Ketamine Treatment for End of Life & Palliative Care
Navigating the Journey: Ketamine’s Role in Enhancing End-of-Life Comfort
End-of-life care encompasses more than just physical comfort; it addresses the profound emotional and existential challenges faced by individuals nearing the end of their lives. At Nushama, we recognize the multifaceted nature of this care and offer ketamine-assisted therapy as a compassionate intervention to alleviate not only physical discomfort but also the psychological and spiritual distress that often accompanies terminal conditions..
Embrace tranquility and support in the final stages of life. Discover the role of our ketamine therapy in facilitating peaceful support.
How Ketamine Therapy Works for End of Life & Palliative Care
In palliative and end-of-life care, ketamine therapy serves as a dual-function treatment, providing relief from pain while addressing the psychological impact of terminal illness. By blocking NMDA receptors, ketamine can significantly reduce physical pain and disrupt the pain signaling that contributes to chronic discomfort.
Moreover, its psychoactive properties allow for profound psychological relief, helping patients address existential anxieties and find peace in their final days. This approach is particularly suited to end-of-life care, where traditional pain management strategies may be insufficient or lead to undesirable side effects.
Our Approach at Nushama
Transforming Lives with Innovative Care
Your journey to overcoming anxiety begins with a detailed assessment and a personalized treatment plan. From preparation to integration therapy post-ketamine sessions, our team ensures a safe, supportive experience focused on long-term anxiety management strategies.
Ketamine Infusions Protocol
01
Medical Assessment
We assess your medical history and medication to confirm ketamine is an appropriate treatment. Pre-treatment testing can include urine and blood tests, blood pressure and EKG.
02
Preparation
Ketamine therapy is unlike any other treatment you are likely to have encountered, so preparing your mind and body for the experience is critical. We’ll give you information on how to cultivate a positive mindset in the weeks leading up to your journey. We will also encourage you to set an intention before each infusion—a goal or purpose for your journey that will help direct the experience and gather insights—and then “let go.”
03
Psychedelic Treatment Sessions
Nushama physicians or doctors typically administer 6 treatments/infusions over a 3-6 week period, receiving up to 2 infusions per week. The treatments take place in a serene environment with ambient music. Vitals and anesthesia levels are constantly monitored by Nushama doctors and nurses to ensure the highest level of safety.
04
Integration
Licensed therapists or trained integration coaches work with members with the intention of helping them glean insights after each journey to integrate into their daily lives. Integration can also include practices like yoga, journaling, meditation, mindfulness techniques, or listening to music from the treatment. The idea is to help individuals tap into their inner healer for lasting change.
05
Follow-up
If a member does not have a therapist (or would like additional support), Nushama therapists work with members to integrate learnings into their daily lives for lasting results. Some members may also benefit from additional “booster” sessions. Psychedelics are transformative medicines, but healing requires more than the experience of the journey.
Ketamine Infusion Protocol
01
Preparation
Ketamine therapy is unlike any other treatment you are likely to have encountered, so preparing your mind and body for the experience is critical. We’ll give you information on how to cultivate a positive mindset in the weeks leading up to your journey. We will also encourage you to set an intention before each infusion—a goal or purpose for your journey that will help direct the experience and gather insights—and then “let go.”
02
Medical Assessment
We assess your medical history and medication to confirm ketamine is an appropriate treatment. Pre-treatment testing can include urine and blood tests, blood pressure and EKG.
03
Psychedelic Treatment Sessions
Nushama physicians or doctors typically administer 6 treatments/infusions over a 3-6 week period, receiving up to 2 infusions per week. The treatments take place in a serene environment with ambient music. Vitals and anesthesia levels are constantly monitored by Nushama doctors and nurses to ensure the highest level of safety.
04
Integration
Licensed therapists or trained integration coaches work with members with the intention of helping them glean insights after each journey to integrate into their daily lives. Integration can also include practices like yoga, journaling, meditation, mindfulness techniques, or listening to music from the treatment. The idea is to help individuals tap into their inner healer for lasting change.
