Transcranial Magnetic Stimulation (TMS) therapy has been researched for over thirty years. In 2008, the FDA approved it in the United States for the treatment of Major Depressive Disorder in adult patients who tried medications with no satisfactory results.
TMS therapy utilizes a series of brief magnetic pulses that stimulate targeted neurons in the prefrontal cortex of the brain. Neuronal lesions found in this area of the brain are responsible for symptoms of depression and anxiety. These lesions can be described as poorly communicating brain cells often due to periods of heightened stress or trauma. Using Stim-Guide mapping, our targeted approach will determine each patient’s ideal treatment target and ensure perfect stimulation for the entirety of each treatment. The goal is optimization of neuronal communication and restoration of brain activity to normal levels with little to no side effects.
Many mental health professionals are including TMS therapy as part of their treatment plan to address the root cause of their client’s depression. The treatment is simple, non-invasive, and medication free. While the treatment does not require any downtime, the two protocols offered at Scenic City Neurotherapy require different time commitments.
Choosing a TMS treatment path that fits the patient’s schedule is imperative for success.
Scenic City Neurotherapy is the region’s only provider of iTBS (SNT Protocol). This aggressive 5-day protocol was developed by the Stanford Department of Psychiatry. It allows the patient to undergo 10 sessions per day for five consecutive days, totaling 50 sessions. In addition to the treatment room, the patient is provided access to a kitchen area and their own private room to relax, read, study, or work (if necessary) between sessions. This option is good for individuals who have the ability to take time off from work.
The rTMS (Classic TMS) protocol is one treatment per day, Monday-Friday, for 6 weeks with a 3-week wean, totaling 36 sessions. This option is good for those who cannot take off time from work or daily responsibilities. Individuals can drive themselves to and from each session and carry on normally for the remainder of the day.
It is important that treatment protocols are tailored to fit the needs of the individual. While counseling and/or medication alone can effectively treat depression, there are many advantages to including TMS therapy in your treatment plan to address the root cause of your client’s depression.
There are many advantages to TMS therapy as a treatment option for depression. At Scenic City Neurotherapy, we utilize Magstim, the most advanced FDA-approved rTMS therapy system offering Stim-Guide mapping. This type of neuronavigation helps to ensure precise coil positioning with every patient treatment – thus enhancing optimal outcomes for a much-improved quality of life.
The TMS therapy protocols with StimGuide boast the following success rates:
The patient can achieve long term relief in as little as five days without the long-term need for a daily medication. TMS Therapy bypasses common side effects of antidepressants such as:
The patient can achieve long term relief in as little as five days without the shock or induction of a seizure like with ECT. TMS avoids the unpleasant side effects of ECT therapy such as:
During the consultation process at Scenic City Neurotherapy, medications are thoroughly discussed and taken into careful consideration when formulating the patient’s treatment plan. We prioritize the safety and well-being of our patients, which is why we require any adjustments to their medication regimen to be done under the guidance of their prescriber.
Throughout the stabilization phase of treatment, we encourage patients not to make any medication or lifestyle changes. Our focus during this period is to ensure a stable foundation for their treatment journey.
Once stabilization treatment is complete, our collaborative approach comes into play. Patients will work closely with their prescriber to optimize medication plans and, in many cases, reduce the need for daily medications. Our goal is to support patients in accessing a wide range of therapeutic options, and ketamine-assisted TMS is one such resource we offer to enhance their treatment experience.
By combining our expertise in ketamine-assisted TMS with the guidance of the patient’s prescriber, we aim to create a comprehensive treatment approach that complements and augments the therapeutic tools available to your clients. Our shared goal is to empower patients on their path to improved mental health and well-being.
Research shows the combination of psychotherapy and TMS therapy can positively affect the patient’s response and remission rates. It may also decrease the number of sessions required to respond.
Neurotherapy treatments such as TMS therapy cause the brain to undergo an optimization process. The goal with these treatments is to enhance cognition and emotional regulation while improving emotional and physical reactivity. Simply put, TMS therapy restores 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 success while working with his or her psychotherapist to reach goals and establish daily self-management of mental health.
We have developed our approach with the specific goal of collaborating with our patient’s entire health care team. Our focus is on refining the brain’s unconscious response to various stimuli, leading to more appropriate reactions. By doing so, we facilitate improved outcomes in conjunction with the care plan other medical providers are conducting with our patients.
One of the key benefits we offer is the enhancement of neuroplasticity, or the brain’s ability to adapt and reorganize itself in response to new experiences and information. An increase in neuroplasticity enables patients to integrate and retain new information more effectively, promoting overall growth and progress.
Our commitment is to work alongside all health care providers in our community, utilizing our expertise to enhance the patient’s neuroplasticity and overall treatment experience. Our medical team is readily available for discussions with supporting health care providers regarding their patient’s treatment plan. Together, through a collaborative effort, we can empower patients to achieve their goals and make meaningful improvements in their journey towards better mental well-being.
