Many advocates of ketamine infusion therapy believe the antidepressant effect is due to a psychedelic therapeutic experience that leaves the individual with a greater sense of self and a greater understand of the world in which they live. It sounds wonderful, right? Magical even. On the other hand, there are those who are critical of the process and believe that patients are just “high†and that is why they feel better. While I could not be more of an advocate for ketamine infusion therapy, some clarification is necessary. I want to assure you that there is no magic involved, and if getting high is your goal, there are much cheaper, easier ways to get a buzz.
According to Yale, Johns Hopkins, Stanford, and many other Departments of Psychiatry around the nation, ketamine infusion therapy is the gold standard in the treatment of mood disorders. It is able to boast the highest rate of remission of depressive symptoms compared to any other antidepressant therapy available. Let’s discuss why.
A brief history of ketamine hydrochloride is the best place to start. It was created in the 1960’s in response to the need for a safer anesthetic. Unlike other anesthetics that can affect vital functions like heart rate, breathing, and blood pressure, ketamine hydrochloride was specifically designed to support these functions. With a wide margin of safety, it is one of the safest anesthetics available. This makes it ideal for use in pediatrics, lengthy orthopedic or abdominal surgeries, and even veterinary medicine, where higher doses can be administered without compromising vital functions.
Ketamine hydrochloride is a non-opioid, non-narcotic medication used in surgery as a dissociative anesthetic and analgesic. It has repeatedly shown to help patients recover faster with fewer side effects than those who use opioid pain management in the post-operative period. It is currently used in every operating room in the world and is listed among the World Health Organization (WHO) top 100 essential medications. The stigma surrounding ketamine as a “street drug†originated from its accessibility before 1999. Its frequent theft and abuse led the DEA to classify ketamine as a Class 3 non-narcotic.
In the late 90s, the psychiatric community began researching the benefits of NMDA glutamate receptor antagonism and the neuro-regenerative proteins the brain releases when these receptors are blocked. The Yale Department of Psychiatry conducted a large-scale study on several NMDA glutamate receptor antagonist drugs and found that patients who received low doses of these medications over specific periods demonstrated improved cognitive function and relief from depressive symptoms.
Among the drugs tested, intravenous ketamine hydrochloride was found to be far superior in stimulating brain-derived neurotrophic factor (BDNF), a protein essential for neuro-regeneration. In 2011, Yale presented its findings. Ketamine hydrochloride administered intravenously has shown to have the greatest success with treatment-resistant mood disorder patients in comparison to all other treatment options.
It was not long before psychiatric clinics across the country began to offer ketamine infusion therapy to their patients who had not responded to traditional antidepressant therapy. However, they quickly encountered challenges, learning something that every anesthesia provider already knew: ketamine is a dissociative anesthetic. Without minimizing stimulation and properly preparing the patient, it can cause distressing effects. Some clinics abandoned the practice, while others embraced the psychedelic experience, framing it as a spiritual journey. However, this approach was rejected by the broader medical community, and ketamine therapy nearly disappeared.
Several clinics have continued to offer ketamine infusion therapy since its early days. Some stayed committed to best practices based on scientific research from institutions like Yale, Johns Hopkins, and Stanford, while others embraced the “mind-expanding” nature of the dissociative experience, viewing it as the source of the antidepressant effect.
Anesthesia providers soon recognized the need for their expertise in optimizing ketamine infusion therapy. Working alongside psychiatric colleagues, they helped create a more comfortable and therapeutic treatment experience. This collaboration brought ketamine infusion therapy into the mainstream.
Those who cling to the idea that this style of therapy is purely a psychedelic journey into the subconscious have led the charge into other psychedelics such as MDMA (ecstasy), psilocybin (magic mushrooms), or other hallucinogens thinking that they might also work. Turns out that these also have an antidepressant effect like that seen with ketamine infusion therapy. As research continues on hallucinogens, we learn that they stimulate the neuro-regenerative process much like ketamine hydrochloride, but to a lesser extent.
The brain is the control center of our existence, and it must maintain balance in our bodies. Turns out anesthetics like ketamine and hallucinogens such as MDMA or psilocybin disrupt this balance, prompting the brain to react. In response, the brain releases protective proteins, with BDNF and GSK3B being the most prominent. These proteins are initially neuro-protective, providing patients with immediate relief from depressive symptoms and even eliminating suicidal ideation.
