The Remedy is an innovative mental health clinic committed to meeting patients where they are with forward-thinking treatments that offer a better quality of life.
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No. At The Remedy MN Ketamine TMS, we treat you as the whole person that you are. Our psychiatrists are highly trained in psychopharmacology but also recognize the value of a full mind-brain-body perspective as well as psychotherapy and coaching. Doing a 90-minute initial consultation allows them to assess you not just from a medication perspective but to fully evaluate all the issues you may have, including medical problems that may be impacting your mental health, sleep disorders, issues related to your life experiences, and childhood, which may be relevant. In addition, at The Remedy, we offer non-traditional approaches such as dTMS and Ketamine treatment for those who have not tolerated/or are not interested in traditional medication approaches. Our psychiatrists also work in a highly collaborative approach with our therapists to provide you with a well-rounded, comprehensive treatment experience.
At The Remedy, we focus on mood disorders, depression, anxiety, and trauma. If you have other concerns, please discuss them with our team to see if we are the right fit with you. If not, we are happy to provide a referral to other mental health resources.
We have therapists who are dually trained in mental health (including trauma) at a master’s level. Our therapists have a focus on treating trauma/PTSD with modalities such as Prolonged Exposure Therapy and other evidence-based therapies for trauma. Other general approaches include CBT, DBT skills, and others.
Ketamine was first synthesized in 1962, quickly gaining notoriety as a “dissociative anesthetic” that could be used safely on the battlefields of Vietnam to treat wounded soldiers without compromising their ability to breathe and maintain good blood pressure. Since then, ketamine’s use has become a staple in ambulances, emergency departments, and operating rooms across the country. It is particularly useful for procedures in the pediatric population, given its unique properties. Ketamine’s safety and effectiveness profile is so good it’s on the World Health Organization’s List of Essential Medicines. Only those medicines that are the most effective and safe make it to this list.
Ketamine works on several brain chemicals (neurotransmitters, including NMDA and BDNF—brain-derived neurotrophic factor) and receptors. Ketamine also appears to be an opioid receptor agonist (stimulates opioid receptors), which may account for its effectiveness in treating pain disorders and also provides benefits for mood disorders*.
Ketamine’s rapid effects appear to be related to its ability to form new brain nerve connections (receptors and synapses, vital connections between brain nerves – and neurons). Research has shown that a lack of these connections is associated with major depression and other mood disorders.
*If you are taking opioid-blocking medications such as naltrexone, it may interfere with the effectiveness of ketamine treatments. Please discuss this with your doctor.
More than 70% of people treated for depression with Intravenous Ketamine infusions have a significant reduction in depressive symptoms. This includes people with difficult-to-treat depression who had minimal or no response to antidepressants.
No. As with all chronic illnesses, we have no cure for depression, but we do have effective treatments, ketamine infusions being one of the most rapid and effective. Many people experience weeks or months of improvement in their depressive symptoms after a ketamine infusion series and may require periodic “booster” infusions thereafter. On average, people have booster treatments every 4 weeks. Each person’s need varies, and treatment is tailored to suit yours.
Ketamine has been used at very high doses, illegally obtained for recreational use. It can be misused on the streets and is often referred to as “special k” that sends users into a psychedelic ‘k-hole.” The doses used for treating depression and pain, however, are much lower. Using ketamine in a clinical setting, such as at The Remedy, under the careful supervision of our highly trained practitioners, there is little risk and a great opportunity to have your depression fully treated.
Yes, it is used as an “off-label treatment”- a non-FDA-approved treatment. In a recent study published 2/1/2020 in the American Journal of Psychiatry, a single infusion of ketamine combined with motivational enhancement therapy significantly increased the likelihood of abstinence, delayed the time to relapse, and reduced the likelihood of heavy drinking days … Infusions were well tolerated, with no participants removed from the study as a result of adverse events. Two published studies have demonstrated that ketamine is effective in treating opioid use disorder. Krupitsky et al. conducted a randomized controlled trial of 70 heroin-addicted participants in which they compared the efficacy of high-dose ketamine (2 mg/kg IM) vs. low-dose ketamine (0.2 mg/kg IM) in conjunction with psychotherapy. Abstinence rates at 1 month approached 85% in the 2 mg/kg group and were 24% at 1 year in the 2 mg/kg group. Craving was also notably reduced. They noted significantly greater reductions in heroin craving in the repeated treatment group as compared to the single treatment group (The Hefter Review of Psychedelic Research). A recent systemic review of the efficacy of ketamine infusions in treating substance use disorders published in Frontiers in Psychiatry suggests that ketamine may facilitate abstinence across multiple substances of misuse and warrants broader investigation.