We believe that maintaining better mental health is an ongoing and lifelong journey. Our boosters serve as a tool to be utilized in sustaining and supporting this continuous improvement.
Typically, the patient will receive their first booster approximately 4-6 weeks after the initial stabilization period. However, the frequency and timing of these boosters are tailored to each individual’s specific needs and response to treatment. As practices and coping skills improve, there is a diminishing need for regular treatment. The patient becomes empowered to navigate their mental health journey more independently.
Whether the patient chooses to proceed with TMS boosters or ketamine infusion boosters, one of the significant advantages of our approach is there is no risk of dependency, eliminating the need for a wean-off process.
Our goal is to equip patients with the tools and necessary support for long-term well-being and resilience. By customizing maintenance plans and providing booster infusions when needed, we strive to assist our patients in achieving sustained progress and a fulfilling quality of life.
Insurance coverage for TMS therapy varies by location, insurance plan, and protocol.
Our Classic TMS Protocol is covered by the vast majority of insurance providers with the exception of Medicaid. Patients are usually responsible for their portion of deductibles and copays until they meet their maximums. Our TMS Director will file the insurance application and find out the specific details on the patient’s financial responsibilities.
The SNT protocol currently is able to report the highest rate of remission when compared to all other neuro-regenerative interventions for intractable depression. While this protocol is not yet covered by insurance, it is the most effective treatment available for depression. We work with the patient to maximize affordability and help facilitate coverage through financing options and health spending accounts.
Check out our TMS pricing.
We have seen TMS therapy help patients transition a chronic condition into complete remission, minimizing the need for a daily medication. Their ability to feel present in the moment is enhanced so that they can feel good when good things happen, feel bad when bad things happen, and feel reasonably neutral when nothing is happening.
TMS therapy functions as the missing piece of today’s mental health care plan. Improvement will continue as the patient works to improve their environment and coping skills. Progress made during psychotherapy in the days after treatment works to build them up as they advance toward a long term goal of self-maintenance.
Minimally Stimulated Ketamine Infusion Therapy (MSKIT®) protocols were established to ensure the treatment provides the greatest success for the patient in the safest possible way. MSKIT® protocols include adjuncts such as NAD+ to enhance the benefits of what we can do with ketamine-only treatment. When a patient receives treatment at Scenic City Neurotherapy, they are receiving a process, not a single drug.
What is NAD+?
Nicotinamide adenine dinucleotide (NAD+) is a coenzyme that is naturally produced in your body to repair DNA and facilitate energy production. Coenzymes, often referred to as “helper molecules”, are less effective alone and a crucial catalyst for enzymes that also cannot function solo. Consider the enzymes in your mitochondria – NAD+ is responsible for activating these enzymes, turning nutrients into energy, and assisting in the production of over 90% of your body’s energy.
Scientists began studying NAD+ in the early 1900s for its role in fermentation. Little did they know that years later it would play a role in mitigating pellagra, a debilitating disease caused by a deficiency in niacin (Vitamin B3), a precursor to NAD+. These findings and more pointed to what we now know about NAD+ playing a critical role in facilitating the body’s creation of proteins, enzymes, and other biologic compounds necessary for our body’s natural processes to occur.
How does NAD+ affect withdrawal?
Since the 1960s, NAD+ has been used to minimize symptoms and shorten the duration of alcohol, opioid, benzodiazepine, and antidepressant withdrawal. The excessive use of these substances depletes NAD+ stores, inhibiting the production of energy needed for on-going metabolic processes. You can think of NAD+ as a powerful detoxifier. Your body begins to clear out the unnatural substances in your system, resulting in removal of cravings and reduction of withdrawal symptoms, which we understand to be extremely difficult, uncomfortable, and the reason many people end up in and out of treatment facilities.
When your body is capable of optimal energy production for its natural processes, you are able to recover better both physically and mentally. Thus, the benefits associated with adequate NAD+ levels extend far beyond withdrawal.
Can NAD+ reduce fatigue?
The straightforward answer is yes, NAD+ can reduce fatigue. There are a variety of factors that can drain your energy and leave you feeling more exhausted than usual such as irregular sleep patterns, persistent stress, mental illness, or brain fog.
NAD+ plays an essential role in the production of ATP, an organic compound that transfers energy from one cell to another for many processes in our body. It is an immediate source of energy (in small quantities) that cells can access faster than other larger energy sources such as glucose. Its functions include assisting metabolic processes, muscle contraction, synaptic signaling, helping enzyme-catalyzed reactions take place more quickly, and more. When NAD+ levels are in-balance, our body is better equipped to maintain homeostasis.
Why does NAD+ decline with age?
It is often said that our bodies and brains begin to decline as we age, but it’s rarely explained why. Over time our cells can become damaged from environmental factors, including extremes of temperature, exposure to toxins, and mechanical damage. Such damages trigger your internal cellular stress response, promoting cell survival or evoking programmed cell death.
