FAQs
Frequently Asked Questions
What is ketamine?
Ketamine is a generic medication that has been used as a surgical anesthetic for more than 50 years. It is FDA-approved for that purpose, and the World Health Organization considers it an “essential medication” for any medical system in the world. In addition to its anesthetic effects, in recent decades low doses of ketamine have been found to exert powerful beneficial effects on neurons (nerve cells) which have proven to be useful in treating many conditions that affect the brain, including: • Depression (including treatment-resistant depression and post-partum depression) • Anxiety disorders • Obsessive-compulsive disorder (OCD) • Post-traumatic stress disorder (PTSD) Ketamine has also also been found to help other disorders of the nervous system that result in chronic pain, such as: • Sciatica • Fibromyalgia • Migraine headaches • Various forms of chronic nerve-related (neuropathic) pain
How does ketamine work?
Pharmacologically, ketamine acts by blocking NMDA receptors found on neurons in the central nervous system. However, it is not fully understood how or why this results in ketamine’s beneficial effects. Ketamine’s many novel effects on the brain are an active area of ongoing medical research, but neuroscience has shown that ketamine promotes the growth of new nerve synapses in the prefrontal cortex of the brain. This encourages the development of new neural connections and pathways that support positive thoughts and behaviors, and enhance psychological flexibility and ability to change. Scientists call this process of forming new connections in the brain “neuroplasticity”. In this way, ketamine can be thought of as “rewiring” the brain. One leading physician-scientist researching ketamine has described it as “awakening the mind”.
How is ketamine different from other antidepressant medications (like Prozac, Zoloft, Lexapro, etc.)?
Ketamine has been studied most extensively for the treatment of depression, and has rightly been called the first new type of antidepressant to come along in decades. Unlike most antidepressants which are pills that must be taken every day (sometimes multiple times a day), ketamine is administered by IV infusion typically no more than a few times a year. Ketamine works by a completely different mechanism than traditional antidepressant medications (such as SSRIs). For this reason, it tends to work much faster than those medications and can often help even when those others don’t. What’s more, ketamine does not interact negatively with those other antidepressants, so ketamine can be used together with them.
Is it necessary that I have tried and failed other antidepressants before pursuing ketamine therapy?
No, while ketamine is often used to help people who have not responded well to other antidepressants, it is not necessary to have been prescribed those medications before pursuing ketamine therapy. In fact, if you are currently taking other antidepressant medications but feel you are not getting enough relief, it is possible to pursue treatment with ketamine while still taking your other medications.
How is ketamine administered?
At Ketamine Center of Central Georgia, Dr. Greenberg will administer ketamine by slow intravenous infusion (typically through an IV placed in your arm) over 40-60 minutes in a calm, quiet, comfortable environment. Clinical studies have demonstrated that a series of six IV ketamine infusions (referred to as the “induction” series) should be administered over the course of 4-6 weeks in order to achieve optimal therapeutic results, followed by periodic “maintenance” infusions as necessary to maintain those positive results. The dosing schedule for treatment of chronic pain conditions differs somewhat. For specific treatment protocols, see the “Treatment Plans” section of our site.
How soon can I expect results?
Ketamine is considered a revolutionary treatment largely because it works so much faster than traditional antidepressants (which can take up to 6 weeks to take effect). Many patients can experience improvement almost immediately after an infusion, but some may not notice a difference until hours or even days after infusion. Alternatively, some patients experience steady, incremental improvement in their symptoms with each subsequent infusion. There are also a few patients who may feel temporarily worse after an infusion before starting to feel better.
How long do these results last?
A single IV ketamine infusion may provide temporary relief for a few weeks, but it is very important to note that clinical research has shown that the initial “induction” series of six infusions (over 4-6 weeks) is essential to achieve sustained positive results. For many patients, this means a remission of their symptoms that can last months or even years. However, most patients will require occasional “maintenance” (or “booster”) infusions to “maintain” their positive results. Medical science has not yet defined how frequent these “booster” infusions should be, so Dr. Greenberg will individualize each patient’s treatment schedule guided by their symptoms and response to treatment. Typically, “booster” infusions are necessary no more once every 1-3 months.
How likely is ketamine to help me?
