ketamine clinic

[rkaz]

So on my daily commute, I keep hearing this advertisement on the radio about 'Get relief from depression within an hour' at this Depression Recovery Center. The doctor there is an anesthesiologist who has made a center exclusively treating depression with Ketamine. Seems like a lucrative gig, with heavy direct-to-consumer advertising. Just wanted to know people's thoughts on this:

http://www.azcentral.com/community/...ens-in-scottsdale-for-chronic-depression.html

http://depressionrecoverycenters.com/

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Members don't see this ad.

 

[vistaril]

So on my daily commute, I keep hearing this advertisement on the radio about 'Get relief from depression within an hour' at this Depression Recovery Center. The doctor there is an anesthesiologist who has made a center exclusively treating depression with Ketamine. Seems like a lucrative gig, with heavy direct-to-consumer advertising. Just wanted to know people's thoughts on this:

http://www.azcentral.com/community/...ens-in-scottsdale-for-chronic-depression.html

http://depressionrecoverycenters.com/

we do it at my academic center(clinical trial).....lots of places are doing this, but I think they are still in clinical trial mode for the most part.

The word is that ketamine will eventually be commonly prescribed in clinics everywhere, probably in intranasal formulation. Not sure how long this is going to take.

There is also some local outpt guy in my area doing PO ketamine. No data this works, and he isn't making any money off of it. see below.

Note that he is cash pay, but his rate for a 1 hr session is 150/hr(and he gives some discounts) and 80 dollars for 25 minutes.

 

[birchswing]

NPR had an interesting piece on ketamine a while ago for children with extreme fear (various types of anxiety disorders). It sounded very promising. I've also heard about it being helpful with complex regional pain syndrome.

 

[heyjack70]

There isn't enough data yet to know it's safe for long term use, or that we even know why it's working. Ketamine has several effects (mu opioid receptors, serotonin norepinephrine and dopamine reuptake inhibition, and of course glutamate NMDA receptor blocking). It's safe for anesthesia, which might be a few times over a persons life. But if it only lasts for a week or two patients will be getting it much more frequently. I read that it causes irreversible neuron vacuoles in rats.

And the biggest study for depression only had 73 people in it. The total n for all the randomized controlled trials for depression is about 140 patients. The follow-up is about five weeks. The jury is still out on this medicine.

 

[strangeglove]

A number of anesthesiologists are doing this in NYC.


Sent from my iPhone using Tapatalk

 

[whopper]

A major researcher in this area that works with me presented a grand rounds on this. This is far too early for someone, especially an anesthesiologist, to be doing this. There are far too many unknowns with it. I'd suspect this doc, like some doctors giving out medical marijuana to everyone, are out to profit instead of truly treating.

Where I'm working, we are considering doing trial runs for extremely depressed and suicidal patients with Ketamine but it's going to be done under high scrutiny and the data will be used for research to advance the area.

 

[johnhoedack]

A major researcher in this area that works with me presented a grand rounds on this. This is far too early for someone, especially an anesthesiologist, to be doing this. There are far too many unknowns with it. I'd suspect this doc, like some doctors giving out medical marijuana to everyone, are out to profit instead of truly treating.

Where I'm working, we are considering doing trial runs for extremely depressed and suicidal patients with Ketamine but it's going to be done under high scrutiny and the data will be used for research to advance the area.

Don't be a pussycat. Go big or go home.

 

[whopper]

Some of the unknowns---
Ketamine can significantly reduce suicidal ideation, but for how long? That's the problem. If you got someone better that was suicidal, how long will they be safe? A week? A few hours? We don't know.

Same with depression. Another problem, will the person need ever increasing dosages to keep the depression at bay? If so should Ketamine treatment only be considered acute and only for a few days? Should it be administered only in person like a methadone clinic to prevent abuse?

There is research going on into how much should be given because there's data showing it can have useful benefits with mood at dosages that are not likely going to cause euphoria and then down-the-road, addiction. The problem here is it's not been researched well and this going on now. The acceptable dosage for depression is not yet at a level where there's an accepted standard.

Anyone making a clinic now, unless that clinic is heavily involved with the research is doing something that is not considered standard of care or something I would believe a reasonable practitioner would do and in the case of the anesthesiologist mentioned, he's not even working within his field.

Like I said before, a psychiatrist could do surgery in most states but if one did so, I'd think there was something seriously wrong with that psychiatrist. Hey, you could also buy a Tesla (the car) and let a complete stranger test drive it while you gave him the keys and trusted him to give it back to you. I woudln't do that either.

 

[heyjack70]

A ketamine clinic website I saw required a psychologist or psychiatrist to diagnose the "depression" and refer the patient for treatment with Ketamine . It seems like the anesthesiologist is trying to sidestep being the one deciding to treat depression with Ketamine. The logic is weak IMO, because he's still the doctor administering the medicine and knows it's an off label use. At least the anesthesiologist isn't diagnosing MDD themselves.

 

[whopper]

If you're in a state where you see this thing going on, you should consider contacting the state medical board and your local APA branch about this. If we have strong reason to believe bad practice is going on we should at least inform the right people that something could be amiss.

Off-label use is appropriate when everyting conventional and on-label was tried and failed, but Ketamine, given that it's a controlled substance, the prescriber is not a psychiatrist and it's a clinic, that just smells real fishy. Someone should be considered for antidepressant polypharmacy or ECT before something like Ketamine is tried given how little we know about it and that nothing is yet approved--by anyone. Kind of like those pill-mills that advertise in the City Beat alongside the escort services. I'm speculating that such doctors really want to be drug dealers like a pill-mill doctor and they've cooked up a front-business in the name of treating depression.

