A “disruptive technology” is something that completely alters the playing field and changes the paradigm in which people view a certain condition or activity. Relatively recent examples are things like smartphones and rideshare services such as Uber and Lyft. One area where such a disruptive technology has been long overdue is in the treatment of mental health conditions. Now, a new treatment is available that some people feel has the potential to really disrupt the paradigm of treatment for severe depression and post traumatic stress disorder (PTSD). The peculiar thing is that the “new” treatment really isn’t new at all…it’s been around for over forty years. What we are talking about, of course, is ketamine. Ketamine is a tried and true medication which has been used by emergency physicians and anesthesiologists for years. Almost two decades ago, however, a small study sponsored by the National Institutes of Mental Health demonstrated that infusions with a low dose of ketamine can potentially break the cycle of treatment resistant depression (TRD). In the intervening years, there has been a steady stream of research studies showing that a series of six low dose outpatient ketamine infusions can break the cycle of TRD in over 70% of patients. Ketamine has since garnered a lot of attention and, of course, raised a few eyebrows.
The first center in Austin which was created for the express purpose of providing ketamine infusion therapy is Klarisana. Klarisana’s founder and Medical Director, Dr. Carl J. Bonnett, MD opened the first Klarisana center in San Antonio in 2015. “The spark that initially made me open Klarisana was the unacceptable veteran suicide rate this this country. As I researched ketamine more and saw what it could do for patients who have failed basically every other treatment, I really felt compelled to make ketamine available to people in the South Texas area,” Bonnett said. He goes on to say, “I firmly believe that every person was created for a reason and has a purpose in this world. As an emergency physician, I have seen severe depression and PTSD lead people down a dangerous path. When a person makes the choice to end his or her life, they derail their personal mission and it is a huge loss for all of us. Both the medical literature and our personal clinical experience since 2015 suggest that ketamine can have a significant impact on mental health conditions where other therapies have failed. For us, the term ‘rebuilding lives’ is not just a catchy tag line…it is what we do and who we are.”
The way in which ketamine works to treat severe depression and PTSD is complex and, admittedly, not completely understood. Many researchers feel that there is an important biochemical component but there seems to be something more to how ketamine works than simply connecting to the right receptors. Sherri Scott-Hunter, one of the nurse practitioners at Klarisana – Austin describes it by saying, “there are two schools of thought regarding how ketamine works. Some feel that all that matters is that ketamine hits various receptors and causes a change in a patient’s mood. At Klarisana we believe that the ‘experiential’ component of ketamine is also a vital part of how it works.” Ketamine, in the high doses that are traditionally used in emergency rooms, is what is known as a “dissociative anesthetic.” At outpatient centers like Klarisana, much lower doses are being used and patients are interactive and responsive throughout the whole process. Scott-Hunter explains, “this is a fundamentally different use of ketamine from what has traditionally been done. This is not sedation, it would be more accurately described as Ketamine for Non-Anesthetic Indications (KNAI).” Dr. Bonnett describes, “in the ER we give a large dose of ketamine all at once because our goal is to completely disconnect the brain from the rest of the body in order to perform a painful procedure painlessly. In this context ketamine works like the clutch on a manual transmission car…you press it in and it disconnects the engine from the drive train. With the clutch analogy, the engine is still running but it is disconnected from the rest of the vehicle. This property of ketamine is what gives it a great safety profile and makes it useful in the ER…it doesn’t cause patients to stop breathing. In the outpatient setting, we take advantage of this fact but we use ketamine in a fundamentally different way. At Klarisana it is more like ‘riding the clutch’ meaning we create a mild sense of disconnection in the patient. Far from being a ‘side effect’ we, and many other clinicians around the country, feel that this is an integral part of the therapy.”
Scott-Hunter adds, “we gradually increase the dose over the course of the six infusions until the patient attains what we call the Psychotropic Therapeutic Response (PTR). This is the point where the patient finds the optimum intersection of perceptual changes and alterations in one’s thought process which allows for a very powerful transpersonal experience.”
Gerson Barahona, the Operations Director for Klarisana further puts this in context. “Critics might just dismiss this as a “psychedelic trip” or smugly reference other tired cliches, but the idea that the psychedelic experience itself can be therapeutic is one that is gaining a lot of traction in the United States.” Dr. Bonnett adds, “we have become ingrained in the traditional mindset that there is a pill for everything. We have gotten used to the idea that a drug company makes a pill, they give it a cool name, put some food coloring in it and give the tablet itself a unique shape, spend a lot of money on marketing and there you have it. Ketamine totally throws a wrench in this paradigm because it allows the patient to be an active participant in their treatment and relies upon much more than receptors getting blocked or stimulated.”
Theresa Riggins, another Klarisana nurse practitioner expands upon this, “you can see over the course of the six infusions that many patients are having changes in the way that they think about issues and problems. They seem to get a different perspective while receiving ketamine that is very hard to achieve in everyday existence. You can really see this difference in the patients who choose to have ketamine facilitated psychotherapy. There we have one of our therapists working with the patient while he/she is receiving ketamine. This can really affect some breakthroughs that I think would have been hard to get with regular talk therapy.”
Mr. Barahona adds, “when you talk about the experience of receiving a ketamine infusion there are actually two components to this. First, there is the physical experience of receiving the medication that Dr. Bonnett talked about. Second, there is just the overall experience that a patient has in the clinic. At Klarisana, patients are in comfortable and aesthetically pleasing private rooms. We have one staff member assigned to each patient during their whole infusion. Some clinics try to cut costs by either placing multiple patients together in the same room or by leaving them by themselves in a room with a ‘nanny cam’ but we feel that this is not only ineffective but it can be very counterproductive.”
Many people have likely never heard of ketamine, or if they have, it is wrapped in a shroud of preconceived notions. Barahona says, “the safety of our patients is our number one priority and we do not cut any corners. Klarisana ensures that a robust intake and follow up process is followed as well as making sure we have appropriate cardiopulmonary monitoring during the infusions. Dr. Bonnett is one of the founding Board Members of the American Society of Ketamine Physicians (ASKP.org) and works closely with leaders in the field around the country to ensure that Klarisana sets the standard for safety and effectiveness.”
If readers would like to learn more about ketamine infusion therapy for the treatment of severe depression, PTSD, and various forms of chronic pain they can go to Klarisana.com or call 210-556-1430.