{"id":425,"date":"2024-03-05T09:51:07","date_gmt":"2024-03-05T09:51:07","guid":{"rendered":"https:\/\/oxfordhealth.nhs.uk\/ips\/?page_id=425"},"modified":"2026-04-29T10:37:00","modified_gmt":"2026-04-29T09:37:00","slug":"faq","status":"publish","type":"page","link":"https:\/\/oxfordhealth.nhs.uk\/ips\/ketamine-trd\/faq\/","title":{"rendered":"FAQ"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_83 ez-toc-wrap-left counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\"><p class=\"ez-toc-title\" style=\"cursor:inherit\">Sections<\/p>\n<\/div><nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/oxfordhealth.nhs.uk\/ips\/ketamine-trd\/faq\/#Accessing_the_service\" >Accessing the service<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/oxfordhealth.nhs.uk\/ips\/ketamine-trd\/faq\/#Versions_of_depression\" >Versions of depression<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/oxfordhealth.nhs.uk\/ips\/ketamine-trd\/faq\/#Effects_and_side_effects\" >Effects and side effects<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/oxfordhealth.nhs.uk\/ips\/ketamine-trd\/faq\/#Practical_arrangements\" >Practical arrangements<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/oxfordhealth.nhs.uk\/ips\/ketamine-trd\/faq\/#Taking_other_medicines_with_ketamine\" >Taking other medicines with ketamine<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/oxfordhealth.nhs.uk\/ips\/ketamine-trd\/faq\/#What_other_treatments_do_you_prescribe\" >What other treatments do you prescribe?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/oxfordhealth.nhs.uk\/ips\/ketamine-trd\/faq\/#Medical_care\" >Medical care<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/oxfordhealth.nhs.uk\/ips\/ketamine-trd\/faq\/#Therapy\" >Therapy<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/oxfordhealth.nhs.uk\/ips\/ketamine-trd\/faq\/#Clinical_results_and_research\" >Clinical results and research<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/oxfordhealth.nhs.uk\/ips\/ketamine-trd\/faq\/#Cost_effectiveness_and_financing\" >Cost effectiveness and financing<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/oxfordhealth.nhs.uk\/ips\/ketamine-trd\/faq\/#Education\" >Education<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/oxfordhealth.nhs.uk\/ips\/ketamine-trd\/faq\/#Science_of_ketamine_treatment\" >Science of ketamine treatment<\/a><\/li><\/ul><\/nav><\/div>\n<p>Please find below frequently asked questions about our service.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Accessing_the_service\"><\/span>Accessing the service<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Is ketamine treatment available on the NHS?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>The service described here is a \u2018self-pay\u2019 or \u2018private\u2019 service which is provided by Oxford Health NHS Foundation Trust (OHFT).\u00a0 All potential patients must establish their own funding arrangements.<\/p>\n<p>Patients who live in Oxfordshire or Buckinghamshire who are referred by an OHFT consultant may be able to have treatment &#8216;on the NHS&#8217;. The referral for OHFT-funded treatment must come from an OHFT consultant psychiatrist.\u00a0 If you then have ketamine treatment, you will remain under the joint care of the OHFT psychiatrist.<\/p>\n<p>The processes for this group are similar to those described in this website except that direct referral by a GP is not possible.<\/p>\n<p>Unfortunately, we are no longer able to accept any new patients from outside Oxfordshire and Buckinghamshire.\u00a0 As of 19 February 2024, we are no longer able to accept those whose treatment is funded through an \u2018Individual Funding Request\u2019 to the Integrated Care Board.\u00a0 This is because we are a small team and we are unable to manage the variable processes required to secure funding for ongoing treatment, and to recoup payment.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Is ketamine a licensed treatment?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Drugs receive a licence if the MHRA approves them as safe and effective for a particular condition. Ketamine is not a licensed treatment for depression. It is used in depression as an \u2018off-label\u2019 treatment. However, ketamine is licensed as an anaesthetic and for analgesia because it is safe and effective for short term use for those conditions. A version of ketamine, Spravato esketamine nasal spray, has a licence for use in Treatment Resistant Depression alongside an SSRI or SNRI. It has not been approved by NICE (National Institute for Health and Care Excellence) and is therefore not available on the NHS. It is expensive. We are happy to provide this for those who would prefer it. Some details about this are provided in the FAQs.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">How long is the waiting list?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Waiting times can vary throughout the year, on average once we have received a referral for you the appointment for an initial consultation will be booked for within 3 months.<\/p>\n<p>Waiting times for treatment after an initial consultation can range from 1 \u2013 8 weeks depending on the availability of appointments.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">What if I can\u2019t get a referral?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>We will not be able to see you without a referral from your GP or psychiatrist. Sometimes people have found it helpful to take the information leaflet about the service to their doctor.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Do you accept referrals from psychotherapists or psychologists?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>No.