Treatment of Clinical Depression:
Ketamine infusion therapy has recently been shown to have beneficial effects on clinically depressed patients. The exact mechanism has yet to be elucidated. There is evidence that ketamine works by preventing the uptake of glutamate, an inhibitory neurotransmitter believed to be responsible for normal brain function, as well as evidence for ketamine leading to a burst of new connections to form between nerve cells in parts of the brain involved in emotion and mood.
Not everyone who receives ketamine for depression experiences any relief, but some studies show results of 60-70% range of response.
The technique is still performed as an infusion but in a much smaller dose and shorter duration than required for pain management. All details of ketamine infusion therapy as explained in this site that are not specific to the action in pain management apply equally to depression. I encourage any prospective depression patient to use the search engine of your choice to fully investigate ketamine infusion therapy before requesting treatment.
Recently performed and published studies have shown that a very low dose of ketamine infused over one hour have had dramatic positive effects on clinical depression, especially with regard to suicidal feelings and in cases refractory to standard treatment. The results indicate a rather immediate resolution of depression, as early as immediately to a few hours, and the relief achieved lasts for as little as a few hours to as much as nine months, but in general most patients typically realize one to two weeks of relief. However ketamine is not touted as the "cure" for depression, and the relief is beneficial in breaking the depressive cycle and opening up the possibility of continued improvement through oral medication and/or psychotherapy. An additional benefit may be found in results which seem to indicate a greatly accelerated clinical response to traditional anti-depressant medications, in many cases showing clinical response in as little as one week as opposed to four to twelve weeks. There may be a clear benefit in a coordinated therapy of a single one hour ketamine infusion combined with a newly prescribed oral anti-depressant pill with a result of immediate relief of depression from the ketamine infusion with continued and hopefully long term relief resulting from the accelerated effects of the oral pill.
In particularly severe cases of clinical depression ketamine infusion therapy can be used to allow standard treatment to benefit by diminishing the severity of depression.
In those cases which have failed all traditional forms of anti-depressant treatment, and as a result have no further option than Electro Convulsive Therapy (ECT), it may be reasonable to try a single ketamine infusion. When factoring all the negative side effects of ECT such as damage to additional areas of the brain or permanent change in affect, etc., into the equation, ketamine may be a better choice. In the doses used in treatment of depression, there is little chance of additional damage or change in affect except of course the loss of depression.
Even taking into consideration that the effect of ketamine may be short, weigh the advantages and disadvantages of ECT vs. weekly ketamine infusions, if necessary.
We are always trying to improve our techniques and are hoping to discover whether higher doses, consecutive infusions, or any other variance undertaken with complete patient safety may yield better and longer lasting results. Ketamine infusion therapy as a treatment of clinical depression is still relatively new, but safe. We are participating in a multi-disciplinary study to try and answer many of these questions. The Mayo Clinic did some investigation as to whether multiple daily doses of ketamine would better relieve depression, and sustain the relief longer than single low dose. Their results were inconclusive. However the low dose of ketamine used to treat depression is extremely safe in the right hands, and if a patient desires multiple day treatment, it will be made available. More research is needed in this field.
There are many variations of protocols for administering ketamine to help depression, not so much in dosage, but in frequency of administration. Most clinicians still advocate a single low dose infusion followed by adjuvant therapy. There a re also advocates of four doses given over two weeks, roughly equally spaced, and there is a protocol giving six courses, essentially one every other day, followed by occasional booster doses as needed. Only the patient in consultation with their psychiatrist should determine which protocol to follow, there is no clear evidence yet showing superiority of one protocol over another. Unless and until it is proven nthat there is a "best" protocol, Dr. Leverone is capable of delivering ketamine using any of the accepted protocols in collaboration with each patient's psychiatrist.
We have actual clinical experience demonstrating resolution of depression with treatment by ketamine infusion therapy. Any patient wishing to receive treatment for depression using ketamine administered by Dr. Leverone should first fully investigate the drug, as well as the published reports of therapy, and must remember that like any ketamine infusion therapy treatment of depression utilizing ketamine infusion is purely elective and there is no guarantee whatsoever of any beneficial result.
Requirements for Treatment:
Requirements for treatment for depression include provision of a recent (within the preceding 30 days) complete History and Physical from your general practitioner or internist, and a written diagnosis and clinical summary of your depression from your psychiatrist or treating psychotherapist, and a driver. Usually no specific lab work or ECG is required, unless something in the medical history warrants.
On the day of treatment the patient will receive an IV of course, and monitors for vital signs will be applied, but the patient may remain in their street clothes. The infusion is preceded by very mild sedation as a protective measure against ketamine induced dreams, and the drug is given over one hour. Most patients are ready to leave the Center within 30 minutes to one hour after the cessation of treatment.
Patients are not allowed to drive or operate machinery, care for others, or sign important papers on the day of treatment, therefore it is required that the patient arrange a driver to and from The Center and preferably someone to stay with them that day.
It is highly recommended that patients bring with them their preferred form of relaxing music with headphones to listen to during the infusion.
Total cost per depression treatment is $1000.00 all included. Please note that we do not accept insurance of any kind. Payment may be made in cash or credit card (Visa, MC, Amex only) or by personal check, but personal checks will delay treatment because we will need to wait for the check to clear your bank.
Treatment is offered at:
Central Coast Surgery Center
160 Green Valley Road
Freedom, CA 95019
If any patient wishes to proceed, please first complete the contact form and complete the depression questionnaire.
BUT YOU MUST CONTACT DR. LEVERONE FIRST VIA THE CONTACT FORM AND QUESTIONNAIRE, THEN YOU WILL BE TOLD TO CALL THE CENTER. DO NOT CALL THE CENTER WITHOUT FIRST SUBMITTING THE CONTACT FORM AND COMPLETED QUESTIONNAIRE.
Since the treatment for depression is so short, and can often be fit into even a busy schedule, after communicating with Dr. Leverone, the patient may schedule his/her own treatment. Call the Center and ask to speak to the scheduler, verify that you have been in contact with Dr. Leverone and you wish to schedule.