Consent for Psychiatric Medication Management (with Ketamine Consent)

JOURNEY CLINICAL PSYCHIATRY PC
JOURNEY CLINICAL PSYCHIATRY CA PC
JOURNEY CLINICAL PSYCHIATRY TX PC

By signing below, you consent to receive psychiatric medication management services through Journey Clinical Psychiatry PC and/or Journey Clinical Psychiatry CA PC. Psychiatric medication management services may involve psychiatric medications such as, but not limited to, ketamine, SSRIs, SNRIs, TCAs, MAOIs, Atypical antidepressants, other anxiolytics, mood stabilizers, benzodiazepines, stimulants, hypnotics, and additional agents as applicable. Your Journey provider will discuss with you all of the medication options available to treat your current condition. You will learn how the medication works, its dosage, frequency, expected benefits, possible side effects, drug interactions, and any withdrawal effects you may experience if you stop taking the medication abruptly.

Ketamine Consent

Overview
Ketamine is a dissociative class compound, with an FDA schedule III designation. It is indicated for and commonly used as an anesthetic medication. Ketamine has demonstrated efficacy for treating depression, even in individuals who have not responded to other interventions. It works rapidly; individuals often see improvement in depression within hours. However, response is not guaranteed and therapeutic effects are often time-limited, with relapse typically occurring within several days to weeks without maintenance strategies.

Off-label use
Ketamine does not have an FDA indication for treatment of depression, anxiety or other psychiatric conditions, making its provision for these conditions an ‘off-label’ use.

Mechanism
Ketamine primarily operates on the glutamate neurotransmitter system in the central nervous system, stimulating glutamate release and activating AMPA receptors. This enhances neuroplasticity and promotes brain function and flexibility, which can contribute to antidepressant responses.

Route of Administration
Ketamine can be administered via various methods:

Dosing protocols
Standard protocols often involve administering 0.5 mg/kg of ketamine via IV infusion over 45 minutes, typically using a series of 2 treatments per week for 3 weeks. More recent protocols explore the combination of ketamine with therapy.

Effects
Ketamine effects can be classified as acute (during dosing) and ongoing (post metabolism). Subjective effects range from cognitive disturbances to dissociative states. The therapeutic outcomes may depend on the quality of the therapeutic environment and mindset.

Ketamine-Assisted Psychotherapy

The efficacy of Ketamine-Assisted Psychotherapy is influenced by ‘set and setting’. A supportive therapeutic environment contributes to the safety and therapeutic potential of the experience.

Adverse and side effects associated with treatment
Ketamine can increase sympathetic tone, potentially raising blood pressure and heart rate. Side effects may include:

• drowsiness
• dizziness
• impaired coordination
• nausea
• blurry vision

Preparation
Prior to treatment:

• Fast prior to your session as directed.
• Avoid certain medications (stimulants, psychedelics) as advised.

Outline of a standard KAP session

1. Preparation (0-15 min): Evaluation and blood pressure measurement.
2. Dosing (15-30 min): Administration of ketamine.
3. Trance state (30-45 min): Rest and assurance during the ketamine experience.
4. Early Integration Phase (30-45 min): Reflection and discussion of the experience.

Aftercare
Post-session care includes arrangement for transportation and a recommendation for rest and quiet reflection.

Ongoing and concurrent treatment
Continuous collaboration with a psychotherapist is necessary for effective treatment.

Final declaration
In signing this agreement, you acknowledge understanding the treatment relationship with Journey Clinical Psychiatry PC, the alternative options for treatment, and the risks associated with ketamine therapy.