Frequently Asked Questions
IV Ketamine
Ketamine is an FDA-approved anesthetic and pain reliever used worldwide for decades. Recent research within the past two decades, helmed by some of the world’s finest medical institutions, has shown ketamine’s potential as a breakthrough treatment for mood disorders and mental health conditions.
Some doctors, such as the former Director of the National Institute of Mental Health, call ketamine the “biggest breakthrough in depression treatment in decades.”
Although some have abused ketamine in illegal and illicit means, ketamine itself is very safe. When administered at a safe dose by medical professionals, it is effective with little to no side effects. Compared to other antidepressant mediations, ketamine is also very effective at treating depression and other mood disorders. Studies indicate up to 75% of patients may find relief with a series of ketamine infusions.
In some instances, there are some light side effects of ketamine infusions. Some patients report side effects like mild drowsiness, increased blood pressure, and nausea. In other cases, side effects can include vivid dreams or a sense of anxiety. That said, many patients report feelings of relaxation or ease during their infusions as well.
At Ketwell Alaska, we carefully monitor every patient during their entire treatment journey to ensure they are attended to comfortably and respectfully. Infusion length can vary depending on a patient’s needs. Most people describe feelings of lightness and relaxation, sometimes referred to as “dissociation.” After an infusion, you will be unable to drive or operate heavy machinery for 24 hours.
Research shows that ketamine stimulates neurons’ growth (and regrowth) throughout the body. Ketamine influences glutamate, an important neurotransmitter in the brain that plays a vital role in both mood disorders (like depression) and chronic pain conditions.
Studies by institutions like Yale Medicine and Harvard Medical School show that ketamine is a powerful new tool for treating mood and pain disorders and substance abuse. Ketamine therapy is thought to provide relief in up to 70% of patients.
Ketamine Assisted Psychotherapy (KAP):
Ketamine-assisted psychotherapy (KAP) is a therapeutic approach that combines the use of ketamine, a dissociative anesthetic, with psychotherapy to treat mental health conditions like depression, PTSD, anxiety and substance use disorders.
The process begins with a comprehensive medical and psychiatric assessment to establish eligibility. This is followed by “preparation” therapy sessions where you meet with the therapist beforehand to set intentions and build trust. Ketamine is then administered (by various routes) to establish a dissociated state of consciousness and induce neuroplasticity and prepare the patient for integration. Integration therapy sessions are held after ketamine treatments and focus on processing emotions, insights or memories that come up during ketamine treatments.
While ketamine treatment alone has been shown to produce rapid antidepressant and anxiolytic effects, evidence suggests that combining it with psychotherapy can prolong the effectiveness of treatment. Continued engagement in psychotherapy before, during, and after ketamine administration allows for the integration of psychological insights into everyday functioning, thereby potentiating the effectiveness of ketamine treatment.
Spravato + Group Ketamine Assisted Psychotherapy (KAP):
SPRAVATO is a prescription nasal spray, FDA-approved to treat adults with treatment-resistant depression (TRD) and/or Suicidal Ideation. SPRAVATO can only be administered at a certified treatment center. Patients may qualify for SPRAVATO if they have major depressive disorder and haven’t responded to at least 2 traditional medications from at least 2 different classes of drugs. SPRAVATO + Group KAP combines the transformative power of ketamine with the support of a safe and empathic group environment. Led by skilled and experienced “guides”, group sessions allow participants to explore emotional healing, build resilience, and foster personal growth in a shared setting.
Group KAP is simply KAP performed as a group rather than individually. For some patients, the shared experience can be more powerful and therapeutic than individual KAP alone. Group KAP combines the healing power of ketamine with the support of a small, trusted group in a comfortable and safe setting. Sessions help build meaningful connections and shared experiences, resulting in lasting transformation. Group KAP, however, is not for everyone. Careful consideration is given when selecting patients who would benefit most from group KAP
sessions.
Days before your first group session, all participants meet as a group to share intentions, establish group norms (confidentiality, respect, etc), undergo psychoeducation, build group rapport, and practice grounding techniques like breathing exercises and mindfulness.
Each Spravato + Group KAP session is held in a comfortable, low-stimulation environment. Participants wear eye masks and are comfortably resting in a recliner. Ketamine is administered by a medical provider to begin the journey. The experience is generally non-verbal and guided with the help of music and talk therapy. The session usually lasts around 90-120 min.
Within 48 hours of treatment, participants meet to discuss their experience, emotions, and insights. Guides help draw connections between the ketamine journey and the participant’s goals.
Typical group size is 5-10 participants. Sessions are held twice weekly for 6 weeks.