As noted above, ketamine has been studied most extensively for the treatment of depression, and clinical studies have shown that as many as 70-80% of patients experience significant improvement of their symptoms. By comparison, SSRI medications―which have for decades been considered the “gold standard” for the treatment of depression―have been reported in various studies to result in a similar degree of improvement in no more than 20-40% of patients. Moreover, recent studies (including one published in the New England Journal of Medicine, perhaps the most prestigious medical journal in the world) have shown that ketamine works at least as well for the treatment of severe depression as electroconvulsive (“electroshock”) therapy, which has long been considered the most powerful, “last resort” treatment for depression. This is especially hopeful news given that ketamine treatment is far less intensive than ECT and has many fewer risks and side effects.
Since ketamine is an anesthetic, will I be asleep during a ketamine infusion?
No, the doses required to achieve ketamine’s beneficial therapeutic effects are significantly lower than the doses used in anesthesia, so while you will likely feel drowsy and serene during a ketamine infusion, it will not "put you to sleep".
What can I expect during a ketamine infusion?
During IV ketamine infusion, in addition to drowsiness it is common to experience a dream-like state of mind, feelings of dissociation (“out of body” experience), and perceptual changes such as seeing colorful shapes or patterns. Many patients find these experiences pleasant.
What are potential side effects of ketamine?
Ketamine is typically very well-tolerated and its side effects are generally mild and manageable. The most common unpleasant side effect experienced during/immediately after ketamine infusion is nausea. This can be easily managed by an anti-nausea medication administered before/during treatment. During infusion, ketamine can also cause elevated blood pressure and heart rate (for which patients are observed closely, and can be treated if necessary). In the hours after infusion, ketamine also commonly causes short-term dizziness, fatigue, difficulty concentrating, and dry mouth. These side effects typically subside after a good night’s rest, but it is essential that a patient not drive (or operate machinery, etc.) for at least 12 hours after a ketamine infusion. Ketamine can also theoretically result in a flare-up of interstitial cystitis (an inflammatory condition of the bladder), though typically only at much higher doses. Please be sure to notify Dr. Greenberg prior to treatment if you have a history of interstitial cystitis.
Is ketamine dangerous?
Any medication can be dangerous if misused and ketamine, like all prescription medications, should only be used under a doctor’s supervision. When used appropriately, ketamine is a very safe medication with few risks and side effects. In fact, ketamine’s track record of safety is one reason it is favored as an anesthetic for even young children undergoing surgery. Moreover, the doses of ketamine necessary to achieve its beneficial therapeutic effects are significantly lower than those necessary for anesthesia, further minimizing risks and side effects.
Is ketamine addictive?
As with many medications, misusing ketamine (that is, taking it too frequently and/or at too-high doses) could result in addiction/dependence. However, at the low therapeutic doses and dosing frequencies used in the course of ketamine infusion therapy, there is effectively no risk of addiction or dependence.
Is ketamine a narcotic?
No, ketamine is not a narcotic. Ketamine is, in fact, a very unique anesthetic, and so does not have many of the risks and side effects common to narcotic medications (and even many other anesthetics). Unlike those medications, ketamine does not lower the heart rate, blood pressure, or respiratory rate; does not cause amnesia or constipation; and does not cause withdrawal when stopped.
Is ketamine a “horse tranquilizer”?
This is an exceptionally common question! The simple answer is that ketamine is a very safe and effective anesthetic, so it has long been used as a sedative (“tranquilizer”) in both human and veterinary medicine. So while it certainly can be used to sedate horses (and many other mammals as well), it is also commonly used (at much lower doses) for human adults and especially children. A few reasons why ketamine is favored in veterinary medicine specifically are: ketamine, unlike other anesthetics, remains effective even when administered by intramuscular (rather than intravenous) injection―which is very helpful in creatures who might make placing an IV challenging―and is so safe that it does not typically require continuous vital sign or airway monitoring. These are also reasons why ketamine is favored as an anesthetic for even young children undergoing surgery.
Is ketamine a “party drug”?
As noted above, almost any medication (particularly those with psychoactive properties) can be misused or abused. Ketamine is no exception, due to its ability to cause an altered state of consciousness. However, the fact that ketamine can be abused does not invalidate the very real medical benefits it can offer when administered responsibly under a doctor’s supervision. In fact, it is theorized that some “recreational” drug users turn to illicit substances in an attempt to “self-medicate” for legitimate mental health conditions that would be better addressed in an appropriate clinical setting.
