Guide to Ketamine Therapy

What is Ketamine?

Ketamine was approved for medical use as a fast-acting anesthetic by the FDA in 1970. In addition to its anesthetic properties, ketamine has been observed to have mood-enhancing, analgesic, and dissociative effects, which has led to its off-label use in the treatment of conditions such as depression and post-traumatic stress disorder (PTSD). The dissociative effects of ketamine can include experiences of altered perception, such as hallucinations and a sense of detachment from one's physical body. The Drug Enforcement Administration (DEA) classifies ketamine as a Schedule III controlled substance, meaning it has a moderate to low potential for physical and psychological dependence.

Ketamine is widely used in both human and veterinary medicine. Its non-opioid nature has garnered interest, especially in light of the opioid crisis, as it offers an alternative to opioids for pain management, which are known for their potential for addiction and other adverse effects.

Esketamine is a derivative of ketamine and is distinct from ketamine itself. In 2019, the FDA approved esketamine (under the brand name Spravato) in the form of a nasal spray specifically for use in conjunction with an oral antidepressant for the treatment of treatment-resistant depression (TRD). Esketamine has also been approved for the treatment of depressive symptoms in adults with major depressive disorder (MDD) who have current suicidal ideation with intent. It's important to recognize that while ketamine and esketamine are related, they are not the same and are used differently in clinical settings.

Brief History of Ketamine

Ketamine was first synthesized in 1962 as a derivative of phencyclidine (PCP) and was patented in the United States as an anesthetic in 1966 ^[1]. Its combination of sedative and analgesic effects, along with a favorable safety profile and rapid onset, made it an appealing option for medical use. The United States Military recognized the value of ketamine as a field anesthetic, and it was widely used during the Vietnam War in the late 1960s and early 1970s. While there have been observations and studies regarding ketamine's impact on symptoms of PTSD among soldiers, it's important to note that the FDA approval of ketamine in 1970 was specifically for its use as an anesthetic and not for the treatment of PTSD ^[2].

In the 1990s, ketamine gained notoriety as a recreational drug due to its dissociative and psychedelic effects, and it became known by various street names such as K, Ket, Special K, Vitamin K, and Lady K. Despite its reputation as a party drug, interest in ketamine's potential therapeutic effects, particularly in the treatment of depression and chronic pain, continued to grow among researchers and clinicians.

In the 2000s, evidence began to accumulate supporting the rapid antidepressant effects of ketamine, leading to increased interest and the establishment of ketamine clinics. After 2010, there was a significant increase in the number of clinics and treatment centers in the United States specializing in ketamine therapy, particularly for treatment-resistant depression.

Ketamine's potential in treating various mental health disorders has continued to be a subject of research, and clinical trials are ongoing. Its use has garnered international attention as well, with researchers and clinicians around the world exploring its therapeutic potential.

What Can Ketamine Treat?

Ketamine is primarily known for its potential to treat depression, PTSD, anxiety, pain, bipolar disorder, and addiction. Here's an overview of each.

What is Ketamine Therapy? How does Ketamine infusion therapy work?

Ketamine therapy typically refers to the off-label use of ketamine to treat various mental health disorders and pain. Ketamine therapy is generally utilized after other treatments prove ineffective for symptom relief. However, more recent studies show that ketamine may become a more common first-line medication for treating various disorders.

The two main ways ketamine is administered during therapy are IV infusion and nasal spray. IV infusion is the most common and researched treatment. Intranasal ketamine therapy is administered through the nose and utilizes the drug Esketamine, which the FDA approved in 2019 and is slightly different from traditional ketamine. The therapy regiment for nasal spray therapy is very similar to IV infusion.

Methods of Ketamine Ingestion

The most common type of ketamine administration method is via IV infusion. Most ketamine clinics throughout the United States provide IV ketamine infusion therapy. However, in 2019, the treatment administered via a nasal spray began to rise in popularity and availability. This follows the approval of Esketamine by the FDA^[3]. Overall, there are three main methods for ketamine administration:

It's challenging to identify the exact dosage and absorption amount with ketamine is administered intranasally. For understanding the exact dosage requirements for treatment, IV infusions are best. However, there is always a trade-off between convenience and accuracy. You may find nasal spray works fine for you.

Ketamine vs Esketamine

Esketamine is a medication that the FDA approved for use against treatment-resistant depression. It's very similar to ketamine, which was approved in 1970 for use as an anesthetic ^[4]. Despite this, there are a few significant differences between Ketamine and Esketamine that you should understand before deciding which to choose.

What does ketamine feel like? What are the effects of ketamine?