When the patient sleeps, and over the next several days after administration, the protein stimulates a process called neurogenesis, or the growth of new neuronal synapses. This process enhances communication between brain cells, resulting in improved clarity of thought. The ability to think clearly helps prevent patients from becoming easily overwhelmed, which leads to improved functionality in daily activities.
This neuro-optimization aids the brain in recovering and healing from the traumas and stressors that contribute to depression and anxiety disorders. With continued therapy and support, patients experience long-term relief and even remission of depressive symptoms, particularly when working alongside a therapist who helps guide the recovery process.
Ketamine infusion therapy is incredibly safe. Unlike hallucinogens, dissociative anesthetics do not cause hallucinations – no pink elephants are present during the process. Administered via infusion, ketamine offers significantly more control for the provider, allowing us to optimize the experience for the patient. In contrast, hallucinogens require patients to simply “ride it out” until the effects subside.
Ketamine infusion therapy also carries fewer risks than hallucinogens, such as the absence of allergen risks. Furthermore, it is administered by a board-certified anesthesia provider, and all medications used are FDA-approved, ensuring a safe and controlled environment for treatment.
As research continues, we better understand that it is the ketamine treatment, and not the experience, that provides the lasting antidepressant effect. The best part about how ketamine infusion therapy works is that it does not rely on a psychedelic or spiritual journey to find relief. When a bone is broken, we do not force the bone to heal or say that a person is weak because their bone is not healing as fast as others. We utilize the treatment to create an optimal environment for the body to do what it is designed to do.
Everyone’s journey to mental health is different. Ketamine infusion therapy remains one of the best options for regaining clarity of thought and optimizing neuronal signaling, which are two of the keys to getting the most out of other therapeutic interventions such as psychotherapy.
Founded in 2019, Scenic City Neurotherapy is at the forefront of advanced and comprehensive treatments for those facing treatment-resistant conditions. Our goal is to excel in opioid free pain management and mental health treatment, setting a standard of care that results in better outcomes and improved brain health. We specialize in Minimally Stimulated Ketamine Infusion Therapy (MSKIT®) and Transcranial Magnetic Stimulation (TMS) Therapy.
If you’re seeking innovative solutions for mental health, chronic pain, or neurodegenerative conditions, Scenic City Neurotherapy offers transformative treatment options. Join us in advancing brain optimization and empowering individuals to reclaim their lives.
Contact Charles Miller, Founder and Chief Medical Officer, to learn more about our Minimally Stimulated Ketamine Infusion Therapy (MSKIT®) and Transcranial Magnetic Stimulation (TMS) protocols. Call 423-228-0579 or visit www.ScenicCityNeuro.com.
If you are supporting a loved one who is about to go through Scenic City Neurotherapy’s treatment process, there are a few things you might want to know:
1. We love to educate and questions are welcome! Education on neurotherapies, how they work, and why they work is imperative for the success of the patient. The support person needs to be informed as well. The patient will feel the need to talk things through after consultation or treatment. With two or more sets of ears taking in information and education, the whole team is better equipped to support the patient throughout the treatment process.
2. Comfort is key. At Scenic City Neurotherapy, safety and efficacy are priority number one, but comfort is a close second. As board certified anesthesia professionals, we understand best how to manage the comfort of patients undergoing anesthesia. This is the case with Ketamine Infusion Therapy. Since the patient is essentially inebriated and quite suggestible, it is important to minimize external stimulation. Noises, lights, and even pleasant conversation can feel overwhelming quickly for a patient who is under the influence. Most patients prefer to be alone. Some prefer to have a support person act as a “hand holder†in the room. In this case, we spend time educating, monitoring, and supporting both the patient and the support person on how to optimize comfort during the treatment process. Patients are encouraged to bring blankets, pillows, and wear comfortable clothing to enhance his or her experience. This treatment is about the patient so we optimize the patient’s process to meet individual needs.
3. Environment outside of the clinic needs to reflect security and comfort. Not a time to take on new challenges. Ketamine Infusion Therapy and Transcranial Magnetic Stimulation stimulate new neuronal regrowth. We are growing and enhancing brain cells. Avoid depressants like alcohol or marijuana. Do NOT make any medication changes during the stabilization phase of treatment. Daily oral antidepressant weaning occurs once improvement is made and under the supervision of your prescribing physician. Avoid conflicts when possible. Minimize variables that will affect mood changes so we can better establish which changes are a result of the neuro-regeneration.