No. Intranasal ketamine does not get absorbed into the body as efficiently as IV ketamine and thus has a weaker effect at the same dose as IV ketamine. Even when adjusting to a higher dose to account for the lower absorption rate, intranasal Ketamine does not appear to have as robust an effect as IV ketamine infusions. In addition, compounded intranasal ketamine can have a lot of variability due to the different methods and delivery systems used by compounding pharmacies.
Unlike a conventional antidepressant, ketamine causes minimal side effects, all of which are short-term, so patients enjoy better quality relief without the additional challenges of weight gain, loss of libido, dry mouth, and other undesirable side effects often associated with antidepressant medications. There are no known long-term side effects of ketamine when used in a clinical setting. (Used illicitly on the street at high doses for prolonged periods of time, there can be serious side effects, the most common of which is cystitis- severe inflammation of the bladder lining)
While ketamine for depression has been researched thoroughly for more than 20 years, ketamine has been used for sedation and other indications at much higher doses for over 60 years and has proven itself to be a very safe medicine—so safe, in fact, that it’s the preferred choice for pediatric cases.
The most common short-term ketamine side effects are:
Most Ketamine treatment side effects are temporary and gradually subside following treatment. Typically, any side effects completely disappear after a full night of sleep.
If you are concerned about potential short-term side effects, you can ask one of our practitioners for tips on minimizing or preventing them. For example, antiemetics (medication for nausea and vomiting) may be helpful for IV ketamine therapy patients who are prone to nausea.
If any of the side effects of ketamine infusion therapy persist or become bothersome, or you have questions, we are always available to discuss and assist. Minor changes in other bodily systems may sometimes occur during an infusion. For instance, the blood pressure, pulse rate, or heart rate may increase. These changes in vital signs usually normalize without intervention soon after an infusion is completed, if not sooner. Medication may sometimes be used to minimize or prevent these side effects.
Most medications can be continued. There are very few medicines that cannot be taken in combination with ketamine. For treatment planning purposes, please contact us with any questions regarding interactions between your current medications and ketamine.
Your insurance may cover this service, but you should check with them directly on the details, co-insurance, and deductible portion you will be responsible for. There have been many recent advancements and acknowledgments in Ketamine Infusion Therapy.
In a clinical study lasting four weeks, Spravato improved symptoms of depression in people taking the drug. One group was given Spravato and an oral antidepressant. The other group was given a placebo (no treatment) and an oral antidepressant. Depression symptoms were measured on a scale of zero to 60 (with higher scores indicating worse depression symptoms). People taking Spravato had fewer depression symptoms than people taking the placebo; their scores improved by 4 points more than scores for people taking the placebo. The greatest symptom improvement was seen in the first 24 hours after people took Spravato. After the four-week trial, some people enrolled in a year-long study. These were people who had a significant improvement in their depression symptoms during the first study. In the year-long study, Spravato also improved depression symptoms. During this study, people were taking an oral antidepressant with either Spravato or a placebo nasal spray. Those who took Spravato were 51% to 70% less likely to relapse back to severe depression than those taking the placebo.
There are no current head-to-head studies comparing the effectiveness of Spravato to IV Ketamine infusions. Based on the experience of practitioners using compounded intranasal ketamine vs. IV Ketamine infusions, Ketamine infusions appear to have a more robust effect in treating depression and can also be individually adjusted to provide the effectiveness you need.
Although it is given as an intranasal spray, the FDA has highly regulated Spravato and requires that the medication either be sent by the pharmacy directly to the practitioner’s office or purchased from the practitioner’s office. The FDA has also required that Spravato be administered in the practitioner’s office with a 2-hour post-application monitoring period in the office.
You can check with your insurance provider as to whether Spravato is a covered service for you, both the medication and application in the office /post-application monitoring period. As it is a brand name drug, as opposed to IV ketamine, which is generic, without insurance, Spravato is quite expensive. However, Janssen, the company that developed Spravato, does have financial support options for patients who need it. Janssen CarePath
The current recommended treatment protocol is for 2x a week of treatment for the 1st 4 weeks, then weekly treatments for weeks 5-9. Thereafter, treatment frequency is once every 1-2 weeks. Currently, there are no studies of Spravato for longer than a year.