05
Follow-up
If a member does not have a therapist (or would like additional support), Nushama therapists work with members to integrate learnings into their daily lives for lasting results. Some members may also benefit from additional “booster” sessions. Psychedelics are transformative medicines, but healing requires more than the experience of the journey.
Understanding End of Life & Palliative Care
End of life and palliative care focus on enhancing the quality of life for individuals facing life-limiting illnesses or conditions. While often used interchangeably, these two terms highlight different aspects of care during critical life stages:
End of Life Care refers to the support and medical care given during the time surrounding death. This care does not only manage pain and other distressing symptoms but also includes guidance on making complex decisions and emotional and spiritual support for both the patient and their family. The goal is to ensure comfort and preserve dignity at life’s end, making it as meaningful and respectful as possible.
Palliative Care can be provided at any stage of a serious illness, not just the final months or days. It addresses a wide range of issues, integrating an individual's emotional, physical, and spiritual well-being and can include, but is not limited to, management of pain and other distressing symptoms, provision of psychological, social, and spiritual support, and coordination of care to ensure the patient’s and their family's comprehensive needs are met.
In these instances, ketamine therapy serves as a dual-function treatment, providing relief from pain while addressing the psychological impact of terminal illness. By blocking NMDA receptors, ketamine can significantly reduce physical pain and disrupt the pain signaling that contributes to chronic discomfort. Moreover, its psychoactive properties allow for profound psychological relief, helping patients address existential anxieties and find peace in their final days. This approach is particularly suited to end-of-life care, where traditional pain management strategies may be insufficient or lead to undesirable side effects.
Ketamine's unique properties make it an invaluable tool in this holistic approach, offering a potential reconnection to life's meaningful experiences and easing the transition during palliative stages. By incorporating ketamine therapy, we provide a pathway that supports both the patients and their families during these challenging times.
Frequently Asked Questions
WHAT IS PSYCHEDELIC THERAPY, AND HOW DOES IT WORK?
Psychedelic therapy refers to the therapeutic use of psychedelic molecules like ketamine, psilocybin, LSD, and MDMA. Studies have shown that when taken in a safe environment with therapeutic support, psychedelics can relieve symptoms of depression and anxiety after only a few hours. In psychedelic therapy, the participant must first undergo a medical and psychiatric intake to ensure the experience will be the right option for them. Next, the psychiatric team prepares them for the experience beforehand, discussing what to expect and how to ease their mindset leading up to it.
With ketamine-assisted therapy, on the day of treatment, a medical professional administers the psychedelic intravenously, intramuscularly, or orally while the participant lays down with an eye mask and listens to music. A guide, known as an integrator, provides breathing techniques and reassurance if adverse effects should arise. The dosing session is followed by an integration session to recount their experience, describe their feelings during and after, talk through lingering questions, and glean key insights or takeaways.
To learn more, read A Complete Guide to Psychedelic Therapy.
WHAT IS KETAMINE TREATMENT?
Ketamine is a dissociative anesthetic that elicits psychedelic-like effects. It can be used as an alternative treatment for depression, anxiety, PTSD, and other mood disorders. At certain doses, similar to traditional psychedelics, ketamine allows one to experience different planes of consciousness.
ISN’T KETAMINE DANGEROUS AND ADDICTIVE?
While ketamine has been used safely since the 1960s for pain and anesthesia, just like any psychoactive medicine, it can be misused, especially at lower doses and in recreational settings. However, when ketamine is administered by a medical professional in a clinical setting with proper education and support, the likelihood of addiction is low.
Read Myths About Ketamine to learn more.
HOW MUCH DOES KETAMINE TREATMENT COST?
For information on pricing for our treatment protocols, please visit https://nushama.com/pricing
Nushama does offer financing through Care Credit at the link below:
https://www.carecredit.com/go/868GCS/
ARE KETAMINE TREATMENTS COVERED BY INSURANCE?
While ketamine is not currently covered by insurance, some aspects of our treatment process may be eligible for coverage. For more information, please visit https://nushama.com/pricing
Nushama does offer financing through Care Credit at the link below:
https://www.carecredit.com/go/868GCS/
DOES NUSHAMA HAVE A PAYMENT PLAN?
