Ketamine is a synthetic medication that has been used in humans for over 50 years. It is a non-addictive treatment option for major depression, mood irregularities, and various chronic pain conditions. Recent evidence has strongly supported its’ effectiveness. Ketamine can be administered multiple ways, however, the most efficacious route is intravenous. At Ketamine Healing of Los Angeles, we use the intravenous route.
Under the care of a board certified Anesthesiologist, intravenous Ketamine is extremely safe, even in large doses.
You do not need a Psychiatrist’s referral for treatment. However, Dr. Mahjoubi will speak with you on the phone to discuss your prior treatment history and assess your candidacy for IV Ketamine treatments.
Ketamine works two ways: psychotropic and biochemical. With the psychotropic pathway, patients have mild, euphoric dissociations and enter a state free of worries- this carries over to their day to day lives. For the biochemical pathway, Ketamine increases connections between neurons, or brain cells, and alters the concentration of Glutamate, a neurotransmitter in the brain.
At the Ketamine Healing Clinic of Los Angeles, infusions are 60 minutes long. However, we don't disturb you until 75 minutes have passed, since patients often feel they are processing deep thoughts and "getting work done" on themselves. Ketamine therapy is often described as "A very deep therapy session with yourself.
We have seen patients wake up with positive results. The average length of time to noticeable benefits is anywhere from the same day to 48 hrs later. The number of treatments also influences the time to chronic relief.
A small percentage of patients experience nausea or headache. For our infusions we always place an anti-nausea medication called Zofran. If this does not work we add a second type of anti-nausea medication for the second and subsequent infusions. If a headache does occur, we add a medication called Toradol to the infusion for subsequent treatments - this medication is similar to aspirin.
For patients with Depression or PTSD, we have approximately an 85% success rate. For patients with chronic pain, please call our office to speak to the doctor about your chances for pain relief with Ketamine.
If you have any symptoms of depression, mood irregularities or chronic pain you may be a candidate for IV Ketamine treatments. Please call to speak to the doctor at (866) 987-7874 to assess your candidacy.
The fee for each of the first 5 treatments is $625. You are not charged up front and pay as you go. Each infusion thereafter (after the 5th) costs $475. If you have received 5 or more infusions at another Ketamine clinic, each infusion would be $475 upon receipt of proof of infusions. Pricing differs for patients receiving infusions for Chronic Pain. Please refer to our pricing page
for further details about our Tier 1-3 pain infusions.
At this time insurance does not recognize Ketamine as a treatment option for depression or chronic pain. However, we are happy to provide you with documentation for treatment so that you may attempt to get reimbursed.
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With the IV route, you get a more controlled and pure experience, since with an intramuscular injection one must wait for the Ketamine to enter the bloodstream from the muscle. With the IV route, the Ketamine is directly placed into the bloodstream which reaches your brain quickly. The intramuscular route, because you have to deposit all of the dose in one (or two) injections, you get more of an intense high and fast come down. The IV route allows for a gradual onset and and longer experience. The ideal route is the IV route.
Anesthesiologists are much better trained to give Ketamine intravenously. You should ask the Psychiatrist you’re thinking about going to if they’re able to give you Ketamine via the intravenous route- this is the most ideal and effective route. If they are, you should ask if they feel comfortable giving more than 0.5 mg per kg. Many clinics give this standard, low dose, which is not sufficient for most patients.
Patients who are taking benzodiazepines (alprazolam, lorazepam, clonazepam, etc.) or lamotrigine (Lamictal) should work with their prescribers to try to lower their intake or wean off these medications prior to beginning ketamine therapy in order to maximize the treatment's efficacy. If this is not possible, the dose prior to each infusion should be held. This can be further discussed with the doctor and a plan will be made between you and him. Taking the above medications does not mean Ketamine will not work for you. Marijuana can also impede in Ketamine's efficacy, and should be held at least 3 days prior to a Ketamine infusion, if not longer.
The first appointment consists of an evaluation by Dr. Mahjoubi, with your first infusion to follow. We encourage patients to plan to be with us for 2 to 2.5 hrs the first time we meet you.
Please notify us within 48 hours of your appointment if you need to cancel it for any reason. If you cancel your initial appointment, Ketamine Healing Clinic of L.A. reserves the right to re-assign the remainder of your reserved treatment appointments to a patient on the waiting list. Our goal is to keep the waiting list for treatment to a minimum and serve those patients who are ready for treatment as soon as possible.
All our infusions take approximately 60 minutes to administer. We don't interrupt you for 75 minutes however, since Ketamine levels are still high at the 60 minute mark.