NAD+ functions at the center of your cellular stress response. It binds with protein molecules to support cell vitality and survival. Low levels of NAD+ could result in an inability to stimulate the cellular stress response. The current body of research shows supplementing NAD+ can slow or prevent your body and brain’s decline with age.
Why Scenic City Neurotherapy?
At Scenic City Neurotherapy, we understand our patients’ outcomes depend on the protocols we follow. We follow best-practice methods developed by the foremost experts in the field of psychiatry and anesthesia at Yale, Stanford, and Johns Hopkins.
Our MSKIT® protocol, including NAD+, is designed for efficacy. Ketamine stimulates neurogenesis, or the regrowth of brain cells known as neurons, returning the brain to an optimal state in which you can work to alleviate depressive or chronic pain symptoms. NAD+ provides you with the boost in energy and cognition that is often needed to get back on track with daily practices that support your desired quality of life.
If you have questions about our process, call 423-228-0579 to schedule a no-cost consultation.
At Scenic City Neurotherapy, we refer to our evidence based IV ketamine therapy protocol as Minimally-Stimulated Ketamine Infusion Therapy (MSKIT®). It produces the highest rates of patient reported remission of symptoms, maximal comfort while undergoing treatment, and a team approach which includes counselors, general physicians, psychiatrists, physical therapists (for pain) and our anesthesia team.
MSKIT® requires significant patient preparation and education. We passionately believe it is important for each patient to have a fair understanding of how Ketamine Infusion Therapy works and accurate expectations with physiologic improvement.
What can you expect at your No-cost Consultation?
The process will begin with a no-cost consultation. One of our qualified medical providers will sit down with you to determine if you are a good fit for therapy, or if you have any contraindications that would put you at risk. In addition to discussing your mental and physical health history, your provider will explain the ketamine infusion therapy process. You will have as much time as you need to ask questions and address concerns you have with the treatment process.
You are welcome to bring a friend or family member to your consultation, but it is not required. During the treatment process, you might feel the need to talk things through. It can be helpful for your support system to be educated on neurotherapies, how they work, and why they work as well. If they have questions about how to support you, have them check out our Supporting a Loved One Through Neurotherapy blog.
If you are a candidate for ketamine infusion therapy, our Care Team will collaborate with you to establish a personalized treatment plan. It is crucial we promote the best environment, including before, during, and after the treatment process, for you to achieve your goals. Here are a few things to consider when creating your treatment plan:
When you feel prepared to start treatment, our Patient Care Coordinator will work with you to manage logistics. You will want to make sure that paperwork, payment, drivers, and schedules are sorted out before beginning the Stabilization.
What do you need to know about the Stabilization Phase?
Stabilization refers to your initial series of infusions. The mood and mood/pain hybrid protocols consist of six infusions over three weeks. You should plan about an hour and a half for a standard mood infusion appointment door to door. The acute pain protocol typically calls for four infusions over a two week period. These infusions will be longer so it is best to ask your provider about the length of your pain focused infusions. While your experience in the chair does not affect the outcome of the treatment, our goal is to make your time in the chair as comfortable as possible.
There are a few things you can do in preparation for your infusion.
There are a few things we want you to know about during your infusion.
Watch Key Steps to Navigating Stabilization on our YouTube Channel.
It is important you understand Stabilization is only the beginning. The work you do outside of our treatment room, during and after the Stabilization Phase, will help you achieve the long term goal of self-maintenance.
What is Maintenance Phase?
The rapid improvements seen with Ketamine Infusion Therapy are only the halfway mark. By establishing custom maintenance plans and providing booster infusions as needed, we are able to assist you in achieving sustained progress and a fulfilling quality of life.
Ketamine infusion therapy enhances the way your brain communicates and allows you to maximize the gains you make outside of the treatment room. Psychotherapy – establishing positive coping skills, working through past traumas, and optimizing your daily habits are oftentimes – is extremely effective after completing our process. Patients who are being treated for chronic pain might also require physical therapy to increase muscle mass and improve flexibility. Everyone’s process is different and should be tailored to each person’s individual needs. If you feel things start to slip, it might be time to schedule a booster appointment.
Ketamine boosters are similar to a safety net which help maintain plasticity while you optimize coping skills, environment, and medications. Typically, our patients will receive their first booster approximately 4-6 weeks after stabilization. However, the frequency and timing of these boosters are tailored to each individual’s specific needs and response to treatment. There is a diminishing need for regular treatment as practices and coping skills improve.
Good mental and physical health is a process to achieve and a lifetime of practice. Improvement is incremental, not always linear, and a result of continuous effort and self-prioritization by the patient.
If you have questions about treatment, boosters, or a referral, call 423-228-0579.
