Healthy Outlook: Ketamine a new depression treatment option in Lawrence
photo by: Mackenzie Clark
For those who have battled depression, finding a treatment option that actually works can be life-changing. That makes it all the more difficult when symptoms begin to creep back in.
Lawrence psychiatrist Dr. Hiten Soni has experienced this firsthand. He’s familiar with patients’ tiresome trials of drug after drug to achieve little to no effect, or an effect that’s good for a while, but doesn’t last.
It was his own struggle with depression that inspired him to bring deep TMS, or transcranial magnetic stimulation, to his practice, Interpersonal Psychiatry, which moved last fall from Ninth and Kentucky streets into a larger, standalone office at 1045 E. 23rd St. I reported in April about deep TMS, which uses MRI-like technology to activate certain areas of the brain in patients with hard-to-treat depression.
After trying “30-something” drugs and several different types of therapy, Soni said he tried deep TMS himself, and it did help his depression a bit — “maybe about 50 percent,” he said.
In an emerging treatment, Soni said he has finally found a release from the daily exhaustion and dread that has plagued him for decades, and he’s excited to be able to offer it to his patients.
Ketamine is often used as an anesthetic for surgery, Soni said, but in much smaller doses, it has shown promise for treatment-resistant depression.
“After one treatment, for the first time in my entire life, I experienced what it really feels like to not have a depression for a few weeks,” he said. “It just felt amazing that I actually wanted to get up in the morning, and I wanted to come to work.”
If you’ve heard of ketamine before, chances are it’s in a much different context — either as a veterinary tranquilizer or as the recreational club drug dubbed Special K. In the clinical setting, though, the controlled doses through a slow drip of an IV allow just the right amount of the drug to be beneficial without potential for abuse.
For ketamine infusions, as the treatments are called, patients will head to one of two small, dimly lit private rooms at Soni’s practice. It feels more like a living room than a clinical setting, minus the equipment to measure vitals. Bags for IVs will hang from wall hooks above a large recliner, rather than an imposing pole next to the chair.
photo by: Mackenzie Clark
The infusions last about 45 minutes, followed by a recovery period that lasts about the same amount of time, though Soni said patients can take as long as they need. Afterward, patients should have someone drive them home, and he said they tell patients not to undertake any dramatic life changes the same day — wait a while to get married, sell your house or move across the country, for instance.
Treatment starts with “loading doses,” roughly four to six doses over two to three weeks. After that, patients enter the “maintenance” phase. Soni said he’s had maintenance doses at eight weeks after his loading doses, then 10 weeks later, then 12 weeks after that.
Soni uses Beck’s Depression Inventory, a 21-item questionnaire for patients to self-report on a scale of 0 to 3 about various moods and feelings, and other factors such as sleep, appetite and interest in activities. Those scores, collected repeatedly over the course of treatment, help him determine a schedule for patients’ maintenance doses of either deep TMS or ketamine — or both, since he has both available at his practice.
photo by: Mackenzie Clark
One common side effect of ketamine infusions is nausea, so patients are asked to come in with an empty stomach.
Another possible risk is a spike in blood pressure, so patients who have a history of heart problems would need to have their cardiologists sign off prior to the treatment. But patients’ heart rates, oxygen levels and blood pressure are closely monitored during infusions. Soni said he also got advanced cardiovascular life support (ACLS) certification to be prepared in the event of an emergency, and he has the necessary medications and equipment on hand.
How it feels
Ketamine is a dissociative drug, which Soni said means it produces what’s more commonly called an out-of-body experience.
“It felt like you’re directing your own movie,” he said. “… You’re reliving some of the traumatic moments and you’re redoing them.”
Soni said his first dose was a good experience, though it did bring up some painful memories from the past. His next three loading doses were “very amazing and very positive,” he said.
“I felt as if there were different colors and images and patterns I was seeing, and she was playing for me the Tibetan singing bowl,” he said, looking to his wife, Mamta, who is also manager of the practice. “It was a very meditative kind of an experience, and I experienced this oneness with the universe.
“… I understood that I’m often running around in a circle, focused on my own pain and suffering and not seeing the bigger picture, that the purpose is helping others,” he said.
Finally experiencing life without depression, Soni said he’s more motivated from the moment he wakes up on through his day, treating patients from 8 a.m. to 8 p.m. He’s “pushing 55,” but he said he has more energy than he did even at 30. He willingly helps around the house and keeps Mamta company as she cooks dinner instead of going to lie down until the food is ready.
“That’s a big change we’ve had,” she said.
Under lock and key
Because it does have potential for recreational abuse, ketamine is a highly controlled substance. As such, it must be kept in a safe behind another locked door. That door must be monitored by security cameras from two angles, and the premises must be monitored by alarms.
When it’s time to prepare IV bags for patients, Soni and a nurse must both verify the dose being taken from the vial and keep a detailed chart of every dose for every patient. Auditors from the Drug Enforcement Administration can drop in anytime without notice to review the records and inventory.
Ketamine infusions aren’t an option for everybody — Soni will carefully vet interested clients to consider their medical history and the more common options they’ve tried for depression.
For training, Soni said he did a mini-internship following anesthesiologists who use ketamine at the Vitalitas Denver Ketamine Infusion Center in Littleton, Colo., where he has also received his doses. He worked with the center’s medical director, Dr. Roman Langston, to learn about the calculations, preparing the IV bags and administering the treatment. He took nurses from his staff for the same training.
“We spent a lot of time actually hands-on doing the treatment,” he said.
Ketamine is being offered in some clinics around Kansas City and Wichita, but Soni seems to be the first in Lawrence to offer the treatment.
photo by: Chris Conde
Treatment of depression is still considered an off-label use of the drug, which means insurance doesn’t cover it yet. Soni said he did some comparison shopping, and the costs range up to $3,000 per treatment in some areas around the country; in Kansas City, they average about $1,000. He’s offering infusions for $800, but he has coupons as he rolls out the treatment here in town (Sept. 8 was the first day he offered it). He’ll also work with clients on payment arrangements as needed.
At noon this Friday and Friday, Sept. 28, Soni will hold information sessions (with pizza and coupons) at his office to answer questions from anyone who might be interested in ketamine treatments. More information about ketamine treatments is also available at ketaminemidwest.com, and Interpersonal Psychiatry can be reached at 785-393-6167.
About Healthy Outlook
Healthy Outlook is a column written by Journal-World reporter and Health section editor Mackenzie Clark, in hopes of helping readers make their lives a little bit happier, healthier and more active.
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