4. Manage logistics well. Make sure that paperwork, payment, drivers, and schedules are sorted out before beginning the stabilization process. We want you to focus on getting well, and not get stuck in the details. After a ketamine infusion, make sure the patient remains hydrated, fed and gets plenty of rest. Most patients only need a couple of hours of downtime after an infusion. Others might need to take it easy the rest of the day. Don’t overschedule the day. With TMS, the patient can resume normal activity immediately.
5. It is all about the patient. The improvement seen with Ketamine Infusion Therapy and TMS therapy manifests differently for each patient. Be prepared for them to respond differently to different stressors or situations. The patient is the priority. While we do not need to avoid all stressors, stressors should be kept at a normal level. Do your best to pay attention to the patient’s spoken and unspoken needs. Be encouraging. Be someone with whom they can talk to about their process and remind them to talk to the provider should they have any questions.
The most common question I receive about Neurotherapy is, “If this works so well, why aren’t more providers offering it?†My answer to this is, “Adoption takes time, and the current standard of psychiatric practice is devoted to managing symptoms.”
Symptom management is our first approach to the treatment of any disease process. In other forms of medicine, symptom management is how we discovered anti-inflammatories or anti-pyretics. We use medications and natural supplements to manage symptoms like weight gain, poor sleep, pain, and other health issues that we have limited ability to treat directly.
Psychiatry is one of many medical specialties which is constantly working toward maximizing quality of life through symptom-based medication management. Until the root cause of a disease is fully understood, treatments often aim to manage symptoms rather than cure the underlying condition.
The development of psychiatric medications has largely been guided by the Monoamine or Serotonin Hypothesis. In 1965, Joseph Schildkraut proposed that depression was associated with low levels of norepinephrine, and later researchers theorized that serotonin was actually the neurotransmitter of interest. The field recognized that mental health optimization was achieved by optimizing communication in the brain. By manipulating neurotransmitters, clinicians sought to regulate mood disorders and their effects.
Psychologists, therapists, and counselors complement this approach by teaching patients essential skills, such as coping mechanisms, cognitive processing techniques, and goal oriented strategies so they can regain control of their mental health. It wasn’t until the late 1990s that attention turned to optimizing neurons themselves, rather than neurotransmitters, as a way to enhance brain communication more effectively.
Somewhere along the way, psychiatry confused the symptom with the disease. Consider this: what disease do psychiatrists actually treat? Most people would say depression. However, that’s not entirely accurate. Psychiatrists prescribe medications to manage depression, but depression is a symptom, not the underlying disease. So, what is the disease? This is where Neurotherapy offers a transformative perspective.
Advances in imaging technology have deepened our understanding of how the brain communicates and how mood disorders manifest. These breakthroughs allow us to address the “mechanical” disruptions in the brain that produce feelings of depression, anxiety, PTSD, bipolar disorder, and elements of OCD.
For decades, psychiatric medications have targeted neurotransmitters in an effort to enhance communication between brain cells (neurons). However, this approach has its limits. Imagine neurotransmitters as cars and neurons (brain cells) as roads. Nearly all antidepressants are designed to add more cars to the road, but if the roads are blocked, the cars can’t go anywhere.
This is where Neurotherapy steps in, offering solutions that clear the path for optimal communication.
Neurotherapies, including Minimally-Stimulated Ketamine Infusion Therapy (MSKIT®) and Transcranial Magnetic Stimulation (rTMS/iTBS), act as catalysts for self-optimization in the brain. These therapies stimulate the growth of new, undifferentiated neurons and restore neurons with limited communication ability, which we now recognize as the root cause of depressive symptoms. These poorly communicating neurons are the true disease, while depression, anxiety, PTSD, bipolar disorder, and OCD are merely symptoms of this underlying issue.
We all have neuronal lesions, areas of poor communication, within our brain. These lesions can form as a result of traumatic experiences, prolonged stress, and extended periods of anxiety. Non-trauma related lesions typically manifest during puberty but have the ability to appear at any time throughout the lifespan. Over time, these lesions may accumulate, producing an atrophy of the prefrontal cortex and contributing to what we call age-related or idiopathic dementia. Neurotherapies have proven effective in addressing these lesions, offering better treatment options for mental illness, chronic pain, dementia, stroke recovery, traumatic brain injuries, and even assist in treating post-acute coronavirus syndrome.