Yes. The total cost can be split into 3 payments.
Nushama does offer financing through Care Credit at the link below:
DOES NUSHAMA WORK OUTSIDE OF NEW YORK?
Currently, our ketamine treatment centers are based in Midtown New York.
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IS THIS TREATMENT LEGAL?
Ketamine is FDA approved as an anesthetic which is why its use for pain treatment can sometimes be covered by insurance. The S-form of ketamine was approved in 2019 to treat depression as a nasal spray called Spravato®. Nushama uses the R-form of ketamine which is legal to prescribe, however it is not FDA approved and considered “off-label”. According to WebMD, over 20% of US prescriptions are for off-label therapies.
HOW EFFECTIVE ARE KETAMINE TREATMENTS?
There is a lot of mounting evidence that ketamine can be effective in the treatment of many psychiatric conditions, however each person is different and may respond differently. Ketamine treatments are most effective when coupled with any number of therapeutic modalities including traditional psychotherapy, integration coaching, movement modalities, meditation practices, and personal reflection.
See the ketamine section, “WHERE CAN I READ THE RELEVANT STUDIES, TRIALS, AND DATA?”.
WHAT IF I NEED TO CANCEL MY APPOINTMENT?
Please call us at (646) 394-9996 by noon, the business day before your scheduled appointment to notify us of any changes or cancellations. Failure to do so may result in incurring penalties as outlined in our cancellation policy.
WHERE CAN I READ THE RELEVANT STUDIES, TRIALS, AND DATA?
Here’s is a list of ketamine-related studies and trials available:
Ketamine for Generalized Anxiety Disorder
Ketamine for Social Anxiety Disorder
Ketamine Administration for Chronic Post-traumatic Stress Disorder
Ketamine Effects on EEG during Therapy of Treatment-Resistant Generalized Anxiety and Social Anxiety
Safety and efficacy of maintenance ketamine treatment in patients with treatment-refractory generalized anxiety and social anxiety disorders
Remission from Chronic Anorexia Nervosa With Ketogenic Diet and Ketamine
Effects of Ketamine in Treatment-Refractory Obsessive-Compulsive Disorder
Randomized Controlled Crossover Trial of Ketamine in Obsessive-Compulsive Disorder: Proof-of-Concept
Double-blind, placebo-controlled, dose-ranging trial of intravenous ketamine as adjunctive therapy in treatment-resistant depression
Ketamine Reduces Alcohol Consumption in Hazardous Drinkers by Interfering with the Reconsolidation of Drinking Memories
A sub-set of psychoactive effects may be critical to the behavioral impact of Ketamine on cocaine use disorder
Ketamine psychotherapy for heroin addiction: immediate effects and two-year follow-up
Efficacy of Ketamine in the Treatment of Substance Use Disorders: A Systematic Review
IS KETAMINE TREATMENT SAFE?
Ketamine infusions for therapeutic use are considered safe when administered in a clinical environment by medical professionals. Participants will be carefully screened to ensure they’re appropriate candidates for the treatment. People are monitored throughout their treatment process for any signs of discomfort, dependence, or increased heart rate. While dissociative or “psychedelic” properties may be experienced, a number of studies show they contribute to the molecule’s antidepressant effects.
HOW IS KETAMINE ADMINISTERED DURING TREATMENT?
There are four ways to administer ketamine for therapeutic use:
- Intravenously (IV)
- Intramuscularly (IM)
- Lozenge (orally)
- Spravato (intranasally)
At Nushama, we believe IV is the safest and most efficacious method. The dose can be adjusted or stopped at any time if participants become uncomfortable for any reason, which has been extremely rare at our center. Nushama does not offer lozenges or intransal spray, but for group therapy, we use intramuscular injections. Depending on the route of administration, effects are felt within five to ten minutes and last from 45 to 60 minutes.
HOW MUCH KETAMINE IS DOSED?
Ketamine IV for psychedelic therapy is most commonly administered at doses around 0.5 mg/kg over a period of 40 minutes. There is a range of effective doses and evidence for its efficacy at double that amount.
