Currently, with the growing use of IV or IM ketamine treatment for treatment resistant depression and bipolar depression, and years of clinical evidence to draw from, some people wonder if repeated use can cause adverse effects. 

And while there is irrefutable evidence of serious adverse conditions among those who have used ketamine on the street in unmonitored doses, it’s time we learned more about the safety of repeated infusions of ketamine under a physician’s supervision. Thankfully, a prominent researcher has stepped up to the plate to give us answers to the question, “What is the safety of IV ketamine?” ~~

Jackie’s sister Janie knocked on the door of her apartment. No answer. Her sister’s depression made it hard for her to see people…so it was common for her to not answer the door. Janie slipped the key from under the mat, and let herself in quietly. She found her sister in a ball in her bed… something was wrong. “Jackie, what is it? What’s happened?”

Her 31-year-old sister was crying, and one look at her face told her she was more heartbroken than usual. She garbled through her tears, “I was so hoping ketamine treatment was going to help. I’d put all my hopes in it… that I’d get better, and be able to function, get a job and live like a normal person… But I was looking on the internet, and I found a site that said there are so many things that go can go wrong. I know it was just social media but I’m so afraid now…

What is the safety of IV ketamine? I mean I really need to know. I so want my life to get better.”

Janie sat next to Jackie wrapped her arms around her… and held her while she cried. She reached for the box of tissues and gave her one.

“I have to tell you, Jackie, I’m not sure. But what I’ve read sounded good. My impression is that it’s safe, and effective…most of the time. Even though there are no guarantees…it sounds pretty transforming for most people.

“But I’m sure there are naysayers out there. So let’s research it together — now. Let’s find out. I feel pretty sure we can read more studies and doctors; reports, and figure out how true what you read is.”

She continued, “As it turns out, I did learn you may improve after the first infusion, but you may not. It may take a few. We won’t rush it, though. You suffered so many years from this depression, let’s give this treatment every chance to help you get truly, deeply better.

“My hope for you to get help is huge. I’m not an expert, but this is the best potential solution we’ve found anywhere. So let’s dig. Let’s find the best truth we can.”

Jackie had stopped crying…she was nodding. She sat up in bed and pulled her laptop into her lap. Together, they started with pubmed.gov and searched for studies about ketamine for depression.

                                                  ~~

Just what is the safety of IV ketamine treatment? …Really.

Then, there are those who talk about psychotic breaks during treatment, and those who say they have severe bladder damage… and the list goes on. But does that happen?

Let’s face it, if you’ve never received ketamine treatment, you know how desperate you feel to get something that can alleviate your treatment resistant depression. But you read these reports that seem to be all over the internet … and you don’t want to be duped. You wonder if ketamine infusions are not as safe as you thought, and you don’t want to add other problems to your already horrific treatment resistant depression.

Don’t you just wish you could get help to empower you to live your life? This life. The only life you have. And fear says…What is the safety of IV ketamine treatment? You don’t want to jump from the frying pan into the fire, right?

Then, there are the reports of alarming hallucinations that are supposedly so terrifying some people are afraid to undergo this treatment. So much exaggeration.

A research team led by David Feifel, MD, whose reputation in studying ketamine for depression stands for itself, recently published a study about the safety of IV ketamine treatment.

His research team used a survey sent to 69 providers — most of whom were psychiatrists — originally. Since some didn’t complete the survey, and some surveys were incomplete that number for the survey reduced to 27 providers who reported on a total of 6630 patients who had received repeated ketamine treatment by IV or IM administration.

Their focus was to determine the amount of adverse events these patients experienced and reported to their doctors…and it was surprisingly low.

The patients were divided in the survey results by the number of treatments they received, the length of time they’d been receiving them, and how many discontinued their treatment due to adverse events. 

Considering all the scuttlebutt and rumors that you can read about, it turned out that out of the 6630 patients, only 47 had to stop their treatment because of a side effect. (That’s means 0.7%.) Of those, 33 of the 47 had reported psychological distress during the treatment.

Sometimes that can happen with dissociation. People with complex histories, lots of losses, tremendous trauma, and incredible emotional pain can sometimes experience distress or fear during a ketamine treatment session.

With an IM treatment, absorption is quick and ketamine can peak quickly in the body — and it may be more challenging to manage distress. With IV treatment, the infusion can be stopped or slowed, or additional medication can be given rapidly to help quell the distress.

This is why it’s so important for patients to be appropriately selected for this treatment, prepared for it–for what they might experience. And why it is so important that distress be recognized and attended to in the best possible way.

In addition, Dr. Feifel reported that only 2 people experienced hypomania, which is 0.03%. No one became addicted to ketamine. No one suffered cognitive deficits as a result of the treatment. And only 1 person out of 6630 reported psychotic symptoms.

As far as bladder symptoms…there were 3, or 0.06%. Let’s remember that some of these patients received ketamine far more than 20 times.

And this may surprise you…

About a quarter of the 6630 patients had 5 or less treatments.  But 42% received what’s considered the standard number of treatments: 6-10. And that left 1/3 of the 6630 who received over 10 treatments, with 7% of that 1/3 receiving over 20.

So this population was well distributed to reveal the adverse effects in a few vs. a larger number of treatments.  

The researchers noted that a study in South Korea on ketamine treatment for chronic pain used ketamine doses of 1mg/kg — higher than most in this study.  And that dose produced very few adverse events, with the treatment being considered very safe and tolerable.

All in all, the adverse events seen with repeat ketamine treatments given IV or IM are pretty low risk. Of course we still have to be aware of all of the possible risks, and of all that we still don’t know about long-term side effects, especially about the incidence and severity of bladder symptoms. We are learning all the time — from our patients, our colleagues, and researchers around the world.

And we learn from anecdotal experiences we read about of those who’ve used it on the street without medical supervision. 

Dr. Feifel’s sorely needed report provides evidence about the safety of repeated parenteral (IV, IM) ketamine treatments. But even in those extremely rare situations where an adverse side effect occurred, we don’t know the particulars that may have contributed to it.

But for many people who suffer treatment resistant depression or bipolar depression... or PTSD… and who look at the risks and benefits of a series of IV ketamine, the potential benefits often outweigh the risk of an adverse effect.

Maybe that’s true for you, too.

You deserve to have the power to live and enjoy your life.

At Innovative Psychiatry, we’re uniquely equipped to keep you safe (and we’re working to do that even in the pandemic!). We welcome you into our treatment offices. Especially now you may need the freedom, relief, and extraordinary joy that ketamine infusions can provide.

And if you, or your family or friends, want to know about the risks of repeated infusions in real world patients and real world outpatient settings, the data speaks for itself.

And we’re always searching for more.

Don’t miss the opportunity to feel like yourself… even if you haven’t been yourself for so long you don’t remember. You’ll recognize the real you when depression lifts and you are yourself again.

Give yourself the chance to experience freedom, joy, and hope.

If you believe ketamine treatment can help you, call us.

We believe in who you can be.

And we’re here to help you enjoy you again.

To the restoration of your best self,

signature of Lori Calabrese, M.D.

Lori Calabrese, M.D.

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