Mark Twain once said, “It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.” This insightful quote resonates strongly with the events surrounding the tragic loss of lives during a deep water dive conducted by OceanGate Expeditions on June 18, 2023. The ill-preparedness of the submarine they were aboard, despite the presence of the CEO among the passengers, suggests that the problem was not deliberate carelessness but rather a lack of fact-based decision making. This exemplifies the crucial role of incorporating scientific evidence to ensure safety and success in any endeavor. In the context of ketamine and psychedelic therapies, it is essential to recognize the risks associated with an incomplete understanding and the need for accurate information and effective dissemination among practitioners.
Ketamine and psychedelic therapies have gained significant attention in recent years for their ability to positively influence the brain’s baseline function without inducing unconsciousness. These therapies stimulate a neuroregenerative response, leading to enhanced connectivity, cognition, and mood regulation. There are even some who find benefit in the “experience” due to the loss of inhibition and suggestibility which occurs during psychedelic inebriation. The foremost experts have established best-practice protocols which outline the best administration route, modality, and environment for optimal results among all patient populations and demographics who suffer with a particular disease or diagnosis. However, due to the abundance of inaccurate knowledge available among the public and professional communities, there is a growing number of practitioners who are administering these substances without a comprehensive understanding of their side effects and health risks. This knowledge gap poses potential harm to the individuals they aim to treat and hampers the field’s progress.
Ketamine is a well-known and safe anesthetic adjunct used across various medical settings, including anesthesia for children aged six months and older. While ketamine itself is generally safe, it is not without its risks. During the COVID-19 pandemic, authorized providers became able to prescribe controlled substances via telehealth, which opened the door for companies to offer sublingual compounded forms of ketamine for at-home use. Thus, venture capitalists invested billions of dollars in advertising for web-based companies and providers who were prescribing opioid agonists, adderall, and other substances that had once required an in-person appointment. While venture capitalists saw a profitable opportunity, ethical ketamine therapy providers refrained from using this sublingual route due to its poor absorption and potential health risks, including the life-threatening complication of laryngospasm. Unfortunately, some patients have diverted from best-practice models and opted for self-administration of sublingual ketamine. I have seen this poor, ignorant decision result in fatal incidents such as laryngospasm-induced deaths associated with companies pushing take-home ketamine.
My outrage sparked by large investment firms endangering patients’ lives for profit turned into shock when it became evident that these providers had no knowledge of laryngospasm or the potential risks associated with sublingual ketamine. These practitioners adopted non-scientific ideas about the therapeutic benefits of ketamine and psychedelics in treating mood disorders, abandoning the scientific and reproducible approach in favor of a human experimentation model that often lacks factual basis. While their intent was to increase access to care and help struggling individuals, the result became increased risk for patients due to a lack of familiarity with established research and data on safe and effective ketamine administration.
When I openly confronted these providers and companies about their unethical practices, I learned their intent was to increase access to treatments for those who are struggling. While this softened my approach significantly, good intentions alone cannot protect those seeking help from unnecessary risks. Neglecting to invest a mere ten minutes in understanding potential risks can have severe consequences for patients. Continuing to prescribe at-home ketamine administration prioritizes profits over patient safety, sacrificing optimal outcomes for the sake of convenience. The belief that nothing bad can happen due to the absence of prior incidents perpetuates confirmation bias and stifles critical thinking regarding safer and more affordable administration methods. The tragedy involving the CEO of OceanGate Expeditions serves as a poignant reminder that ignorance, rather than greed, can lead to devastating outcomes.
In the end, the events surrounding the loss of lives during the ill-fated dive expedition and the misuse of ketamine in therapeutic settings underscore the importance of knowledge and understanding in ensuring safety and success. It is crucial for practitioners to continually educate themselves on the potential risks and best practices associated with ketamine and psychedelic therapies. By prioritizing accurate information, adhering to scientific approaches, and maintaining a deep sense of responsibility towards patients, we can foster a safer and more effective treatment environment, thus avoiding the perils of ignorance.
Every day there is another article written about psychedelic therapy and its “amazing breakthroughs” in the treatment of mood disorders. The numerous medicinal claims made regarding psychedelics have been hovering at the fringe of western medicine for several decades. Only within the last 20 years has a concerted effort been made to investigate the efficacious use of anesthetics and psychedelics in the treatment of mood disorders. For decades, there were claims and “studies,” which upon closer examination included small sample groups and subjective experiential data, that had a strong bias and could not be reproduced. This was the Achilles heel in the alternative medical research groups. There was a clear bias in the interpretation of data to fit the narrative that a psychedelic experience was allowing patients access to a higher form of processing. This practice is often fueled by the researchers’ spiritual beliefs or other dogma. There have been entire communities and cultures built around the use of psychedelics throughout history, all of which claim a greater understanding of self or spiritual enlightenment.