\u00a0 If you are seeing a psychotherapist or psychologist it would be extremely helpful to receive a letter describing the sort of work that you have done together.\u00a0 However, because we need a full medical background, the referral letter must come from a medically qualified doctor who has been responsible for your clinical care.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">What are the reasons you decide not to offer a patient an assessment following referral?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>We cannot give an exhaustive list as we review each case on the basis of how likely it is that the patient will benefit.\u00a0 A global assessment is made of this.<\/p>\n<p>Some of the reasons include:<\/p>\n<ul>\n<li>Urgent need for intervention to save life. Such patients should contact their local team immediately<\/li>\n<li>Currently taking psychedelics from other legal or underground clinics<\/li>\n<li>Alcohol Use Disorder<\/li>\n<li>Lack of persistent alteration in mood. Some people have abrupt severe fluctuations in mood but do not experience low mood most of the day nearly every day.\u00a0 An exception to this is the frequent occurrence of suicidal ideas and behaviour.<\/li>\n<li>Recent mania<\/li>\n<li>Unstable social circumstances that would interfere with ability to persist with treatment.<\/li>\n<li>Patient does not allow us to communicate with any professionals involved in their care<\/li>\n<\/ul>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Do you do treatment on weekends, in the evenings and on Bank Holidays?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Not yet.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Why is ketamine not routinely available on the NHS?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Ketamine is not licensed in the UK by the Medicines and Healthcare products Regulatory Agency for the treatment of depression.\u00a0 This is because, so far, no company has made an application for such a licence.\u00a0 This is because the cost of generic ketamine is low, the cost of gathering the data required by the MHRA is very high, and there is no possibility of patent protection for the currently available formulations.\u00a0 It is possible that companies may apply for the licencing of new formulations in the future.<\/p>\n<p>Because the MHRA has not approved ketamine for the treatment of depression, the safety of ketamine has not been confirmed using the high quality of evidence required.\u00a0 Therefore, as with other unlicensed treatments, NICE will not consider whether it should be routinely available in the NHS.\u00a0 Because NICE has not given an opinion on its cost-effectiveness, the health commissioning bodies (formerly CCG, now ICB) cannot routinely fund it.<\/p>\n<\/div>\n                <\/details>\n<h2><span class=\"ez-toc-section\" id=\"Versions_of_depression\"><\/span>Versions of depression<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">I have anorexia with depression. Can ketamine help?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Yes, we find that ketamine can help the depression and can make a big difference.\u00a0 It has helped some patients to be discharged from hospital.\u00a0 It is less helpful in combatting the disordered ideas about shape, weight and eating.\u00a0 We are grateful to a patient who was involved in <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/9797933\/\">this earlier study<\/a> who called us to tell us how her life had been changed by it: this emboldened us to try ketamine in patients with anorexia.\u00a0 (If you are that patient, we managed to lose your contact details \u2013 do get in touch again!).\u00a0 The information about Treatment Resistant Depression all applies, and should be read carefully.\u00a0 Treatment needs to be long term.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">I have bipolar disorder. Can ketamine help?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Patients with treatment resistant depression in bipolar disorder respond at about the same rate as those with unipolar depression.\u00a0 There is a risk of manic relapse, particularly perhaps in those where mania has previously been drug induced.\u00a0 Depending on the exact circumstances and history, we recommend taking a mood stabiliser before starting ketamine.<\/p>\n<p>In the small number of patients we have treated (~5), we have <u>not<\/u> found ketamine to be useful in rapid-cycling bipolar disorder.\u00a0 Not only is it hard to time the doses, but it also does not appear to affect the cycling.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Does ketamine work for postpartum depression?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Yes.\u00a0 We and others have had very positive experience of its use for postpartum depression with rapid and permanent resolution after a short course of treatments.\u00a0 Research suggests that the level of ketamine and metabolites in breast milk is safe, though we still recommend caution and a \u2018pump and dump\u2019 strategy for three days after ketamine treatments.<\/p>\n<p>There is also RCT evidence that IV ketamine, given at the time of caesarean, reduces the incidence of post-partum depression.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">What the effects of ketamine on unborn foetus?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>The effects of ketamine on the unborn foetus are unknown. Women of child-bearing potential should use effective contraception. It is essential that ketamine treatment is stopped during pregnancy and that a thorough review of risks and benefits is conducted before restarting. If you are trying to conceive it may be reasonable to restrict ketamine treatment to days when you are menstruating as a way of reducing risk \u2013 but this is not a perfect marker that you are not pregnant.