For decades, mental health care has focused on managing symptoms rather than treating the root cause of the disease. MSKIT® and rTMS/iTBS are two of the most effective means of improving neuronal communication, leading to enhanced emotional control (doing good elicits good feelings/neglecting self-care feels worse), increased clarity, better cognitive function, and the patient’s own perceived ability to be present and enjoy the moment. Neurotherapy doesn’t replace psychotherapy or psychiatry; rather, it fills the gap, empowering patients to take control of their own mental health management.
Scenic City Neurotherapy offers a better way forward.
Founded in 2019, Scenic City Neurotherapy is at the forefront of advanced and comprehensive treatments for those facing treatment-resistant conditions. Our mission is to optimize brain function and elevate well-being through cutting-edge therapies. We specialize in two pioneering approaches: Minimally Stimulated Ketamine Infusion Therapy (MSKIT®) and Transcranial Magnetic Stimulation (TMS).
If you are exploring innovative solutions for mental health, chronic pain, and other neuro-degenerative conditions, Scenic City Neurotherapy offers transformative treatment options. Join us in leading the charge towards groundbreaking brain optimization treatments and empowering individuals to reclaim their lives.
Contact Founder and Chief Medical Officer, Charles Miller today to learn more about our proven protocols for Minimally Stimulated Ketamine Infusion Therapy (MSKIT®). Call 423-228-0579 or visit www.ScenicCityNeuro.com.
Neurotherapy, much like other therapeutics, is focused on achieving an optimized state of function. While psychotherapy optimizes the cognitive processes and physical therapy optimizes muscle mass and flexibility, Neurotherapy optimizes the communication between brain cells (neurons) which can be utilized for much more than mood disorders. It is used for age-related dementia or Alzheimer’s Disease, stroke recovery, cognitive loss due to prolonged inflammation like we see with Post-Acute Coronavirus Syndrome and post-sepsis. Neurotherapy treatments such as Ketamine Infusion Therapy and Transcranial Magnetic Stimulation cause our brain to undergo an optimization process which enhances cognition, improves emotional and physical reactivity, and enhances emotional regulation, meaning they restore the conscious, logical areas of the brain’s control like what we feel and how much we feel. It is a purely physiological change which allows the patient to maximize gains while working with his or her psychotherapist to reach goals and optimize their mental health self-management on a daily basis.
Not at all. Ketamine is a children’s anesthetic. Psychedelic therapies refer to hallucinogenic therapies where a patient is guided through their thought processes by a “psychedelic guide†to seek answers as is typically an experiential based treatment process. Many people find psychedelic therapies helpful and they can even produce a limited amount of neuro-optimization like what we see with TMS and ketamine infusion, but the quality of hallucinogens varies depending on the dose, environment, and route of administration (oral, intranasal, sublingual, intravenous). Ketamine is an anesthetic and medication used in every operating room in the world. There are no hallucinatory effects with ketamine (at normal treatment doses). Ketamine is a non-sedating anesthetic. In fact it has a stimulating effect on several body systems which is why we use it as a catalyst for neuro-optimization. While the patients feel “weird†during the infusion such as experiencing a very present feeling like they are sinking deep into themselves, this is only the dissociative anesthetic effect and is not necessary for neuro-optimization to occur. Patients do not see things that are not there. They may perceive thoughts, feelings, think about memories, or people they love during the infusion, but it is more like a very positive dream. It can leave you feeling positive the rest of the day, but it is not an experience or realization while inebriated that is corrective. In fact, patients who receive ketamine as part of their anesthesia cocktail in surgery are fully unconscious and perceive no part of the dissociative experience, yet they still report marked improvement in cognition, motivation, and mood stability. Ketamine Infusion Therapy is grouped as a Neurotherapy along with TMS and the Stellate Ganglion Block (SGB). We understand the confusion. While there is ongoing research with psychedelics, the science behind Ketamine Infusion Therapy and TMS is not subjective or experimental. These therapies have been around for more than a decade, and currently, they are able to boast the highest efficacy of any treatment for depression, anxiety, PTSD, bipolar disorder, and OCD.
