What Is Ketamine?

Ketamine is a highly effective medication that has been used in medical and veterinary science for over a century. It has gained recent popularity for the use of treating depression.  All formulations of ketamine, except Food and Drug Administration-approved Spravato, are being used off-label when used for the treatment of depression.

Spravato, however, is approved as a nasal spray for treatment-resistant depression in adults and for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior.

Ketamine for Depression

How does ketamine therapy help with depression symptoms?

• Growing new pathways and connections between brain cells, called neuronal growth.

• Maintaining neuroplasticity, which is the ability to learn new skills and become better at them.

• Helping different parts of the brain work together as a team, called neuronal interconnectivity.

• Helping you feel energized and focused, while also maintaining a sense of calm.

With ketamine giving a boost to the glutamatergic system, it may help people struggling with depression to feel like their brain is working more harmoniously, giving them energy, strength and focus to be able to face the day.

What types of depression is ketamine therapy used for?

Ketamine is primarily used for a type of depression called treatment-resistant depression. TRD is a type of major depressive disorder that doesn't respond to traditional first-line treatment, like selective serotonin reuptake inhibitors (SSRIs), such as Prozac or Zoloft.

How does ketamine make you feel?

Many people compare taking ketamine for depression to taking a psychedelic "trip." While the experience is different for everyone, many people feel a sense of overwhelming calm and relaxation. The importance of ketamine aftercare can not be overstated, including psychotherapeutic sessions about the experience and journaling.

Typical Routes of Ketamine Administration

• Intravenous ketamine. IV ketamine works the fastest, with symptom relief within a few hours. IV ketamine doses are weight-dependent and commonly administered at 0.5 mg/kg. Dr. Danielle Greenman, a functional medicine physician and head of ketamine-assisted psychotherapy at Blum Center for Health in New York, says IV ketamine peaks around one minute, and many providers prefer IV ketamine due to its rapid onset, ability for more precise dosing and fewer side effects.

• Intramuscular ketamine. Ketamine can also be given as a shot into the muscle, usually in the upper outer gluteus. A standard IM dose is 0.25 to 0.5 mg/kg of body weight. Greenman says IM ketamine peaks around five minutes.

• Oral ketamine. A standard dose is 1 mg/kg of body weight. Greenman says oral ketamine effects peak at about 15 to 30 minutes.

• Ketamine lozenges. Greenman says this is a less invasive option for patients to do the treatment at home, but less medication will be able to enter the bloodstream. Standard dosing varies.

• Intranasal ketamine (Spravato). As this is the only FDA-approved formulation of ketamine for depression, there is standard dosing. The dose for TRD is 56 mg for adults, which may increase to 84 mg. For major depressive disorder or suicidal ideation, the dose is 84 mg for adults. For nasal administration, medical providers give patients a nasal spray device, similar to one you might use for a stuffy nose. Greenman says peak effect of intranasal ketamine is around 15 minutes.

Ketamine Benefits

Using ketamine for depression has a few key benefits:

• Rapid onset. Most SSRIs take four to six weeks to achieve remission, whereas ketamine is going to be much faster.

• Relief from depression symptoms. Especially with TRD, other treatments may not be working. Ketamine may be the treatment to finally provide relief from depression.

• May be combined with psychotherapy. Because ketamine can induce an altered state of consciousness, individuals may be more receptive to emotional processing and therapy.

Ketamine Side Effects and Risks

Using ketamine for depression also has a few side effects and risks:

• Medical surveillance is needed after treatment. All patients require some level of medical surveillance after treatment, like staying in the clinic so the staff can watch vital signs and assess for loss of consciousness. Koo also says that patients cannot drive post-session for at least 24 hours.

• Dissociative effects. The effects differ between individuals, but some may experience emotional numbness or detachment, out-of-body experiences or hallucinations. Koo adds that these effects can be uncomfortable ketamine side effects for many people.

• Nausea. Romig says that nausea is one of the most common side effects, and usually, the side effect is mitigated with medications prior to treatment.

• Headaches. Romig adds that headaches are another common effect, also treated with medicine beforehand.

Who Is Eligible for Ketamine Therapy?

Ketamine therapy is usually for individuals with depression, anxiety, PTSD and OCD — these are typically individuals who have not responded to other types of treatment, or those with active suicidal thoughts.

Beyond that, anyone considering ketamine therapy would need additional medical clearance. This process includes:

• Patient intake. Your provider will take a complete medical history, family history, surgical history, medication list and allergies.

• Rule out contraindications. Your provider will need to make sure you don't have a condition that makes taking ketamine unsafe, like pregnancy. Who is not a good candidate for ketamine therapy? Romig says that other contraindications may be heart disease, uncontrolled high blood pressure, untreated thyroid disease, schizophrenia, acute drug intoxication or acute mania.

• Psychological assessment. Greenman says she checks for risk of abuse or active substance use disorders or other mental health conditions that could interact with ketamine, like psychosis.

• Assessment of developmental and trauma history. Greenman wants to understand what her patients have tried for previous treatment, their religious or spiritual preferences and their support system at home.

• Informed consent. Everyone needs to sign consent forms and agree that they understand the risks and benefits of ketamine therapy and the importance of regular medical follow-ups.

If you would like to know more about Ketamine treatments at ArtistServices in Culver City/Los Angeles, reach out and say hello — info@artistservicestherapy.com