Over the past two years of the pandemic, feelings of loneliness and isolation have increased. The Centers for Disease Control and Prevention’s National Center for Health Statistics shows suicide rates are at their highest in 30 years, and research from Boston University’s School of Public Health shows depression has more than tripled since the start of the pandemic, now affecting 1 in every 3 American adults.
Even for those without depression or suicidal ideation, mental health care resources have become more difficult to access during the pandemic.
For Madison native and now Fitchburg resident Sarah Wilczewski, a board-certified nurse anesthetist who had performed anesthesia in Madison’s operating rooms for 10 years, a traumatic experience at work that led to post-traumatic stress disorder in last October caused her to need to be away from work for a while.
She was involved in a case at work that didn’t go well that involved the legal team and hospital lawyers, which led to her PTSD.
Meanwhile, Wilczewski has sought mental health care for herself for the first time in her life – and said she realized how little access there is for people with health conditions. mental illness and the number of therapists who have waiting lists.
Around the same time, her husband lost a cousin to suicide who suffered from postpartum depression, leaving behind three children.
Wilczewski started thinking about what she could do with her skills to help with mental health. Between these two personal experiences, Wilczewski said she felt inspired to help using her background in anesthesia.
On February 14, she opened Revival Infusion at 5936 Seminole Center Court, a clinic that administers therapeutic doses of ketamine.
Although she’s never had ketamine herself, recent traumatic events in her life have her thinking about taking this different path after a decade-long career in the operating room.
But despite having no experience with the drug herself, she said that once she got into research, she found its effectiveness when used to treat depression quite compelling, anxiety and suicidal thoughts.
Ketamine is a drug primarily used to induce anesthesia for pain relief or sedation. Apart from its use in hospital settings, it is also used by veterinarians and has been used by paramedics to assist police when a suspect has been deemed dangerous or belligerent.
The Food and Drug Administration approved ketamine for medical use in 1970, and the first free-standing clinic was opened in New York City in 2012 by a Harvard-trained anesthesiologist. Since then, stand-alone clinics have sprung up across the country.
Revival Infusion is the first stand-alone ketamine clinic to open in the Madison area.
“Over the past few years, research has shown that ketamine, when given in micro doses, is extremely effective in treating major depression, PTSD, severe postpartum depression and suicidal ideation. – even in patients who have failed to respond to traditional treatments,” says Wilczewski. “I decided to take my knowledge and years of experience in anesthesia and use it in a different way – in a way that could potentially help so many people in need.”
There’s a doctor at the University of Wisconsin-Madison who also offers it, but Wilczewski prides itself on being a fully independent, woman-owned business.
As a dedicated ketamine clinic, the drug is used as an off-label antidepressant, meaning services are mostly paid out of pocket by patients, not covered by insurance co-payments.
The recommended initial therapy is six sessions, which when purchased as a package cost $2,700. Individual sessions cost $495.
The clinic is practically in the backyard of Wilczewski, who lives just two blocks away. She said she appreciates that it’s a close and convenient place for her, while being a quiet and central place for her customers.
Before being approved for ketamine infusions, a patient must first demonstrate that they have failed to improve their depression with at least two antidepressants or other therapeutic modalities, such as electroconvulsive therapy or stimulation transcranial magnetic.
Those interested begin with a telephone consultation that explains what ketamine is and what a patient can expect to feel or hear during infusion therapy.
When a patient arrives at the clinic, they first have their full medical history reviewed and a mini health exam covering things like hypertension and high blood pressure before intravenous therapy begins.
Wilczewski also checks liver health; history of strokes or tumors and glaucomic, interocular or hemorrhagic pressure; and asks about recent psychotic episodes.
So far, she hasn’t had to turn anyone away, she said.
Once installed in his chair, the patient will be connected to an ECG device to monitor his pulse.
It is recommended to bring a relaxing music playlist and headphones, otherwise the clinic can provide them. Blankets and eye masks are also provided.
A friend or family member should sit in the room with them during the session for support, but after that a patient can come back on their own.
“We want them to be as comfortable as possible, because sometimes that’s scary,” Wilczewski said.
During the experience, some people have blurred or double vision, have vivid dreamlike states, or colors become more vivid. Actual hallucinations are rare, she says.
Some people never feel anything at all, others may still feel lightheaded the next day, she said.
While the majority of people choose to listen to music, some just like to talk to their support person, a few even just scroll through their phones.
The full session lasts approximately 40 minutes.
Then they spend some time in the waiting room to recover and feel lucid before being discharged. Most people feel back to normal within an hour or less, she said.
“Seeing patients come back and hearing the noticeable improvements from them between sessions is fun for me,” she said. “I like to see people progress.”
While Wilczewski said that with the small microdoses she gives — which are intended for mental health protocols and a much lower dose than given in clinical settings for pain — an emergency is “very unlikely” to occur. Even so, she said she was “very well equipped” in an emergency, with an airway suction device, Advanced Cardiovascular Life Support certification and a defibrillator on site.
She has also been in touch with local emergency medical services personnel to introduce herself and let them know what her clinic is doing.
She works with a Madison doctor who specializes in substance abuse and addiction who helps her review her records and is available any time she has questions or concerns about a client.
Wilczewski also completed the Ketamine Academy online program, which was designed by a CRNA, and allows him to connect with other providers across the country.
For those worried about the “k-hole” — a slang term for getting stuck in a dissociated or trance-like state for hours on end on ketamine — Wilczewski said it only happens in recreational settings using ketamine. street-bought ketamine, which could be 100 times stronger than the microdoses she administers.
“It’s just very different,” she said.
While there are also nasal sprays and sublingual lozenges that can deliver ketamine, she said she’s more comfortable with IVs.
“As a provider, I want to stay in my comfort zone,” she said. “IVs are more predictable. If the patients don’t like it, I can turn it off, and it should be out of their system pretty quickly. »
She also said that these other two forms of ketamine are less bioavailable and less effective.
Since research shows it’s “super effective” to integrate consultations with a therapist with ketamine infusions, Wilczewski said she would like to eventually add this service and have an in-house therapist.
For now, she said it was “very, very important” for clients to have their own therapist and said 90% of her patients see one, or a psychiatrist.
Usually, infusions are scheduled twice a week and a patient goes to see their therapist on the intervening day to help process their experience.
Wilczewski also likes to keep in touch with her clients’ therapists or psychiatrists when they are ready to let her make that connection.
She uses the Patient Health Questionnaire-9, a screening tool for depression, to help chart her clients’ improvement over time and shares this with therapists or psychiatrists.
Ketamine helps regenerate or repair neural pathways lost to stress or depression, Wilczewski said, and his patients often tell him they can feel the connections reestablishing themselves.
She said 60% of her patients report feeling a change in their depression after their first dose and 80% after the initial six doses. She admits the process doesn’t work for everyone.
After the first six infusions, Wilczewski recommends a booster infusion every three to six weeks.
“A woman just completed her first set last week and she has made remarkable progress,” Wilczewski said. “She said she never realized what a bad place she was in – now she has coping mechanisms, takes holidays and is happy about it. She’s very well. Another client has made incredible progress. Before they were very suicidal, now they are fine and don’t feel so stressed all the time.