FOR PROVIDERS

Michigan Progressive Health is dedicated to providing the best ketamine experience possible for your patient.  As a founding board member and current Vice President of the American Society of Ketamine Physicians, Psychotherapists and Practitioners (ASKP), Dr. Megan Oxley is up to date on the most current practice of ketamine therapy for mood disorders and pain conditions.  An emergency physician by training, Dr. Oxley is highly experienced in both administration of IV ketamine and psychiatric diagnoses and crisis. Having performed over 3,000 infusions, Dr. Oxley is well versed on ketamine effects both medically and psychiatrically.

The entire staff at MPH is trained to treat our patients with the utmost respect and compassion and our goal is to work with you to help your patient get well.

Feel free to reach out to Dr. Oxley  via phone or email, or fill out the new patient referral form, link below left.

SCIENTIFIC ARTICLES

Ketamine and Treatment Resistant Depression

  1. Murrough, Perez, et al. “Rapid and Longer-Term Antidepressant Effects of Repeated Ketamine Infusions in Treatment-Resistant Major Depression” Biological Psychiatry 2013 Aug 15; 74(4): 250–256.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725185/

SUMMARY: In this article, there were 24 patients treated with six IV infusions of ketamine (.5mg/kg) over 12 days. The overall response rate was 71% as defined as a reduction in the MADRS scale by greater than 50%. The median time to relapse after the last ketamine infusion was 18 days. 25% were symptom free at 90 days, 75% of patients had symptoms free days between 11-27 days. Side effects were reported to be a mild significant increase in dissociative symptoms. One patient had to discontinue therapy due to an increase in blood pressure that did not respond to medications (highest BP 180/115).

  1. Shiroma, Johns et al. “Augmentation of response and remission to serial intravenous subanesthetic ketamine in treatment resistant depression” Journal of Affective Disorders. 2014 Feb;155:123-9.

http://www.jad-journal.com/article/S0165-0327%2813%2900778-7/abstract

SUMMARY: In this article, there were 14 patients treated with six IV infusions during a 12 day period. 12 subjects finished all six infusions with 92% response rate and 66% went into remission. 5 out of 11 responders remained in “response status” during the next 28 days. For the 6 out of 11 responders that relapsed, the mean time was 16 days. Response was defined as ≥50% improvement in baseline MADRS score and remission was defined as MADRS score ≤9. No subject experienced severe dissociative symptoms or hemodynamic changes that required stopping the infusions.

3.   Sanacora, Frye, McDonald, et al. “A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders” JAMA Psychiatry. April 2017;74(4):399-405.

http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2605202

SUMMARY: This review and consensus statement provides a general overview of the data on the use of ketamine for the treatment of mood disorders and highlights the limitations of the existing knowledge. The suggestions provided are intended to facilitate clinical decision making and encourage an evidence-based approach to using ketamine in the treatment of psychiatric disorders considering the limited information that is currently available. This article provides information on potentially important issues related

Ketamine and Complex Regional Pain Syndrome

Ketamine and Complex Regional Pain Syndrome

4. Correll, Maleki et al. “Subanesthetic ketamine infusion therapy: a retrospective analysis of a novel therapeutic approach to complex regional pain syndrome.” Pain Medicine. 2004 Sep;5(3):263-75.

http://painmedicine.oxfordjournals.org/content/painmedicine/5/3/263.full.pdf

SUMMARY: This article reviewed 33 cases of patients with CRPS that were treated with Ketamine infusion. The patients received a prolonged low dose infusion of ketamine, on average 10-20mg/hr over 2-4 days. 76% of patients experienced complete pain relief after the first course of treatment. Pain relief lasted at least three months for most patients. Adding a second course of treatment allowed over 50% to be pain free for over a year. One patient had to discontinue additional treatments after the first infusion after developing elevated liver enzymes. These did normalize after treatment was stopped.

Ketamine and Chronic Pain Syndromes (Headache, CRPS and back pain)

  1. Patil S, Anitescu M. “Efficacy of outpatient ketamine infusions in refractory chronic pain syndromes: a 5-year retrospective analysis. Pain Medicine. 2012 Feb;13(2):263-9.

http://painmedicine.oxfordjournals.org/content/13/2/263.long

SUMMARY: This article reviewed 49 patients receiving outpatient ketamine infusions for various pain syndrome – 18 with CRPS. For patients with CRPS, the average reduction in the pain score on a ten point scale was 7.2. For the other pain conditions, the average reduction in the pain score was 5.1. Average pain relief was at least three weeks.