The optimal regimen for ketamine therapy has not been established and may vary among individuals. We do know the following from various studies and from our own clinical experience over 4 years:
- Serial infusions have been shown to be more effective than single infusions.
- Closely spacing infusions in the initial treatment phase (two to three infusions per week), then fine-tuning an individual's regimen with well-timed maintenance infusions and the Ketamine spray, appears to confer the best hope of success.
Typically we offer four to six infusions within a two to three week period, with subsequent infusions as needed to relieve symptoms. Most patients require “maintenance” infusions. The response of individual patients varies and is impossible to predict with current available resources. Each Ketamine treatment plan is designed according to the particular needs of any given patient, and Dr. Mahjoubi is dedicated to getting to know each patient's needs and responses and tailoring therapy to the individual, per his Advanced Personalized Ketamine Protocol.
Responses to ketamine vary from individual to individual. You will be awake and can continue to be able to interact with those around you if needed. Most patients just close their eyes and relax during the infusion. Some people may experience transient dizziness, nausea, mild visual hallucinations, a sense of disconnection from the body, and mild distortions of space and time perception. The infusion is generally a tolerable and euphoric experience for most people, though is commonly described as "weird." It can also leave some people feeling emotionally vulnerable, while others may feel a sense of well-being and openness. You will be back to your baseline about fifteen to thirty minutes after the infusion ends and will be monitored for as long as needed before you are discharged. Less commonly, some people become fatigued after infusions and/or may develop a headache, a feeling of "heaviness," or some nausea. While you may not be groggy after the infusion, we strongly advise that you avoid driving, operating machinery, or participating in challenging mental work or decision-making for at least twelve hours after the infusion, and we require that someone drive you home.
Please do not consume solid food or liquids in the 3 hours preceding your appointment.
PLEASE REFRAIN FROM CONSUMING ALCOHOL, SMOKING OR INGESTING MARIJUANA, OR USING COCAINE, HEROIN, OR OTHER ILLICIT SUBSTANCES. Not only can they pose a safety risk when combined with ketamine treatment but also they can interfere with the effectiveness of ketamine therapy.
Ketamine is an anesthetic that has been widely used for decades. It was synthesized by Calvin Stevens at Parke Davis Laboratories in 1962 and has been used as an anesthetic in both children and adults since the 1970’s.
Ketamine has been used illegally under the street names K, Special K, Vitamin K, Kit Kat, Cat Valium, Special LA Coke, Super Acid, Super C, Green, Purple, Honey Oil, Bump, and Jet. Abuse of ketamine can be very dangerous and potentially lethal, as is the case with alcohol and narcotic medications, and should only be used under the direction of an experience physician.
In the hands of clinicians specially trained to provide ketamine such as Anesthesiologists, Ketamine has a wide safety margin. In fact, in some cases when other anesthetics are unsafe to use because of a patient’s unstable condition, many Anesthesiologists will choose to use ketamine for the patient’s protection. The doses used for treatment of depression are “subanesthetic”: they are well below what anesthesiologists use to anesthetize patients for surgery.
Which mood disorders? Studies at the National Institutes of Mental Health, Mayo Clinic, Mt. Sinai School of Medicine, and Yale have shown significant benefit with the use of ketamine infusions for depression. Research supports the use of ketamine for depression, bipolar disorder and post traumatic stress disorder. Obsessive-compulsive disorder, substance addiction, and even traumatic brain injury as well. It has also been used for chronic pain conditions such as CRPS.
Some patients begin to feel a difference by the evening or day after their first infusion. Even for "responders," periods of sadness or depressed mood may still occur between infusions, but the overall trajectory of mood symptoms should be one of improvement. Responders may also find urges to self harm and suicidal thoughts diminished and ability to cope with stress improved. Patients may find that functional improvements - getting a to-do list done, socializing more easily, etc. - occur before improvements in mood. Family and friends thus sometimes observe that a patient "seems better" even though the patient still feels the same. Changes can be gradual.
Some patients find that the positive effects of ketamine may wear off with time. There is research to suggest that in order for the effects of ketamine to be sustained, a maintenance regimen is advisable. The response of individual patients varies. There have been rare cases of remission after ketamine infusion therapy, but these should be considered the exception rather than the norm.
Ketamine should not at this time be thought of as a cure for depression but rather as an adjunct to ongoing treatment that can help reset a person's baseline, relieve some of the suffering and hopelessness of major depression, and give other therapies such as oral medication and psychotherapy a chance to progress.
