For individuals with treatment-resistant major depression and other serious mood disorders, effective treatment options are few and far between. For many, mood disorders like clinical depression do not respond to traditional treatments, like medications or talk therapy. Individuals with non-responsive mental health disorders such as these are at risk for hospitalization and a degraded quality of life. But there is hope in the form of new depression treatments that can be done safely on an outpatient basis. One of these, therapeutic IV infusions for depression, is offered at the Delray Center, as part of our comprehensive depression treatment program.
Ketamine is a well-tolerated anesthetic that has been widely used in medicine since the 1960s. In a recent breakthrough, it was discovered that when ketamine is administered at sub-anesthetic levels, it has a powerful antidepressant effect. In one infusion, ketamine can reduce or even remove the symptoms of depression that months of conventional medications could not. It is believed that a Ketamine infusion clears excess build-up of neurotransmitters in the brain that prevent normal brain function and contribute to depression. The result of IV infusions for depression is a significant mood uplift after just one session. Done as part of a multi-infusion treatment protocol, the result is the long-term reduction or remission of major depressive disorder symptoms.
Raul J. Rodriguez, MD is a pioneer in the field of therapeutic IV infusions for depression using ketamine. For over five years, Dr. Rodriguez has administered hundreds of intravenous ketamine infusions, with a success rate of depression remission of over ninety percent. Dr. Rodriguez is the creator of the Rodriguez Method of Ketamine Infusions (RMOKI), his own proprietary form of therapeutic IV infusion for the most severe cases of major depression. RMOKI is a dual intravenous and subcutaneous infusion. Patients receive a direct IV infusion, coupled with a subcutaneous infusion, of ketamine. The dual infusion has a strong synergistic effect, with both the immediate improvement of the IV infusion, as well the longer-lasting antidepressant effect of the subcutaneous infusion. A single RMOKI infusion can relieve severe depressive symptoms for weeks or even months.
All prospective ketamine infusion patients at the Delray Center meet with a medical doctor for a comprehensive psychiatric evaluation before beginning treatment. A trained psychiatrist specializing in depression treatment will review your symptoms and history, and determine if ketamine infusion therapy is right for you. If you are a good candidate, our ketamine infusion clinic, the Delray Center for Integrative Medicine, is conveniently located close to the Delray Center’s psychiatric and clinical offices in downtown Delray Beach, Florida. To start the assessment process, contact us today and someone from our staff will schedule you for your initial evaluation.
The Delray Center For Healing offers Therapeutic IV Ketamine Infusions as one of the most comprehensive outpatient depression treatment programs in the country.
Ketamine is a medication that has been FDA-approved for anesthesia since the 1960s. It is still widely used and is considered very safe and effective. In recent years Ketamine was discovered to have an off-label use in the treatment of Major Depression, as well as a number of other psychiatric conditions. Ketamine is a racemic mixture of mirror image “right” and “left-handed” molecules that are both psychoactive. In 2019 the left-handed isomer esketamine delivered by a nasal spray received FDA approval for the treatment of Major Depression in conjunction with antidepressant medication as well as an indication for suicidal depression.
The success of esketamine in the form of a nasal spray was enough to receive FDA approval for the treatment of Major Depression in conjunction with antidepressant medication as well as an indication for suicidal depression. IV infusions of ketamine have demonstrated an even higher response rate. Ketamine infusions are the most effective when done in combination with antidepressant medications, TMS, and psychotherapy.
If your antidepressant/psychotropic medication regimen will be managed by another physician or mental health practitioner, then that professional must make the referral. If your antidepressant/psychotropic medication regimen will be managed by one of the mental health practitioners at the Delray Center then a referral will not be needed.
The decision to remain with the current mental health provider for medication management and/or psychotherapy is made mutually between the patient and referring mental health provider. Both options of remaining with a current mental health provider or transferring to a Delray Center provider are available. If you do not already have a mental health provider you will undergo an evaluation and start treatment with a Delray Center provider. You must be under the care of a mental health provider while undergoing treatment with Ketamine.
Individuals who are 18 years old or older are eligible. Individuals under the age of 18 must have parental consent and are considered on a case-by-case basis following a comprehensive evaluation.
Ketamine’s exact mechanism of action remains unknown. Most hypotheses are focused on inhibition of the NMDA receptor, which affects the transmission of the excitatory neurochemical Glutamate. There is also evidence suggesting connectivity changes with Default Mode Network. The net effect fundamentally is twofold: a direct rapid antidepressant effect and an arguably greater indirect benefit that makes the brain more receptive to other antidepressant treatments. Ketamine exerts its greatest therapeutic benefit when done in combination with another psychopharmacological agent and TMS (Transcranial Magnetic Stimulation).
