Depression and anxiety are amongst the most devastating mental health and mood disorders in the United States. Affecting over 16 million Americans, depression is the leading cause of disability in the country.
While there are a number of known natural remedies for treating mild depression and anxiety, such as meditation or TMS, major depression often requires further intervention.
For treatment-resistant depression (TRD) cases, low-dose ketamine therapy may provide more mid- to long-term relief than traditional treatments or antidepressant drugs. In fact, ketamine has been shown to reduce not only symptoms of depression, but also suicidal ideation.
This means that even in the most severe cases of major depressive disorder and suicidal patients, ketamine therapy may provide immediate and lasting relief. And it’s helping individuals with other mental health disorders like anxiety, PTSD, and borderline personality disorder.
Of course, no single treatment is best for every individual. There are plenty of factors to consider, and we’ll walk you through them.
What is ketamine therapy?
Ketamine therapy is the off-label use of ketamine infusions, intramuscular injections, and nasal spray to treat severe depression, chronic pain, substance use, or other mental health disorders.
History of Ketamine Treatments
Researchers originally studied the use of ketamine in the 1950s. They were looking for an anesthetic with analgesic (pain-relieving) effects. While ketamine was first used in these ways in operating rooms and on battlefields, researchers soon found additional uses for the drug.
By 1975, researchers began studying ketamine for its antidepressant effects. By the year 2000, studies showed the rapid efficacy of the treatment, with patients experiencing significant improvement within 72 hours.
What is the difference between ketamine and morphine? Ketamine is a non-opioid medication that operates differently from morphine. Morphine is an opioid.
Ketamine affects the brain’s N-methyl-D-aspartate (NMDA) receptors. It also appears to help the brain produce glutamate, a neurotransmitter that has been linked to depression. Glutamate helps the brain repair damaged neurons and neural connections and form new ones.
Ketamine has anti-inflammatory properties, which may help reverse damage to the brain by cortisol or other stress hormones.
The drug is sometimes combined with morphine for pain relief. However, it may prove as an effective alternative to opioid medications entirely, as ketamine offers less severe side effects.
Common Uses for Ketamine Therapy
Ketamine therapy can help treat several conditions. In addition to being an effective anesthetic and analgesic, the drug’s anti-inflammatory and anti-depressive attributes make it an effective treatment option for nervous and mental health conditions such as:
- CRPS (complex regional pain syndrome)
- Migraines
- Fibromyalgia
- PTSD (post-traumatic stress disorder)
- Bipolar disorder or borderline personality disorder (BPD)
- Various anxiety disorders
- Obsessive-compulsive disorder
- Suicidal thoughts
At this time, ketamine therapy is most commonly used to treat depressive and nervous disorders.
How does Ketamine therapy for depression work?
How ketamine therapy works depends on the method of administration. There are 3 primary ways of administering ketamine as a therapy treatment for depression and other mental health disorders. They are:
Ketamine Intramuscular (IM) Injection: This method involves a shot into your muscle, typically the thigh or shoulder, where it then travels to your blood. This is a quick and easy treatment method, with appointments lasting only 30-45 minutes. It typically also costs less compared to infusions. Depending on how the patient does with the first injection, they may return for future injections, with the total number of injections required varying patient by patient.
Ketamine IV Infusion: Infusions are intravenous (IV) drips which titrate ketamine into your bloodstream over the course of 1 to 4 hours. Depending on the individual, treatment may consist of multiple infusions over a 1- to 2-week period, with ongoing treatments as deemed necessary. This is generally how patients get higher doses of ketamine in contrast to other methods.
Ketamine nasal spray: Also called Esketamine or Spravato, ketamine nasal spray is occasionally prescribed as an adjunct to IM or infusion treatments. As a home administration method at lower doses, Esketamine can help patients between IMs or infusions.
While the food and drug administration has approved ketamine nasal spray, it does not appear to be as effective compared to infusions in treating depression, so it is not used as a standalone. This may be due to the delivery method or how Esketamine interacts with brain receptors. More research is needed overall.
Getting Started
No matter the administration method, a consultation with your physician or health care provider is the first step. Because many factors affect mental and physical health, we recommend finding a physician who performs comprehensive whole-person testing.