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">I am peri- or post-menopausal.  Should I take ketamine?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>If you have not had a review from a specialist in this area, we recommend that you do so as HRT can sometimes be very effective in alleviating depression and prevent the need for ketamine treatment.\u00a0 Sometimes a combination of both can be effective.\u00a0 We suggest you review <a href=\"https:\/\/www.balance-menopause.com\/\">https:\/\/www.balance-menopause.com\/<\/a> in detail.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">I am under 18. Can I have ketamine?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Possibly. We will need to work with you, your parents and your current doctors to work out if this is the right option for you.\u00a0 The adolescent brain may be more susceptible to being overactivated by ketamine and to developing brain lesions of uncertain significance (Olney lesions).\u00a0 However, adolescents with resistant depression can sometimes benefit.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">I have emotionally unstable personality disorder \/ borderline personality disorder \/ PTSD \/ complex PTSD.  Can I have ketamine?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>The depression associated with these conditions does respond to ketamine.\u00a0 This can help with managing day to day life. However, entrenched patterns of thinking and relating can take a long time to change even when the depression is better.\u00a0 Ketamine may help with the avoidance that maintains these problems.\u00a0 Ketamine is particularly helpful for suicidal ideas in the context of depression.<\/p>\n<p>Concurrent psychotherapy and engagement with another team are essential in these conditions, but often difficult to maintain.<\/p>\n<\/div>\n                <\/details>\n<h2><span class=\"ez-toc-section\" id=\"Effects_and_side_effects\"><\/span>Effects and side effects<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Is ketamine safe?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Please look at the <a href=\"https:\/\/oxfordhealth.nhs.uk\/ketamine\/risks-benefits\/\">Side Effects<\/a> section<\/p>\n<p>Ketamine is not licensed by the MHRA as being safe for the treatment of depression.\u00a0 However, it has been licensed as safe for use as an anaesthetic and as an analgesic.\u00a0 This means that, although side effects are well known, it is considered safe for short term use as an anaesthetic or analgesic.<\/p>\n<p>The important question of whether ketamine is safe if used regularly over a long period has not been formally answered and there are no published studies of its long-term use.<\/p>\n<p>Our experience so far is that, at the frequency and doses we use, we have not observed important safety signals.\u00a0 This is consistent with the wide experience in the US.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Is ketamine addictive?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>When people use ketamine illegally \u2013 either recreationally or for self-treatment \u2013 it is not uncommon for the dose and frequency of use to escalate. Drug abusers can become addicted to it.<\/p>\n<p>Sometimes people find that if they stop ketamine their depression relapses. This is not the same as addiction. This is reliance.\u00a0 The same phenomenon has been noticed with other psychedelics such as psilocybin.<\/p>\n<p>There are a handful of reports of patients who have been prescribed ketamine for the treatment of depression and who has become addicted. In all cases, the doses used are very much higher and more frequent than we use.<\/p>\n<p>People who try to treat their depression with ketamine without medical support use higher doses, more frequently and are more likely to want to reduce the dose they are using than those who use it recreationally.\u00a0 We strongly advise against treatment outside a conventional medical setting.<\/p>\n<p>For comparison, in our opinion, when used in a medical setting, ketamine is much less addictive and dangerous than strong opiates (eg fentanyl, methadone) or nicotine, is probably less addictive than benzodiazepines, and is probably about as addictive as whiskey.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Could I become tolerant to ketamine?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Yes.\u00a0 Sometimes patients taking it for depression find that their depression is no longer controlled despite continuing to have treatment with ketamine. There can be several possible reasons, one of which is that they have developed tolerance to ketamine. In our clinic, we use a variety of strategies to minimise this.<\/p>\n<p>We are currently formally evaluating the frequency of this but estimate that this becomes a problem for about 15% of people who take ketamine long term.<\/p>\n<p>A treatment break or increase in the interval between treatments may be needed.<\/p>\n<p>We sometimes add another off-label medication that has an antidepressant effect (eg pramipexole).<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">How well and how quickly does ketamine work?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>For some people, ketamine can work within a few hours. For other people it may take a few treatments before their depression improves. It is not possible to tell who will respond, or how quickly to ketamine.<\/p>\n<p>If you do not respond to 6 treatments of ketamine then you are unlikely to see a benefit from any further treatment.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">What dose of ketamine is usually prescribed?