Ketamine was unveiled as one of the top 10 medical innovations by Cleveland Clinic in 2017 due to

its beneficial effects in mental health illnesses. S-ketamine nasal spray was approved by FDA

for use in treatment resistant severe depression in 2019. More and more clinical evidence has

been emerging in last couple of years to support ketamine use in alcohol and substance use

disorder. All of this has led to exponential increase in outpatient ketamine clinics and

outpatient ketamine infusions.

As a patient or family member, sometimes it becomes overwhelming and even scary to decide

whether ketamine is right for you and if yes, which practice you should go to get it. No worries,

we have assembled a list of important questions you should ask prior to committing to a

specific ketamine practice.

Who is administering the ketamine?

In New state, any board-certified MD/DO can provide ketamine infusion if he/she can

demonstrate competence in the ketamine administration. In general, emergency medical

physicians, critical care providers, anesthesiologists and hospitalists with ICU patient

management experience have enough exposure to the ketamine administration during their

training. Hospitalists (internal medicine) have added advantage of having better knowledge of mental

health illnesses as compared to other specialities.

Who is supervising the ketamine administration?

Ketamine is a schedule III controlled substance. Its administration must be supervised closely by

ACLS certified medical professional preferably MD/DO in stead of nursing staff. Ketamine can cause increase in blood pressure and heart rate in some patients. So  close monitoring and timely intervention is a must for safe administration.

How is each ketamine infusion monitored?

As mentioned above, ketamine is known to increase blood pressure and heart rate. Patient's vital signs (blood pressure, heart rate, respiratory rate, oxygen saturation and heart rhythm) should be monitored closely every 10-15 mins or continuously using automated machines.

How is ketamine administered?

Use of automated infusion pumps to infuse any medication intravenously is a gold standard of care. Some practices use old school 'counting drops' method to give medication to cut cost but it can be dangerous with iv ketamine.

What intravenous ketamine protocol is being followed?

No large randomized clinical trial has been done so far to demonstrate that one protocol is

better than the other. Several small studies have shown that six to ten (0.5 mg/kg) ketamine infusions

given over 2-3 weeks period provide the best possible outcome.

Does practice offer personalized treatment?

Although Six to ten ketamine infusions of 0.5mg/Kg given over 2-3 weeks provide the best possible

outcome, but sometimes one size does not fit all. Some patients do need higher titratable

ketamine dose. This is where an experienced ketamine specialist can make a significant

difference.

When to stop the ketamine treatment?

Ketamine is not 100% effective in all the patients.  If patient and/or family don’t notice any improvement after 6 sessions, it is likely that ketamine might not work for you.

Ketamine is a safe and most effective rapidly acting anti-depressant with its own limitations. You should do your thorough research prior to choosing a practice for ketamine infusions. ketamine wellness Medical practice uses automated infusion pumps to administer and titrate each ketamine infusion; uses automated machines to monitor vital signs. Dr Goyal supervises each infusion and is readily available to each of his patients. Each patient receives access to free online behavior therapy programs (worth $60 each) that patient can use at ones's own pace and home comfort.

If you have any further questions, please feel free to contact Dr. Goyal at

(516)280-3842 or email at contact@ketamine-wellness.com