The effects of ketamine range from physical to psychological, depending on the dosage and the individual. The most often reported effects and feelings are inner reflections, quieting of the mind, and the feeling of floating or weightlessness. These are accompanied by a sense of euphoria, love, and gratitude, and at a higher dosage, very mild hallucinations, primarily through colors and sounds. Remember that ketamine therapy is a pleasant experience for most, and its rise in popularity as a mental health treatment can attest to that.

It's also important to note that your clinic or doctor can always make adjustments depending on your reaction to the treatment. For example, for IV infusions, you will be back to baseline with a clear thought process only after about 15 minutes from when the IV is removed.

After the session, you may feel cloudy or tired for a few hours, but this subsides quickly and has not been known to cause issues.

What are the results of ketamine therapy for my mental health? Does it work?

As with any medication or therapy, you can respond differently depending on your situation. In the case of ketamine therapy, the results are generally very positive, with high success rates, especially for those with treatment-resistant disorders. Using data from numerous ketamine studies and trials, the American Psychiatric Association reports that 70% of patients responded positively with improvements to their mood and helping their respective disorders after receiving only one round of ketamine IV infusion therapy ^[5].

Another review of the efficacy of ketamine therapy found that ketamine resulted in a rapid antidepressant effect for patients with treatment-resistant depression, which lasted as long as a week after a single IV infusion session^[6].

How do I qualify for ketamine therapy? Where should I start?

Contrary to much of the information on the web, for many Ketamine clinics and doctors, you do not need a direct referral from a psychiatrist or other mental health care provider to receive ketamine therapy. Instead, many clinics will provide an initial survey followed by a phone or in-person consultation to determine if you are a good fit for ketamine therapy. Consultations are typically free of charge.

With that said, ketamine therapy is best suited for adults with moderate to severe depression, bipolar disorder, anxiety, PTSD, or chronic pain. Additionally, most ketamine clinics focus on providing treatment for patients where other treatments, such as antidepressant medication like SSRIs, have been ineffective, and ketamine therapy thus acts as an alternative.

However, a growing body of practitioners and researchers are pushing for ketamine to be utilized as a first-line medicine rather than only for resistant disorders. This is especially true as the recent opioid addiction epidemic has taken hold, pushed less by the big pharmaceutical companies, and alternatives are given more attention.

Who should avoid ketamine therapy?

There is a consensus at the American Psychiatric Nurses Association that ketamine should be avoided if you have any of the following:

History of psychosis or psychotic disorder
Pregnant
History of intracranial pressure
Uncontrolled high blood pressure
Unstabled heart disease
Uncontrolled thyroid disease
Existing substance abuse
Previous bad experience with ketamine

^[7]

As always, it's important to consult with your primary doctor before receiving ketamine therapy.

Will ketamine interact with my current medications?

In contemplating whether ketamine will interact with your current medications, it's important to be informed about potential interactions. For instance, benzodiazepines, when used in frequent or high doses, can potentially diminish the effectiveness of ketamine therapy ^[8]. This category includes well-known medications such as Xanax, Klonopin, and Ativan.

If you're regularly taking monoamine oxidase inhibitors (MAOs), it's generally recommended to avoid ketamine therapy ^[9]. However, SSRIs and other antidepressants are generally considered to be compatible with ketamine therapy ^[10].

Nevertheless, this information should not replace a consultation with your primary care doctor. It's always crucial to discuss potential interactions with your healthcare provider before beginning a new treatment like ketamine therapy.

Where can I get Ketamine therapy?

Ketamine therapy is often provided by certified and licensed doctors and clinics, which have exploded in popularity in recent years. You can browse our website directory of clinics and doctors and inquire about therapy here. In addition, a separate reliable source for clinics can be found on the American Society of Ketamine Physicians website.

What should I look for in a ketamine therapy clinic?

There are many ketamine therapy options regardless of your location, and it's sometimes difficult to decide which is best for you. In general, there are clinics for ketamine therapy or individual doctors and psychiatrists who are well-trained in ketamine therapy.

Overall, clinics abide by similar medical standards, and most administer therapy with IV infusions, but nasal spray therapy is rising in popularity. Clinics will differ mainly across two areas: setting and approach. During your consultation, be sure to ask about the setting or environment of the therapy. Many clinics provide a more comforting living room setting that feels very different from your typical doctor's office. These settings may offer more comfort for you during your sessions. Secondly, there are three common approaches to therapy today:

Is ketamine therapy covered by insurance?