Esketamine (Spravato) has received an FDA indication for the treatment of Treatment-Resistant Depression as well as Major Depression with suicidal ideation. IV Ketamine infusions are highly effective in treating Treatment-Resistant Depression and Major Depression with suicidal ideation, as well as Bipolar Depression, Generalized Anxiety Disorder, Panic Disorder, Fibromyalgia, PTSD (Post Traumatic Stress Disorder), and OCD (Obsessive Compulsive Disorder). For best results, the treatment plan for all of these conditions should also include the appropriate psychotherapy and psychopharmacological medication management.
Ketamine infusions are not safe in individuals who are actively using or have recently used alcohol or illicit drugs, especially marijuana. Ketamine interacts with illicit substances and alcohol in a manner that produces unpredictable reactions and possibly psychosis. Marijuana use is especially dangerous if mixed with ketamine. Individuals with a history of psychosis cannot receive ketamine. Physical conditions such as cardiovascular disease and pulmonary issues require medical clearance prior to receiving Ketamine. Hypertension must be well controlled prior to receiving Ketamine. Individuals with a history of stroke, unstable angina, and carcinoid tumors cannot receive Ketamine.
No food can be consumed within 6 hours of receiving ketamine. Clear liquids can be consumed up to within 2 hours of receiving ketamine. Individuals should remain very well hydrated for the 24 hours prior to receiving ketamine. Light social alcohol (no more than 1 drink) cannot be consumed within 72 hours of receiving ketamine. Illicit substances, especially marijuana, cannot be consumed within 30 days of receiving ketamine.
Ketamine is dosed so as not to cause any loss of consciousness. With both intranasal Spravato (esketamine) and Ketamine IV infusions the possibility of inducing a dissociative reaction exists, where there is a transient loss of consciousness. These reactions occur infrequently and they are self-limited. The staff is trained and experienced in managing these reactions safely.
Ketamine is administered intravenously with the use of anesthesia-grade pumps at a precise pace over 60 minutes. Most patients describe a feeling of “floating” that is considered pleasant, often followed by deep relaxation and elevation of mood. Many patients describe mild feelings of dissociation without going into a full dissociative episode. Once the infusion is over each patient is monitored for another hour until they regain full consciousness and alertness.
The primary response goal that is desired is elevation of mood. Secondary goals include reduction of anxiety and general tolerability. The dosing for each patient is completely individualized and titrated to optimize response while still maintaining tolerability. Doses may change over time if and when sensitivity to Ketamine changes or there is a change in body weight. Dosing is titrated until the optimal positive response is achieved.
The mood-elevating effects of a single effective ketamine infusion will usually last one to two weeks. After a series of 6 to 12 infusions, many patients will experience the mood-elevating effects for a few months. When the ketamine infusions are done in combination with another psychopharmacological agent and TMS (Transcranial Magnetic Stimulation), the response can last indefinitely. Continued psychopharmacological management coupled with intermittent Ketamine and TMS maintenance can help maintain an optimal response.
A minimum of 6 infusions over a span of 2-3 weeks is needed to yield a response. A course of at least 12 to 18 infusions will typically yield a much more robust and sustained response. The frequency and the total number of Ketamine infusions for each patient are determined on a case-by-case basis and are completely individualized. The optimal timing for a series of ketamine infusions is to do them in parallel with psychopharmacological medication titration and a full series of TMS (Transcranial Magnetic Stimulation).
Ketamine can be abused recreationally at much higher doses when obtained illicitly. Therapeutic Ketamine is administered under close medical supervision in a controlled setting at subanesthetic doses. The patient does not have any access to the ketamine to self-administer. As a result, addiction-related issues have very rarely been encountered with ketamine infusions at the Delray Center. Patients that are already struggling with addiction are not appropriate candidates for Ketamine based treatment.
Benzodiazepines and pain medications can interfere with the effectiveness and safety of a Ketamine infusion. Patients that are prescribed benzodiazepines and/or pain medications should time their infusions either in the morning before their first benzodiazepines and/or pain medication dose or at a point in the day when the benzodiazepines and/or pain medication that was already taken is wearing off.
Ketamine exerts its greatest therapeutic benefit when done in combination with another psychopharmacological agent and TMS (Transcranial Magnetic Stimulation). Patients will continue taking their psychotropic medications while receiving Ketamine and usually the oral antidepressants will continue to be actively titrated.
Without any insurance coverage, a single infusion costs $445 and a prepaid package of 6 costs $2,395 ($399 each). With insurance coverage the out of pocket cost is much lower and possibly zero. The exact out of pocket cost for each patient can be determined after a verification of benefits is conducted by the billing department. Spravato (esketamine) is usually covered by insurance.
Dr. Rodriguez founded the Delray Center in 2003 and built it on a foundation of core clinical, professional, and ethical principles that are adhered to still to this day. Dr. Rodriguez founded the Delray Center in 2003 and built it on a foundation of core clinical, professional, and ethical principles that are adhered to still to this day.