New England Ketamine PLLC
288 N Broadway Unit G, Salem NH 03079
Treating Provider: Casey Brachvogel, CRNA
During this consultation we discussed the relevant medical and psychiatric history and any concerns regarding these. We also talked about the potential physical and emotional toll this treatment course can take on both patients and families / supporters. Specifically, l outlined possible symptoms and side effects during infusions, including but not limited to: light headedness, nausea, vomiting, a feeling of heaviness, oral numbness / fullness, perceptual distortions involving size and/or distance of hands and feet, visuospatial disturbances, slowing of speech production, hallucinations / mental visions, euphoria, dysphoria, panic, feelings of motion or floating out of body, or, of the room changing shape or closing in, recall of traumatic memories/feelings, and metaphysical insight.
I also talked about what can occur between infusions, including a significant downturn in mood the first or second post-infusion day, backsliding despite improvements, headache, fatigue, vertigo (rarely), sleep disturbances, emotional vulnerability / feeling of being emotionally raw, tearfulness, and dredging up of repressed issues. I explained that ketamine therapy can be difficult and rocky, and that improvement can be subtle or incremental, with functional gains often preceding improvement in mood symptoms. I offered a reminder that I am not a qualified therapist, or, a mental health provider, and cannot offer professional help in that specific arena (which is why I stress the importance of a treatment team approach here), but I do sit with patients during the infusions to offer reassurance, support, and listening. I also made clear that ketamine is not FDA-approved for depression and that its use for mental disorders is off-label, albeit legal.
I mentioned that the effects of ketamine can vary greatly among individuals and are often unpredictable - even to the point of infusions experienced by the same person sometimes feeling very different from one another. I outlined the typical treatment course/s here, of an induction phase consisting of six infusions in the space of two to three weeks, followed by a maintenance phase, usually beginning with a maintenance infusion every two to three weeks, then increasingly spaced apart based on ongoing and collaborative discussions for mental health. And for chronic pain it is an initial series of 3 infusions, with additional infusions as needed, discussed and planned 2 weeks after treatment, once pain reduction scores can be adequately assessed. Booster pain infusions scheduled as needed, usually one to two based on pain severity and length from last treatment. I discussed that ketamine might not work to adequately treat their pain. I mentioned that despite its observed benefit as a reliever of depression and suicidal ideation, ketamine treatment can rarely, paradoxically, worşen symptoms and/or suicidality, and should this occur, immediate emergency medical attention should be sought. I gave opportunity to voice any concerns and ask questions, and we discussed these until the patient was satisfied.
H & P Performed by: