Ketamine is an FDA-approved anesthetic. But these days, ketamine is receiving a lot of positive attention due to being used “off-label” to treat treatment-resistant depression (TRD). Whenever a drug is used “off-label” it means that it is being used in a manner that doesn’t have FDA approval. Ketamine infusion therapy is the administration of a single infusion or a series of ketamine injections. This type of therapy helps with the management of several psychiatric disorders such as:
- Major Depressive Disorder (MDD)
- Acute Suicidal Tendencies
- Post-Traumatic Stress Disorder (PTSD)
- Obsessive-Compulsive Disorder (OCD)
- Bipolar Disorder
While ketamine isn’t considered a front-line therapy for chronic pain, depression, or any other disorder, it can be used to treat severe cases that haven’t responded to traditional medications or therapies.
What is Ketamine?
Ketamine is a widely used FDA-approved anesthetic that’s been used for more than 50 years. It’s also a medication with quick-acting antidepressant properties that have been studied by mental health experts for over two decades. Also known on the street as “Special K,” ketamine has been abused in the past as a recreational drug because of its hallucinogenic and tranquilizing effects.
What are the Advantages of Ketamine Infusion?
Worldwide, depression is the principal cause of disability and the main mental health disorder that brings about suicidal tendencies. About two out of three people with major depression eventually achieve lasting remission of their symptoms with traditional antidepressants. The remaining one does not change.
For those people with treatment-resistant depression, anxiety, persistent PTSD, and chronic pain, ketamine infusion can provide several advantages including:
Ketamine infusions work quickly to ease symptoms of depression–frequently within hours. Although researchers are still trying to identify the process behind this dynamic effect, they do know that it stimulates a rapid increase in glutamate.
Glutamate is the main neurotransmitter, a chemical messenger that carries, boosts, and balances signals between nerve cells. This encourages the growth of synapses in your brain.
Synapses connect nerve cells in the brain to nerve cells in the rest of the body. Ketamine helps strengthen and restore important brain connections and pathways in the areas of the brain that are most impaired by depression. The new connections help encourage beneficial changes in the function of the brain’s circuitry.
High Success Rate
Research shows that ketamine infusion has a high rate of success in treating TRD. Several studies indicated that over half of people with TRD were able to obtain significant relief of their symptoms after a single infusion. Many more found relief after two or three infusions.
An excellent rate of effectiveness is an important part of what makes ketamine infusion therapy so beneficial for individuals who haven’t been able to get lasting relief through common medical solutions.
Ketamine infusion therapy isn’t a treatment that cures depression in a single session. However, it’s also not like traditional antidepressants that have to be taken daily for years, or as long as they are effective. Rather, ketamine infusions stimulate beneficial changes in the brain that bring lasting symptom relief throughout a single treatment cycle.
On average, the acute phase of ketamine infusion therapy calls for a series of six infusions spread out over the course of two or three weeks. This beginning treatment is followed up by a long-term maintenance phase that includes booster shots as needed.
Ketamine may give relief from PTSD that many people, particularly veterans, suffer with. PTSD is a mental health disorder that people may develop after experiencing a trauma such as combat. At the Neurosciences Medical Clinic in Miami, where 35% of their clients are military veterans who need treatment for PTSD, ketamine therapy is giving them hope that other kinds of treatment can’t provide.
In addition to being included in the treatment of psychiatric disorders, ketamine is also being used for post-operative and chronic pain management. Intravenous (IV) ketamine infusion therapy has been developed as a treatment for a number of conditions.
Ketamine Infusion Disadvantages
Of course, no treatment is perfect. And even though it can offer major benefits in the treatment of persistent depression, the disadvantages of ketamine have to do with its dissociative (feeling detached from reality) effects and its potential for addiction.
