Protocols of Ketamine Delivery in Ketamine Therapy


How a Standard protocol for Ketamine infusions was established?

"Most ketamine clinics follow a protocol of administering intravenous ketamine 3 times per week for 2 weeks. This protocol was not based on an understanding of the unique pharmacology of ketamine but merely because this was the treatment protocol for electroconvulsive therapy (ECT; PR Shiroma, personal communication). As a result of an almost random decision, the “established” protocol for ketamine infusions became 3 times per week; however, is this frequency supported by the mechanisms of action of ketamine?"

Read full article Painting Ketamine in a Bad Light by Theodore Henderson, MD, PhD


What are the mechanisms of action of ketamine?

"Ketamine activates the production of brain-derived neurotrophic factor (BDNF), which is the brain’s own repair inducer. Not only does ketamine increase BDNF, but it also increases the number of receptors to which BDNF binds. As a result, over time, there is more repair factor and more receptors available to be activated by the repair factor. The outcome is that over a period of weeks, neuroplasticity and repair occur in the brain. This leads to reduction of depression, because depression is the result of the breakdown in circuits and damage to the brain."

Read full article Painting Ketamine in a Bad Light by Theodore Henderson, MD, PhD


Is standard protocol supported by the mechanisms of action of ketamine?

"If it takes weeks for this neuroplasticity to develop fully, it should not be surprising that people do not feel better at the end of 2 weeks of ketamine treatment. Moreover, if it takes weeks for BDNF to work, why should a person get 3 infusions in 1 week? That makes no sense.

On average, at Neuro-Luminance Brain Health Centers, our patients receive 4.3 ketamine infusions total over their entire treatment course of 5 to 7 weeks."

Read full article Painting Ketamine in a Bad Light by Theodore Henderson, MD, PhD


What is the dose?

In the clinical Ketamine Service at McLean Hospital: "The protocol includes an induction phase and either a booster or maintenance phase. The induction phase consists of 8–10 treatments on a twice-weekly schedule with the IV ketamine dose initiated at 0.5 mg/kg over 40 min; thereafter, titration to response was permitted in a conservative fashion at the discretion of the ketamine team with the maximum dose up to 1.0 mg/kg.

In terms of dosing strategy, there is currently no established consistent and optimal dose of intravenous ketamine for TRD. Nevertheless, small, randomized trials that compared different doses of ketamine suggest that generally, the preferred dose may be 0.5 mg/kg of body weight. However, dose adjustments may be appropriate for specific patients. A dose of up to 1 mg/kg may be suitable for patients not responsive to 0.5 mg/kg."



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