In the late 1990s, the chemical imbalance theories which were dominating psychiatric practices and the development of modern medications and treatments were called back into question. This time, alternative concepts were proposed with the backing of legitimate research institutions. Since the release of Prozac in 1987, pharmaceutical companies have been developing new drugs and manufacturing new diagnoses with which to market them. Librium, the drug of choice for anxiety, was superseded in 1963 with Purdue Pharma’s introduction of Valium. To justify a stronger medication to the FDA and prescribers around the country, the Purdue Pharma marketing team invented a new diagnosis that is still used today and known as “psychic stress.” The term is often heard in mental health communities, but few, if any, physicians and providers know that the term psychic stress was brought into existence by pharmaceutical companies trying to market a novel anti-anxiolytic. Valium was the number one pharmaceutical from 1968 to 1982. In much the same way, many ketamine providers use the terms “psychedelic therapy” or “psychedelic medicine” to infer a psychedelic experience component to treatment.
The hype around the term, psychedelic, has re-awakened the “spiritually” driven, yet pseudoscience based groups, as if “this is what they have been saying.” It is not. The potential of Ketamine Infusion Therapy as a treatment has pulled on the pursestrings of big pharma and opportunistic medical providers who care less about the research and more about what sells. We have an opportunity to demonstrate that Ketamine Infusion Therapy, as well as potential future medications, chemical substances, and even mechanical stimulations, produce a powerful optimization in how our patients feel about the world around them. As a community, we need to reject the misnomer of psychedelic and embrace the appropriate accepted medical terminology of psychoplastogenic medicine. Psychedelic pseudoscience dilutes our standing in best-practice medical communities. Ketamine Infusion Therapy and other psychoplastogenic compounds will not reach their full potential until we clearly separate best-practice, peer-reviewed science that supports psychoplastogenic medicine from that which panders to psychedelic experience.
Psychedelic: relating to or denoting drugs that produce hallucinations and apparent expansion of consciousness.
Psychoplastogen: a group of small molecule drugs that produce rapid and sustained effects on neuronal structure and function, intended to manifest therapeutic benefit after a single administration.
Terminology changes perception and focus. While many drugs that are psychedelics can also be psychoplastogens, this is not the case with ketamine. Ketamine is classified as a psychoplastogen because the effector of change is the optimization of neuronal structures and function rather than an experience. Understanding ketamine as a psychoplastogen refocuses the treatment for what it is – something that is being done to the patient rather than something that the patient is doing or has control over. The psychology of the patient is enhanced by the neuroplasticity provided by this treatment.
Chemical imbalance theories were proposed initially in the 1950s. They were not wrong about the importance of neuro-chemicals and how our brain communicates with itself and with the body. Unfortunately, the error occurred when they labeled an emotional response to a neuro-chemical. Dopamine is described as the neuro-chemical which makes us feel warm, fuzzy, pleasure, or motivation. It is lesser known for the role it plays in movement, heart rate, kidney function, blood vessel function, pain processing, and lactation. A deficit in dopamine leads to the stiff movements that are the hallmark of Parkinson’s disease. In cardiovascular surgery, we often give dopamine to enhance heart rate and contractility. Serotonin is often mentioned when discussing depression. Serotonin plays a key role in nausea, wound healing, bone health, blood clotting, bladder control, and blood pressure. Both dopamine and serotonin affect many different body systems.
So why is it that we look at mood disorders as some sort of dopamine or serotonin deficit/imbalance? The role of dopamine and serotonin in the causation of mood disorders has been wildly overstated in the last several years. The “serotonin hypothesis” of clinical depression is almost 50 years old. At its simplest, the hypothesis proposes that diminished activity of serotonin pathways plays a causal role in the pathophysiology of depression. This hypothesis is the source of what we often refer to as “chemical imbalance theory.” It makes sense to all of us that if we are low on fuel then adding more is the solution, but our bodies do not function on a less or more system. Most of our body systems function on a delicate balance of supply and demand. When a neural or hormonal transmitter level gets too high, a message is sent by way of our built-in feedback system to the organ or process that is producing the specific neuro-chemical or hormone, and it stops production to allow levels to return to normal. If levels are low, another message is sent to stimulate production with the end result of raising levels. Our amazing bodies are constantly releasing and withholding neural and hormonal chemicals to maintain our bodies delicate balance. A deficit of dopamine and serotonin can contribute to depression, but we would also likely see problems in other body systems.
Chemical imbalance theory would lead us to believe that we do not produce adequate amounts of serotonin and dopamine. If this were the case, why is the mood disorder the only manifestation we see when neuro-chemicals so crucial to our vital functions, movement, and general health are unaffected? The answer is right in front of us. The chemical imbalance theory is incorrect. Chemical imbalance theories were shut down quickly when proposed due to this very issue. Seems simple, right? In the late 1980s, Prozac hit the market and with it came a campaign of pharmaceutical reps who revived the idea that primary mood disorders such as depression and anxiety are the result of a chemical imbalance. These pharmaceutical reps are charged with educating psychiatrists on the medications and the research into why and how these medications work. With our limited, yet ever-expanding, understanding of how an area of the brain actually communicates with another, the science that was presented contained a fair amount of speculation and theoretical conclusions. Many of the terms and sub-types surrounding mood disorders were not developed by the psychiatrists treating patients. Rather they were created by pharmaceutical marketing teams. Mental health care carries with it unique challenges which are not seen in other areas of medicine.