- The helpful effects tend to wear off after 7 to 10 days so infusions need to be done on a regular basis
- Studies have indicated that it might be toxic to brain cells
- At higher doses, it may cause bladder damage
- Psychotic-like symptoms during treatment
All drugs have side effects. But when a person is suicidal or seriously depressed, the potential benefits may outweigh the possible side effects. While ketamine infusion therapy is used in doses that are below the level for anesthetizing, it can still cause temporary side effects that include the following:
- Mild hallucinations
- Sensation of floating
- Blurry vision
- High blood pressure
- Nausea and vomiting
Because of these side effects, ketamine infusion must be:
- Only approved for use after a complete evaluation
- Administered in a ketamine-certified clinical setting
- Administered and supervised by an experienced provider
The possibility of immediate side effects from ketamine infusion therapy means that you need to arrange for someone to drive you to and from the treatment session. Although the mild dissociative side effects of ketamine infusion therapy diminish quickly, it can leave you feeling groggy and tired until you’ve gotten a good night’s rest.
Not for Everyone
Ketamine isn’t the solution for everyone with TRD. Due to its potentially addictive properties, it might not be a good choice for people who have a history of substance abuse or a diagnosed addictive disorder.
Why Ketamine is Important for Treating Depression
The importance of ketamine as a form of depression treatment is that it can:
- quickly reduce suicidality (life-threatening behaviors and thoughts)
- relieve other serious symptoms of depression
- be effective in treating anxiety combined with depression
In addition, other treatments for depression and suicidality usually take weeks or even months to take effect, as noted earlier, and many people need to try several different methods and medications to achieve relief. This is true for:
- Psychotherapy (talk therapy)
- Antidepressant medications
- TMS (transcranial magnetic stimulation
- ECT (electroconvulsive therapy)
Currently, ECT is the most effective treatment for people that suffer from major depression that don’t respond to other therapy approaches.
Two Types of Ketamine Treatment
There are two types of ketamine used to treat major depression that hasn’t responded to two or more treatments (TRD). The two types are:
- Esketamine (Spravato): It is given as a nasal spray and is FDA-approved. Patients continue to take their antidepressant medications and receive the esketamine at their doctor’s office or in a clinic where they can be watched for 2 hours after the dose. To treat TRD, patients typically get the nasal spray twice a week for 1 to 4 weeks and then once a week for up to 9 weeks. Then once a week after that.
- Racemic ketamine: Usually given as an IV into the bloodstream (infusion). Is what’s FDA-approved as an anesthetic and used off-label for depression. You can only get it by IV or shot in a doctor’s office. Patients usually start with two infusions a week, then down to one infusion per week. Eventually, most people go to one infusion every 2 to 4 weeks. Most research stops the treatment at 6 weeks. There hasn’t been any research to show that more than 6 weeks in a row provide ketamine therapy more benefits, but people do go back for boosters if symptoms return.
These two types of ketamine have different effects on the receptors in the brain. The method that the drug ketamine is administered and the type will determine the drug’s effectiveness and side effects. Most of the research so far has been on ketamine infusions.
John Krystal, MD, chief of psychiatry at Yale-New Haven Hospital and Yale School of Medicine encourages patients to continue with their psychotherapy after receiving ketamine treatment. Likewise, physicians who administer ketamine infusions usually recommend that patients continue with their antidepressant medication plan also. Also, nasal spray is only approved with oral antidepressant medication.
Where Did Ketamine Come From?
The story of ketamine began in 1956 with the synthesis of the drug, phencyclidine (PCP). PCP was discovered to be a great anesthetic for monkeys and was used on humans after many testings on animals. However, the side effects observed in some patients were disturbing.
Instead of waking up peacefully from anesthesia, some were experiencing acute delirium that lasted for hours after their operation was over. Patients described feeling deprived of their senses and the loss of sensations in their limbs. Subsequent studies showed that phencyclidine caused a sensory deprivation syndrome.
In an effort to find a short-acting alternative, Dr. Calvin Lee Stevens synthesized phencyclidine derivatives. The compounds he synthesized were tested on animals and one was found to be successful as a short-acting anesthetic. After being selected for human testing, it was titled CI-581 and eventually came to be named ketamine for the ketone and amine group in its chemical makeup.
Treatment for Depression at Florida Center for Recovery
Are you struggling with depression? Or are you using substances to dull the feelings? It is a common occurrence. You don’t have to suffer from either one. Florida Center for Recovery has specialized programs for individuals who have co-occurring conditions of addiction and depression.
Don’t let these debilitating conditions rob you of your life and happiness. It is possible to live a fulfilling life and reach your goals, but you have to get started. Take that first step and contact us now. You have everything to gain.
