CONSENT

INFORMED CONSENT FOR IN-OFFICE KETAMINE THERAPY

Ketamine is a dissociative class medication that is considered a schedule III-controlled substance. It is predominately used in the emergency department and in the operating room as an anesthetic medication. Ketamine is FDA-approved for anesthesia and pain relief during procedures. Ketamine is not considered FDA-approved to treat depression, PTSD, acute or chronic pain, or any additional conditions outside of anesthesia and pain relief during procedures.

The use of ketamine to treat the above conditions is considered “off-label” by the FDA. There is nothing wrong with using medication for “off label” purposes as a large percentage of medication prescribed in this country is for “off label” use. Ketamine therapy for psychiatric conditions and acute or chronic pain is considered safe, even though it is considered “off label”, but be aware that Ketamine has been used safely over the past 50 years.

Ketamine has been shown to improve the symptoms of various psychiatric conditions and pain in certain populations. Everyone’s response to treatment will be different but individuals usually report improvements in psychiatric symptoms and pain to be aware that symptom relief cannot be guaranteed. You need to be aware that symptom relief can last from days to months, therefore multiple treatments might be recommended or required for long-term symptom relief.

There are no long-term studies to show the safety or effectiveness of repeated ketamine treatments, therefore the potential long-term risks or treatment efficacy cannot be established for the treatment of chronic pain disorders, depression, PTSD, anxiety, and other psychiatric conditions.

What Can I Expect with Treatment?

The procedure for ketamine therapy is straightforward. You will get either oral or intra-nasal forms. If you are given a sublingual form, you will be given a tablet to keep under your tongue for 15-20 minutes and spit it later. You need to have someone to be with you before during, and after you take ketamine wither sublingually or intranasally.

After the treatment, you should rest for 30 minutes to 2 hours depending on your response. The amount and duration of the treatment with be decided in consultation with our certified psychiatrist

Risk

Any procedure or medication carries with it possible risks and side effects. Even though significant side effects are rare, you need to be aware of all the possible risks and side effects before starting treatment. Unknown or unexpected side effects or risks could also occur. Most side effects are mild in nature. Possible side effects include but are not limited to,

• Elevations in blood pressure and heart rate.

• Laryngospasm

• Urinary frequency, urgency, hesitancy, or burning with urination.

• Dizziness

• Headache

• Increased saliva production

• Restlessness

• Impaired coordination

• “Out of body” experiences

• Twitching of arms and legs

• Decreased appetite

• Nausea and vomiting

• Pain, rash, bruising, or possible infection

• Blurred or double vision

• Hives and allergic reaction

• Increased ocular (eye) pressure

• Hallucinations and flashbacks

• Increased mania or hypomania in bipolar disorder

• Increased suicidal thoughts and ideation

• Cystitis

• Slowing of heart rate

• Irregular heart rhythm

• Low blood pressure

Ketamine also carries with it a risk of abuse and tolerance, especially if you have a history of drug abuse or dependence. This is rare though as ketamine does not have a physiological withdrawal syndrome associated with it and most patients do not develop cravings for ketamine.

As with the administration of any type of medication, especially an anesthetic, there is a risk of dosing errors, drug interactions, and rare serious side effects that could require intubation, anaphylactic treatment, and/or hospitalization. These can be serious and life-threatening. For this reason, it is imperative to be truthful with your medical history and all medications, supplements, or illicit drugs you are taking.

Female Only: You should not receive ketamine if you are pregnant, breastfeeding, could be pregnant, or trying to get pregnant as ketamine could harm the developing fetus. If you believe you could possibly be pregnant, then a pregnancy test will be available for you before treatment. Please notify a staff member and discuss this with our team.

Benefits

Ketamine therapy for depression, PTSD, and anxiety has been associated with decreases in the symptoms associated with such psychiatric conditions. Every patient’s response to treatment is different. The length of time of symptom relief can vary from person to person as can the intensity of relief. Your individual response to therapy will be monitored by your treating provider and additional treatments could be recommended depending on your response.

Preparation for Treatment and Risk Management

• You must abstain from the use of alcohol, cannabis, and other illicit substances before and during the treatment with ketamine 
• You should not make any life-changing or legal decisions for up to 12 hours after treatment
• You may not operate heavy machinery or drive motor vehicles for 24 hours after the ketamine treatment.
• You can take your regular medications as normal on the day of treatment. If you are taking any of the following medications, you must hold them the day of your treatment:

o Stimulants that can increase your blood pressure and heart rate 

o Benzodiazepines such as Xanax, Klonopin, or Ativan.

o Lamictal (Lamotrigine)

 o MAOIs

• You must also notify our psychiatrist who is overseeing your mental health and/or pain conditions that you are seeking treatment with ketamine. It is important that you maintain contact with managing your pain for ongoing therapy and treatment outside of ketamine therapy.

WHAT TO EXPECT WITH KETAMINE TREATMENT

Tips for more positive results from your Ketamine Treatment 

Dress comfortably so that you may relax when you plan to take ketamine. 

Blocking outside noise is helpful; you can use noise-canceling headphones or earplugs. 

Many people find music very helpful- choose the music which relaxes you.

Many patients prefer to keep their eyes closed during the treatment, you can also use eye masks if you like.

Practice meditating; choose several positive & happy mantras. If your ketamine treatment begins to cause anxiety, these practices can help you redirect your thoughts away from the anxious thoughts or dreams.

Please communicate with us during your treatment if you begin to feel anxious or tense. We can help you talk through your feelings & redirect your thoughts.