We researched the currently available TMS devices and found that the deep TMS provided by the Brainsway unit was more effective in clinical trials due to its ability to provide deeper and broader stimulation to the appropriate areas of the brain. Brainsway is also the only company with an FDA-approved indication for OCD. Brainsway is also involved in excellent research for other applications of dTMS, including smoking cessation, other trauma/PTSD, ADHD, and certain neurologic disorders.
Our dTMS team will work to create a comprehensive treatment plan for you. This may include psychotherapy or medication adjustments to achieve the best treatment outcomes. Treatment involves sitting comfortably in a chair and wearing the treatment helmet for 20 minutes. The coil in the helmet stimulates the brain in the areas that affect mood and OCD symptoms by creating a temporary magnetic field. Approximately 50% to 60% of people with depression who have tried and failed to receive benefits from medications experience a clinically meaningful response with dTMS. About one-third of these individuals experience a full remission, meaning that their symptoms go away completely. It is important to acknowledge that these results, while encouraging, are not permanent. Like most other treatments for mood disorders, there is a high recurrence rate. Most dTMS patients feel better for many months after treatment stops, with the average response length being a little more than a year. Some will opt to come back for subsequent rounds of treatment. For individuals who do not respond to dTMS, other treatments, such as ECT (Electroconvulsive Therapy), are effective options to consider.
A course of treatment with dTMS usually consists of 37 treatments. You will have the first 20 treatments over 4 weeks, with treatments occurring 5 weekdays weekly. You will see your psychiatrist weekly during this time to assess treatment progress. A tapering phase then follows for 8-16 weeks, with treatments occurring 2x a week. During the tapering phase, you will see your psychiatrist every 2 weeks. After treatment is completed, you will see your psychiatrist as recommended. If symptoms recur, you may benefit from another course of dTMS treatment.
dTMS is being studied extensively across disorders and even disciplines with the hope that it will evolve into new treatments for neurological disorders, pain management, and physical rehabilitation in addition to psychiatric disorders. There are currently large clinical trials looking at the effectiveness of dTMS in conditions such as pediatric depression, bipolar disorder, smoking cessation, post-traumatic stress disorder, and ADHD. Studies are also being designed to look at the efficacy of dTMS in treating certain conditions. While promising avenues for research, dTMS for these conditions is not yet approved and would be considered “off-label.”
Antidepressant medications and psychotherapy are the first-line treatments for major depression. These treatments, however, do not work for all patients. In these instances, dTMS might be used as an alternative treatment or to augment antidepressant medications or psychotherapy. Patients who have failed to achieve an adequate response from antidepressants or who are unable to tolerate medications might consider dTMS therapy. (Every insurance company’s prior authorization requirements are different. Many require that you have failed 2 adequate trials of antidepressants in different classes at the highest FDA-approved, tolerated dose, 2 trials of augmentation – medications of a different class added to your regimen – and 1 trial of appropriate psychotherapy).
*Certain medications (and drugs) may reduce the effectiveness of dTMS, so you should discuss them with your doctor prior to starting treatment. Also, any new medications started during treatment should be reviewed.
dTMS is well-tolerated and associated with few side effects, and only a small percentage of patients discontinue treatment because of these. The most common side effect, which is reported in about half of patients treated with dTMS, is headaches. These are mild and generally diminish over the course of the treatment. Over-the-counter pain medication can be used to treat these headaches. About one-third of patients may experience painful scalp sensations or facial twitching with dTMS pulses (during treatment). These, too, tend to diminish over the course of treatment, although adjustments can be made immediately in coil positioning and stimulation settings to reduce discomfort. The dTMS machine produces a loud noise, and because of this, earplugs are given to the patient to use during the treatment. However, some patients may still complain of hearing problems immediately following treatment. No evidence suggests these effects are permanent if earplugs are worn during the treatment. dTMS has not been associated with many of the side effects caused by antidepressant medications, such as gastrointestinal upset, dry mouth, sexual dysfunction, weight gain, or sedation. The most serious risk of dTMS is seizures. However, the risk of a seizure is exceedingly low. Overall, dTMS is a very safe procedure.
*Certain medications, drugs, caffeine, and alcohol may increase the risk of seizures, impact the effectiveness of dTMS, or require a dTMS dose change and should be discussed with your doctor prior to starting treatment or if any changes in your medication/drug/alcohol or caffeine use should occur during treatment.