For people to achieve and maintain sobriety after struggling with drug addiction, they need to be motivated within themselves to do so. Unfortunately, this doesn’t come as easy or natural to some as it does to others. That’s where motivational interviewing for substance abuse comes in.
What is Motivational Interviewing for Substance Abuse?
Motivational interviewing (MI) for substance abuse is a therapeutic tactic that was created by Dr. William R. Miller and Dr. Stephen Rollnick. It was initially created to help treat alcohol addiction.
Now MI helps motivate all types of substance abuse treatment patients to change their destructive behaviors so that they can achieve and maintain sobriety. Motivational interviewing (MI) also helps substance addiction treatment patients to overcome their fear of changing their lives by no longer abusing substances.
MI is particularly helpful when dealing with people who don’t think their substance abuse issues are as severe as they are or people who just don’t want to give up the euphoric sensations they feel when abusing substances. People that fear experiencing withdrawal symptoms when no longer abusing substances can also benefit from receiving motivational interviewing.
How Does Motivational Interviewing for Substance Abuse Work?
Motivational interviewing for substance abuse works by having a therapist conduct an interview with an addiction treatment patient. In this interview, the therapist works with the patient to help him, or her create addiction recovery goals. In helping the patient create addiction recovery goals for him or herself, the therapist is empowering the patient—that way, the patient is given autonomy over their own addiction recovery journey.
Helping addiction treatment patients set recovery goals for themselves also gives them things that they feel responsible for achieving within themselves. This, in turn, motivates MI patients to achieve and maintain sobriety.
Principles of Motivational Interviewing for Substance Abuse
There are certain key principles that all motivational interviewing therapists follow, especially when conducting MI for substance abuse treatment. These core principles are listed below.
1. Express Empathy Through Reflective Listening
During motivational interviewing for substance abuse treatment, it’s important that therapists put themselves in the patients’ shoes rather than judging them. That way, the patients feel as if their thoughts and feelings are validated and that they have some control over what will occur to them during the MI process.
2. Develop Discrepancy Between Client Goals or Values and Their Current Behavior
This principle of MI focuses on helping addiction treatment patients see the difference between who they are today and who they want to be in the future.
3. Avoid Argument and Direct Confrontation
To ensure that MI patients always feel some sense of autonomy, MI therapists make sure to avoid any arguments or confrontations with them.
4. Adjust to Client Resistance Rather Than Opposing It Directly
When resistance occurs to MI by addiction treatment patients, the MI therapists make sure to hear out what the patients are saying. The MI therapists also make sure to adjust to meet the patients where they are at mentally.
5. Support Self-Efficacy
One key principle that MI therapists must follow is working hard to rebuild self-efficacy amongst their patients. That way, addiction treatment patients leave motivational interviewing feeling capable and motivated to achieve and maintain sobriety on their own.
Objectives of Motivational Interviewing for Substance Abuse
There are certain key objectives that motivational interviewing therapists make sure to achieve. These MI objectives align with the key principles of motivational interviewing.
MI objectives are met to ensure that patients leave motivational interviewing feeling motivated to achieve and maintain sobriety on their own. The key objectives to motivational interviewing for substance abuse treatment include the following:
1. Collaboration vs. Confrontation
It’s vital that motivational interviewing therapists collaborate with their patients when creating addiction recovery goals for them. That way, the MI patients always feel in control and responsible for their own recovery. Collaborating when creating addiction recovery goals rather than confronting MI patients with information on what they should do also helps create trust between MI therapists and their patients.
2. Drawing Out vs. Forcing Ideas About Change
Drawing out ideas out of therapy patients rather than forcing ideas on them is vital during motivational interviewing. This is because it helps bring out the patients’ own motivations and skills for change.
3. Autonomy vs. Authority
Ultimately the goal of motivational interviewing is to get the patients motivated enough to follow through on achieving recovery on their own. To achieve this goal, MI therapists must encourage the patients to take the lead when it comes to coming up with their addiction recovery goals. That way, the MI patients are empowered and always feel a sense of responsibility and autonomy when it comes to achieving their addiction recovery goals.
4. Roll With Resistance
To ensure that motivational interviewing patients are empowered and decide on their own to achieve sobriety, MI therapists must not react to any resistance that the patients may initially give during therapy. Instead, MI therapists must allow any patient resistance to “roll” off their backs.
