Major depressive disorder, commonly referred to as depression, is a mood disorder that changes the way you feel. You have been advised to a ketamine infusion because you are experiencing major depressive disorder that:

• is moderate to severe in intensity and

• has not responded to two or more courses of treatment in the current episode of depression

Description

 

Ketamine belongs to a group of medicines that work on N-methyl-D-aspartate (NMDA) receptors. It works by changing the activity of certain natural substances in the brain.

Intravenous (IV) Ketamine infusions involve delivery of ketamine into the bloodstream. This treatment is done in-clinic under the constant monitor of nurses and doctors. The infusion is delivered via a catheter in the arm or hand and each session has an estimate duration of 1 hour.

You should not have a ketamine infusion if you:

• are allergic to ketamine

• have any condition for which high blood pressure or high pressure within your brain (intracranial pressure) poses a serious risk

• have a weak portion of the blood vessel wall (aneurysmal vascular disease) including in your brain, chest or abdominal aorta, arms and legs

• have an abnormal connection between your veins and arteries (arteriovenous malformation)

• have ever had bleeding in the brain

• had a major heart event (such as heart attack) or stroke within the last 6 weeks

What medicines are infused?

CHANGEpain uses ketamine (DIN 02246796 or DIN 02246795, depending on availability) in 5% dextrose solution (DIN 02403536 or 00060348 or 00037915, depending on availability).

The infusion does not cause pain, although some patients find some discomfort with catheter insertion. You will not be “put out” for this procedure.

Will it hurt?

Possible side effects

• Increased blood pressure

• Increased heart rate or changes in rhythm

• Abuse and misuse (ketamine is an addictive substance and cravings are a possibility)

• Dissociative experiences (feelings of disconnection from your thoughts or things around you)

• Hallucinations

• Sedation

• Faint

• Dizzy/lightheaded

• Anxiety

• Worsening or development of suicidal thoughts

• Bladder pain

• Liver impairment

If this is you first time having ketamine infusions for treatment of depression, it is suggested that you start with 10 ketamine infusions; 3 ketamine infusions per week for 2 weeks, then 2 infusions per week for 2 weeks. The starting infusion is dosed at 0.5mg/kg (based on each person’s individual weight) and infused over 40 minutes.

There is escalation of dosed based on responsiveness in a standardized manner, agreed upon with your psychiatrist.

Some people who have benefit from ketamine infusions will require some form of maintenance treatment with repeated infusions. The exact schedule for this depends on your symptoms and your response to treatment.

Screening

Before being approved for IV Ketamine infusion at CHANGEpain, you will need to undergo some laboratory testing to ensure the procedure is safe for you, including liver function testing. Testing includes an ECG,bloodwork, and urine testing. You will receive questionnaires that look at your risk of sleep apnea and blood clotting risk factors, according to mandates from the College of Physicians and Surgeons of BC. Depending on your answers to these, your infusion physician may want to have a discussion with you before your first scheduled infusion.

Team Involved

  • Infusion doctor, an Anaesthesiologist (a specialist physician) who has a formal appointment with the College of Physicians and Surgeons of BC to practice in the CHANGEpain infusion room

  • Registered Nurses with Critical Care training.

What happens after the infusion?

After your infusion you will be monitored for 60 minutes, which is the time required by the BC College of Physicians and Surgeons of BC. You must be sure to have someone readily available to help care for and monitor you for 24 hours after the infusion. You are not allowed to drive for 48 hours after the infusion. Please arrange for a safe and reliable ride to and from CHANGEpain clinic. Please avoid heavy lifting or strenuous activities. After 48 hours, you may resume activity as tolerated, however use caution against any injury.

MSP does not cover IV Ketamine infusions, so this is a private pay service. Note that if hospitals provide this procedure, their funding is secured through their Health Authority budget, not MSP. CHANGEpain Clinic does not have access to Health Authority funding for this procedure. Patients may be able to check with an extended health insurer about coverage.

IV ketamine infusion:

  • IV Ketamine for Depression Single Session - $775 (1h)

  • IV Ketamine for Depression 5 Sessions - $3475

  • IV Ketamine for Depression 10 Sessions - $6950

  • IV Ketamine for Pain full day -$3100 (7h)

  • IV Ketamine for Pain short single - $775 (1h)

  • IV Ketamine for Pain short recurrent - $695(1h)

The fee includes medication (ketamine), infusion supplies and physician/nursing fees. We require a 50% deposit to be paid one week prior to your scheduled infusion. The remaining 50% will be paid before the start of the infusion.

Pricing

How do I book an assessment?

Please contact our Private Pay Services Coordinator at 604-566-9101, Ext 105 or privateservices@changepain.ca

Cancellation and Refund Policy

We require at least 48 hours notice to cancel your appointment.

If you cancel more than 48 hours in advance, we will refund your deposit with a $50 deduction for the admin fee.

If you cancel within less than 48 hours, the deposit is non-refundable.

However, if you cancel with less than 48 hours notice, and re-book your appointment before your prescription expires, $850 will be credited to your account. Be advised that you will be required to pay the difference in order to complete the 50% deposit.

If you purchase a package of infusion sessions but later decide to stop the treatment, we will refund you the incomplete sessions in full if you paid upfront. Sessions completed will not be refunded.

If you book multiple infusion sessions but miss 2 of them, any upcoming sessions will be cancelled. You will be rescheduled for a review appointment with your doctor.

***We do not give refunds once an infusion has started. This includes if the infusion must be stopped for safety reasons.