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>The dose of ketamine you are prescribed is decided by the ketamine clinic treatment team. Intravenous doses are calculated on your weight at 0.5mg\/kg and will be reviewed before each treatment. For some people this dose will not change; however, doses may be increased or decreased during your treatment period.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Is there any way of knowing who will benefit?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Patients over 65 years old are less likely to respond or to respond more slowly.\u00a0 Therefore, a longer trial (eg up to 10 infusions) may be needed before it is clear that there will be no response.<\/p>\n<p>People who have been extremely unwell with depression for a very long time (ie to the point of immobility and prolonged hospitalisation) may be less likely to respond.<\/p>\n<p>Patients whose depression has not responded to ECT or to many antidepressants at high doses may be slightly likely to respond than those with less severe illness.\u00a0 However, they do sometimes respond dramatically.<\/p>\n<p>These predictors have not been confirmed and patients who have been chronically or severely depressed, or who have had poor response to conventional antidepressants, have also benefitted.<\/p>\n<p>There is a possibility that a genetic mutation predicts whether patients develop an initial response. However, we do not assess whether you have this mutation. There are no known predictors of a longer duration of response.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">How does ketamine compare to ECT?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>A single, large, well conducted randomised controlled trial has shown that ECT is slightly more effective than ketamine (Ekstrand 2022).\u00a0 Overall, ECT caused more cognitive side effects than ketamine, but ketamine caused more acute dissociative effects.\u00a0 Ketamine was slightly more effective in younger patients and ECT was slightly more effective in older patients.\u00a0 When the treatments were stopped, patients relapsed at the same rate.\u00a0 In practice, however, maintenance ECT is less commonly used than maintenance ketamine.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">How does ketamine compare to psilocybin?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Psilocybin is not a licensed treatment for any condition and experience with its use in conventional medical settings is limited.\u00a0 There has been no research which compares the effectiveness of ketamine and psilocybin.\u00a0 It is possible that the effect of psilocybin last longer, though some patients report needing to take it repeatedly to maintain benefit.\u00a0 In current research, psilocybin is given 2 or 3 times to induce remission, compared to up to 6 with ketamine.\u00a0 Psilocybin treatment typically involves more preparation and integration sessions than we offer.\u00a0 Each treatment session lasts a day.\u00a0\u00a0 There is preliminary evidence that long ketamine infusions lasting 4 days may result in longer duration of benefit than the 40-minute infusions we use.\u00a0 Psilocybin may be less likely to induce tolerance than ketamine and it is not associated with addiction.<\/p>\n<\/div>\n                <\/details>\n<h2><span class=\"ez-toc-section\" id=\"Practical_arrangements\"><\/span>Practical arrangements<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">I live a long way away. Can I stay overnight in Oxford?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Yes.\u00a0 Patients often do this.\u00a0 There are a variety of B&amp;Bs, AirBNB, hotels etc available.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Can I drive or ride a bicycle if I am having ketamine?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Yes, but not until the morning after you have had ketamine treatment.<\/p>\n<p>However, when you first start taking ketamine or when your dose is increased you may feel drowsy the next day. You should use common sense and not drive if you feel drowsy. It is your responsibility to decide whether you are fit to drive on each occasion.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Can the person bringing me for treatment sit with me?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>No. The person accompanying you will normally be shown to a room where they can have a drink and wait with others. During times of covid-19 restrictions, the person accompanying you will not be allowed into the department but is welcome to make use of our cafe and hospital grounds.<\/p>\n<p>There are two main reasons for this. Clinic bays are small, and staff need room to access the infusion pump during treatment. Also, there will be other patients having their treatments at the same time and we try to create a quiet and calm environment.<\/p>\n<p>Additionally, staff are trained and experienced to be able to look after you during your treatment and through any of the side effects associated with ketamine. Friends or family members may find observing this distressing and alarming.<\/p>\n<\/div>\n                <\/details>\n<h2><span class=\"ez-toc-section\" id=\"Taking_other_medicines_with_ketamine\"><\/span>Taking other medicines with ketamine<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Can I take other medicines if I am having ketamine?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Benzodiazepines such as Diazepam, Lorazepam and Clonazepam probably reduce the effect of ketamine, so we advise that these are not taken the night before or the day you have ketamine.\u00a0 If you are on long term benzodiazepines we will discuss how far and how fast you should reduce these before having ketamine.\u00a0 The Ashton method of reduction is a slow careful method which we recommend: https:\/\/www.benzoinfo.com\/.<\/p>\n<p>If you take venlafaxine or duloxetine, this may increase the risk of tinnitus following ketamine, but you should not stop it before starting ketamine.