Your doctor will ask you about:
- Any previous mental health treatment
- Medications you’ve tried and why they didn’t work for you
- Lifestyle changes you’ve made to manage your condition
- Any questions you have regarding ketamine therapy
If you and your doctor decide that ketamine treatment is the right choice for you, your doctor can then take steps to get you approved and scheduled for ketamine therapy.
Preparing for Ketamine Treatment
If you tend to experience anxiousness around needles or in medical settings, we suggest preparing yourself for the best possible experience beforehand. Some tips for your ketamine therapy appointment:
- Do your best to arrive at your appointment in a calm state of mind. Avoid stress and engage in calming activities beforehand.
- Bring an eye mask. Some patients find that using an eye mask helps them stay calm.
- Prepare calming music. Meditative or otherwise calming music may help ensure a pleasant experience. Don’t forget your headphones.
- Arrange transportation. After treatment, you will have a recovery time of about 30 minutes but may continue to feel drowsy. Plan ahead of time for a ride home.
What is a typical dose of ketamine infusion? The typical dosage for ketamine infusion is 0.5 mg/kg, but this may differ according to individual needs. Some patients may need as little as 0.1 mg/kg. Others may be less receptive, needing up to 0.75 mg/kg.
After Treatment
Patients experience different responses to ketamine treatment. Some people see positive results after the first session, while others may take up to 3 or more sessions. Many clinics will schedule 6 infusions over a few weeks for initial treatment.
If a patient does not respond to treatment after 6 sessions, further sessions are unlikely to show improvements. At this point, you may want to discuss other options with your doctor.
Note: While ketamine therapy is promising, it is not a stand-alone treatment. We highly recommend integrating your ketamine therapy with CBT or alternate psychotherapy with a licensed professional for best results. Some clinics may even include a discussion with a therapist at the infusion appointment.
How long does ketamine treatment last? The effects of successful ketamine treatments can last up to 3 months after a full round of treatment. While results vary from patient to patient, the effects of sessions tend to last longer after each treatment.
Cost
Because racemic ketamine and IM ketamine are not FDA-approved, health insurance may not cover the cost. Depending on the provider and dosage, a single IM or infusion can cost anywhere between $400 and $1200. This means full treatments cost thousands of dollars in total.
Since nasal ketamine is FDA-approved, it is more likely to be covered under health insurance.
Risks & Side Effects
What are ketamine therapy‘s side effects? Side effects of ketamine therapy may include:
- Nausea or vomiting
- High blood pressure
- Involuntary muscle movements
- Trouble sleeping
- Loss of appetite
- Dizziness
- Drowsiness
- Confusion
- Double vision or blurry vision
- Disturbance in the perception of time, color, texture, or sound
- Dissociation, or feeling outside of one’s body
These physical and cognitive side effects may occur after both short-term and prolonged exposure to ketamine.
Some individuals have also described a dream-like or psychedelic state during their treatment in which they feel drowsy yet awake.
Due to these risks, ketamine therapy is suggested only for patients who do not respond to more conventional treatments. However, for those with severe symptoms or suicidal thoughts, the benefits of ketamine treatment may outweigh the risks.
Other Considerations
Addiction Concerns
Ketamine is less addictive than opioid medications like morphine. This is what makes ketamine particularly appealing as a morphine alternative.
However, there is still some potential for abuse, and ketamine treatments should be approached with due care. Individuals with a history of or a predisposition toward substance abuse should consider ketamine therapy with caution.
Ketamine vs. SSRIs
SSRIs (Selective Serotonin Reuptake Inhibitors) increase serotonin in the brain. Ketamine affects the brain differently than SSRI medications like Zoloft and other prescription antidepressants. Because ketamine promotes glutamate, it may reduce stress-induced damage to brain tissue.
If you have taken SSRI medications without results, you may want to consider ketamine treatments.
A Whole-Body Approach to Healthcare
Ketamine therapy is extremely promising for treating major depressive disorder. One study found an overall success rate of 85%.
If you think ketamine treatments may be right for you, we recommend speaking to your trusted physician. We highly suggest a comprehensive analysis of your symptoms, history, and all related genetic and lifestyle factors before moving forward with any course of treatment.
And we’re here to help. Schedule a free consultation today to discuss your concerns with providers who take a whole-body approach to healthcare.
Read next:
- SAM-e: A Natural Alternative to Antidepressants
- Adaptogens For Stress Management & Mental Wellness
- The Gut-Brain Connection: How Your Gut Impacts Your Mental Health
- 5-HTP
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