Interview with Rita Rutland about Ketamine Therapy

Rita Rutland, APRN, is a nurse practitioner in private practice with Restorative Health in Sandy, Utah. Rutland’s practice focuses on family and adult medicine with an emphasis on depression and pain management without opioids. Her work centers on providing a holistic approach to treatment with an emphasis on health promotion and lifestyle modification. She provides medicine that is tailored specifically to meet the needs of her patients.

Q: Please describe the patients you work with.

A: Describing the patients that visit my practice, I often say that they are normal people with challenging health concerns. The most common issues my patients suffer from are mood disorders such as depression and anxiety followed by chronic idiopathic or neuropathic pain. Lastly I work with patients struggling with autoimmune disorders.

Q: What is Ketamine?

A: Ketamine is a medication that is traditionally used for inducing anesthesia for smaller operations. Recently there have been well done studies backing up ketamine’s use for the treatment of resistant-mood disorders and idiopathic pain.

Q: For what types of conditions do you prescribe Ketamine Therapy?

A: I recommend ketamine for many disorders because I’ve had tremendous success with it personally at my practice. Specifically I would recommend ketamine therapy for

• Depression and some of its subtypes

  • Bipolar depression

  • Recurrent depression

  • Dysthymia

  • Psychotic depression

• Obsessive-compulsive disorder and OCD-spectrum disorders

• Anxiety

• Suicidal thoughts/ideation;

• Post-Traumatic Stress Disorder (PTSD)

• Insomnia

• Chronic neuropathic pain

• Fibromyalgia

• Migraines

Currently, ketamine therapy is not recommended for use in schizoid disorders. However, it does have the potential to provide symptomatic relief in most other neuropsychiatric disorders.

Q: Other than neuropsychiatric disorders, what else does Ketamine Therapy help with?

A: Ketamine works to reduce the severity of chronic pain disorders especially those that do not have an identifiable cause, such as fibromyalgia, complex regional pain syndrome, and neuropathy. Chronic pain from injuries is less likely to be relieved by ketamine as the therapy cannot treat the cause of that type of pain. However, what I have personally seen is a reduction in the overall intensity and spread of the pain even when there is an identifiable cause or injury. It does this by condensing the pain to a smaller area.

Ketamine can reduce the frequency and severity of migraines and headaches in some patients. Its nasal spray can be used for immediate relief in preventing severe migraines. I have had patients report back a reduction in their insomnia for up to several months post-treatment as well.

Q: What areas of success have you seen with Ketamine Therapy?

A: My success stories include patients who have experienced a decrease in their area of neuropathy, reduced frequency and severity of migraines, absence of fibromyalgia symptoms for months, reduced OCD behaviors, abortion of actively suicidal states, a significant reduction in depression symptoms, and resolution of PTSD triggers.

Q: How much time does it take for Ketamine to work?

A: The timing varies based on what condition is being treated. Current literature suggests six treatment cycles reasonably close together for depression. Most studies do these treatment cycles within a few weeks. In my own practice I have noticed positive effects are present regardless of frequency. I recommend doing 2-3 treatment cycles fairly close together when possible, for extended benefits.

For chronic pain, one treatment cycle may provide extended relief for some, while others may need more treatment cycles that are close together. The response is very individualized and should be adjusted based on the patient’s symptoms, response, financial capability, and time availability.

Q: What are the positive long term effects of Ketamine therapy?

A: I started offering ketamine treatments June of 2018, so I currently don't have much personal experience with long term effects. I have seen depressed patients with minimal to no symptoms after one treatment for more than six months, which is considered remission. Concerning suicidal ideation, one of my very first patients reported that he felt as if those suicidal thoughts were no longer accessible to him months after the therapy. He has only undergone one treatment cycle, but whenever I check in on him, even months later, he reports that he is doing well.

I personally get nine months of relief from my fibromyalgia symptoms with each treatment. I have a patient who had severe neuropathy from diabetes, which went all the way up into her abdomen. After six treatment cycles, each 4-6 weeks apart, she reported that her neuropathy had reduced to below her knees and has remained below her knees.