<\/p>\n<p>Other than those listed above, ketamine should not affect your other medicines. Other painkillers including opioids (e.g. codeine), non-steroidal anti-inflammatory drugs such as ibuprofen, or paracetamol can be taken at the same time as ketamine.<\/p>\n<p>When you start ketamine, you will be asked to complete paperwork asking about your current medications.<\/p>\n<p>Before you take or buy any new medicines always tell your doctor or pharmacist that you are having ketamine.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Can I have oral ketamine straight after my infusions?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>No. There will be a period of 3-4 weeks after your 3-6 ketamine infusions before \u00a0you might start any oral ketamine.\u00a0 This is to see how long any benefit lasts.<\/p>\n<p>Not everyone is suitable for oral ketamine treatment, this will be assessed during your telephone follow-up appointment.<\/p>\n<p>We do not provide an \u2018oral ketamine only\u2019 service<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Can I drink alcohol if I am having ketamine?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>You should not drink alcohol on the night before and day you take ketamine and for 24 hours afterwards.<\/p>\n<p>If possible, you should avoid drinking alcohol completely while you are taking ketamine. This is because alcohol may reduce the benefit and increase some of the side-effects of ketamine.<\/p>\n<\/div>\n                <\/details>\n<h2><span class=\"ez-toc-section\" id=\"What_other_treatments_do_you_prescribe\"><\/span>What other treatments do you prescribe?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Do you provide nasal esketamine?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Yes.\u00a0 Nasal spray esketamine (Spravato), in conjunction with an oral antidepressant, is licensed as safe and effective for the treatment of Treatment Resistant Depression.\u00a0 Ketamine does not have such a license and we use it \u2018off-label\u2019.\u00a0 The data supporting the use of esketamine nasal spray are of a much higher quality and of a longer duration than those supporting the use of ketamine.<\/p>\n<p>Esketamine nasal spray was developed because the effect of ketamine was recognised to be novel and an important advance.\u00a0 There are randomised trials suggesting that ketamine is not inferior to esketamine.<\/p>\n<p>We are happy to make esketamine nasal spray available and are registered with the Janssen for pharmacy and the Risk Mitigation Scheme.<\/p>\n<p>Nasal spray esketamine (Spravato) is not available on the NHS because it has not been approved for routine use by NICE.\u00a0 The cost of the drug for self-pay patients is \u00a3326 or \u00a3489 per dose.\u00a0 Patients must come to the clinic for every dose and stay for an hour after administration.\u00a0 It cannot be administered at home.\u00a0 On top of this drug cost, we must therefore charge the same clinic fee (\u00a3265) to cover our staffing and clinic overheads as for ketamine (which costs about \u00a31 per dose).\u00a0 The frequency of maintenance esketamine nasal spray dosing is initially twice weekly for four weeks, then weekly or every 2 weeks thereafter.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Do you offer psilocybin, MDMA, LSD, 5Me-OT or other psychedelic treatments?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>No.\u00a0 Unlike ketamine, none of these drugs are licensed for medical use.\u00a0 Long term data on their safety and effectiveness is not available.\u00a0 It is not known how often they need to be given.\u00a0 We do not know if they will be more effective than ketamine.\u00a0 Given the very low cost of ketamine, and the high cost of developing new drugs to the point of licensure, it is rather unlikely that licensed forms of these other drugs will be more cost-effective than ketamine.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Will you prescribe other medications?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Should you experience acute sickness during your infusion we will prescribe an anti-sickness medication to be given in clinic.<\/p>\n<p>Your referring doctor will remain responsible for your overall care and the prescribing of all other medications including any other antidepressants.<\/p>\n<\/div>\n                <\/details>\n<h2><span class=\"ez-toc-section\" id=\"Medical_care\"><\/span>Medical care<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Will you take over as my psychiatrist?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>No. The service is set up only to provide and manage ketamine treatment. Any other psychiatric care will remain with your current team. We are unable to take on the overall care of patients and will correspond with your referring team about your ketamine treatment.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">I am under the care of an NHS team. What are the arrangements with them?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>We do not have the option of admitting you to hospital and cannot follow you up as closely during crises as your local team can.\u00a0 The management of all your other psychiatric medication apart from ketamine will remain the responsibility of your current team.\u00a0 However, we recognise that, for a period, you may see more of us than them.\u00a0 Therefore, we keep in touch with your GP and current team and may advise about adjusting other medication (typically, reducing it).<\/p>\n<p>This is why we need the names and contact details of your GP, psychiatrist and care coordinator.\u00a0 Many patients find that their contact with their local team reduces considerably once they start treatment with us.