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Psychiatrist

Since July 2021, we have been offering chronic pain treatments in Gatineau at our private clinic at 430 Boulevard de l'Hôpital. Among the treatments offered, we provide therapeutic infusions for the control of chronic pain, namely lidocaine, ketamine, and pamidronate. We noticed that some patients mentioned being improved in terms of mood. Knowing that ketamine infusion is a treatment for depressive states that do not respond to conventional treatment, we decided to offer the service.

Clinic context: We have been an anesthesiologist for 22 years and continue to practice anesthesia in a private clinic in Montreal. Our ACLS certification is valid and renewed every 2 years. On site, I am assisted by a nurse who, together with myself, closely monitor the patient during the procedure. On site, we have a defibrillator and resuscitation medications that are available and ready to be used.

Limit of the service: we provide the medical procedure with safety and supervision, we do not carry out the psychiatric follow-up of the patient, this follow-up must be provided by the referring doctor.

Here are some inclusions/exclusions criteria for this treatment.

Inclusions:

Adult 18 years and over
Patient resistant to conventional treatments for depression
DSM5 diagnosis of major depression
Patient able to sign and consent to treatment
Patient must have a satisfactory medical condition according to the preliminary evaluation of the anesthesiologist

Exclusions:

Dementia or cognitive impairment
Psychosis or psychotic component
Symptomatic head trauma
Alcoholism or other addictive disorder
Patient who cannot be accompanied
Aggressive patient

Operating mode:

Referral from a psychiatrist
Follow-up by psychiatrist or family doctor
Questionnaire to assess the medical condition by phone call before the procedure
Progressive dose protocol 0.5-0.75-1.0 mg/kg if necessary, (going beyond this dose increases the risk of side effects)
Duration of infusion 2 hours with a monitoring of vital signs and side effects
4-6 infusions,1 every 2 weeks for initial treatment then, depending on the response to treatment, maintenance will be every 4-6 weeks.