Posted by NuminousMist on October 16, 2015, at 16:34:05
In reply to Re: Ketamine pipeline, posted by Hugh on August 3, 2014, at 9:27:10
Hello Friends,
Thought I'd speak up because I see above in this thread a reference to Dr. Fruitman (Trifecta Health, in NYC), and the topic of cost is an important. I've been seeing Dr. Fruitman for over a year and can confirm that he charges $250.00 per in office Ketamine session. My understanding of the reason this is cheaper than many other providers is because he does it intramuscularly. A shot in the arm is a lot less complicated, and thus less costly, than IV. Would like to say right off that Dr. Fruitman is a wonderful PDoc! Over the past twenty years, I have worked with probably 10+ PDocs, and he is in league of my own. I wouldn't say that haphazardly. I strongly, strongly recommend him. He knows a lot, lot more than just Ketamine. I find the breadth and depth of his knowledge of pharmacology for depression, anxiety, ADHD truly exceptional. He is also no B.S. He has proven to me beyond any doubt that he is far more interested in helping me than making money.
Regarding the advantages and disadvantages of intravenous versus intramuscular, I was told IM is a better route of administration because it is more controllable and safer. With IV, there is a risk of too much Ketamine entering the blood stream at one time, either through human error or malfunction, How much risk? Dont know, but with IM, there is no risk, the reason for which is self-evident. (Fruitman gave me an initial injection, waited fifteen minutes, took my blood pressure and asked me how I felt. Because blood pressure was acceptable and I felt fine, he gave a second, final injection.) Another argument why IM is safer is because you don't have needle sticking into a vein for an extended period, creating a greater risk of infection than a two second shot in the arm. Regarding which route is more effective in treating depression, I've read articles stating that IV is the more effective, but these articles didnt providing any convincing supporting evidence, whatsoever. Granted, may a higher percentage gets to the brain via IV, but that can easily be compensated for by administering a higher dosage intramuscularly.
So, why do most shops administer intravenously? What I heard is the reason is that anesthesiologists are the ones who have the easiest access to and experience with Ketamine, since Ketamine has been used as an anesthetic for many years now. And administering drugs intravenously is what anesthesiologists do when a large percentage of the time. Makes sense to me. If this argument is correct, then the prevalence of IV administration for Ketamine is more the result of circumstance than efficacy and safety: Anesthesiologists have had the good fortune to be in the right place at the right time and are cashing in Ketamine for depression. Nothing wrong with that, except that a lot of people may be paying a lot more than they need to do. I do not know whether the doctors who administer Ketamine intravenously for depression are primarily anesthesiologists or pdocs, but Id be curious to find out.
Why more pdocs have not gotten off their butt and started administering Ketamine intramuscularly is another question, but the answer, in my opinion, is obvious: they are lazy. Fruitman is the exception. I thought I was up on the latest, but the first I heard of Brintellix, Fetzima, folate metabolism deficiency (and the genetic test to determine it), was when I first saw Fruitman.
Please note: Everything I have said is just my opinion. I am not claiming I am right about all, or even most, of what I have written. But I giving you my honest opinion. When I saw Dr. Fruitman mentioned on this thread, I felt an obligation to speak up, as I have gotten tremendous benefit from working with him, and from Ketamine.
Incidentally, he is also open to prescribing intranasal administration. I happen to live three hours from NYC and am not independently wealthy, so it was something I was interested in. Turns out, intranasal administration is unbelievable cheap and it works beautifully. Filling a prescription for a bottle providing fifteen intranasal Ketamine sessions currently costs around $100 at specialty pharmacy in NYC. That comes to something like $8.00 a session! Considering how many people must be out there who are currently suffering, despite taking one or more first line ADs, as I was, I felt it might duty to speak up here and share my positive experience. Good luck to everyone.
poster:NuminousMist
thread:1069138
URL: http://www.dr-bob.org/babble/20150929/msgs/1083532.html