\u00a0 However, we ask that you remain \u2018on the books\u2019 of the local team so that, if there are acute crises, they are able to help you without requiring a re-referral from your GP.\u00a0 Your team is very welcome to contact us on 01865 902522 or at <a href=\"mailto:ketamineclinic@oxfordhealth.nhs.uk\">ketamineclinic@oxfordhealth.nhs.uk<\/a>.<\/p>\n<\/div>\n                <\/details>\n<h2><span class=\"ez-toc-section\" id=\"Therapy\"><\/span>Therapy<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">I am seeing a psychotherapist privately. Will that influence my care?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>We very much support the combination of ketamine and psychotherapy.\u00a0 This may help you to make the most of being well, using your newly well mind to explore issues that you were unable to address when depressed.<\/p>\n<p>We are unable to recommend particular therapists but recommend that if you are considering starting therapy you chose either someone who is experienced in Acceptance Commitment Therapy (ACT), which is a NICE approved therapy for pain, or in psychedelic assisted psychotherapy:<\/p>\n<p><a href=\"https:\/\/contextualscience.org\/civicrm\/profile?gid=17&amp;reset=1&amp;force=1\">https:\/\/contextualscience.org\/civicrm\/profile?gid=17&amp;reset=1&amp;force=1<\/a> <a href=\"https:\/\/instituteofpsychedelictherapy.org\/psychedelic-integration-database\/\">https:\/\/instituteofpsychedelictherapy.org\/psychedelic-integration-database\/<\/a>.<\/p>\n<p>We are always happy to speak with therapists who can contact us on <a href=\"mailto:ketamineclinic@oxfordhealth.nhs.uk\">ketamineclinic@oxfordhealth.nhs.uk<\/a> or 01865 902522.<\/p>\n<p>&nbsp;<\/p>\n<\/div>\n                <\/details>\n<h2><span class=\"ez-toc-section\" id=\"Clinical_results_and_research\"><\/span>Clinical results and research<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">What research are you doing?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Our clinic is focussed on delivering treatment, is run under the auspices of the NHS and is not primarily a research clinic.<\/p>\n<p>As with other NHS services, we routinely ask patients to provide information which helps us with making clinical decisions and in order to evaluate our service.<\/p>\n<p>We are also now running a project evaluating the effect of long-term ketamine on changes in different frequencies of brain waves. You may be invited to participate in this or future research projects.\u00a0 Participation in research is always optional.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">How do your results compare with those of other clinics?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>We have not compared our results with others.\u00a0 There are many factors that may cause different clinics to have different results.\u00a0 For example, different clinics probably see slightly different sorts of patients.\u00a0 We aim to be transparent about our results and to keep expectations realistic.\u00a0 We would be surprised if, like-for-like, our results are better or worse than elsewhere.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Why should I come to Oxford rather than elsewhere?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>We have more experience of long-term ketamine use than any other UK provider.<\/p>\n<p>Our user satisfaction is high.<\/p>\n<p>We are transparent about our results.<\/p>\n<p>Our costs are competitive. We run within the NHS and are priced to cover costs, not to make a profit.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-231773 size-full\" src=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/2022\/10\/ketamine-treatment-service-satisfaction.png\" alt=\"Chart\" width=\"600\" height=\"347\" \/><\/p>\n<table style=\"border-collapse: collapse;width: 100%;height: 192px\">\n<thead>\n<tr style=\"height: 24px\">\n<td style=\"width: 83.961%;height: 24px\"><strong>Question asked<\/strong><\/td>\n<td style=\"width: 16.039%;height: 24px\"><strong>Average rating<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"height: 24px\">\n<td style=\"width: 83.961%;height: 24px\">The effectiveness of ketamine<\/td>\n<td style=\"width: 16.039%;height: 24px\">3.7<\/td>\n<\/tr>\n<tr style=\"height: 24px\">\n<td style=\"width: 83.961%;height: 24px\">The overall side effects of ketamine (high score = good)<\/td>\n<td style=\"width: 16.039%;height: 24px\">3.9<\/td>\n<\/tr>\n<tr style=\"height: 24px\">\n<td style=\"width: 83.961%;height: 24px\">The assessment interview you had before starting ketamine<\/td>\n<td style=\"width: 16.039%;height: 24px\">4.5<\/td>\n<\/tr>\n<tr style=\"height: 24px\">\n<td style=\"width: 83.961%;height: 24px\">The follow-up reviews with a doctor which you had<\/td>\n<td style=\"width: 16.039%;height: 24px\">4.2<\/td>\n<\/tr>\n<tr style=\"height: 24px\">\n<td style=\"width: 83.961%;height: 24px\">The support from nurses on, and between, treatment days<\/td>\n<td style=\"width: 16.039%;height: 24px\">4.5<\/td>\n<\/tr>\n<tr style=\"height: 24px\">\n<td style=\"width: 83.961%;height: 24px\">The clinic&#8217;s administrative processes<\/td>\n<td style=\"width: 16.039%;height: 24px\">4.4<\/td>\n<\/tr>\n<tr style=\"height: 24px\">\n<td style=\"width: 83.961%;height: 24px\">The forms your were asked to fill in<\/td>\n<td style=\"width: 16.039%;height: 24px\">3.7<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>Outcome QIDS scores &#8212; long term<\/strong><\/p>\n<table style=\"border-collapse: collapse;width: 100%\">\n<thead>\n<tr>\n<td style=\"width: 12.5%\"><\/td>\n<td style=\"width: 12.5%\"><strong>Baseline<\/strong><\/td>\n<td style=\"width: 12.5%\"><strong>3 months<\/strong><\/td>\n<td style=\"width: 12.5%\"><strong>6 months<\/strong><\/td>\n<td style=\"width: 12.5%\"><strong>9 