Ketamine Infusion Therapy stimulates a global (or total) optimization of neuronal communication. TMS (rTMS and iTBS) is a focused treatment that stimulates optimization specifically where depression and anxiety exist in the brain. Depending on a patient’s symptoms, we will recommend either TMS or Ketamine Infusion Therapy as a primary treatment. TMS does not address outlying neuronal communication issues, such as cognitive issues, dementia, OCD, primary anxiety without depression, and PTSD. Ketamine Infusion Therapy is required to get global optimization and address these outlying conditions. TMS is recommended for patients with treatment resistant major depressive disorder and generalized anxiety. Neuronal lesions (poorly communicating brain cells) which are responsible for symptoms of depression and anxiety reside in the prefrontal cortex of the brain. We are able to use a targeted approach known as Stim-Guide mapping to determine each patient’s ideal treatment target and ensure that we are providing perfect stimulation for the entirety of each and every treatment. We will often use two ketamine infusion sessions included in a patient’s TMS care plan so our patients receive the benefits of both targeted and global optimization.
As Ketamine Infusion Therapy becomes more available, it is important to choose a Ketamine clinic that follows best practice methods. Ideally, all medical facilities subscribe to best practice methods, including:
Private treatment rooms are the minimum standard. Ketamine Infusion Therapy is a very personal, private experience and it should be treated that way. Minimizing stimulation is important, including screen time and conversation, and your own treatment room will allow for this. Those considering Ketamine Infusion Therapy should avoid clinics that have decades-old furniture; secondhand furniture can contain unknown contaminants from previous owners. A quality clinic invests in new, clean, non-porous furniture designed for comfort and cleanliness. Scenic City Neurotherapy also provides eye coverings and headphones for each treatment session.
Steady-state administration is key to reaching and maintaining the therapeutic blood levels necessary for the highest efficacy of treatment. Therefore, beware of clinics that administer Ketamine Infusion Therapy in a bag without a pump. Administration of ketamine without a syringe pump is irregular and highly unpredictable. Therapeutic blood levels are necessary for successful remission of symptoms and comfort of treatment. At Scenic City Neurotherapy, we utilize syringe infusion pumps that allow perfect dosing and administration so that your infusion quality is up to the highest standard.
While Ketamine Infusion Therapy is very safe, it is not without potential risks. Continuous monitoring removes the risk of missing harmful events that could arise with intermittent monitoring which generally occurs every 5-10 minutes. At Scenic City Neurotherapy, we utilize CareTaker Monitoring which allows us to monitor heart rate, blood pressure, and oxygen saturation second by second. All patients are continually monitored by board certified CRNA professionals, not nurses or medical assistants. Any provider who does not monitor you continuously is likely not competent to handle a problem should it arise.
The ideal doses for Ketamine Infusion Therapy can make stimulation uncomfortable and difficult to tolerate. At Scenic City Neurotherapy, we subscribe to the best practice method of Minimally Stimulated Ketamine Infusion Therapy (MSKIT®). MSKIT® utilizes optimal dosing, producing outcomes that exceed those of other clinics in the region. Ketamine Infusion Therapy is a catalyst that stimulates neurogenesis. This means that the experience, while greatly beneficial in its own way, is not responsible for the lasting relief of depressive symptoms. Creating an environment that minimizes stimulation assists the brain in reaching a theta wave state which then facilitates an ideal stimulation of brain-derived neurotrophic factor (BDNF) release leading to neuro-optimization. Neuro-optimization is why Ketamine Infusion Therapy works.
Patients who are under the influence of ketamine are very suggestible. Any person interested in treatment should be cautious of clinics that utilize “guided experiences†or “ketamine-assisted psychotherapy†which they claim to enhance the experience. To guide the experience, they must reduce the ketamine dose below the recommended optimized dosing, which in turn decreases positive outcomes and typically requires an unnecessary and additional charge for the “guide.â€
The suggestibility of a patient undergoing Ketamine Infusion Therapy allows the guide to lead the patient to realizations, breakthroughs, or higher understandings that hold little value once the ketamine wears off. Further, a patient being led to a realization under the influence of ketamine is like a drunk person feeling incredibly wise in the moment. The fact of the matter is this treatment is a physiologic reaction to the administration of a low-dose anesthetic causing brain optimization or improvement of neuronal (brain cell) communication. Your time in the chair can be beautiful, cathartic, and therapeutic all on its own. It is never frightening, and you are always in control.
Do not accept substandard care. A provider who does not adhere to the best practice standards listed above is likely trying to save a dime at your expense.
Scenic City Neurotherapy is the premier Ketamine Infusion and TMS therapy clinic in Chattanooga, TN. Our 1st priority is to provide you the highest quality of compassionate care and help you develop a plan for lifelong success. Let us offer you a better way.