Because ketamine therapy is typically used to treat off-label disorders, insurance companies usually do not approve it. With that said, more clinics are beginning to accept insurance, and patients are beginning to receive some reimbursement. Some insurance companies will and have covered treatments, so it's always worthwhile asking the doctor or clinic about insurance and requesting any paperwork you need from them to submit to your insurance company for reimbursement. Typically, reimbursements depend on the type of insurance plan you have and whether you have a valid diagnosis for the disorder that requires treatment.

What are the leading companies offering ketamine therapy for mental health?

Below is a list of the top ketamine companies and a short description and overview. You can also view our directory of therapists and clinics here.

Mindbloom
Field Trip Health
Numinous
Nue Life
Joyous

What does the World Health Organization say about ketamine?

Ketamine has been listed on the World Health Organization (WHO) Essential Medicines List since 1985. The WHO Expert Committee on Drug Dependence has recently recommended against ketamine being controlled under International Drug Control Conventions ^[11]. This recommendation is mainly because ketamine is vital for surgery across many low and middle-income countries around the world and for conflict zones and emergency and disaster situations. In many of these countries and under these circumstances, anaesthesiologists are scarce. For these reasons, ketamine might be the most widely used anesthetic in the world.

Another reason for the widespread use of ketamine globally is its lack of side effects, such as depressed breathing or blood pleasure. This makes it useful for high blood loss situations, such as in combat zones or other situations where a patient may have low blood flow and septic shock. Ketamine also does not require oxygen, electricity, water, or trained doctors to administer it, adding to its versatility and use throughout the globe, where these resources may not be available.

What is the legality of ketamine and ketamine therapy?

The FDA approved ketamine for use as a general anesthetic in 1970. Since then, it has been growing in use both medically and recreationally.

Medically it is used to treat various mental health disorders and provide pain relief, and this spurred the boom in doctors and clinics offering ketamine therapy. According to the FDA, these common types of ketamine therapy are perfectly legal, and their use is determined entirely by the doctor or clinic's best judgment. As long as ketamine is administered under the appropriate safety standards and proper medical ethical circumstances, it's completely legal.

Following ketamine's rise in popularity as a recreational party drug, in 1999, the federal drug enforcement agency classified it as a Schedule III controlled substance similar to steroids. Schedule III substances are defined as drugs with a low to moderate potential for physiological or physical dependence ^[12].

It's important to note that doctors and clinics must obtain the proper DEA license and the state and federal government's standard licenses to practice outpatient medicine. Remember, ketamine for recreational use and without a prescription remains illegal throughout the United States.

Overall, in the United States, Ketamine is perfectly legal if prescribed by a healthcare provider. Ketamine clinics are also legal and becoming more popular for many off-label uses not yet approved by the FDA. In time, there is bound to be more research on ketamine, and we may see additional FDA approvals in the years ahead.

What are the alternatives to ketamine therapy?

Other treatments that ketamine is typically compared with are transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), and common antidepressants (SSRIs).

TMS

TMS, short for transcranial magnetic stimulation, is a treatment that utilizes magnets to stimulate areas of the limbic system within the brain. The limbic system is responsible for regulating emotion and behavioral patterns, and thus stimulation of this area of the brain is thought to be helpful in treating depression and other mental health disorders.

TMS vs. Ketamine

ECT

ECT, short for electroconvulsive therapy, is used mainly to treat severe and treatment-resistant depression and bipolar disorder. It typically involves stimulating the brain using electricity while the patient is under an anesthetic. It requires highly trained medical staff to administer the therapy.

ECT vs. Ketamine

Antidepressants

Antidepressants are prescribed medications that can relieve symptoms of depression, anxiety, and other mental health disorders. They work by helping to rebalance some of the brain's chemicals responsible for mood and behavior. Common antidepressants include selective serotonin reuptake inhibitors (SSRIs), the most common type of antidepressant, and serotonin and noradrenaline reuptake inhibitors (SNRIs), used to treat more major depression symptoms.

Antidepressants vs. Ketamine

The future of ketamine therapy

Ketamine is paving the way for a new era in treating mental and physical disorders. Over the past decade, we've seen a surge in ketamine clinics and research studies exploring its potential as a primary solution for depression and other conditions.

One major shift we hope to see is broader insurance coverage for those who could gain from ketamine therapy. To make this possible, we need more research and clinical trials. Doctors can also help by gathering and sharing data about the results of their ketamine treatments. This could provide the FDA with the evidence they need to approve broader uses of ketamine for a range of mental health issues, which could, in turn, lead to better insurance coverage.

Overall, ketamine therapy holds a promising future.

‍