Stellate Ganglion Block (SGB):
A stellate ganglion block is a procedure whereby a specific collection of nerves in the neck, called the stellate ganglion, are anesthetized using local anesthetic medication. Stellate ganglion blocks are often used to treat chronic pain or autonomic dysfunction, including CRPS and phantom limb pain. More recently, stellate ganglion blocks have been shown to decrease the symptoms associated with PTSD and anxiety by inactivating the “fight or flight” response, which is often in overdrive in patients with PTSD.
Historically, stellate ganglion blocks were performed using a landmark technique, making them less effective and more dangerous. With the advent of ultrasound technology, stellate ganglion blocks have become much safer to perform. Ultrasound allows the needle to be safely guided around the nerves and blood vessels in the neck as it is placed next to the stellate ganglion.
The overall risks of having a significant adverse event are very small (much less than 1 in 1000) when performed by a skilled provider with ultrasound guidance. Adverse events would include injection of local anesthetic into a blood vessel causing seizures and formation of a dangerous hematoma, causing compression of airway structures. One in five patients will develop some degree of hoarseness after the procedure, which usually resolves within 4-6 hrs.
Side effects include droopy eyelid, small pupil, no sweating, hoarseness, difficulty swallowing, infection or bleeding (rare), inadvertent injection into nearby structures.
During a typical SGB procedure, ultrasound technique is used to identify the stellate ganglion in the patient’s neck. The provider then injects local anesthetic around the stellate ganglion near the C6-7 vertebrae. Patients may feel warmth, redness, or drooping of the eyelid on the same side of the face – a temporary sign that the block is working. The procedure takes 30 minutes.
Studies and clinical reports show that approximately 70-80% of patients experience a meaningful reduction in PTSD symptoms, especially hyperarousal, anxiety and sleep disturbances. Improvement can occur within minutes to days after injection and can last for weeks to months.
Transcranial Magnetic Stimulation (TMS):
Transcranial Magnetic Stimulation (TMS) is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. It is commonly reserved for patients who have not responded to medications or therapy.
A device with an electromagnetic coil is placed on your scalp, usually near your forehead. The coil generates magnetic pulses, which pass painlessly through the skull and induce electrical currents in specific areas of the brain. These currents can either activate or inhibit neural activity, depending on the frequency and intensity of stimulation.
Yes, TMS is generally considered safe when administered by trained professionals and for approved conditions. It’s a non-invasive procedure approved by the FDA for depression, OCD, and smoking cessation. TMS does not require sedation or anesthesia and does not have the systemic side effects that traditional medications do, such as weight gain, sexual dysfunction, or drowsiness.
50-60% of patients with depression respond to TMS. Response time can vary, but patients usually feel changes within 2-4 weeks into treatment. Symptom relief can last from months to years, though some patients require maintenance/booster treatments intermittently.
People with metal implants in or near the head (aneurysm clips or cochlear implants), excluding implants in the mouth, patients with uncontrolled seizures/epilepsy, and patients with implanted devices (defibrillators, pacemakers, vagus nerve stimulators, etc). Relative contraindications would include: pregnancy, history of intractable headaches/migraines, and bipolar disorder.
Most side effects are mild and temporary. They include headaches, scalp discomfort at treatment site, tingling or twitching of facial muscles and lightheadedness. Rare but more serious side effects include seizure, mania, hearing problems due to clicking sound of machine.
During a typical TMS session, you’ll sit in a reclining chair or upright seat. You’ll be awake and alert, as no anesthesia or sedation is used. A TMS technician will position a magnetic coil over your scalp, typically over the left dorsolateral prefrontal cortex (linked to mood regulation).
During your first session, motor threshold mapping will be performed, whereby magnetic pulses will be applied to your motor cortex until a twitch is generated in your thumb/hand. This determines the correct intensity for your treatment. During treatment, the coil then delivers repetitive magnetic pulses, which may feel like a tapping/knocking sensation on your head or mild scalp discomfort/tingling. Once the session is complete, you can drive yourself home. Ongoing sessions are usually 5 days per week for 4-6 weeks.
Med Management:
Traditional medication management in psychiatry refers to the standard, structured process of using psychiatric medications to treat mental health conditions under the guidance of a licensed provider.
Key components of traditional medication management start with a comprehensive medical and psychiatric evaluation. Based on this information, the appropriate medication is selected, titrated, adjusted, and monitored for outcomes. Most medication trials can take weeks to months to complete. Once stable on a specific medication and dose, regular visits are conducted with your provider to ensure ongoing efficacy and/or to make changes.
The long-term goal of medication management is to achieve symptom remission, minimize side effects, maximize functioning, and prevent relapse or recurrence. The limitations of med management include a trial-and-error process, side effects, and delayed onset.
