By Shana Liebman–
After eleven years operating two clinics (in Long Island and Manhattan), NY Ketamine Infusions has come to Westchester. Since March, the new West Harrison clinic has been treating patients for treatment-resistant depression with a drug called Ketamine.
Ketamine, an anesthetic that was a popular club drug in the 1980’s, blocks the activity of the N-methyl-D-aspartate (NMDA) receptor in the brain that helps regulate mood, cognition and pain perception. The drug also helps grow new neural pathways that lead to greater access to coping strategies. Many depressed patients who have found little relief elsewhere report a positive change in their behavior and thought patterns after a therapeutic course of Ketamine infusions.
While no long-term studies have been done on Ketamine therapy, it seems to reduce depression symptoms in about 50 to 70 percent of patients — in a matter of hours or days, as opposed to antidepressants which can take weeks. Ketamine was approved as an anesthetic in 1970. Using it for psychiatric purposes, however, is not FDA approved, which means doctors can prescribe it but insurance won’t cover it.
The Hudson Independent spoke to NY Ketamine Infusions’ Dr. Robert Glatter about Ketamine therapy and their new Westchester location.
What is the treatment process like at the Westchester clinic?
We have six treatment rooms. We do six infusions over two weeks, and in about 75% of the cases, we see improvement in mood elevation — that ability to get out of bed, to function, to be able to have less rumination that could lead to self-harm.
Can anyone walk in for treatment?
A nurse practitioner initially does a call with a patient. That’s the first form of contact with our patients. Sometimes we do a peer to peer, like doctor to doctor, doctor to nurse practitioner, to get a little bit further understanding after that intake on the phone. And then if they pass that intake, we bring them into the office and do a formal intake interview, which lasts an hour to an hour and a half. We take all the history. Every patient that walks in, we don’t accept. So we’re very selective.
Are there potential patients that you think are not right for this kind of treatment?
We don’t treat people who are acutely psychotic or people with major psychosis. People with schizophrenia, for example, are not candidates for this type of therapy. People who are on high levels of benzodiazepines like Valium, Xanax or Ativan have to be titrated [concentration reduced] down. People who are actively abusing alcohol have to enroll in a program and be abstinent for 30 days before we will accept them. People with uncontrolled hypertension are patients we can’t treat — they have to have their blood pressure managed first.
What are the safety concerns of using Ketamine as an antidepressant?
Ketamine has been around for quite a while. It’s a very safe and effective drug. The risk of a reaction is exceedingly rare. I haven’t seen it in all my years of practice. I can tell you that as an ER doctor and from working at NY Ketamine.
Who are the best candidates for Ketamine treatment?
Our patients are primarily the treatment-resistant population that have tried at least two [antidepressant] drugs. Many have tried TMS, ECT [Transcranial Magnetic Stimulation; Electroconvulsive Therapy]; they’ve been to multiple providers and really gotten no significant relief. So we’ve taken people that are really barely functional and been able to turn their lives around. Ketamine doesn’t work for everyone, but we see 75-80% of our patients responding to Ketamine.
How does Ketamine work for these patients, as opposed to say SSRIs [Selective Seratonin Uptake Inhibitors, e.g. Prozac]?
It’s helping to grow and repair dendrites and synapses. And the theory is that childhood trauma produces high cortisol levels which inhibit the production of a key protein known as BDNF, or brain-derived neurotrophic factor. BDNF is critical to maintaining the connectivity among our three main mood centers. Ketamine is restoring levels of BDNF and allowing this connectivity to occur by growing and repairing dendrites and synapses. So it’s a structural repair as opposed to a chemical repair that you get with medications.
Is there a risk of addiction with Ketamine, especially with patients who have addictive or compulsive behavior?
We don’t see addiction as an issue. It just doesn’t occur. And we monitor patients for this. At the high doses that the recreational users use, which are beyond two to three milligrams per kilo at psychedelic doses — yes, you can have a risk of addiction and certainly abuse. But we’re using very low levels, half a milligram per kilo, maybe going up to 0.7 to 0.8 milligrams per kilo.
How many sessions or infusions do most patients receive?
Well, we start off with six over two weeks. We typically see response by the third to the fourth infusion, and sometimes it takes until the fifth or sixth infusion. If by the sixth infusion they don’t feel any effects, we don’t continue. If you do respond by the sixth, you will need a booster every four to six weeks because Ketamine’s effect does wane, meaning that your mood will dip after the last infusion.
Is that every four to six weeks forever?
Every four to six weeks for about a year. After a year, 80% of those patients don’t continue to see us, meaning that they’re improved. They’re feeling better, they’re functioning, they’re back to work. We did some recent data from January 2022 to 2023: Out of 2,200 patients, 84% showed at least a 20% improvement and up to 50% from their baseline.
Unlike some of the other clinics, you don’t have an integration (or talk therapy) process immediately after the infusions. Why is that?
It’s not about what you feel during the infusion in any way that predicts the response to Ketamine. You feel the effects of Ketamine— it’s relaxing, calming, very pleasant. But Ketamine begins to work 12 to 15 hours after the infusion. The therapy we believe is best a day or two later.
What does the patient do during the infusion?
We ask patients to sort of push everything away and just immerse themselves in music or a podcast, or even watch a TV show. The key is distraction because you want patients to have a good experience and relax, but it’s all about distracting them and not focusing on issues or problems or mantras. That work can be done after the infusion.
Insurance won’t cover Ketamine treatment so how do most patients afford the costs?
We don’t take insurance but we do offer a financial aid program for people whose incomes present challenges in terms of paying for the infusions. We are certainly aware of that. It’s $525 per infusion and boosters cost the same amount. So it could amount to six plus another six to eight infusions.
What should a patient seeking Ketamine treatment look for in a practice or a clinic?
I think they need to look at who’s staffing the center. You usually want a combination of physicians who have extensive experience using the medication and have training in sedation practices — who understand the drug. They should have psychiatrists on staff, emergency physicians, anesthesiologists, airway equipment, resuscitation equipment, blood pressure and heart rate monitoring, pulse oximetry.
Do you think that the FDA will ever approve Ketamine as a treatment for depression?
I don’t believe so. I don’t think pharma really wants to invest the millions of dollars in this. I think it’ll remain off patent really for the foreseeable future.