solid decisions that renew hope in your life.
Renew your wellbeing.
Slash that powerless feeling and remove it…put yourself back in control.
It may require additional infusions every few months for awhile to get your life on track, your infrastructure in line with your purpose, and to create a life you enjoy. But it’s worth the effort.
And by the way, there’s no shame in additional ketamine boost infusions. No one but you knows what’s working for you. This is not a competition.
The goal is for you to live life as your best self, rather than a shadow of that. That you can enjoy your work, your hobbies, your relationships, and your purpose.
At Innovative Psychiatry we work closely with you and your health care team to help you find the most productive and fulfilled you. Call us.
To the emerging of your very best self,
Lori Calabrese, M.D.