The Ultimate Guide to Ketamine Therapy
Answers to all of your questions about Ketamine
Ketamine therapy is one of the most promising treatments for depression. While studies have hinted at the effectiveness of ketamine as a way to treat depression as far back as 1973, it has only been in the last five years that ketamine has been widely accepted by mental health professionals as a viable option for some patients.
Evan as ketamine therapy has become more widely accepted, most people still do not know much about the drug or how it is used in a therapeutic setting. There are also a lot of myths about what ketamine is and what it does.
What is Ketamine?
Ketamine is a medication that has been safely used in hospitals for more than 50 years as part of various anesthesia protocols. It is a synthetic compound and part of a class of pharmaceuticals known as NMDA receptor antagonists.
An NMDA receptor antagonist is generally used to create a state of dissociative anesthesia. This means the drug is used to help relax someone and render them unconscious for surgery.
However, ketamine has been found to have other effects as well, depending on the dose. It creates a trance-like state and provides pain relief. In the past several years, ketamine has been an effective treatment for several different mental health conditions, especially treatment-resistant depression and anxiety.
It is currently the only psychedelic that has been approved by the Food and Drug Administration (FDA) to treat mental illness.
How is Ketamine Used?
Traditionally, ketamine is used as part of a drug cocktail that anesthesiologists administer to someone before they undergo surgery. It can also be used as a standalone anesthesia, especially in children, when the patient is allergic to other drugs.
In smaller doses, it is also sometimes used for pain relief, usually in an in-patient setting.
Recently, ketamine has been used in small doses to help treat depression and other mental illnesses. Ketamine can be taken in both liquid and powder forms. When used to treat depression, it is used under the close supervision of a clinician.
Often ketamine is administered in a clinical setting as an IV infusion. However, ketamine can also be taken orally.
While anesthesiologists will likely use ketamine for many more years to come, the future of this drug is as a powerful form of mental health treatment.
Ketamine has initially been used to help patients suffering from treatment-resistant depression, anxiety, and PTSD. However, it is increasingly being used to help people with a broader spectrum of mental health issues.
Brief History of Ketamine
Ketamine was first used by the United States as a battlefield medicine during the Vietnam War. It was discovered in 1962 and was approved for use by doctors in the United States in 1970.
The drug was used widely on the battlefield and later in civilian hospitals because of its efficacy, safety, and limited side effects. Researchers as early as 1973 noted that ketamine potentially had the ability to ease the symptoms of depression.
However, at the time, the causes and mechanics of depression were still poorly understood. It was initially thought that the drug's hallucinogenic effects would need to be mitigated for it to be an effective form of depression therapy.
In the past fifteen years, scientists have understood that the dissociative effects of ketamine, including its hallucinogenic effects, are part of what makes it an effective depression treatment.
Ketamine is currently listed as an essential medicine by the World Health Organization (WHO).
In 2019 the FDA officially approved ketamine to combat treatment-resistant depression.
Is Ketamine Legal?
Ketamine is a Schedule III controlled substance. That means it is a legal prescription drug that is highly regulated. It is only available by prescription and should only be used under the supervision of a doctor.
Ketamine is also known as a club drug or party drug. When purchased on the street without a prescription and used without the supervision of a medical professional, it is illegal. The street version of ketamine is sometimes called Special K.
It is legal to use ketamine to treat depression and other mental health issues when it has been prescribed by a doctor, and you are using it as directed.
Often ketamine treatment is given through a ketamine infusion in a controlled clinical setting.
What Does Off-Label Use Mean?
Off-label use means a drug is used by a doctor to treat a condition that is not specified in the FDA approval of the drug. Off-label use is legal and is commonly done by doctors with the consent of their patients.
When a doctor recommends a drug for an off-label use, it is always based on the latest research. Doctors have an ethical duty to carefully monitor patients for any harmful side effects when prescribing a drug for an off-label use.
For several years, using ketamine for treatment-resistant depression was an off-label use. It was only approved to be used in anesthesia. However, in 2019 the FDA approved ketamine for this use. Doctors using ketamine to treat anxiety and PTSD are engaging in the off-label use of the medication. However, it is expected that this will also change soon.