 

[F0nzie]

My substance abusers are curiously interested in the latest ketamine developments

 

[vistaril]

If you're in a state where you see this thing going on, you should consider contacting the state medical board and your local APA branch about this. If we have strong reason to believe bad practice is going on we should at least inform the right people that something could be amiss.

Off-label use is appropriate when everyting conventional and on-label was tried and failed, but Ketamine, given that it's a controlled substance, the prescriber is not a psychiatrist and it's a clinic, that just smells real fishy. Someone should be considered for antidepressant polypharmacy or ECT before something like Ketamine is tried given how little we know about it and that nothing is yet approved--by anyone. Kind of like those pill-mills that advertise in the City Beat alongside the escort services. I'm speculating that such doctors really want to be drug dealers like a pill-mill doctor and they've cooked up a front-business in the name of treating depression.

I see where you are coming from, but I'm skeptical how much ketamine drug seeking really goes on. Seems like that drug hit it's high water mark in the early 90s from LARGE doses stolen through vet clinics. Has since cooled considerably. I don't know that patients seeking substances are going to clamor for ketamine. For example we've had a ketamine study going on for a long time as tons of other places have, and we haven't had any problems with this. And many people/patients know about it too.

 

[Shikima]

My substance abusers are curiously interested in the latest ketamine developments

Advertise for the Special K treatment special... similarly to the "pain clinics" who give methadone for $150/month.

 

[whopper]

For example we've had a ketamine study going on for a long time as tons of other places have, and we haven't had any problems with this

A fair point, but drug use varies per region. Further, there's still several unknowns with this type of treatment. The doctor involved with it could be causing significant harm he/she does not yet know about that would've been caught with the type of standard of care patients and even health care professionals would expect to be reasonable such as professional society backing, backing by a recognized institution (e.g the state/VA) or FDA approval.

It could be such doctors prescribing at such clinics are doing so for benevolent reasons but...ON THE SURFACE.. I don't see a doctor jumping into such a brazenly risky venture unless it was for something selfish. A responsible doctor, if they wanted Ketamine available for mood treatment IMHO would do so using more reasonable avenues such as research.

 

[jettavr6]

My "n" is small, and I mainly do IV Ketamine infusions for pain, but I can say that I have noticed a fairly good response for depression. Some of my patients with comorbid depression and pain have done very well. Higher dosing seems to work better. Doesn't work for everyone.

Intranasal Ketamine as mentioned above in one of the posts --- doesn't seem to work at all.

 

[rkaz]

I really appreciate your posts, Whopper.

This whole thing makes me uncomfortable. I am wondering if patients are referred to this anesthesiologist's clinic by psychiatrists who have suggested ketamine treatment, or if patients are self-referred without even having seen a psychiatrist. Although I do not know the answer, unfortunately I suspect it's the latter, since this guy does significant advertising on the radio directly to the public. So people who know they have a problem are likely bypassing a psychiatrist (who is a specialist trained in mood disorders, and who has multiple treatment options) in order to go to an anesthesiologist who is giving them one option.

It seems the bothersome issues are as follows:
1.) Ketamine lacks sufficient research for depression, and should continue to have research done rather that doing it as a definitive treatment.
2.) An anesthesiologist has made his practice treating depression exclusively, going outside of his scope of practice
3.) Direct to consumer public advertising for this procedure - bypassing the PCP or psychiatrist

 

[vistaril]

I really appreciate your posts, Whopper.

This whole thing makes me uncomfortable. I am wondering if patients are referred to this anesthesiologist's clinic by psychiatrists who have suggested ketamine treatment, or if patients are self-referred without even having seen a psychiatrist. Although I do not know the answer, unfortunately I suspect it's the latter, since this guy does significant advertising on the radio directly to the public. So people who know they have a problem are likely bypassing a psychiatrist (who is a specialist trained in mood disorders, and who has multiple treatment options) in order to go to an anesthesiologist who is giving them one option.

It seems the bothersome issues are as follows:
1.) Ketamine lacks sufficient research for depression, and should continue to have research done rather that doing it as a definitive treatment.
2.) An anesthesiologist has made his practice treating depression exclusively, going outside of his scope of practice
3.) Direct to consumer public advertising for this procedure - bypassing the PCP or psychiatrist

well you have to understand that many of these patients trying this approach have *already* been to psychiatrists, and tried that approach.....they've been put on most all the classes of drugs before, in different combinations and different doses. So telling them to go *back* to a strategy they have tried vs something new/promising is pretty tough for them to see the value in.....

 

[whopper]

At my own institution, I attempted to put someone on Ketamine, but this is someone where the alternatives were brain surgery, or not getting a GAF better than 40 for at least years. I likely already mentioned this patient in other threads.

The same patient's case was reviewed by one of the top psychiatrists in the country, one of the top psychologists in the country, a pharmacist, and a few other psychiatrists becuase he is literally one of the toughest cases I've ever had.

Ultimately I didn't put him on it, but it was one of the last-resort options. I certainly wouldn't open what some of these other doctors are calling a "clinic" for such cases. The bottom line as to why I didn't try it is because even if it worked, I wouldn't have a way to continue his treatment on it in the community and we didn't know how long he should be on it due to the lack of data. All of the pharmacists in this area told me it could only be provided inpatient.

 

[jettavr6]

Ultimately I didn't put him on it, but it was one of the last-resort options.

You can do oral compounded capsules from a compounding pharmacy. However, oral dosing really doesn't do all that much.

 

[Euthymia]

Ketamine has been all over the news today.

http://www.bbc.com/news/health-26647738