Nebulized Ketamine therapy for Major Depression, Bipolar Disorder, and PTSD

NebKet method was developed by an anesthesiologist Dr. Brian Stanton in August 2017

Ketamine therapy is still poorly understood, but appears to produce a reset of the emotional regulatory systems of the brain. Depression is a complex and thorny problem best addressed with a team approach. It is generally recommended that patients pursue psychotherapy with a trained practitioner, and not depend on the infusions alone.

Safety: Although the drug has no known lethal dose, overdose is still a bad event as it can cause possibly nightmarish hallucinations, where a patient could potentially harm themselves or others. A patient could possibly become incontinent as well - not a desirable outcome. To avoid this, blood level of Ketamine should be tightly controlled. This is why a computer-controlled IV pump is the gold standard.

Nebulized Ketamine (NebKet) is an alternative method of Ketamine administration which avoids the risks, costs and inconvenience of the IV method while delivering an almost identical benefit.

Delivery of Ketamine via a Nebulizer with a mask provides good control of Ketamine blood level. Absorption through the lungs is rapid and consistent. This obviates the need for an IV permitting self-administration. Self-administration promises to dramatically reduce the cost of this therapy. There is also a high safety window as the Nebulizer can be switched off or the mask removed by the patient. It is important to use a free standing Nebulizer with the mask, not a hand-held variety. Read FAQ on Nebulized Ketamine>

 

Infusions or NebKet?

So what is the advantage NebKet over IV?

1) NebKet is a safer procedure- IV administration comes with its own list of risks and complications. These include infection, hematoma, that is, continued bleeding from the vein under the skin after either ‘spearing’ the vein through when attempting to place the IV or later after removing a properly placed catheter from a vein that continues bleeding. IV’s can be inadvertently disconnected with subsequent blood loss, infiltration can occur (where medicine is infused into the subcutaneous tissue instead of into the vein), and more rarely blood clots, nerve damage and thrombophlebitis.

2) Fear of needles- Some patients are positively terrified of needles. Causing massive anxiety just prior to giving Ketamine is not a great idea since the drug is a hallucinogen and tends to ‘magnify’ the emotional state of the patient.

Most clinics would agree that anxiolytics are counterproductive as they worsen depression. Local infiltration with lidocaine might be helpful, but can make placement more challenging. Patients with a history of IV drug abuse, or multiple hospitalizations can be very challenging.

3) Veins are precious- There is a growing awareness in the medical profession that ‘veins are precious’. Huge numbers of patients are presenting in hospitals who have had multiple hospital admissions and thus multiple vein sticks, whose peripheral veins are now extremely fragile and limited. Any technique that can preserve the veins in these patients is highly valuable. This goes double for any patient with a history of IV drug abuse.

4) Patients are more comfortable when they have more control over the procedure- There is a therapeutic window where the patient experiences an intense effect from the Ketamine without crossing into dissociation that seems to produce the most benefit. The patients themselves have a very good sense of whether they are losing control, and found it quite comforting to know that they could simply pull the mask off their face at any time.

5) A cost saver for the patients- Self-administration promises to dramatically reduce the cost of this therapy.

6) Income stream for physicians- If some intrepid Physicians, CRNA’s, APRN’s or PA’s out there with prescribing power start writing these prescriptions, they might find it to be a very nice supplementary income stream. E.g., charge $50/visit for checkups and renewals without any of the expense and heartaches associated with filing with insurance companies, and avoid the risks, time and expense of IV infusions. Collect 1000 patients and bingo, nice income stream. Initial sessions should be conducted under the auspices of the clinic setting, with patients self-administering in their homes after that. There could be a setup where patients are only dispensed only 1 or 2 treatments/month and not the ad libitum situation as with Nasal.

7) Ease of administration- The expense of IV supplies versus nebulization is comparable. But consider also how easy it is to administer NebKet.

8) Using self-administration patients don't need to take a day or even a week from work to travel to the nearest Ketamine Clinic.

 

NebKet vs. Intranasal Ketamine

It is important to note the distinction between nasal administration where precision and absorption depends on absorption in the nasal mucosa of an imprecise nasal spray vs. nebulized Ketamine where ketamine concentration of the vapor is far more precise and absorption occurs more reliably in the lungs.