Following a predetermined series of sessions, you’ll then talk about what you may need in the future. But most patients continue psychotherapy [with the clinic or one’s own therapist],” says De La Hoz. Being “under” in ketamine is being in a wake state but resting, says Uribe. This is a dissociative state where you feel detachment from your body and your environment, per a study published in Anesthesiology in November 2020. “You’re not paralyzed, but you feel a weight over you that makes it difficult to move around and speak,” says Uribe.
How Ketamine Infusion Therapy Works
These are not always easy things to sit with, let alone long enough to deal with. Rest, if you can, when you get home, and take advantage of your brain’s ability to create new thoughts and habits. The American Society of Ketamine Physicians, Psychotherapists & Practitioners (ASKP) directory is a good place to start.
Ketamine makes people feel detached from their environment, eases pain, and produces hallucinations, which has led to its inappropriate use. Evidence shows that ketamine is safe for use in people within a wide age range when taken correctly. Ketamine can also produce an extensive array of other symptoms that affect many parts of the body, but they are less common. Despite these positive results, the authors warn that data on the use of ketamine for this condition are limited, so practitioners should consider the risks of the drug before prescribing it.
Ketamine and the Treatment of Mental Health Conditions
One may experience oneness with the universe, or feel they are a part of something greater. Others may experience increased feelings of love and compassion towards oneself and others. Some patients report feelings of well-being and coming to terms with existential anxiety. There is some debate whether this kind of experience may augment or be correlated to an antidepressant response. As a physician, I am what are whippets able to witness firsthand the healing power of these types of experiences that may occur.
Ketamine Safety and Risks
“When enough stories like that started to pile up, doctors said, ‘Maybe there’s something here,’ ” says Stewart, an emergency physician and founder of Insight Ketamine in Santa Fe, NM. Like the drug itself, Stewart got his start in combat medicine during the Vietnam War. As with any practice that involves bringing up painful feelings and experiences, things can feel a lot worse before they start to feel better.
Certain continuing education training programs are designed specifically for healthcare providers who administer ketamine-assisted therapy to treat patients in a clinical setting. Emerging research suggests that ketamine can be used to treat alcohol, cocaine, or opioid use disorder, per a systematic review published in Frontiers in Psychiatry in 2018. Ketamine treatment has been found to improve cravings, enhance one’s motivation to quit, and lessen withdrawal symptoms, according to researchers. Right now, however, more research is needed to look at larger sample sizes and demographics of people, more controlled studies, and lengthier follow-up to assess the long-term effects of ketamine on substance use issues. In 2020, esketamine was also FDA approved for use to treat depressive symptoms in adults with MDD with acute suicidal ideation. In short, to date, only the esketamine form of ketamine is FDA approved for mental health conditions.
Gail Serruya, M.D., is a psychiatrist with years of training in psychotherapy, who recently founded Voyage Healing PC, a ketamine-assisted psychotherapy clinic in Philadelphia. Research is, of course, still ongoing for KAP and other psychedelic psychotherapies. While this doesn’t mean KAP will be a guaranteed fix, it opens a much-needed door for people struggling to progress with more traditional forms of therapy. Many have found that the experience of KAP led to therapeutic breakthroughs at an exponentially faster rate than traditional talk therapy. They’ve uncovered repressed memories, faced previously unbearable emotions, and even found the purpose they have been searching for. Ketamine can decrease sensitivity to pain, and depending on dosage, route of administration, etc., it can create hypnotic, dream-like, or even fully dissociative trance states for a person.
Research suggests that though ketamine’s main action is in glutamate receptors, it needs opioid receptors to have its antidepressant effects, too. For psychiatrist Alan Shatzberg, MD, who did some of the research that uncovered this, that’s concerning. Christa Coulter-Scott says ketamine treatment eased the depression she’s had for most of her life.
