Intranasal Ketamine and Esketamine Infusion

UC Health is at the forefront of innovative treatments for individuals suffering from treatment-resistant depression.

Our specialized intranasal ketamine and esketamine infusions offer a promising alternative for those who haven't found relief with traditional antidepressants. These treatments are administered through a nasal spray, which delivers the medication directly into the bloodstream, bypassing the digestive system and allowing for quicker symptom relief.

By targeting the NMDA receptors in the brain, ketamine and esketamine help to rapidly alleviate depressive symptoms, offering new hope to patients who have struggled with persistent depression.

At UC Health, we combine advanced medical care with compassionate support, guiding our patients towards improved mental well-being.

Intranasal Ketamine and Esketamine

At UC Health, intranasal ketamine and esketamine are administered in a controlled, clinical setting to ensure patient safety and optimal results. The treatment is delivered using a specialized nasal spray device, which atomizes the medication for easy absorption through the nasal passages. This non-invasive method allows active compounds to enter the bloodstream rapidly.

Monitoring and Safety

Following administration, patients are closely monitored in the clinic for at least two hours. During this time, healthcare professionals assess the patient's response to the treatment and monitor for any potential side effects, such as changes in blood pressure or dissociation. Patients are provided with a comfortable environment and are encouraged to relax.

To ensure the utmost safety, patients are advised not to drive or operate heavy machinery on the day of treatment. Patients are required to arrange transportation home, after each treatment, as the medication may impair coordination and alertness temporarily and prevent safe driving. At UC Health, patient safety is our top priority, and we take all necessary precautions to provide a secure and supportive treatment experience.

Intranasal Ketamine

Intranasal ketamine is an innovative approach to treating depression, utilizing a nasal spray to deliver the medication directly into the nasal mucosa. This method allows for rapid absorption into the bloodstream, providing quicker onset of antidepressant effects compared to traditional oral medications. Intranasal ketamine is particularly beneficial for patients who have difficulty swallowing pills or who require immediate symptom relief.

Intravenous Ketamine (IV)

Intravenous ketamine involves administering the medication directly into the bloodstream through an IV line. This method allows for precise control over the dosage and immediate adjustment based on the patient's response. IV ketamine is often used in a clinical setting, where medical staff can closely monitor the patient's vital signs and adjust the infusion rate as needed. This treatment is typically reserved for patients with severe depression or those who have not responded to other forms of therapy.

Esketamine Nasal Spray

Esketamine, a derivative of ketamine, is available as a nasal spray under the brand name Spravato. This FDA-approved treatment is specifically designed for adults with treatment-resistant depression. Esketamine nasal spray offers a similar mechanism of action to ketamine, targeting NMDA receptors in the brain. The convenience of a nasal spray, coupled with its proven efficacy, makes esketamine a valuable option for patients seeking an alternative to traditional antidepressants. Like intranasal ketamine, esketamine provides rapid relief from depressive symptoms, often within hours of administration.

These different forms of ketamine treatment provide flexibility in addressing the unique needs of each patient, allowing for tailored therapeutic approaches based on individual circumstances and treatment goals.

Rapid Symptom Relief

One of the most significant benefits of intranasal ketamine and esketamine treatments is the rapid onset of symptom relief. Unlike conventional antidepressants, which can take weeks to show effects, ketamine-based treatments often provide noticeable improvement in mood and reduction of depressive symptoms within hours to days. This rapid action is especially valuable for patients experiencing severe depression or suicidal ideation, offering them timely intervention and hope.

Comparison with Conventional Antidepressants

Ketamine and esketamine represent a new class of antidepressant treatments that work differently from traditional options. Conventional antidepressants typically target neurotransmitters like serotonin or norepinephrine, but they can be slow to work and ineffective for many patients. Ketamine, on the other hand, acts on the NMDA receptor in the brain, influencing the glutamate system, which plays a crucial role in mood regulation. This unique mechanism can lead to faster and more robust antidepressant effects, particularly for those who have not found success with other medications.

Long-Lasting Effects

While the initial effects of ketamine treatments can be rapid, the duration of symptom relief varies among patients. Some individuals experience sustained improvements for several weeks following a single treatment course, while others may require maintenance treatments to preserve the benefits. Research continues to explore the optimal dosing and frequency to maximize the longevity of the antidepressant effects.

Overall, ketamine and esketamine treatments provide a powerful option for individuals who have struggled with depression, offering a new pathway to relief and improving quality of life. At UC Health, our specialized team works closely with each patient to monitor progress and adjust treatment plans as needed, ensuring the best possible outcomes.

Ideal Candidates

Intranasal ketamine and esketamine treatments are particularly suited for individuals diagnosed with treatment-resistant depression. This condition is characterized by a lack of significant improvement after trying at least two different antidepressant medications. These treatments are often considered when other therapeutic approaches have failed, providing an alternative for patients who continue to struggle with debilitating symptoms despite standard care.