MI therapists must then help their patients work through why they are feeling resistant. Ultimately, this will help motivational interviewing patients come up with their own ideas for change. This, in turn, will make it easier for MI patients to stay motivated to achieve their goals for change.
Stages of Motivational Interviewing for Substance Abuse
There are certain stages, or steps, of motivational interviewing that therapists must follow for it to be effective. These stages are described below.
Stage 1: Engage
Before anything else, it’s important that motivational interviewing therapists make their patients feel as if they are on their side. That way, MI patients feel as if they are working with their therapists to achieve recovery rather than working to achieve recovery for their therapists. To make sure that MI patients trust their therapists, motivational interviewing therapists must engage with their patients.
Stage 2: Focus
In the next stage of motivational interviewing, MI therapists should help their patients focus in on what their substance abuse issues are. Then MI therapists must help their patients focus in on what their goals are for fixing their substance abuse issues.
Stage 3: Evoke
During this stage of motivational interviewing, MI therapists must discover their patients’ “why.” By this, we mean the MI patients’ why for changing. Motivational interviewing therapists must then discuss with their patients why their patients’ motivations for changing are what they are. After summarizing and reflecting on why their patients’ motivations for change are what they are, MI therapists must work on increasing the level of motivation behind their patients’ desire to change.
Stage 4 – Planning
During the planning stage of motivational interviewing, MI therapists work to build the coping skills and knowledge of their patients. That way, motivational interviewing patients have the ability to achieve and maintain sobriety long-term on their own.
Motivational Interviewing Techniques
There are certain key therapeutic techniques that all motivational interviewing therapists use. The exact therapeutic techniques that are behind the motivational interviewing process can be described in the acronym O.A.R.S.
O – The O in the acronym O.A.R.S. stands for asking open-ended questions. This is because open-ended motivational interviewing questions for substance abuse leave room for MI patients to dive into what their motivations for change are and why they are what they are.
A – A stands for affirmations. Giving affirmations is an important therapeutic technique that MI therapists follow. This is because affirmations give highlights to the strengths of MI patients. This, in turn, will provide MI patients with the positive reinforcement that they need to build on their motivations to change.
R – R stands for reflecting. This means that motivational interviewing therapists must conduct simple and complex reflections on what their patients have said and implied. That way, MI therapists can provide their patients with input and feedback that can make the MI patients have an even better understanding of why they are motivated to change. MI therapists giving proper reflections on what their patients have said and implied in therapy thus far also helps MI patients feel seen, heard, and understood.
S – S stands for summarizing. This means that motivational interviewing therapists must compile all of the information that they’ve gathered on their patients and their motivations and present it to the patients themselves.
By MI therapists summarizing everything that they’ve learned about their patients and presenting this information to the patients themselves, it will hopefully help the MI patients see what exactly they need to do left to change. Seeing all of the information on themselves will also hopefully help strengthen the motivation that MI patients have to change.
What’s the Best Time to Use Motivational Interviewing for Substance Abuse Treatment?
Dr. William R. Miller and Dr. Stephen Rollnick originally created motivational interviewing to help treat alcohol addiction. As a result, MI best works when doing so.
In fact, motivational interviewing has become such a successful alcohol addiction treatment therapeutic tactic that professionals now use it to treat other substance and behavioral addictions. People can even use motivational interviewing to simply increase the frequency that they exhibit positive behaviors.
What’s the Primary Goal of Motivational Interviewing?
At the end of the day, motivational interviewing’s primary goal is to help individuals overcome any internal battles that keep them questioning whether they want to quit abusing substances or not. Thus, through motivational interviewing, individuals receive the motivation that they need to go on the path towards achieving recovery. Motivational interviewing also helps individuals receive the motivation that they need to maintain sobriety long-term.
Receive Motivational Interviewing At Florida Center for Recovery
Here at Florida Center for Recovery (FCR), we offer motivational interviewing for substance abuse treatment. Thus, individuals that need motivation to achieve sobriety and maintain it long-term can receive MI therapy at our rehab facility.
To learn about the other forms of addiction therapy that we offer here at FCR, contact us today. We are here to help you change your life for the better.