Ketamine's anesthetic effects are mediated by interactions with a member of the glutamate receptor family, the NMDA receptor. It interacts with other receptors as well, including opioid receptors, dopamine receptors (it appears to reduce dopamine deficits in a brain circuit involving the hippocampus and the nucleus accumbens) and a receptor known as the AMPA receptor, thought to be an important component of its antidepressant effects. Instead of targeting neurotransmitters in the brain, ketamine is thought to target gene expression and protein manufacture in certain important brain pathways or circuits. It rapidly activates a biochemical pathway associated with synaptic plasticity, the mTOR pathway, by increasing expression of a gene encoding the protein BDNF, which gets the m-TOR pathway going. Activation of the protein-making machinery of this pathway in brain cells leads to an increase in the number of synapses in the prefrontal cortex and the increased formation of synaptic signaling proteins. Put simply, ketamine appears to restore brain synapses, both structurally and functionally, that have been damaged by the disease of depression. As one NPR article reported, describing a discussion with researcher Carlos Zarate, “[Zarate] says depression not only weakens connections between neurons; it affects the neurons themselves. ‘A healthy neuron will look like a tree in spring: you have branches, you have leaves.’ (Zarate says the leaves are synapses.) ‘What happens in depression is there’s a shriveling in these branches, these leaves, and it looks like a tree in winter. And a drug like ketamine does make the tree look like one back in spring.’ Zarate says the change is obvious and almost immediate.”
Because it is abused as a "party drug" or "club drug," there are legitimate concerns about ketamine addiction. It currently does not meet criteria for being physically addictive, though tolerance to its effects may occur with prolonged exposure. It may pose a risk of being psychologically addictive for some. Here at the Ketamine Healing Clinic of L.A. we prescribe the Ketamine nasal spray, which we have not found to be addictive.
Patients do not have to stop their antidepressant medications to receive ketamine. Ketamine can be used safely with most medications including SSRIs, SNRIs, lithium, Wellbutrin, and tricyclics (with caution). Patients taking aminophylline for asthma or COPD may be at greater risk for developing seizures if they receive ketamine. Patients who are taking benzodiazepines (alprazolam, lorazepam, clonazepam, etc.) or lamotrigine (Lamictal) should work with their prescribers to wean off these medications prior to beginning ketamine infusion therapy in order to maximize the treatment's efficacy. If that's not possible Ketamine treatment can begin with a proper plan discussed between you and the doctor.
Ketamine is not beneficial and may in fact be harmful or exacerbate symptoms in patients with schizophrenia, psychosis or individuals having a manic episode that have been diagnosed with Bipolar. If you have epilepsy, Ketamine is still a treatment option for you- however, please let us know so we can take the necessary dosage precautions. If you take Aminophylline for Asthma or COPD please let us know as the combination of Aminophylline with Ketamine may increase the risk of seizures. If you have uncontrolled high blood pressure please consult your primary care physician to treat your blood pressure before pursuing Ketamine treatments. Patients with cardiac arrhythmias or a history of a heart attack or stroke need to have a clearance note from a Cardiologist prior to receiving Ketamine.
While some pain conditions do respond to the Ketamine mood protocol, not all pain conditions will. This is especially true of back pain. Chronic back pain does require a much higher dosage which would be infused over multiple hours. For Depression it would be one hour at a lower dose.
The pain protocol can help with depression, but it is not ideal because higher doses of ketamine require some sedation to be tolerated. And there is the possibility that sedation can impede in the dissociative aspect of Ketamine which can have a therapeutic effect. That being said, I have many patients whose depression is lifted with a high dose pain protocol.
We ask that opiates not be taken on the morning of an infusion. Eventually, patients whose pain has responded to Ketamine significantly decrease or stop using their opiates. This in turn has led many to see a lifting in their depression and greater daily productivity.
Ketamine can help with opiate withdrawal that is mild to moderate. Ketamine can also reduce opiate requirements for pain. However, weaning off opiates should always be done under the guidance of the prescribing physician so as to not elicit dangerous withdrawal symptoms.
Ketamine is not considered a permanent cure for any condition; but it is a highly effective alternative with minimal if any side effects. Some patients come back once every 4 months for continued relief, others once every 8 weeks, and some once a month. Everyone is different and there is no way to predict it until the treatment is tried. However, many patients have done one treatment and felt relief for longer than six months. Others have needed our 5 day pain protocol to feel prolonged pain relief that lasts longer than a few months.
There are no large scale and good studies to provide a statistically significant answer to this question. However, of the patients I have treated, approximately 75% do benefit with significant pain relief, while 25% do not. Generally, if there is a high degree of anatomic pathology or nerve impingement, Ketamine therapy may be limited in providing pain relief. However, if the only other option is open surgery, Ketamine therapy may be worth trying at least once prior to proceeding with surgery. I have been surprised many times in my career with how much pain relief ketamine has provided.