months<\/strong><\/td>\n<td style=\"width: 12.5%\"><strong>12 months<\/strong><\/td>\n<td style=\"width: 12.5%\"><strong>15 months<\/strong><\/td>\n<td style=\"width: 12.5%\"><strong>18 months<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"width: 12.5%\">mean<\/td>\n<td style=\"width: 12.5%\">17.5<\/td>\n<td style=\"width: 12.5%\">11.8<\/td>\n<td style=\"width: 12.5%\">10.1<\/td>\n<td style=\"width: 12.5%\">12.0<\/td>\n<td style=\"width: 12.5%\">10.7<\/td>\n<td style=\"width: 12.5%\">11.2<\/td>\n<td style=\"width: 12.5%\">9.2<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 12.5%\">SD<\/td>\n<td style=\"width: 12.5%\">4.7<\/td>\n<td style=\"width: 12.5%\">6.0<\/td>\n<td style=\"width: 12.5%\">6.3<\/td>\n<td style=\"width: 12.5%\">6.8<\/td>\n<td style=\"width: 12.5%\">6.4<\/td>\n<td style=\"width: 12.5%\">5.4<\/td>\n<td style=\"width: 12.5%\">5.2<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 12.5%\">N*<\/td>\n<td style=\"width: 12.5%\">33<\/td>\n<td style=\"width: 12.5%\">33<\/td>\n<td style=\"width: 12.5%\">25<\/td>\n<td style=\"width: 12.5%\">19<\/td>\n<td style=\"width: 12.5%\">13<\/td>\n<td style=\"width: 12.5%\">12<\/td>\n<td style=\"width: 12.5%\">8<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 12.5%\">p-val<\/td>\n<td style=\"width: 12.5%\"><\/td>\n<td style=\"width: 12.5%\">&lt;.00001<\/td>\n<td style=\"width: 12.5%\">&lt;.00001<\/td>\n<td style=\"width: 12.5%\">0.0008<\/td>\n<td style=\"width: 12.5%\">0.0198<\/td>\n<td style=\"width: 12.5%\">0.0058<\/td>\n<td style=\"width: 12.5%\">0.0251<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Summary: patients who received the &#8216;Oxford Protocol&#8217; continued to benefit for 18 months.<\/p>\n<p>*falling N is because some patients in this analysis have not yet had eg &gt;12 months treatment.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-231779\" src=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/2022\/10\/registered-to-ketamine-clinic.png\" alt=\"Chart\" width=\"503\" height=\"391\" \/><\/p>\n<p>Summary: In a population with TRD:<\/p>\n<ul>\n<li>49% of those who start ketamine think it is sufficiently worthwhile that they continue with regular treatment<\/li>\n<li>6% are discharged off treatment, well<\/li>\n<\/ul>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">When should I go to another provider rather than Oxford?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>If:<\/p>\n<ul>\n<li>Your local NHS service provides ketamine.<\/li>\n<li>You have a closer clinic. Ketamine treatment is not a one-off so the practicalities of getting to and from Oxford are important.\u00a0 It takes 60-90 minutes to get from London to Oxford by car or train.<\/li>\n<li>You want a friend\/relative in the room with you.<\/li>\n<li>You want a private room for treatment. (We do not yet provide single rooms or allow friends\/relatives into the treatment space with the patient).<\/li>\n<li>You are looking for help with addiction<\/li>\n<li>You are unable to use the electronic systems we use and do not have anyone who can help you do this.<\/li>\n<li>You want a less \u2018medical\u2019 experience. We are based in an NHS hospital rather than a private clinic.<\/li>\n<\/ul>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">What are your plans to improve the clinic?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>We are constantly open to suggestions, but our facilities mean that there are limitations in what is practical.\u00a0 We are planning to open new space at the Warneford towards the end of 2022 but we do not have a budget to refurbish this space at present.<\/p>\n<p>If you have suggestions for improvements, please let us know.<\/p>\n<\/div>\n                <\/details>\n<h2><span class=\"ez-toc-section\" id=\"Cost_effectiveness_and_financing\"><\/span>Cost effectiveness and financing<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">What is the evidence that the ketamine you provide is cost-effective?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>The cost of each IV treatment is \u00a3225 and of oral ketamine is \u00a360 per month.<\/p>\n<p>There have been no long-term cost effectiveness studies of ketamine.<\/p>\n<p>Ketamine is not a licensed treatment for depression.\u00a0 It has meta-analysis level evidence for a 7- day benefit.\u00a0 <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/33726522\/\">Guidelines<\/a> for its use have been published in American Journal of Psychiatry.\u00a0 Nasal esketamine is licensed is not NICE approved, and costs approximately 400 times as much, per dose, as ketamine.<\/p>\n<p>Short term racemic ketamine may be superior to and is at least non-inferior to esketamine.\u00a0\u00a0 NICE has reviewed esketamine nasal spray <a href=\"https:\/\/www.nice.org.uk\/guidance\/indevelopment\/gid-ta10371\/documents\">several times<\/a>.\u202f <a href=\"https:\/\/www.nice.org.uk\/guidance\/gid-ta10371\/documents\/129-2\">The last consultation document<\/a> where a cost per QALY was given says (p34) that : \u2018Using the committee\u2019s preferred assumptions, the ERG\u2019s ICER [for Spravato esketamine nasal spray] was in the range of \u00a364,554 to \u00a372,158 per QALY gained\u2019.\u202f The current NHS list price for esketamine 84mg (which is the dose that would likely be administered weekly for the most severe cases) is \u00a3489 per dose.\u202f The current NHS list price for a vial of IV ketamine, from which it is usual to treat about 7 patients, is \u00a37.\u202f Each oral, weekly, ketamine dose costs about \u00a315.\u202f <u>Drug<\/u> costs for four week\u2019s treatment with esketamine (ie not including service costs) are \u00a31,956 (assuming no NHS discount).\u202f The <u>total<\/u> costs of drug, administration and follow-up with ketamine, are \u00a3225+60 = \u00a3285.