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A new way to treat depression, anxiety and chronic neuropathic pain
Newsletter No 23 (14 September 2023)
Co-morbid refractory chronic pain and depression - why is ketamine effective?
At KetaMIND clinics, patients presenting with chronic pain are monitored using the Defense and Veterans Pain Rating Scale (DVPRS). The DVPRS considers not only pain score (rated on a standard VAS) but also four other psychosocial parameters. We routinely monitor PHQ-9 and GAD-7 scores in these patients as well.
A recent cohort study in JAMA Network Open Anesthesiology found that co-morbid depression was actually the mediator of ketamine's efficacy in pain diminution - 'a radical new insight'. Up to 85% of patients with chronic pain are depressed.
The authors conclude that ketamine reduces chronic pain primarily by 'dampening depression' (pain and depression share common neurobiological elements) and stress how important it is to diagnose severe depression in patients with chronic pain and offer ketamine infusion as an effective treatment option.
KetaMIND Paarl opened on 17th August...
Seen with Dr Alan Howard (Founder and National Medical Director of KetaMIND Clinics) are Kathryn Mann (Managing Director) (left) and Dr Talitha Harvey (Clinical Director).
One of South Africa's oldest towns now offers a groundbreaking new treatment thanks to the vision and dedication of Kathryn Mann, KetaMIND Paarl's managing director.
Located in the brand new Paarl Medicentre, KetaMIND Paarl is easily accessible off Eskdale Street.
Take a tour of the new clinic by clicking the link below.
"I've had the best three-weeks of my life!"
"Ketamine infusion is like taking out my brain and my eyes and replacing them with new ones! Now I think about and see things so differently. I feel so 'normal' and cannot overstate how great it is."
Angeline (not her real name) is 33-years-old and has suffered from depression, anxiety, and suicidality since her schooldays. She self-harms and has made numerous suicide attempts over the years. Regular antidepressants and several treatments with ECT over 5-years did not help. Two-weeks before starting ketamine infusions at KetaMIND Umhlanga she overdosed.
On presentation, Angeline's PHQ-9 score was 26/27 and her GAD-7 score was 21/21. These rapidly reduced and after 6-infusions over 3-weeks, both were zero.
Reflections during a ketamine infusion...
The spiritual nature of some ketamine infusions can be profoundly healing. After a recent maintenance infusion, a patient whose life has changed since attending a KetaMIND clinic for infusions, shared his reflections in a poem.
You can read Calum's ketamine story published in SA Gay Pages.
"By the end of the treatment, I felt radically transformed within myself."
In my chapel of silence,
I sit quietly, and gaze out into the setting sun.
The last rays of light catch clouds in velvet purples and pinks.
On a winter's night, alone I sit, with my heart's memories of warmth.
Love of burning embers that shines, from souls of the past, and those to come, on a new leaf.
Sitting, I hold the stuff of my humanity and yours.
The wells of light, so painful yet beautiful together.
In my chapel of silence.
(KCSA patient)
Can a single ketamine infusion provide long-term benefit in PTSD?
A recent study published in Nature in June 2023 by the American College of Neuropsychopharmacology suggests that ketamine may enhance post-retrieval extinction of original trauma memories in humans and modulate the fear response for at least 30-days post-extinction.
Finding the 'sweet spot' in the timing of KIT and psychotherapy for PTSD patients is crucially important and warrants further study.
We previously linked to an editorial in the AJP discussing the effect of 6-ketamine infusions over 2-weeks in PTSD patients.
Researchers at Yale randomized patients with PTSD to receive either a single 40-minute infusion of ketamine or midazolam after retrieval of the traumatic memory. 24-hours later, patients received trauma-focused psychotherapy. Symptoms and brain activity were assessed prior to, at the end of, and 30-days after treatment.
KetaMIND clinics currently offer outpatient ketamine infusions at the following locations:
BEDFORDVIEW (GP)
CONSTANTIA (WC)
UMHLANGA (KZN)
HILTON (KZN)
HILLCREST (KZN)
PAARL (WC)
In the next newsletter..
Dyskinesia and dystonias ... is there a place for ketamine infusions? In a previous newsletter, we linked to an article describing the benefits of ketamine infusion therapy (KIT) for L-DOPA-induced dyskinesias (LID) in Parkinson's patients. Now the FDA is considering fast-tracking registration of R/S Ketamine for this indication, a complication that affects millions worldwide. To boot, the benefit of KIT for refractory dystonias is also gathering momentum. We will discuss and link to articles dealing with this exciting indication for ketamine infusions in the next newsletter.
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How did KCSA start in South Africa?
KetaMIND Clinics of South Africa (KCSA) was founded by Dr Alan Howard, a Consultant in Emergency Medicine who returned home permanently to his native South Africa from Ireland in 2019. Read more about Dr Howard and KCSA's flagship clinic in the Natal Midlands in two informative articles published in South African Psychiatry A follow-up article, Ketamine Clinics beyond the Hills can be accessed here. Dr Howard is a member of the American Society of Ketamine Physicians (ASKP3), The Society of Sedation Practitioners of South Africa (SOSPOSA) and is an associate member of the South African Society of Psychiatrists (SASOP). He also serves on the KZN Advanced Trauma Life Support (ATLS) faculty. He founded the Society of Ketamine Practitioners of South Africa (SOKePSA) in 2020. |
