What is Ketamine Therapy and How Does It Work?

Health care professionals treat mental health conditions such as depression, anxiety disorders, bipolar disorder, and post-traumatic stress disorder (PTSD) with a combination of medications and behavioral therapies. However, some people do not respond to these standard treatments. Ketamine therapy involves using low doses of an anesthetic drug called ketamine in patients with treatment-resistant depression.

What is Ketamine Therapy?

Ketamine is an anesthetic drug that was first patented in Belgium in the 1960s as a veterinary anesthetic. The U.S. Food and Drug Administration (FDA) approved ketamine for use in humans in 1970. Because of its efficacy and safety profile, ketamine was widely used as an anesthetic on the battlefield during the Vietnam War.

Therapeutic Uses of Ketamine

Ketamine (brand name: Ketalar) is an anesthetic drug. It is used, in combination with other medications, to induce general anesthesia (a sleep-like state) before and during some types of major surgery.

Therapeutic Uses of Ketamine Beyond Anesthesia

Over the past few decades, researchers have found that ketamine has antidepressant effects. However, ketamine therapy is not approved as a first-line treatment for patients with major depressive disorder. Rather, it is used in patients with treatment-resistant depression, i.e., patients who have not responded to at least two standard treatments. Ketamine may also be used to treat acute suicidality, for example, to calm a person after an attempted suicide.

How is Ketamine Treatment Given for Mental Health Conditions?

Ketamine is given in the form of an intravenous infusion (injection into a vein) to manage psychiatric disorders. It can be a single infusion or a series of infusions.

What is Esketamine (Spravato)?

In 2019, the U.S. Food and Drug Administration (FDA) approved a new ketamine-derived antidepressant nasal spray. This drug called esketamine (brand name: Spravato) is used along with an oral antidepressant to treat adults with:

  • Treatment-resistant depression.
  • Major depressive disorder (MDD) with depressive symptoms including suicidal thoughts or behaviors.

How Does Ketamine Therapy Work?

The mechanism of action of ketamine for depression treatment is not entirely clear. Researchers believe the drug binds with n-methyl-d-aspartate (NMDA) receptors in the brain. This leads to increased levels of an excitatory neurotransmitter (natural chemical) called glutamate. Glutamate plays a key role in memory formation. Through a complex cascade of events, increased levels of glutamate trigger the formation of new neuronal connections. This, in turn, is believed to improve mood and promote healthy thought patterns.

Experts say that ketamine and esketamine are particularly effective for treatment-resistant depression because they work differently than other antidepressant drugs. For example, anti-anxiety medications such as benzodiazepines (Valium, Xanax) only work while they are in the system. Esketamine, on the other hand, triggers regrowth of connections between brain cells. As a result, the effects of esketamine continue to be present even when the drug is no longer in the body.

How Effective is Ketamine Therapy for Treating Depression?

Studies suggest that a ketamine infusion can result in a significant improvement in depressive symptoms within 72 hours.

Other studies have found that 7 out of 10 people who took esketamine along with an oral antidepressant medication had improvement in their symptoms compared to only 5 out of 10 people who did not receive esketamine with the antidepressant taken by mouth.

Who is Eligible for Ketamine Infusion Therapy?

Ketamine infusions are not for everyone with major depressive disorder or anxiety disorders. This drug is reserved for people with treatment-resistant depression, i.e., depression that has not responded to at least two standard antidepressant drugs. Your doctor may prescribe ketamine infusions for depression if you meet this eligibility criteria.

Is ketamine approved for mental health treatment?

Ketamine infusions are not FDA-approved for mental health treatment. They are used off-label in people with treatment-resistant depression or acute suicidality. As mentioned, treatment-resistant depression is depression that has not responded to two or more standard antidepressant drugs.

However, the FDA has approved a ketamine-derived drug, esketamine (Spravato) nasal spray for adults with treatment-resistant depression and major depressive disorder with suicidal ideation.

Note: We do not know if esketamine is safe or effective in preventing suicide or reducing suicidal thoughts or actions.

Does insurance cover ketamine infusion treatments?

Insurance does not usually cover ketamine infusion treatments for depression because it is not an FDA-approved therapy for this condition. Ketamine is used off-label for depression. However, esketamine (Spravato) nasal spray may be covered by insurance because it is FDA-approved. Check your health insurance plan for prescription drug coverage.

Common Questions About Ketamine Therapy for Depression

How long does it take for the effects of ketamine therapy to start?

Ketamine therapy for depression starts working within 1 hour. There is a significant improvement in depression and anxiety within 72 hours of an infusion.

Note: In contrast, it can take several weeks to see results after starting other antidepressants.

Moreover, the severity of the mental illness continues to be decreased 2-4 weeks after the last infusion of ketamine. In other words, ketamine has a sustained effect on reducing depressive symptoms.

Is ketamine therapy effective in treating depression?

Studies suggest ketamine therapy can be very effective in treating depression in people who have not responded to other treatments. This drug is not a first-line treatment for depression. It is only used off-label in people who did not get improvement in their depression symptoms with standard antidepressant medications.

What are the benefits of ketamine therapy for depression?

  • Ketamine may provide relief from depressive symptoms in people who have not responded to other standard treatments.
  • Ketamine starts working within 1 hour and results in significant improvement in depressive symptoms within 72 hours. In contrast, most other antidepressant medications take 2-4 weeks to have an effect.
  • The effects of ketamine continue to be present 2-4 weeks after the last infusion.

What is the success rate of ketamine therapy for depression?

Studies suggest that 70% of people report an improvement in their depression symptoms after ketamine therapy for treatment-resistant depression.

Ketamine Therapy Procedure

What is the typical ketamine infusion session like?