Ketamine and PTSD

Ketamine and PTSD

6. Feder, Parides et al. “Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial.” JAMA Psychiatry. 2014 Jun;71(6):681-8.

http://archpsyc.jamanetwork.com/article.aspx?articleid=1860851

SUMMARY: In this double blind, placebo-controlled cross over study, a single dose of Ketamine (.5mg/kg over 40 minutes) was compared to midazolam. Authors note a significant immediate reduction in the CAPS score and frequently this reduction was maintained for over 2 weeks. The only side effects noted were transient dissociative symptoms, none of which required stopping the infusion.

Does oral administration of ketamine accelerate response to treatment in major depressive disorder?

Arabzadeh, S. et al.  “Does oral administration of ketamine accelerate response to treatment in major depressive disorder? Results of a double-blind controlled trial”.  Journal of Affective Disorders. 2018 Aug 1;235:236-241

https://www.ncbi.nlm.nih.gov/pubmed/29660637

SUMMARY:  In this study 81 patients were randomized to two groups.  150mg of sertraline plus 50mg of daily oral ketamine and 150mg of sertraline and placebo.  The oral ketamine cohort had a statistically significant mood improvement (85.4%) as compared to the placebo group (42.5%) as measured by HADRS at 2,4 and 6 weeks.  For both groups, side effects were mild and the frequency was the same between groups. No patients developed abuse of dependence to ketamine.

Impact of oral ketamine augmentation on hospital admissions in treatment-resistant depression and PTSD: a retrospective study

Hartberg, J et al.  “Impact of oral ketamine augmentation on hospital admissions in treatment-resistant depression and PTSD: a retrospective study.”  Psychopharmacology. 2018 Feb;235(2):393-398

https://www.ncbi.nlm.nih.gov/pubmed/29151192

SUMMARY:  In this study, 37 patients with TRD (15 of whom had PTSD as their primary diagnosis) were given oral ketamine twice a week.  Doses started at .5mg/kg orally and were titrated to effect. After initiation of ketamine therapy, the participants had a 70% reduction in hospital admissions.  The average dose was ultimately 2.0mg/kg twice a week. There was no evidence of tolerance. No serious adverse events were recorded among patients. The most common side effects were light-headedness, sedation and mild dissociative effects.  Remarkably, there was typically a decrease in the amount of ketamine needed over time.

MICHIGAN PROGRESSIVE HEALTH
PROVIDER EDUCATIONAL PROGRAM

Dr. Oxley and the staff at MPH are committed to not only providing the most up to date treatment with ketamine, but also training other providers to ensure the most safe and therapeutic treatment is available to patients. As such, Dr. Oxley has created two training programs for providers:

How to add oral or intranasal ketamine to an existing psychiatric practice:

  • This program consists of a two hour one-on-one lecture with Dr. Oxley which can take place in person or via on-line video chat as well as two follow up phone calls and one year of consultation service.
  • Participants will have access to the key articles supporting ketamine therapy for treatment of mood disorders, GAD and OCD.
  • This program will review the risks, benefits and alternatives of oral ketamine for mood disorders, GAD and chronic pain conditions. Dosing strategies, office observation and long term follow up will be discussed.
  • Participants will receive copies of our patient consent form for oral ketamine administration and home use agreement.

How to provide IV ketamine infusions for mood disorders and chronic pain:

  • This program consists of three days on-site clinical education at the MPH clinic. We have four infusion rooms as well as a group therapy room and perform 8-14 infusions a day.  We have a therapist on staff two days a week and have group patient meetings weekly.  The prospective provider can also bring one staff member with them for the clinical education.
  • Along with clinical education, the provider will have access to the 20 most important published research papers on ketamine reviewing: Standards of Care, Dosing Protocols, Mechanism of Action, Long Term Studies, Oral Ketamine, Ketamine Assisted Psychotherapy, Ketamine for Pediatrics as well as Ketamine for Chronic Pain.
  • Lastly, the participant will receive paper and electronic copies of our dosing protocols and all the forms needed to establish a ketamine clinic. These forms consist of consents per condition, patient information sheets, discharge instructions, necessary registration forms, medication logs, procedure sheets and others.

Please email Dr. Oxley directly at droxley@michiganprogressivehealth.com for further information and prices.  You can also call our office at 248-291-7709 and ask to speak to our office manager, Ryan.