Is there a minimum age to undergo ketamine therapy?
As mentioned previously, ketamine is known to be safe for use even in children, and its beneficial mental health effects have been utilized in teenagers. If you have a teenager (younger than 18) for whom you would like to consider ketamine therapy, please schedule a consultation with Dr. Greenberg to discuss further.
Who is NOT a good candidate for ketamine therapy?
Ketamine therapy is not a good option during pregnancy. Patients with a history of schizophrenia (or psychosis) should not undergo ketamine therapy. Patients on buprenorphine (Suboxone) may not be eligible for ketamine therapy. Please schedule a consultation with Dr. Greenberg to discuss further.
Does Ketamine Center of Central Georgia offer Spravato?
No, Ketamine Center of Central Georgia does not offer Spravato. Spravato (esketamine) is a brand-name derivative of ketamine that is administered as a nasal spray. While this may be a reasonable option for some patients, multiple studies have shown that esketamine is actually not as effective as ketamine for the treatment of these conditions. Also, the absorption of any medication through the nasal mucosa (the sensitive tissue inside the nose) is not as consistent or predictable as an IV infusion, so intranasal Spravato is considered to be less controllable and thus less dependable than ketamine infusion therapy.
Do I need a referral to Ketamine Center of Central Georgia?
No referrals are necessary. Feel free to schedule a consultation at your convenience.
Do I need to see a psychiatrist, or to have been previously diagnosed with the above conditions, before coming to Ketamine Center of Central Georgia?
No, it is not necessary that you have seen a psychiatrist in the past nor that you already carry a diagnosis of any of the above conditions prior to coming to Ketamine Center of Central Georgia. At your initial consultation, Dr. Greenberg will conduct a thorough evaluation to determine if you are an appropriate candidate for ketamine infusion therapy. If you are already under the care of a psychiatrist or other specialist, however, we encourage you to continue seeing them, and Dr. Greenberg is happy to communicate with them to coordinate your care.
Is ketamine infusion therapy covered by insurance?
Although ketamine has been FDA-approved for other uses (anesthesia) for more than 50 years and has a long and growing track record of safety and efficacy, the use of ketamine for the treatment of these conditions is still considered “off-label” by the FDA. For this reason, it is typically not (yet) covered by insurance. However, many patients have success using their insurance to help partially defray the cost by utilizing a “superbill”―an itemized list of healthcare services which we are happy to provide―that you can submit to your insurance to request reimbursement as an “out of network” service. At Ketamine Center of Central Georgia, we try to make the payment process as straightforward and painless as possible and offer a variety of payment options, including: credit/debit card, cash, check, health savings account (HSA) or flexible spending account (FSA), various online payment platforms, as well as several online "buy now, pay later" payment plan systems. For more information, please see the “Treatment Plans” section of our site. We are also working towards being able to accept the CareCredit "health and wellness" credit card (designed exclusively for healthcare services, with special financing options).
Why isn’t ketamine therapy used more commonly?
Part of what limits ketamine’s wider availability is the unfortunate lack of insurance coverage. While ketamine is known to be safe and effective, its lack of formal FDA approval for these conditions makes insurance companies reluctant to pay for ketamine infusion therapy. And since ketamine is a generic medication (that has long outlived its patent), there is no financial incentive for big pharmaceutical companies to fund another lengthy and expensive FDA approval process. Another barrier is the equally unfortunate stigma that can be associated with ketamine (and other so-called “psychedelic” medications). While there is an ever-growing body of scientific evidence supporting ketamine’s legitimate medical uses, many people (including some doctors) continue to mistakenly associate ketamine with recreational drug use. It is hoped that as more and more evidence accumulates for the revolutionary potential of this medication, these outdated cultural biases will fall by the wayside.
Does Ketamine Center of Central Georgia offer discounts for military personnel or first responders?
Absolutely. At Ketamine Center of Central Georgia, we are enormously grateful to the brave men and women who serve in our Armed Forces and help keep us safe at home, and we recognize that they may be at significantly higher risk for many of the conditions that ketamine therapy can help. Therefore, we are honored to offer discounts to active-duty military personnel, military veterans, and first responders.