A ketamine infusion takes place in a hospital or other healthcare setting. It usually takes 40 minutes to complete. You are monitored by healthcare providers throughout the infusion.

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Esketamine (Spravato) nasal spray is also used under the supervision of a healthcare provider in a healthcare setting. Your doctor will show you how to use the nasal spray device.

The healthcare team will observe you for 2 hours after the treatment. You should plan to have a friend or family member drive you home.

How often do you need ketamine infusions for treating depression?

Your doctor will develop a customized ketamine infusion plan based on the severity of your symptoms. In general, recommendations are to start with two infusions per week, then decrease the frequency to one infusion per week, and ultimately to one infusion every 2-4 weeks, based on response and tolerability.

Your healthcare provider will tell you how much esketamine (Spravato) to take and how often to take it. The recommended dose for most people is two doses per week for weeks 1 through 4, followed by one dose per week for weeks 5 through 9, and then one dose every 1-2 weeks thereafter.

Side Effects and Safety of Ketamine Infusion Treatment

What is a ketamine dissociative experience or “trip”?

Ketamine infusions and esketamine nasal spray can cause feelings of dissociation or euphoria (colloquially called a buzz or trip). For this reason, some people obtain ketamine off the street where dealers sell it as Special K, Super K, K, or vitamin K. It is a club drug and is also added to drinks or smoked or snorted in joints or cigarettes. However, these practices are extremely dangerous and can be fatal.

A ketamine “trip” may consist of visual and sensory distortions, feelings of unreality or dissociation from reality, feeling disconnected from your body, and other unusual thoughts and feelings. These symptoms can last for up to 2 hours.

How do you feel during ketamine therapy in the hospital?

During a ketamine infusion in the hospital, you may make an occasional comment about your surroundings. However, most people don’t move or talk and appear to be asleep. The hospital staff will not disturb you during the treatment unless you need something.

What are the serious risks of ketamine treatment?

Serious side effects of ketamine infusions include high blood pressure, dangerously slow breathing, and loss of consciousness. That’s why ketamine infusions for depression should only be taken under the supervision of a healthcare professional. Obtaining this drug from street dealers can result in life-threatening and fatal health complications.

What are the side effects of esketamine (Spravato) nasal spray?

Side effects of esketamine nasal spray for depression treatment include:

  • Nausea and vomiting – Do not eat for at least 2 hours before a dose and do not drink anything for at least 30 minutes after your treatment.
  • Decreased alertness and problems with thinking – Do not drive or operate heavy machinery until the next day (after a restful night of sleep) and only if you feel fully alert.
  • Bladder problems, such as difficulty urination, frequency, urgency, nocturia (frequent urination at night), or pain with urination.

Tell your doctor immediately or seek emergency medical care if you develop the following serious symptoms after taking esketamine nasal spray:

  • Sudden severe headache
  • Changes in vision
  • Chest pain
  • Shortness of breath
  • Seizures

Note: If you are using nasal decongestants or nasal corticosteroids, use them at least 1 hour before esketamine nasal spray treatment.

Ketamine Therapy for Addiction Treatment

Can ketamine therapy can help in addiction recovery?

As mentioned, ketamine is an anesthetic drug that acts on the central nervous system by blocking NMDA receptors. In addition to ketamine use in general anesthesia, this drug is also used off-label for rapid treatment of depression and acute suicidal ideation.

More recently, ketamine has been studied for its ability to reduce drug and alcohol use. More clinical research is needed to understand the ability of ketamine to treat addiction, but early results are promising.

Ketamine has been found to prolong abstinence from alcohol in people who have undergone detoxification. It has also been found to prolong abstinence from heroin in people who are dependent on this illicit opioid drug. Additionally, ketamine has been found to reduce cravings for the stimulant drug cocaine in individuals who are not in active treatment for cocaine abuse.

Why is ketamine therapy an effective addiction treatment method?

Possible ways in which ketamine works to treat addiction may include:

  • Increased formation of new nerve cells and nerve cell connections.
  • Disruption of certain functional neural networks that play a role in substance abuse.
  • Blocking reconsolidation of drug-related memories.
  • Provocation of mystical experiences and enhanced efficacy of psychotherapy.

Comprehensive Treatment Plans Incorporating Ketamine Therapy

Ketamine therapy for mental health conditions is considered experimental. This drug is used off-label in people with treatment-resistant depression and acute suicidality. The FDA has, however, approved esketamine nasal spray (Spravato) for these conditions.

Mental health conditions such as depression frequently co-occur with substance use disorders. Dual diagnosis and treatment of both conditions is vital for sustained recovery.

Ketamine therapy can therefore be part of a holistic mental health treatment plan that includes detoxification, psychotherapy modalities such as cognitive behavioral therapy (CBT), and antidepressant medications or ketamine therapy for treatment-resistant depression or acute suicidality.

Ketamine Therapy in Washington State

Ketamine is an anesthetic drug that is used off-label to treat depression and anxiety disorders. A ketamine-derived drug, esketamine nasal spray, has been FDA-approved for people with depression that has not responded to at least two other standard antidepressant drugs (this is called treatment-resistant depression). Esketamine is also approved for people with major depressive disorder who have suicidal thoughts or actions.

More research is urgently needed, but early results show that ketamine infusion therapy can prolong abstinence from alcohol, heroin, and cocaine. There may therefore be a role for ketamine therapy in the treatment of substance use disorders.

At Discover Recovery, we use evidence-based treatment for recovery from substance abuse. Our highly experienced team of medical professionals is up-to-date on the latest research findings and FDA-approved drugs. If you think you could benefit from ketamine depression therapy or ketamine addiction treatment, call now to check your eligibility.

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