Is Ketamine a Psychedelic?
Psychedelics are a class of psychoactive drugs that trigger a hallucinogenic state as one of its primary effects. Sometimes psychedelics are referred to as consciousness-altering drugs.
Ketamine is a psychedelic. Patients using ketamine will typically experience a trance-like state where they often have hallucinations or feel like they are separated from their bodies.
Because psychedelics create a state of altered consciousness, they are tightly regulated. So-called party drugs like MDMA, are also psychedelics. It is unlawful almost everywhere to use psychedelics for recreational use because the danger of addiction and harm is so great.
Researchers have discovered that the reason ketamine works to treat depression is because of the altered state it creates in patients. Currently, ketamine is the only psychedelic approved for the treatment of depression, or any other mental illness, in the United States.
Many studies have found that the psychoactive properties of ketamine are uniquely effective in the treatment of depression.
How is Ketamine Administered?
Ketamine is currently not considered a front-line treatment for depression or other mental health issues. It is only used when other therapies have not worked.
Currently, ketamine is administered in one of four primary ways:
- Orally
- Nasal Spray
- Injection
- Infusion
Ketamine can be into pill form. However, typically, ketamine is not administered this way when being used to treat depression.
In 2019, a nasal spray containing ketamine was approved by the FDA as a therapy for treatment-resistant depression. It is still not widely prescribed because many health providers prefer to have patients on ketamine in the safety of a clinical setting.
Ketamine can also be administered in a shot. The proper dose is injected into the patient through a syringe and needle. The patient is then carefully observed as the drug takes effect.
The most common way ketamine is administered is through an infusion. The patient typically lays down or reclines and is hooked up to an IV where a steady, low dose of ketamine is given. This is almost always done in a clinical setting.
The best way for you to take ketamine will depend on your circumstances and health history.
What is a Ketamine Infusion Like?
Ketamine therapy is varies depending on the patient. Some patients will need several sessions before they see long-lasting effects. However, most patients report feeling better immediately after one session. Some patients undergo a few sessions and feel the effects for months afterward.
When you are receiving ketamine infusions, you will usually be asked to commit to a process that lasts four or five weeks. Most infusion sessions last less than an hour and take place twice a week.
You will receive an infusion at a clinic or ketamine infusion center. You relax in a bed or chair where you can recline. An IV needle will be inserted into an appropriate vein, usually on the hand or forearm.
You will then be connected to a bag of fluid containing the correct dose of ketamine. Depending on the clinic and your needs, you may also be given saline fluid to keep you hydrated along with the ketamine.
The ketamine is typically set to run for 40 minutes. While you are on the ketamine drip, medical staff will monitor your vital signs.
Most patients will quickly begin to experience the dissociative effects of ketamine. You may feel like you are dreaming or hallucinating. Some patients report feeling like their brains had been opened up and that they could see new connections. Everyone seems to experience the effects of ketamine a little differently.
Once the drip is over, and the staff has checked your vitals, you are able to leave the clinic. However, you are not supposed to drive yourself home because the effects of the ketamine may linger for several hours.
How Does Ketamine Work for Depression?
When patients are prescribed typical anti-depressants, they have to wait weeks for the drugs to build up in their systems before they notice any changes. Ketamine is completely different.
It begins to work to ease symptoms of depression as it leaves your body. You are not dependent on a buildup in the same way you are with SSRIs like Prozac.
This is because SSRIs work by increasing certain types of chemicals in your brain. Ketamine works to actually repair neuron synapses that misfire in depressed patients. It triggers a response in the brain that stimulates the regrowth of synaptic connectors.
What Has Ketamine Treatment Taught Us About Depression?
For decades the conventional wisdom was that depression was caused by a lack of certain chemicals in the brain. Scientists believed that most cases of depression were caused by the body not producing enough serotonin.
However, since clinical trials began in the early 2000s with using psychedelics to treat depression, it has become clear that there is more going on in the brain of a depressed person beyond a chemical imbalance.