Its range (0.5 – 2 mg/kg) depends on the biology of the person—we start on the lower end and modify the dose based on someone’s response and individual needs.
Read Ketamine Dosing: Low Dose vs. High Dose to learn more.
ARE THERE ANY SIDE EFFECTS?
Side effects of ketamine infusions can include:
- Increase in blood pressure
- Nausea or vomiting (we can add a medication to prevent this from happening)
- A sense of impaired balance and coordination
- A feeling of dizziness, drowsiness, slurred speech, and/or numbing sensation of the skin
These side effects are normal, rarely require any medical intervention, and resolve soon after the infusion ends.
WHAT HEALTH CONDITIONS CAN KETAMINE TREAT?
Ketamine, most widely used as an anesthetic, is a breakthrough therapy for treating many mental health disorders. The conditions listed below are either being studied in clinical trials (usually combined with psychotherapy) or soon to be studied.
Ketamine can be used to treat:
- Major depression
- Bipolar 1 depression
- Post-partum depression
- Fibromyalgia
- Chronic pain
- Post-traumatic stress disorder (PTSD)
- Suicidal thoughts
- Obsessive compulsive disorder (OCD)
- Alcohol use disorder
- Opioid use disorder
- Disordered eating
- Autism
- Anxiety disorder
IS KETAMINE SIMILAR TO PSILOCYBIN?
Although they are both breakthrough therapies being studied to treat a variety of psychiatric conditions, ketamine and psilocybin are very different. Psilocybin is a “classic” psychedelic meaning it works on the 5HT2A serotonin receptors. Ketamine is a “dissociative anesthetic” that can illicit psychedelic-like experiences but it works primarily on the glutamate receptors called NMDA receptors.
These two also have very different legal statuses. Ketamine is a Schedule III drug that is FDA approved for use in pain and anesthesia and is currently a breakthrough therapy for treatment-resistant depression which means it can be used off-label in clinics. Psilocybin is a Schedule I illegal substance that also received breakthrough therapy designation with the FDA but can only be accessed through legal FDA clinical trials at this time.
What is ketamine nasal spray (intranasal ketamine)?
Ketamine nasal spray (intranasal ketamine) is a medication that is administered through the nose. Please visit our Intranasal FAQ page for more in depth answers to your questions.
HOW DO I PREPARE FOR MY FIRST KETAMINE SESSION?
Preparation for Nushama’s 6-session ketamine program occurs well in advance. We’ll provide you with guidance on how to cultivate a positive mindset, like avoiding news or alcohol, the weeks leading up to your journey.
Our clinicians will also help you set clear intentions and provide guidelines for a safe and meaningful first experience. When preparing, it is important to know that if you do not feel ready at any point, you can let your provider know and we will support you the best we can until you are ready.
WHAT CONDITIONS WOULD PREVENT ME FROM RECEIVING KETAMINE TREATMENT?
If you are experiencing any of the following conditions you will not be able to receive a ketamine infusion:
- Uncontrolled high blood pressure (hypertension)
- Unstable heart disease (arrhythmias, congestive heart failure, chest pain etc.)
- Untreated thyroid disease
- Active substance abuse
- Active manic phase of bipolar disorder
- Active delusions and hallucination symptoms (not on medications or while taking street drugs)
- Schizophrenia
DO I NEED A REFERRAL FROM MY PRIMARY CARE PHYSICIAN?
No, you do not need a referral to receive ketamine treatment for mental health conditions. You may come to us directly, and the medical team will review your intake information, conduct a psychiatric evaluation, and confirm that you’re medically fit for treatment before moving forward.
We will, however, ask permission to speak with your therapist or healthcare provider during our screening process. Any licensed mental health care professional or physician can also refer you.
HOW LONG IS EACH SESSION?
While each person’s experience varies, a psychedelic ketamine journey lasts about 45-60 minutes. You’ll start to feel the effects 10-15 minutes after the ketamine is administered. The peak experience lasts about 30-45 minutes. Most people return to their ordinary level of awareness within 1-2 hours following administration.
HOW MANY TREATMENT SESSIONS ARE REQUIRED?