The inception of functional magnetic resonance imaging (fMRI) allows us to image blood flow and subsequent activity in different areas of the brain. This dramatically enhanced and reinforced our understanding that depression and anxiety are a communication issue like we always believed. Here is the issue though: there were areas of the brain that continued to show low activity regardless of serotonin levels. Increasing neuro-chemicals did not enhance communication in these areas showing low activity. In fact, increasing serotonin would actually cause some areas to become overstimulated, activating areas unintentionally.
Think of neuro-chemicals as cars and neuronal pathways as roads. If the roads are closed, the cars cannot get through, right? If we add more cars, we obstruct the traffic further. What happens if we are able to open up the closed roads? We are now able to handle the traffic no matter the number of traveling cars. This is what Neurotherapies do; they open up the roads. Neurotherapy repairs neuronal pathways by stimulating (using multiple methods and pathways) a process called synaptogenesis. Synaptogenesis refers to the formation of synapses, or the points of contact where information is transmitted between neurons. Moreover, Neurotherapy builds roads between the brain cells.
Ketamine Infusion Therapy produces a steady state anesthetic stimulation without sedating the brain, making ketamine unique compared to other anesthetics used in surgery. The process stimulated by Ketamine Infusion Therapy is purely physiologic in nature, and it has been shown to occur whether the patient is awake or asleep. However, an awake brain responds best. The desired response of the brain is a subsequent higher-than-normal release of certain proteins (BDNF, GSK3b, etc.). These proteins are initially neuro-protective (your brain’s protective mechanism) but, over several days’ time, they will stimulate a mappable, measurable synaptogenesis, causing the dark areas of the brain seen using the fMRI to light up. This new growth can also bring about new and healthy brain cell production.
As the brain communicates more effectively, the patient’s mood is not necessarily better or worse. Instead, the patient begins to feel their environment correctly. The stimulation in the world around them starts to elicit a more appropriate emotional and physical response. Good feels good while bad feels bad. Neutral returns as the feeling of the moment when nothing is happening. A positive, enjoyable experience produces good feelings. This will also mean that if the patient’s day to day life is not conducive with good mental health then they do not get to have good feelings. The best description I have heard to date is that it puts the patient back into the present. Too often, the patient’s mood is driven by feelings of things that happened yesterday or fears of what might happen tomorrow, and today gets neglected. By keeping our unconscious emotional response in the moment, stress is still felt, but the stress fits the activity. Crossing the street SHOULD produce a small amount of stress. It is what makes us look left and right before we cross the street. Stress is not to be avoided or ignored. Relief of anxiety only occurs on the other side of the experience driving the anxiety. Synaptogenesis stimulated by Ketamine Infusion Therapy creates a neuroplastic environment where a patient has the ability to reprogram his or her unconscious emotional and physical responses to an experience or environment. This happens primarily in the 10-14 days following the stabilization series of infusions, but it can continue with the support of periodic boosters to maintain plasticity.
We see a similar synaptogenesis with psilocybin, LSD, MDMA, and other hallucinogenic compounds/neurotoxins which are finally being investigated. Whether it be psychoplastogens like ketamine or one of the hallucinogenic compounds/neurotoxins, the research is finding that the improved communication due to enhanced synaptic activity in the brain leads to an enhancement in how the patient perceives the environment. Bad things still feel bad, but it feels the right amount of bad. External practice-based coping skills and practices which were ineffective before actually begin to stimulate the appropriate emotional response. In summation, the patient is the optimal version of themselves. Sometimes that is not all that great. Work must be done after the optimization of communication to proactively build thought patterns, healthy coping mechanisms, and outlets that drive the day to day environment to promote better mental health.
