In this article, Nina Patrick, Ph.D., explores ketamine therapy – from what the drug is, the benefits of ketamine and what can be expected during a therapy session.
Ketamine is an unusual type of psychedelic drug. It is a dissociative drug, and it does not share a similar chemical pharmacophore as the classic psychedelics. It also is an interesting chiral molecule that can exist in multiple forms: racemic Ketamine and R-ketamine and S-ketamine.
Originally derived from PCP, or “angel dust,” ketamine has been used in hospitals and veterinary clinics for decades.
As a horse tranquilizer, right?
That’s correct. It’s a human tranquilizer too. Ketamine is FDA-approved for use at high doses as an anaesthetic to put you asleep during surgery.
Although not FDA-approved, lower doses that are “sub-anaesthetic” are used “off-label” to treat depression, pain, and other mental health and substance use disorders.
Particularly, it has been more widely used for treatment-resistant depression (TRD), which is severe depression that has not improved via other therapies, including people who are experiencing suicidal thoughts.
A prescription version of ketamine called esketamine (Spravato), is given as a nasal spray and was approved by the FDA in 2019 for TRD. According to its guidelines, it is only to be used “under the supervision of a healthcare provider in a certified doctor’s office or clinic.”
Benefits of ketamine
The medications currently available to treat depression, anxiety and substance abuse disorders involve daily administration of a medication which is targeted toward the correction of neurochemical imbalances of neurotransmitters in the brain such as serotonin and dopamine.
Relief from TRD with ketamine happens rapidly. Instead of waiting several weeks for an SSRI to provide relief, people suffering from TRD can start to feel the benefits of ketamine in 40 minutes.
Furthermore, in contrast to a daily SSRI, a single dose of ketamine has been shown to improve a patient’s depression or anxiety scores from severe to mild, and sustain the improvement for 120 days on average after treatment.
Is ketamine therapy right for you?
This is a question for your primary care doctor, your mental health provider or other healthcare professionals who know you well. It is important to note that ketamine therapy is not a first-option treatment for depression, it is generally used when other longstanding treatments have failed.
What happens at a ketamine clinic?
Independent, outpatient ketamine clinics are popping up all over the world. Typically these are for-profit companies that are staffed by a combination of a psychiatrist or anaesthesiologist (who can administer the infusion), a nurse, a social worker and the business people who run the company.
At most ketamine clinics, patients start with a screening, and if qualified, they get a shot of ketamine and are led through a guided meditation. Afterward, they meet with a therapist.
The assisted therapy model with ketamine produces a short-lived but intense subjective experience – the mystical or peak experience – which triggers or elicits an afterglow, accompanied by the subsequent positive change in affect, insight, motivation, cognition and behavior.
The clinics operate on a fee-for-service arrangement. Treatments can run from $400 to $800 a session, on average, and aren’t covered by insurance. Typically a course of six infusions and a clinical re-evaluation are recommended.
What are the possible side effects?
Ketamine therapy is generally considered safe, including for those who are experiencing thoughts of suicide. The main side effects are dissociation, intoxication, sedation, high blood pressure, dizziness, headache, blurred vision, anxiety, nausea and vomiting.
More detailed research needs to be done on the longer-term benefits and side effects of ketamine treatment and on its safety and effectiveness for teens and older adults, as well as for the emerging indications of ketamine therapy for PTSD, OCD, alcohol use disorder, and other mental health conditions.
Lastly, there is some concern that with repeated dosing, ketamine can start to lose its effectiveness and require larger doses to produce the same effect, which is not sustainable.
Nina Patrick, Ph.D., is a biotech entrepreneur and content creator with expertise in psychedelics, drug discovery, diagnostics and longevity. You can reach her at Nina@ninapatrick.xyz.
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This article was first published in Nina’s Notes on 25 January and is republished on Psychedelic Health with permission.
