80357 Ketamine and norketamine

Name of the Procedure:

Ketamine and Norketamine Therapy (also referred to as Ketamine Infusion Therapy or Ketamine-Assisted Therapy)

Summary

Ketamine and norketamine therapy involves the administration of ketamine, an anesthesia medication with powerful analgesic and antidepressant properties, and its metabolite, norketamine. This therapy is used to treat various mental health conditions and chronic pain syndromes. It is most commonly administered intravenously but can also be given via other routes depending on the diagnosis and treatment plan.

Purpose

The primary purpose of ketamine and norketamine therapy is to alleviate symptoms of severe depression, especially when other treatments have failed. It is also used to manage chronic pain conditions and treatment-resistant mental health disorders, including PTSD and anxiety. The goals include rapid relief of depressive symptoms, significant reduction in pain, and improvement in overall quality of life.

Indications

• Major depressive disorder (especially treatment-resistant depression)
• Bipolar depression
• Post-traumatic stress disorder (PTSD)
• Chronic pain conditions (e.g., neuropathic pain, fibromyalgia)
• Severe anxiety disorders

Preparation

• Patients may be instructed to fast for up to 6 hours before the procedure.
• Medication adjustments might be necessary, especially for antidepressants or pain medications.
• Pre-procedure assessment includes psychiatric evaluation, medical history review, and sometimes blood tests or EKG.

Procedure Description

1. Patient arrival and check-in.
2. Intravenous (IV) line insertion for ketamine administration.
3. Baseline monitoring of vital signs and mental status.
4. Continuous monitoring during ketamine infusion, typically lasting 40 minutes to an hour.
5. Administration of ketamine at a carefully titrated dose to achieve therapeutic effects.
6. Post-infusion monitoring for at least 2 hours to ensure safety and stability before discharge.
   • Tools include IV drip systems, blood pressure cuffs, pulse oximeters, and cardiac monitors.
   • Generally, mild sedation is involved, but anesthesia is not required.

Duration

The infusion typically lasts between 40 minutes to an hour, with total time commitment including monitoring being around 2-3 hours.

Setting

This procedure is performed in a controlled medical environment, such as a hospital, outpatient clinic, or specialized infusion center.

Personnel

• Physicians (typically a psychiatrist or anesthesiologist)
• Registered nurses
• Possibly a psychologist for integrated therapeutic support

Risks and Complications

• Mild disorientation or dizziness
• Nausea or vomiting
• Elevated blood pressure or heart rate
• Rarely, adverse psychiatric reactions such as hallucinations or agitation
• Complications are managed by the medical team with supportive therapies or medication adjustments.

Benefits

• Rapid onset of antidepressant effects (often within hours)
• Potential significant relief from chronic pain
• Improvement in mood and mental clarity
• Benefits can be noticed shortly after the procedure and may last for days to weeks, depending on individual response and treatment plan.

Recovery

• Monitoring recovery period of 1-2 hours post-infusion
• Patients often require someone to drive them home
• Follow-up appointments to assess effects and determine further treatment
• Limited activities for the remaining day, and gradual return to normal activities as tolerated

Alternatives

• Conventional antidepressants and mood stabilizers
• Electroconvulsive therapy (ECT)
• Transcranial magnetic stimulation (TMS)
• Cognitive-behavioral therapy (CBT)
• Pros: Other treatments may have longer-lasting effects and fewer acute side effects.
• Cons: Alternatives may take longer to show results or be ineffective in treatment-resistant cases.

Patient Experience

During the procedure, patients may feel relaxed, slightly dizzy, or mildly dissociated. Most report minimal discomfort. Post-procedure, some may experience mild euphoria, while others might feel temporarily drowsy or disoriented. Pain management and comfort measures include pre- and post-infusion support, as well as adjusting the infusion rate if necessary.