Not everyone gets long term relief. This is a highly effective treatment not a cure. Many patients require maintenance dosing, which can range anywhere from 1-6 months, after completing a series of treatment cycles.

Q: In your experience, has Ketamine therapy been associated with any negative long term effects?

A: So far I have not seen any long term adverse effects in any of my patients. Occasionally some patients do not experience any positive outcomes from the treatment. None of my patients have experienced any lingering negative effects.

Q: What cautions would you advise while receiving Ketamine therapy?

A: One complication that I would advise people to be cautious of is interstitial cystitis, which is inflammation and irritation of the bladder. Studies have shown that this potential side effect is usually dose and frequency-dependent. I closely monitor all my patients for frequency, and caution against high frequency in treatment cycles once the series of 6 cycles are complete to avoid such complications.

Its advisable to start with a low dose of the medicine and monitor the patient to see how well they can tolerate it. If all goes well, slowly increase the dosage to the desired amount. Doing so will ensure that patients don't experience extreme side effects as their body adjusts to the medicine.

Q: Speaking of side effects, what are the most common side effects experienced by patients during and after treatment?

A: The most common side effect experienced by patients is nausea, and for some vomiting post-treatment. We try to minimize this by providing premedication, such as oral anti-nausea medications, which are often sufficient for most patients. In some cases, anti-nausea medications need to be given through either an IV or injection for fast relief. This usually resolves the symptoms rapidly.

Some patients feel groggy or tired for the remainder of the day and occasionally the next day as well, but most feel well enough to return to work the following day without any lingering symptoms. Ketamine has a very short half-life, only about 15 minutes when given through IV, so most people feel "normal" within 24 hours of having taken the drug. But patients should take care never to drive or operate any sort of machinery post-treatment.

A few patients have reported headaches post treatment but this is not a listed side effect of the drug and is unlikely to be directly related to ketamine. Being adequately hydrated is vital to dissipating unwanted side effects quickly.

Some patients may be allergic to ketamine, which could cause them to break out into hives.

Most of these unpleasant side effects occur at high doses. If the drug is taken at the prescribed dosage under supervision the chances of developing negative side effects are minimal.

Q: Can Ketamine therapy cause tolerance or dependence?

A: Based on the available literature neither tolerance nor dependence is an expected outcome of ketamine infusions nor in my practice has there been any need for progressively increasing the dosage or frequency of the treatment cycles.

Although such medicines do usually carry a potential for misuse because of the state of possible euphoria and dissociation they may produce, ketamine has not been observed to cause any dependency or addiction in patients.

For a tiny subset of people, ketamine could be a recreational drug of choice but usually not at therapeutic doses. This is unlikely to happen when treatment is sought for appropriate reasons and is carried out under qualified supervision.

Q: What further research would you like to see in regard to Ketamine therapy?

A: Currently, ketamine is mostly used for producing dissociative anesthesia for small surgeries. I see much potential for the medicine from successfully treating psychiatric disorders to treating chronic pain and lyme disease. My opinion is ketamine has been a relatively overlooked medicine that has tremendous potential.

There should definitely be more research into the use of ketamine nasal sprays for aborting severe migraines as well as its use in the treatment of various neuropathies and insomnia. Currently there is no FDA approved cure for neuropathy. However, ketamine seems quite promising in this regard and has shown to decrease large areas of neuropathy.

Patients with severe migraines sometimes need emergency intervention at an ER facility. Treatment at home with a simple ketamine nasal spray can prevent the need for such ER visits and can ultimately even diminish the loss of productivity due to debilitating symptoms caused by severe migraines.

People with severe insomnia often suffer from numerous problems due to a lack of sleep. Most medications used for the disorder are not adequately effective and carry a potential for dependency along with many other unpleasant side effects. Ketamine has shown some promising results in diminishing insomnia for months after just one treatment. It could prove to be an excellent alternative medicine for the disorder if further research was conducted on the subject.

References

https://www.drugs.com/sfx/ketamine-side-effects.html

https://www.medicalnewstoday.com/articles/302663.php