Contraindications

While many patients can benefit from ketamine-based therapies, certain conditions and factors may preclude its use. Patients with a history of substance abuse, particularly involving ketamine or other dissociative drugs, may not be suitable candidates due to the risk of misuse or dependency. Additionally, individuals with uncontrolled hypertension, cardiovascular conditions, or severe liver disease may be at increased risk for complications. It is crucial for patients to undergo a thorough medical evaluation, including a review of their psychiatric and physical health history, before initiating treatment.

Assessment and Evaluation

Before starting intranasal ketamine or esketamine therapy, patients undergo a comprehensive assessment by a psychiatrist at UC Health. This evaluation includes a detailed discussion of their medical history, current medications, and prior treatment experiences. The goal is to ensure that ketamine therapy is both safe and appropriate, tailoring the approach to each individual's specific needs and circumstances.

Special Considerations

For certain populations, such as older adults or those with complex medical conditions, additional precautions may be necessary. These patients may require closer monitoring during and after treatment sessions to manage potential side effects and ensure safety. At UC Health, we prioritize personalized care, adapting our protocols to accommodate the unique challenges and considerations of each patient group.

By carefully selecting candidates for ketamine treatment, UC Health aims to maximize the therapeutic benefits while minimizing risks, ensuring a safe and effective treatment experience for all patients.

Potential Side Effects

Intranasal ketamine and esketamine treatments, while generally well-tolerated, can cause a range of side effects. Common side effects include dizziness, nausea, and a feeling of dissociation or detachment from reality. These sensations are usually mild to moderate and tend to resolve within a few hours after administration. Some patients may also experience increased blood pressure and heart rate, which is why careful monitoring is essential during and after treatment sessions.

Serious Side Effects

In rare cases, more severe side effects may occur. These can include significant changes in mood or behavior, heightened anxiety, or unusual thoughts, which should be promptly reported to a healthcare provider. Given these potential risks, ketamine treatments are administered under strict medical supervision, with protocols in place to manage any adverse reactions.

Safety Protocols and Monitoring

To ensure patient safety, UC Health follows rigorous safety protocols during the administration of intranasal ketamine and esketamine. Patients are monitored continuously by medical staff for at least two hours post-treatment. This includes regular checks of vital signs such as blood pressure, heart rate, and oxygen levels. The monitoring period allows healthcare providers to quickly address any side effects or complications that may arise.

Post-Treatment Precautions

Due to the potential for temporary cognitive and motor impairment, patients are advised not to engage in activities requiring full alertness, such as driving or operating machinery, for the rest of the day following treatment. It is recommended that patients arrange for transportation home and have a companion accompany them if possible.

Long-Term Safety Considerations

While short-term side effects are well-documented, the long-term safety profile of repeated ketamine and esketamine treatments is still being studied. At UC Health, we adhere to best practices and current guidelines to minimize risks, including limiting the frequency and duration of treatment courses. Patients are encouraged to discuss any concerns with their healthcare provider, ensuring they are fully informed about the benefits and risks associated with these innovative therapies.

By prioritizing safety and thorough monitoring, UC Health strives to provide effective treatment for depression while safeguarding the well-being of our patients.

Frequency and Duration

The typical treatment regimen for intranasal ketamine and esketamine  starts with a series of sessions spread over several weeks. Most patients receive two treatments per week. The initial treatment phase consists of eight sessions over a four-week period, with each treatment session lasting approximately two hours, including both administration and observation periods.. Depending on the patient's response, maintenance sessions may be recommended, either on a weekly or bi-monthly basis, to sustain the therapeutic effects.

Patient Journey

The treatment journey at UC Health begins with an initial consultation, where a psychiatrist evaluates the patient's suitability for ketamine therapy. This includes a detailed discussion of the patient's medical history, current symptoms, and previous treatment experiences. Once deemed appropriate, the patient receives thorough education about the treatment process, potential side effects, and expected outcomes.

During the treatment sessions, patients are welcomed into a comfortable, private room designed to provide a calming environment. The nasal spray is administered under the guidance of trained medical staff, who are present to assist and monitor the patient throughout the process. After administration, patients remain under observation to ensure their safety and to monitor any side effects.

Post-Treatment Support

Following each session, patients are provided with aftercare instructions, including recommendations for managing any side effects. UC Health offers continuous support throughout the treatment journey, including follow-up appointments to assess progress and adjust the treatment plan as needed. Patients are encouraged to communicate openly with their healthcare team, ensuring any concerns or side effects are promptly addressed.

Ongoing Monitoring and Adjustments

The effectiveness of ketamine treatment can vary among individuals, and the treatment plan may be adjusted based on the patient's response. This personalized approach ensures that each patient receives the most appropriate care, with the flexibility to modify the frequency or dosage as needed.

At UC Health, we are committed to providing a compassionate and supportive experience for our patients. Our team works closely with each individual, from initial assessment through ongoing care, to optimize treatment outcomes and enhance overall well-being.