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Ketamine and the Brain

  • Taylor Carter
  • in Blog
Ketamine: The Chemistry, Effects, and Brain Science
By Tessa Eskin

Ketamine is rapidly emerging as an incredibly effective and fast-acting mental health medicine. The drug first emerged after the synthesis of phencyclidine in 1956, an anesthetic for monkeys. Testing on humans, however, resulted in cases of acute ‘emergence delirium’, lasting hours after surgery. Dr. Calvin Lee Stevens, while searching for a short-acting derivate, stumbled onto the compound C1-581—today known as ketamine.

August of 1964 saw the first human trial of intravenous ketamine, resulting in minimal emergence delirium. Subjects reported dissociative effects—a floating feeling with disconnection from their bodies and environment, and numbness in the limbs. From the 1970s, the anesthetic was a staple for surgeries on wounded soldiers during the Vietnam War.

Since the 1990s, ketamine has been a common treatment for chronic pain. But this anesthetic is fast proving to have immense and near-miraculous physiological benefits, most notably for depression. The research reveals a deeper understanding of the brain, giving new hope to hope to patients and clinicians alike.

Floating in Space

Medically, ketamine is administered at many ketamine clinics as a clear liquid. On the street, it appears as a grainy white or brown crystalline powder or tablets. Administered nasally, ketamine takes about 15 minutes to hit, entering the bloodstream quickly. Orally, it takes about 20 minutes.

The intoxicating effects can last from 20 minutes to a couple of hours, inducing a dreamlike, detached, and relaxed state. Ketamine can alter perceptions of time and space, and sometimes causes hallucinations. In fact, the feeling is comparable to ‘floating in space’, prompting the recreational use of ‘Special K’ as a party drug.

Ketamine is at once sedating and stimulating, with mild psychedelic effects on the mind. It can often cause euphoria,  feelings of ‘looseness’, and depersonalization. But beneath the surface of these experiences, a flurry of chemical changes are taking place within the brain. Scientists still can’t fully explain how it works, but have several leading theories resulting from research on ketamine as an antidepressant.

Ketamine & Depression

Research has recently confirmed ketamine treatment as among the biggest breakthroughs in depression in over 50 years. Studies on patients with treatment-resistant depression show both short-term relief and long-term benefits. Amazingly, long after the intoxicating effects of ketamine wore off, subjects with depression reported feeling lighter, more relaxed, and clearer. The next day some even said they felt like they were back to themselves. No antidepressant has ever alleviated depression so quickly.

Unlike traditional antidepressants, ketamine appears to rapidly reverse symptoms of depression in a matter of hours, with long-lasting effects. Ketamine repairs damaged brain circuits, which researchers believe are a leading cause of depression.

Stress, Depression and Synapses

Depression likely results from certain misconnections of synapses, often caused by chronic stress. Ketamine implements a two-step program to resolve this. First, it detaches the improper synapses—allowing them to regrow and reattach. Then, over time, synapses regenerate, connecting cells and allowing the brain to communicate more effectively as a network.

The suspected cause for depression is the effect of stress, which depletes synapses in the prefrontal cortex and limbic system. Studies show that ketamine assists with the regrowth of these damaged synapses.

Ketamine binds to NMDA receptors in the brain, increasing the amount of glutamine between receptors. Glutamine is the most common excitatory neurotransmitter in the brain, regulating large parts of the nervous system. It plays a vital role in the changes synapses undergo in response to experiences that underlie learning and memory. Glutamine then activates connections in the AMPA receptor.

The blockade of NMDA receptors and simultaneous activation of AMPA receptors cause a release of molecules that assist communication between neurons. This creates neural highways that allow better control over negative emotions. Depressive symptoms are relieved almost immediately, with positive behavioral effects maintained over time.

There may be an additional benefit, as depression is linked to chronic inflammation, and ketamine happens to be a powerful anti-inflammatory medication. It’s likely a combination of these effects that give such quick and long-lasting relief for treatment-resistant depression.

In Conclusion

In March 2019, the FDA approved esketamine, a ketamine-derived treatment for depression. The drug will be administered as a nasal spray, released by Janssen Pharmaceuticals of Johnson & Johnson. This and other treatment advances will offer relief to countless patients suffering from depression, hopefully helping combat the current global mental health crisis.

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Revenue Cycle Director, Oak Brook IL - Psychiatry Practice

Position Purpose

The Revenue Cycle Management (RCM) Director for APS Innovations will lead the revenue cycle management of a multi-clinic psychiatric practice based in Illinois. They will have a direct impact on accounts receivable, cash acceleration, and net revenue. The ideal candidate will have multistate payor experience in the field of psychiatry.

Responsibilities Include:

  • Engage in all aspects of Revenue Cycle Management. The RCM Director works
    strategically, proactively, and collaboratively, aligning our system resources to ensure effective outcomes.
  • Manage payer relations to negotiate contracts, resolve unpaid claims
  • Review underpayments and address them in a timely fashion
  • Work with external agencies to address patient collections
  • Monitor billing reports delivered by the contracted billing service and hold them accountable for items they should be completing and providing.
  • Improvements for revenue cycle efficiencies. Measure account performance against revenue cycle KPIs (e.g., days in accounts receivable, first-pass payment resolution, net collection benchmarks, and best practices for timely filing.
  • Establish and maintain system parameters and setup that support timely submission of claims resulting in payment maximization that is both efficient and effective.
  • Utilize system tools to identify at-risk accounts and determine actions required.
  • Manage accounts receivable, including analyzing by category and by the payer and offering strategic solutions to reduce time in aging.
  • Direct follow-up work to determine unpaid claim status and take appropriate actions to ensure prompt payment.
  • Create A/R Plans to drive improved results.
  • Serve as the Subject Matter Expert (SME) in revenue cycle management, including reporting results to senior leadership, identifying performance issues, and recommending actions to drive success.
  • Spravato & TMS pre-authorizations

Qualifications

  • Strong analytical and problem-solving skills with the ability to analyze and interpret large amounts of data.
  • Organized with the ability to identify and track progress against priorities.
  • Committed to delivering tasks and projects on time.
  • Highly skilled in setting expectations and delivering communication/coaching.
  • Has exceptional written and verbal communication skills with the ability engage with front end staff to board members
  • Ability to work in a highly fast-paced and independent environment.
  • Flexible and adaptable.
  • Constantly in search of new and better methods.
  • Bachelor’s Degree in healthcare or a related field required; Master’s Degree preferred
  • 10+ years of provider-based healthcare experience within Revenue Cycle required, and at least seven (7) years of experience managing others required
  • Knowledge of broad Revenue Cycle Systems
  • Clear and concise verbal and written communication skills and the ability to advise our clients professionally and positively
  • Strong people leader, adapt at managing team’s work while developing colleagues’ capabilities
  • College Degree / MBA
  • Senior level of knowledge of medical billing, including commercial payers, Medicare, Tricare, and patient responsibility, is required
  • Training on HIPAA privacy and security requirements

At APS Innovations we believe in and foster diversity, inclusion and equality for our employees, patients, and community. We are an equal opportunity employer. We offer competitive benefits inclusive of:

  • Health, dental, vision, and life insurance
  • 3% Employer Match retirement/401K plan
  • Paid vacation, paid holidays, and other personal time off
  • Advanced training/career advancement opportunities

Interested applicants must submit a cover letter with salary requirements along with their resume.

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