Patients with any type of non-removable metal in their heads (except for braces or dental fillings) should not receive dTMS. Failure to follow this rule could cause the object to heat up, move, or malfunction and result in serious injury or death. The following is a list of metal implants that can prevent a patient from receiving dTMS:
Many terms are used for this type of therapy—ketamine-assisted or facilitated psychotherapy, cannabis-assisted psychotherapy, etc. In the United States, we are limited to utilizing only medications that are FDA-approved. (Though their use in psychotherapy is not FDA approved and therefore done “off label”). Ketamine is an FDA-approved medication for anesthesia, and ketamine (Spravato) is FDA-approved for treatment-resistant depression. Ketamine can be used in an off-label manner either as a sublingual lozenge or “troche,” intramuscular injection, or sometimes at a higher dose with IV infusions. Ketamine is considered a dissociative agent and not a “psychedelic,” though it has been lumped in this category. Some therapists offer “psychedelic integration” of people’s psychedelic experience from drugs not used during the therapy session, which is very different than medication-assisted psychotherapy done in a controlled setting with evidence-based psychotherapy.
There are no quick fixes for complex trauma. Simple traumatic experiences may be resolved in a relatively short period of time. Complex trauma and chronic PTSD take much longer to resolve, especially if there are also childhood and attachment issues connected to the trauma. That being said, medication-assisted therapy is a more effective and efficient way to resolve these issues than what we have seen with other therapeutic modalities.
As Jon Kabat Zinn, the godfather of Westernized mindfulness meditation therapy, once said, “Meditation is not for the faint of heart.” The same can be said of trauma therapy and, more specifically, medication-assisted psychotherapy. Centers around the country working with various techniques and research protocols for medication-assisted psychotherapy have noted that this type of therapy can create a level of “destabilization” (worsening of symptoms) in the early part of therapy. The reason for this is that symptoms of PTSD, such as dissociation (shutting down) and compartmentalization, are your body, mind, and brain’s way of coping and protecting you from the trauma. Although you may not experience the trauma overtly, it does manifest in other ways, such as mood disorders, anxiety, physical symptoms, and relational problems. These coping mechanisms, which have been in place for years, begin to break down during treatment as these “workarounds” are no longer needed to protect you (hang onto or bury the trauma without resolution). The doors to your psyche begin to open in this therapy, and through these doors come the experiences, events, and “programming” that are frequently responsible for the symptoms you have experienced for so long. This traumatic material emerges with the support of medication-assisted therapy, and it is not an easy, blissful journey. Though not easy, it is a path towards wellness and peace of mind which you may never have experienced before. The journey is supported by our expert therapists, and it is an intelligent experience that will make sense to you. For improvement to be made in trauma/PTSD, which is lasting and fulfilling, this is a necessary part of treatment, leading to people feeling more associated but also more symptomatic and less functional in the early part of the work. For many people, the destabilization that occurs is significant, but they can function at an acceptable level at work and with family, though it may not be on their “A game.” Others may require more intensive support to help them through these early, difficult experiences.
At The Remedy, we focus on mood disorders, depression, anxiety, and trauma. If you have other concerns, please discuss them with our team to see if we are the right fit with you. If not, we are happy to provide a referral to other mental health resources.
We have therapists who are dually trained in mental health (including trauma) at a master’s level. Our therapists have a focus on treating trauma/PTSD with modalities such as Prolonged Exposure Therapy and other evidence-based therapies for trauma. Other general approaches include CBT, DBT skills, and others.
Ketamine’s rapid effects appear to be related to its ability to form new brain nerve connections (receptors and synapses, vital connections between brain nerves – and neurons). Research has shown that a lack of these connections is associated with major depression and other mood disorders.
*If you are taking opioid-blocking medications such as naltrexone, it may interfere with the effectiveness of ketamine treatments. Please discuss this with your doctor.
Suboxone (buprenorphine/naloxone) is an effective medication for treatment of Opioid Use Disorder (OUD). It is effective at managing withdrawal, opioid cravings and has been proven to protect against overdose and relapse. Suboxone works by occupying the opioid receptors in the brain, effectively blocking other opioids from attaching to these receptors. This action helps reduce cravings and withdrawal symptoms, allowing individuals to focus on their recovery without the intense physical discomfort associated with opioid withdrawal. Suboxone comes in a long-acting formulation called Sublocade.
The Remedy is here for you. We offer personalized support and are available to answer any additional inquiries you have about our treatments or clinics.
The Remedy is an innovative mental health clinic committed to meeting patients where they are with forward-thinking treatments that offer a better quality of life.