Ketamine is a dissociative anesthetic. Now, this dissociation with ketamine is not like emotional dissociation seen after a traumatic experience or with stressful situations. It is a chemical dissociation between conscious and subconscious processes. It is controlled through continuous IV infusion which allows for it to start and stop quickly on demand. Ketamine does not produce hallucinations. It puts the relaxed mind into a dream-like state. It enhances the feelings of the present while distancing the before and after. You can still access memory, but the emotional connection to the past or future seems distant. Further, it causes a loss of inhibition similar to what we see with alcohol intoxication. The loss of inhibition combined with the dissociation puts the patient in a very suggestible state. This is where the practice, in many places, veers away from the science. Many practitioners will perform psychotherapy while administering the ketamine because they believe this malleable state enhances a patient’s ability to explore traumatic experiences. It does to an extent, but this is due to the aforementioned loss of inhibition. It is my opinion that most psychotherapists would agree that a profoundly intoxicated patient is not in an ideal state to process trauma. Ketamine is an anesthetic meant to degrade the ability to process the environment and stimuli. The mix-up occurs when a provider who is less familiar with the administration of ketamine hears “neuroplasticity” and “dissociation” and muddles the ‘when and how’ of these two processes. Ketamine does produce neuroplasticity through a series of events initiated with IV administration, but no meaningful change in neuroplasticity is present until days after the infusion. These less familiar providers believe the two things happen simultaneously. The dissociative effects of ketamine are a side effect of the anesthetic as it is administered and resolved quickly once the infusion is completed. Peak neuroplasticity is not found for at-least 24 hours and can continue days to weeks after.
The experience or dissociation felt during the infusion degrades the patient’s ability to process stimuli occurring around them. It is like a drunk or high person who feels very wise in the moment. Their understanding of the world has been simplified, but by no means has it been enhanced. During administration, the patient can feel like simple things are very intricate and complex. They can feel many emotions, but the ability to regulate those emotions is deeply dissociated. It can lead to a very embarrassed, upset, or even re-traumatized patient should you ask them to explore feelings while inebriated. It can also lead to a patient feeling amazing and fulfilled in a way they have not felt in years. This feels very good on the day of treatment, but each day that passes, those feelings subside more and more since the “perceived breakthrough” was the result of a chemically induced hypnotism rather than a physiologic change in brain processing.
Like a beautiful dream, the treatment experience can leave you feeling better than ever. I encourage patients to enjoy this feeling to the fullest, but I also educate them on the temporary nature of these feelings. Patients who do not have a deeply experiential therapeutic experience often do better in the long term because they are not clinging to a temporary feeling or experience as the source of their improvement. We want your time in the chair to be wonderful, amazing, comfortable, and even enjoyable, but we also must understand that what happens in the chair is not important. The rapid improvements seen with Ketamine Infusion Therapy are only the halfway mark. The infusions optimize anatomical responsiveness to stimuli so feeling better comes with feeling your world correctly. Improvement is incremental and a result of psychotherapy, prioritization of self care, and follow-up with ketamine infusion boosters as needed.
The ketamine booster process is similar to a safety net, maintaining plasticity while you optimize coping skills, environment, and medications. The need for boosters will lessen to where they become a tool you have in your arsenal should you need it. Daily self-maintenance of your mental health is the goal and is usually achieved in less than 12 months. Each patient’s process is different and should be tailored to his or her individual needs.
Contact our clinic by submitting an online consultation request or calling our office at 423-228-0579.
Why the push for profits is overriding best practice protocols.
A best practice approach is defined as a reproducible, evidence-based treatment or protocol that provides the highest level of patient success. With straightforward medical interventions, success is easily measured because expectations are well understood. For example, if you have a tumor then the complete removal of that tumor is how we determine success. Expectations are clear between the patient and provider. However, in mental health or chronic pain, success is not always so clear cut.
Mental health disorders such as depression, anxiety, PTSD, OCD, or bipolar disorder are considered by many healthcare professionals to be permanent, chronic conditions that must be managed by daily oral medications. These medications stimulate broad spectrum neurotransmitter release or inhibition with the goal of stabilizing the patient’s emotional state. This approach stems from a hypothesis that was first interpreted over 70 years ago, resulting in poor outcomes and unpleasant side effects. More recent research has proven that psychoplastogens, defined as medications, substances, or compounds that stimulate neurogenesis, are able to maximize patient outcomes. Unsurprisingly, many investor groups and venture capitalists see this push as an opportunity to capitalize on a new medical specialty. The ability to optimize neuronal pathways by stimulating the brain’s own neuro-protective response could address the pathophysiology behind many mental health disorders, neuropathic pain disorders, strokes, and traumatic brain injuries. We concur that quick adoption is necessary, but only when the highest standard of care is able to be met.
Ketamine is an anesthetic used by anesthesia providers around the world to optimize outcomes. It is a unique anesthetic that has the ability to support the vital functions such as heart rate, blood pressure, and respiratory drive. Ketamine also produces a chemical dissociation effect, rather than a sedating effect, which essentially changes the brain’s baseline without sedating the brain. The brain responds by releasing elevated levels of a neuro-protective/regenerative protein known as brain-derived neurotrophic factor (BDNF) along with several other lesser proteins as a means of preserving and protecting normal brain function. BDNF is a protein we all produce and release daily as part of our brain’s natural remodeling process. It supports healthy and communicative neuronal synapses, helps us adapt and adopt new processes and information, and aids our recovery from psychological traumas and periods of heightened stress. This protein also releases in response to any significant change in baseline such as the introduction of a neurotoxin, TBI, stroke, and low-dose anesthetic administration. Once BDNF is released, it facilitates improved communication between the brain cells while awake. Then, when we sleep, the protein becomes neuro-regenerative, initiating optimization and rebuilding of neuronal connections that elicit the desired brain optimization.