Due to numerous studies over the last two decades, ketamine has emerged as a potential treatment for various mental health disorders, for example, treatment resistant depression, anxiety, PTSD, and alcohol use disorder. It is only FDA approved as esketamine (similar to ketamine) for treatment-resistant depression and depression with suicidality, although ketamine is prescribed off label to treat other psychiatric disorders. The researchers concluded that in patients with MDD, two to three weeks of ketamine treatments helped sustain the benefit of the initial dose, and people experienced reduced depression severity significantly compared with a placebo. As rates of depression and anxiety have increased dramatically, people have sought therapies outside the standard regimen of oral antidepressants and talk therapy. Beginning in the mid-2010s (see figure 1 in this paper), more doctors started offering ketamine as a treatment for depression. In 2019, the Food and Drug Administration (FDA) approved esketamine as a treatment for forms of depression that haven’t improved with standard antidepressants (like citalopram/Celexa or bupropion/Wellbutrin).
Raising her granddaughter on her own, she says, she still feels stress, but it doesn’t come along with the darkness and anxiety that she had lived with before. “I think it’s probably less addictive than opioids, but it’s not without its risks,” says Shatzberg, who is how to quid salvia the director of Stanford University’s Mood Disorders Center. Indeed, case studies have described people who showed signs of addiction or abused the drug.
- As rates of depression and anxiety have increased dramatically, people have sought therapies outside the standard regimen of oral antidepressants and talk therapy.
- The worry, which other researchers have mentioned in studies of ketamine, is that people might require larger and larger doses of ketamine over time in order to feel its effects – as is the case with opioid painkillers.
- The cost of an infusion can vary widely and is typically paid out of pocket.
- The best clinical evidence shows that patients should start treatment twice per week for 4 weeks.
- The researchers concluded that in patients with MDD, two to three weeks of ketamine treatments helped sustain the benefit of the initial dose, and people experienced reduced depression severity significantly compared with a placebo.
He graduated with a bachelor’s in biology from the University of Wisconsin and a medical degree from the University of Minnesota Medical School. During medical school, he completed a graduate certificate in integrative therapies and healing practices through the group activities for recovering addicts Earl E. Bakken Center for Spirituality & Healing. He is developing a clinical practice for patients with complex trauma, as well as for others going through significant life transitions. He is working on a book distilling the insights from his sabbatical, teaching, and leading retreats on trauma, integrative health, mindfulness, and well-being for health professionals, students, and the community.
Ketamine treatments result in neurogenesis and neuroplasticity in our brains for about 72 hours. We know that in rodent studies, ketamine can cause the brain to grow new nerve cells and can make existing nerve cells sprout new connections between each other. It is thought that the creation of new cells and strengthening of nerve pathways may be correlated with new learning. This is one reason professionals are interested in adding talk therapy or new learning to the ketamine treatment process, as the ability to think in new ways and engage in new behaviors may be amplified during and after ketamine treatment. There are essentially three ways in which ketamine and psychotherapy can be used together for the benefit of the patient.
If patients take ketamine several times a week at high doses for an extended period, this can result in irreversible problems with memory and thinking, and increase their risk of delusions. We know this from studies of people who excessively use ketamine recreationally. For the past 20 years, researchers at top scientific institutions and universities have researched the efficacy of ketamine in the treatment of mental health disorders and shown positive results. There has been much written recently about ketamine and, more broadly, psychedelics and their use in treating mental health disorders. Ketamine is in a different bucket than other psychedelics such as MDMA and psilocybin because it has more than 50 years of clinical use, research, and significant patient safety and efficacy data behind it. From potential side effects to dosage, it is safe to say that the medical community knows almost everything there is to know about ketamine, though it continues to be understood better and better as its use cases expand.
It should be noted that these experiences do not occur for every patient, and it is unclear to me why some patients seem to consistently have this type of experience while others do not. In addition, ketamine therapy may also help turn off a stressed-out state that the brain can get stuck in. The scientific term for this stressed-out state, Robison says, citing animal research, is lateral habenula burst activity. Ketamine was shown to suppress this activity in depressed rats and mice, thereby turning on reward centers linked to mood. “Ketamine [may] hit a reset button in the brain and help people feel quite a bit better rather quickly — even though a single dose doesn’t last forever,” he adds. More research is needed to better elucidate the mechanisms of how ketamine may work in humans.