\u202f It is highly likely that this cost differential means that <u>the cost per QALY of ketamine is well under the conventional NICE threshold of \u00a330k<\/u> per QALY.<\/p>\n<p>Summary:<\/p>\n<p>Cost per QALY nasal esketamine (NICE): \u00a364,554 to \u00a372,158<\/p>\n<p>Drug cost per weekly dose nasal esketamine: \u00a3489<\/p>\n<p>Total cost per week nasal esketamine including administration: \u00a3714<\/p>\n<p>Drug cost per week ketamine (assuming monthly IV and weekly oral): \u00a315<\/p>\n<p>Total cost per week ketamine including administration (assuming monthly IV and weekly oral): \u00a371<\/p>\n<p>Inferred cost per QALY generic ketamine: \u00a36,455-7,216<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">I will have trouble paying. Should I proceed?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>You should carefully consider your budget and the following factors:<\/p>\n<ol>\n<li>Ketamine treatment is not a one-off. If you respond, you are very likely to need continued treatment.\u00a0 This usually continues for several years before people feel strong enough to stop.\u00a0 Some patients have been coming for up to 10 years.<\/li>\n<li>The costs of having ketamine at our clinic are not just those of the treatment. Travel and accommodation costs can be considerable.\u00a0 If someone is bringing you, will they continue to be available?\u00a0 Can you actually manage public transport?\u00a0 Taking time off work can be difficult.<\/li>\n<li>If you are working, will your employer be sympathetic to the amount of time you need to take off?<\/li>\n<\/ol>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Can you reduce your costs if I help you with your work?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>We are grateful for the many offers we receive, but cannot alter our processes or costs.<\/p>\n<\/div>\n                <\/details>\n<h2><span class=\"ez-toc-section\" id=\"Education\"><\/span>Education<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">What education and training work do you do?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>We run an international journal club for clinicians and researchers, twice a month, 5.30pm on 2<sup>nd<\/sup> and 4<sup>th<\/sup> Tuesdays.\u00a0 See <a href=\"http:\/\/www.ketamineconference.org\">www.ketamineconference.org<\/a>.<\/p>\n<p>We host the world\u2019s only hybrid international academic conference for clinicians, academics and policy makers devoted to ketamine and related compounds for psychiatric disorders.\u00a0 The next one is September 11<sup>th<\/sup>-13<sup>th<\/sup> 2023 in Oxford.\u00a0 See <a href=\"http:\/\/www.ketamineconference.org\">www.ketamineconference.org<\/a>.<\/p>\n<p>We host regular peer-support \/ anonymous case review sessions for other clinicians working with ketamine in the UK: 3<sup>rd<\/sup> Wednesdays at 2-3pm<\/p>\n<p>We host visiting clinicians from the UK and abroad who want to understand more about how to run a ketamine service.\u00a0 Such visits are usually for a day.<\/p>\n<p>We train clinical fellows who spend a year with us full time learning about a broad range of Interventional Psychiatry treatments.<\/p>\n<p>MSc and medical students have run service evaluations as dissertations for their courses.<\/p>\n<p>Trainee psychiatrists can elect to be involved in the therapy groups, special interest sessions and as part of training in other Interventional Psychiatry Service modalities.<\/p>\n<p>We introduce medical and nursing students to IPS.<\/p>\n<p>If you would like to be involved in any of this, please send an email to <a href=\"mailto:ketamineclinic@oxfordhealth.nhs.uk\">ketamineclinic@oxfordhealth.nhs.uk<\/a><\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">I would like to train in psychedelic psychotherapy. Can you help?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>We are developing the psychotherapy side of our work but do not run any psychedelic psychotherapy training programmes.\u00a0 These are available through other providers in the UK and US.<\/p>\n<\/div>\n                <\/details>\n<h2><span class=\"ez-toc-section\" id=\"Science_of_ketamine_treatment\"><\/span>Science of ketamine treatment<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<details class=\"nhsuk-details\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">How does ketamine work as an antidepressant?<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p><iframe loading=\"lazy\" title=\"Disinhibition action of ketamine as an antidepressant\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/NvYn-FU1Auw?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe><\/p>\n<p><strong>\u00a0<\/strong><\/div>\n                <\/details>\n<div class=\"nhsuk-care-card nhsuk-care-card--non-urgent\">\n                <div class=\"nhsuk-care-card__heading-container\">\n                    <h3 class=\"nhsuk-care-card__heading\"><span role=\"text\"><span class=\"nhsuk-u-visually-hidden\">Non-urgent advice: <\/span>Downloadable information<\/span><\/h3>\n                    <span class=\"nhsuk-care-card__arrow\" aria-hidden=\"true\"><\/span>\n                <\/div>\n                <div class=\"nhsuk-care-card__content\">\n<div class=\"nhsuk-action-link\"><a class=\"nhsuk-action-link__link\" href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/36\/2024\/03\/Full-information-about-Oxford-ketamine-service-v2.1-190224.pdf\" target=\"_self\"><span class=\"nhsuk-action-link__text\">Full information about Oxford ketamine service v2.1 19 Feb 2024 (PDF)<\/span><\/a><\/div>\n<p>This PDF contains all the text on the website, used for consent.<\/p>\n<\/div>\n            <\/div>\n","protected":false},"excerpt":{"rendered":"<p>Please find below frequently asked questions about our service. 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