Ketamine is readily accessible to medical practitioners and can be administered intravenously in the outpatient setting to produce the desired optimization response. But the push for profits is overriding best practice protocols. Investors and venture capitalists looked to decrease cost and the labor intensive nature surrounding intravenous Ketamine infusions. Many mental health providers wanted to offer this treatment option, but had little to no understanding on how to safely administer anesthetics to patients intravenously. While observing patients under low dose anesthesia, psychiatrists and other mental health professionals recognized the patient as being highly suggestible/malleable while under the drug’s influence. In certain alternative medical communities, a practice where certain psychedelics (hallucinogenic compounds) such as psilocybin, LSD, MDMA, ayahuasca, and DMT are administered, and the suggestible state of the inebriated patient is used to perform a type of substance-guided hypnosis. Over the last decade or so, this practice of substance assisted hypnosis adopted the title of “psychedelic assisted psychotherapy”. This practice has actually produced a measure of success. However, with an incomplete understanding of human neurophysiology, the individuals who performed these practice attributed any patient’s improvement to a psychedelic experience (i.e. mind-expansion) rather than a physiologic optimization secondary to a neuro-protective response which occurs as a result of any alteration of the brain’s baseline. Since the anesthetic, Ketamine, is a medication that produces a chemical dissociation and reproducibly stimulates a neuro-regenerative response, the psychedelic therapy community proclaimed Ketamine as proof of concept.
Ketamine is primarily an anesthetic, but has an additional classification as a prototypical psychoplastogen. Psychoplastogens are defined as medications, substances, or compounds which stimulate neurogenesis. Many of the aforementioned illicit psychedelics also qualify as psychoplastogens, but not all psychoplastogens are considered psychedelics. A familiar prototypical psychoplastogen is scopolamine which is often used to treat motion sickness (sea-sick patches). Scopolamine is treated differently than Ketamine because it does not produce the hallucinations or “psychedelic experience” which some providers believe can be guided to therapeutic realizations. The problem with looking to a psychedelic experience to be the catalyst for lasting emotional regulation is that, while different areas of the brain are activated under the influence of these substances, some areas are suppressed. Ketamine produces a similar manifestation as severe alcohol inebriation. The practice of psychotherapy under the influence of Ketamine is unproductive and often retraumatizing to the patient. We all know someone who, while intoxicated, felt like they were ready to tackle problems or possess a greater understanding of a situation. The new-found wisdom and lack of inhibition is consistently short lived. With Ketamine in particular, this so-called improvement lasts no more than a week or two before the patient must repeat the experience. If feeling weird is necessary to feel better then we will always need to feel weird to feel better.
Since the practice of psychotherapy under the influence of Ketamine statistically decreases patient reported remission of symptoms, why is the practice so prevalent? The answer is obvious. Psychotherapy during Ketamine administration incurs an extra charge of roughly $150 above the infusion cost. It increases a clinic’s profits per infusion significantly. It also appeals to the psychedelic community’s narrative and is stretched to lend legitimacy to practices that otherwise lack scientific backing or reproducibility.
Scenic City Neurotherapy refers to our evidence based administration method as Minimally-Stimulated Ketamine Infusion Therapy (MSKIT®). MSKIT® requires significant patient preparation and education. It is important that each patient has a fair understanding of how Ketamine Infusion Therapy works and accurate expectations with physiologic improvement. The neuro-regeneration and optimization we stimulate cannot roll back in a week or two. A loss of improvement within two weeks is usually from the waning placebo effect. Moreover, if the patient’s focus is on feeling good rather than feeling their world in a better and more appropriate way, they will be sorely disappointed.There is no magic fix; no answers in the ether. If mood disorders or neuropathic pain were something a patient could think his or her way through, they would have done so by now.
Ketamine Infusion Therapy stimulates enhanced communication, meaning that stimuli experienced by the patient produces a more appropriate emotional response. The patient begins to feel their environment correctly. Small stressors produce small anxieties. Large stressors produce bigger anxieties. The patient’s ability to feel present in the moment is enhanced so that they can feel good when good things happen, feel bad when bad things happen, and feel reasonably neutral when nothing is happening. Improvement continues as the patient’s environment improves. Progress made during psychotherapy in the days after treatment works to build the patient as they work toward a long term goal of self-maintenance.
While Ketamine Infusion Therapy is not magic, it is so much better. It is science; a mappable, measurable, reproducible change to the physiology of the brain. While it is not lightning from heaven, it is still a rapid shift in baseline and meaningful improvement over the short term. When appropriately administered, it functions as the missing piece of the mental health process which can help patients transition a chronic condition into complete remission, minimizing the need for a daily medication.
