Ketamine Infusion and Nitrous Oxide Therapy

Ketamine works directly on your brain, targeting Glutamate NMDA receptors there. Glutamate is the most abundant excitatory neurotransmitter that can cause neurotoxicity when unregulated. The drug blocks NMDA receptors from receiving Glutamate attack. Your body can then create new pathways in your brain and even generate new synapses.

Mental and physical illnesses can damage the synapses in your brain. Without healthy synapses, it’s hard for your brain to recover. But ketamine helps your brain regenerate and heal itself. More than 75% of people who try ketamine feel some therapeutic benefits. Most patients report an improvement in their mood, better energy levels, and less physical pain.

Researchers are still unsure of how ketamine therapy helps those suffering from psychiatric disorders or brain conditions. However, it’s theorized that by blocking NMDA receptors, which is responsible for the excitatory neurotransmitter glutamate, it activates other receptors in your brain and creates new pathways for neural communication.  

Referred to as synaptogenesis, the creation of the new pathways may lift your mood and change the negative thought patterns associated with your psychiatric disorder.

Unlike other psychiatric treatments, including antidepressants, ketamine therapy works almost immediately

Ketamine is administered intravenously (through an IV). Duration and prescribed dosage during therapy sessions can vary from patient to patient, but most sessions last one to two hours and occur in a clinical office setting. While Ketamine can be administered in other ways, such as intranasally, or intramuscular, studies have shown that administration intravenously is the most effective method for treatment. The dosage can be delivered and monitored with precision and tritiated accordingly throughout the session through an IV.

Ketamine has unique pharmacological action by blocking the Glutamate NMDA receptor and activating sigma-1 receptor mood regulation and pain control.  Many conditions can be treated by Ketamine Infusion Therapy, including depression, anxiety, PTSD, mania and chronic pain such as Fibromyalgia, Complex Regional Pain Syndrome, Headache, and Neuropathic Pain. .

These qualities make ketamine infusion an excellent option for people with:

• Treatment-resistant depression

• Chronic pain

• Fibromyalgia

• Anxiety

• Migraines

• Bipolar disorder

• Obsessive-compulsive disorder (OCD)

• Complex regional pain syndrome (CRPS)

• Post-traumatic stress disorder (PTSD)

BEFORE  

Before your infusion, you will be given a comprehensive physical and neurological exam. Our physicians can determine the appropriate dosage, duration, and course to best support your healing by utilizing years of experience working with patients with mood and pain disorders. Your treatments may be modified before each session depending on your improvement.

DURING  

Once a protocol is determined, your ketamine infusions will be delivered in a safe and comfortable environment. Your IV will be established, and the treatment will begin with ketamine being infused into your bloodstream. Throughout the infusion, your blood pressure, heart rate, and oxygen saturation are monitored under the supervision of the anesthetist. The anesthetist will titrate the medication doses based on your needs.

AFTER  

Once the duration of the treatment is complete, the IV will be shut off. Any sensations you may have felt during the infusion will quickly wear off within 15-20 minutes, and the medication will be entirely out of your system within a few hours. You will be observed by a medical professional for about 30-45 minutes after the treatment is complete, at which time a loved one can take you home.

Nashville Brain Institute emphasizes individual treatment based upon deeper understanding of the brain chemicals and brain functions. We do Brain Executive Function Testing, Neurotransmitter Assessment, and Pharmacogenetics Testing. This clinical information will give a better predictions to guide the Ketamine treatment with higher response rate. If you’re not sure whether ketamine is right for you, Nashville Brain Institute will provide consultation. During your consultation, you meet with a licensed physician or Nurse practitioner (NP).  Your provider reviews your medical history and asks about your symptoms. They help you decide if ketamine is a good fit.

Alternative to Ketamine treatment:

Nitrous oxide works on the similar pathways as ketamine and may be a good option for severe treatment-resistant depression. The nitrous treatment is similar to a ketamine treatment – resting in a comfortable chair to receive the medication for about 45 – 60 min, but uses a soft mask to deliver the gas mixture instead of an IV, and nitrous has less visual and sensation hallucinations than with a ketamine infusion.

We offer nitrous oxide as an alternative to ketamine for patients who don’t prefer the experience of ketamine or do not want to deal with IV

Nitrous oxide, also called laughing gas, was discovered in 1772. It is a clear gas with a pleasant, sweetish odor and taste. Inhalation of small amounts causes a euphoric sensation, and in larger amounts it causes an anesthetic effect. It was quickly adopted, and still used widely, as a safe option to make dental procedures tolerable. By the 1880s women were using it for pain relief during childbirth – including, famously, Queen Victoria!

Nitrous oxide blocks the NMDA receptor which is generally considered as the mechanism of quick response of the antidepressant effect. 

Although nitrous oxide is considered as off-label use for the treatment of depression, there are numerous clinical studies on the efficacy of nitrous oxide inhalation treatments for depression. Those clinical results are promising – with substantial and durable improvements in symptoms of depression, anxiety, and suicidality.

Nitrous oxide is very safe when carefully and thoughtfully administered by a trained professional in a monitored setting. We use relatively low doses of Nitrous Oxide (25% to 50%)  with a carefully titrated dose to deliver the best outcomes. 

The common side effects are headache, spacing-out feelings and nausea. With very extreme and prolonged exposures, patients can have difficulty metabolizing vitamin B12 which can lead to anemia and nerve damage – these exposures are far greater than from periodic clinical treatments and we do not expect to see these issues.

Compared with ketamine, nitrous oxide also has a relatively rapid onset of antidepressant action (within about 2 hours) but does not result in “psychotomimetic” side effects seen with ketamine (dissociation or hallucination). After the treatment, the patient has quick recovery with no need for a ride to go home.