Extensive studies of ketamine now suggest that depression is related to how the brain’s circuitry relays messages. Certain chemicals, like serotonin, do affect neurotransmitters, but they do not always work. Ketamine therapy indicates that depression is caused by a breakdown in the brain’s circuitry. Certain neurotransmitters and neuron synapses cease to relay the information they are supposed to.
This indicates that depression is not a chemical imbalance as much as it is a short circuit.
The Dissociative Effects of Ketamine
In the early phases of ketamine research, scientists wanted to find ways to give patients the depression relief benefits of ketamine while minimizing or eliminating the dissociative effects.
However, it quickly became clear that the trance-like state, hallucinations, and feelings of being separate from your body were actually part of why ketamine worked so well to relieve symptoms of treatment-resistant depression.
In the language of Silicon Valley, the dissociative effects of ketamine were a feature, not a bug.
Something about the way the drug operates in the brain and produces the psychedelic effects also allows it to repair broken synapses and provide almost immediate relief from symptoms like suicidal ideation.
Currently, patients are given ketamine in clinical settings so that they can safely experience the dissociative effects without putting themselves or others in danger. The dissociative effects are a critical part of successful ketamine therapy.
Is Ketamine Therapy Safe?
One of the reasons ketamine is considered an essential medication by the WHO and has been used for more than 50 years in hospitals is because at the proper doses, it is one of the safest forms of anesthesia.
However, used the wrong way, and in the wrong doses, ketamine is highly addictive. The vast majority of people who become hooked on ketamine are abusing it in a recreational setting. Like any psychedelic, ketamine can be fatal in high doses or lead someone to take dangerous actions because of their altered mental states.
Ketamine therapy is always administered under the careful supervision of a team of medical professionals. The clinical dosage needed for effective treatment of depression is quite low. Patients undergoing ketamine therapy report very few side effects and almost no rates of ketamine addiction.
Ketamine therapy is one of the safest therapies for treatment-resistant depression. For many patients, it is the only viable therapy.
What are the Side Effects of Ketamine?
During a ketamine therapy session where the proper dose is administered, patients will feel calm and relaxed. Often during an infusion, patients will experience dissociative effects like immobility, short-term amnesia, and relief from pain during the infusion in the clinic. The short-term amnesia relates to forgetting the experience of being hooked up to the ketamine drip and the infusion process.
In a recent study, some patients reported feeling strange, loopy, experiencing visual distortions, difficulty speaking, or numbness that lasted no more than four hours after a ketamine infusion.
Most patients successfully undergo ketamine therapy without any side effects.
Can Ketamine Help with Anxiety?
Some providers are willing to prescribe ketamine therapy for treatment-resistant anxiety and treatment-resistant PTSD. Currently, these are both off-label uses for ketamine.
There continues to be extensive research on using ketamine for anxiety. Patients who suffer from depression and anxiety have reported that ketamine treatments relieved symptoms from both their anxiety and depression.
As more research is performed on the effects of ketamine and other psychedelics, on anxiety, more providers will likely be willing to use ketamine therapy even when a patient does not have any symptoms of depression.
Where Can I Get Ketamine for Depression?
Ketamine is a controlled substance. Currently, you can only receive ketamine therapy in a clinical setting.
Because ketamine therapy is still a relatively new treatment, it is not available at a standard clinic where you see your primary care doctor. Almost all ketamine therapy is conducted at specialized ketamine infusion centers. There are ketamine infusion centers located all over the United States, including in Boston, Massachusetts, and New Hampshire.
Before ketamine therapy is prescribed, a doctor must find that you suffer from treatment-resistant depression. Usually, a decision to use ketamine therapy is made in consultation with a team of medical doctors and mental health professionals.
Conclusion
Ketamine is one of the most promising treatments for depression in the past 50 years. Ketamine therapy is already helping thousands of people experience a new life. For many, the experience of a ketamine infusion is a spiritual experience where they enjoy transformational visions, gain new insights, and feel a sense of enlightenment.
For some, ketamine even helps break the cycle of addiction where patients have tried to self-medicate their depression away. They feel hope for the first time in years.
It is now clear that when used in the right doses and under the care of a licensed medical provider, ketamine is an effective therapy for treatment-resistant depression.