Most of the clinical research with ketamine has involved people who receive the treatments twice a week for 3 weeks (6 ketamine sessions total). However, at Nushama we are exploring the potential of fewer sessions with increased support in the form of group sessions, or with wellness protocols throughout the treatment period.
If you are curious about how ketamine’s effects can be increased with supporting modalities, read What is Psychedelic Integration Therapy?
WHAT DO THE PSYCHEDELIC EFFECTS OF KETAMINE FEEL LIKE?
The effects from a psychedelic dose of ketamine are usually felt within 10 to 15 minutes but every person has a slightly different experience. Paticipants may experience:
- Deep relaxation
- Calm sensation
- Heaviness in the body
- Visual patterns and colors
- Separation from usual states of thinking
- Sense of being awake but on a different plane of consciousness
- Separation from the body
- Limited verbal expression
- People, places, or events from their past
Since some of these experiences in an altered state may be novel, they can be frightening or challenging if you are not prepared. Therefore we review the range of possibilities with each person.
CAN I RECEIVE KETAMINE TREATMENT WHILE ON ANTIDEPRESSANTS?
Yes. Ketamine does not have negative medication interactions with antidepressants and does not interfere with their effectiveness at the subanesthetic doses used to treat depression and anxiety.
To learn more, read Ketamine vs. SSRIs to Treat Depression
WHAT MEDICATIONS SHOULD I AVOID?
You should not stop any medications without consulting with your perscribing mental health provider. Any modifications to your medication will be discussed during your medical intake before being cleared for treatment.
But, generally, these are some medications that can effect your response to ketamine:
- Stimulants (Adderall, Concerta, Ritalin, Vyvanse)
- Benzodiazepines
- Lamotrigine
- Memantine
- Opioids
WILL I HAVE A “BAD TRIP”?
Studies have shown the likelihood of a challenging experience is very low when two conditions are met: a positive mindset going into the experience and a comfortable physical environment. However, even when someone reports having a “bad trip”, with the right integration support afterwards, the insights gleaned from those difficult experiences often end up being some of the most valuable take aways from the treatment. To learn more, read 3 Ways to Mitigate the Risks of Ketamine.
HOW SHOULD I EXPECT TO FEEL AFTER TREATMENT?
Once the infusion is over, sensations like dizziness fade gradually over the next 20 minutes. You may notice positive effects, like elevated mood, as soon as 30 minutes post ketamine infusion.
Studies have shown that peak antidepressant effects occur about 24-48 hours after treatment and typically last up to two weeks.
Read A Complete Guide to Psychedelic Therapy to learn more.
DO I NEED SOMEONE TO TAKE ME HOME?
It’s best to have someone to pick you up after ketamine treatment. If this is not possible, for reasons such as privacy, you will have to take a car service home and show proof of the reservation. You may need to stay longer in the center as you will only be released once you are completely safe to leave.
SHOULD I CONTINUE SEEING MY THERAPIST OR PSYCHIATRIST? WHAT IF I DON’T HAVE ONE?
The importance of a continued theraputic process in conjuction with ketamine cannot be understated. The neuroplasticity effects of ketamine may make you more receptive to tools that maybe haven’t worked before or new tools you’ve never used. The more tools you have to address the ups and downs of life, the longer the effect of ketamine can last.
We recommend our members continue working with their outpatient providers for medication management and/or psychotherapy. If you do not have a psychiatrist or therapist, Nushama can facilitate a referral.
HOW LONG WILL THE EFFECTS LAST AFTER ALL 6 TREATMENTS?
Many people report improvement in symptoms for 3-12 weeks, however this range depends on many factors and can last even longer depending on how much you are willing to participate in developing new ways of living.
One of the best ways to prolong the effect of ketamine is to learn and apply new tools for dealing with the stressors that come as a normal part of life.
DO I NEED TO KEEP COMING BACK AFTER 6 INFUSIONS?
Every person is different, and ketamine is very much a personalized medicine—dosing, frequency, and effect can all vary and require an individualized approach. The need to return after the 6 sessions depends on whether or not symptoms return.
However, for some people, even when symptoms return, they are much less intense, which makes them manageable with the new skills they have learned during the treatments.
