Typical antidepressants take 4 to 6 weeks to work. There is no reliable way to know which of the many oral antidepressants will be effective and well-tolerated. Patients often become frustrated that they must tolerate the side effects of the medication for weeks without knowing whether the drug will even really help them. The common side effects are usually weight gain, sexual dysfunction, gastrointestinal disturbances, sleep disturbance, fatigue, and emotional blunting. Conversely, side effects from Ketamine occur during the infusion itself and typically resolve within 15 to 30 minutes after stopping the infusion. Patients don’t experience any significant side effects in between each treatment.
Before ketamine (and TMS), electroconvulsive therapy (ECT) was the only option for patients who either failed to have a positive response from oral antidepressants or could not tolerate the side effects. ECT is an invasive treatment which requires general anesthesia for each treatment and ECT treatments must be repeated several times. The most serious side effects from ECT are memory loss and the risks related to having general anesthesia (airway complications, heart problems, etc.).
There are no reported cases of any patients becoming addicted to Ketamine from receiving the low doses that are used clinically to treat mood disorders and pain disorders.
Most drugs prescribed in the US are listed on different “schedules” based on several criteria including their level of possible addiction. Illegal drugs such as LSD and Heroin are schedule class 1. Commonly prescribed pain medications such as morphine and dilaudid are a schedule class 2. Ketamine is a schedule 3 class medication which is described as having a low to moderate physical dependence.
The World Health Organization (WHO) believes Ketamine is an essential medicine used for anaesthesia and analgesia (pain relief) in adults and children, having been listed on the WHO Essential Medicines List since 1985. In 2015, the WHO Expert Committee on Drug Dependence reviewed the latest evidence on the potential harm to health and dependence- producing properties of ketamine and upheld its previous recommendations (of 2014, 2012 and 2006) that ketamine should not be a scheduled medication.
Patients cannot take MAOI medications within 2 weeks of an infusion. Some common brand names are Isocarboxazid (Marplan), Phenelzine (Nardil), Selegiline (Emsam), and Tranylcypromine (Parnate). If you are taking one of these medications, you must consult with your prescribing physician before either decreasing or stopping your medication.
Lamictal (Lamotrigine) is a medication that should not be taken for at least 12 hours prior to the start of a ketamine infusion. Patients should wait at least 6 hours after their infusion before resuming lamictal. Before making any changes to their dosing of lamictal, the patient must consult with their prescribing physician.
Benzodiazepines taken in large doses or frequently prior to a ketamine infusion will reduce the effectiveness of the ketamine. You may be asked to skip a dose 24 hours before the start of your infusion and wait until 6 hours after before resuming your benzodiazepine. Some common brand names of benzodiazepines are Xanax (Alprazolam), Ativan (Lorazepam), Valium (Diazepam), and Klonopin (Clonazepam).
There are currently two other medications, which are known to significantly interfere or block the response to ketamine, and these are risperidone (Risperdal) and olanzapine (Zyprexa). They are “relative contraindications” to therapy and may need to be reduced or discontinued prior to treatment.
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