Ketamine Therapy

Ketamine may be helpful for some people who have treatment-resistant depression.

In 2020, approximately 21 million adults (aged 18 and older) had a major depressive episode in the past year. Depression is a serious mental illness that impacts a large percentage of the population, but only about 66 percent of people get the treatment they need. 

Nearly 9 million people in the United States are medically treated for major depressive disorder (MDD), but close to a third have treatment-resistant depression (TRD) that does not respond to traditional treatment. This is where ketamine therapy for depression comes in.

What Is Ketamine Therapy?

Ketamine is a short-acting anesthetic drug with dissociative and hallucinogenic properties.

In 2022, researchers published a study on the efficacy of ketamine infusions in people with depression. They found that the medication reduced suicidal ideations by up to 50%, and lowered generalized anxiety symptoms by 30%.

In a separate study published in 2022, researchers examined published studies on ketamine and various mental health conditions. In one section, they examined the efficacy of the medication in substance use disorder. They found that ketamine was effective in prolonging abstinence in people with addictions, perhaps by disrupting the brain networks damaged by addiction.

Ketamine therapy involves administering the medication in a supervised professional treatment environment where a medical or mental health professional can monitor your reactions. Ketamine works as a fast-acting antidepressant. Typically, during ketamine therapy, you will continue to take your antidepressant medications and attend therapy and counseling sessions as well.

Ketamine stimulates a different part of your brain than traditional antidepressant medications. During ketamine therapy, you will remain on site in a specialized clinic for about two hours.

After the therapy, you can feel sleepy, and you should have someone else drive you home. The next day you can wake up feeling refreshed and notice an improvement in your mood.

Key Facts About Ketamine Therapy

Ketamine’s Effect on Depression

Ketamine is best used to treat depression that is not responding to other forms of treatment. It is not generally used as a first-line treatment option. 

Ketamine is FDA-approved as an anesthetic medication. As of March 2019, it is approved  as a nasal spray (Spravato) for treatment-resistant depression. 

When used to treat depression, it is given in a much lower dose than is needed for sedation. It can provide a kind of “timeout” for the brain, as it works differently than traditional antidepressant medications. 

Ketamine has been proven to reduce thoughts of suicide and suicidal ideations, as well as improve moods and successfully manage depressive symptoms. 

Ketamine is a dissociative drug that can change your sensory awareness while undergoing ketamine therapy. It can make colors seem brighter and give you a feeling of floating or being outside of your body, for instance. 

Ketamine therapy can offer a peaceful and beautiful experience that can help to reset your brain’s emotional pathways. This can make you more open to positive feelings, making therapy more effective. Ketamine therapy for depression can very quickly improve your moods and ways of thinking, and these positive changes can last for a period of time.

What Are the Benefits of Using Ketamine Therapy for Depression?

Ketamine therapy can help to improve depressive symptoms in up to 70 percent of cases, and the effects can be long-lasting. Ketamine works quickly in the brain to improve symptoms, and these positive effects can continue for up to a month or longer. 

Treatment-resistant depression can be debilitating, and it may include suicidal ideations. In 2020, there were 1.20 million suicide attempts and over 45,000 deaths by suicide in the United States. 

Ketamine therapy can help to reduce rates of suicide by improving mood and minimizing thoughts of suicide. It can also be effective in treating anxiety symptoms that are concurrent with treatment-resistant depression.

How Does Ketamine Therapy for Depression Work?

It is not clear exactly how ketamine works to manage depression. However, it is known that ketamine interacts with NMDA receptors in the brain, blocking them, which in turn increases levels of glutamate, an excitatory neurotransmitter. This can help to stimulate nerve cell action, which can dispel some of the symptoms of depression and improve moods. 

Ketamine can also enhance the neuroplasticity of the brain and create new neural connections, which can have an effect on some of the brain’s wiring of the reward processing pathways. This can then mitigate some of the negative side effects and thought processes of depression. 

It can also allow the brain to be more flexible, opening up new feelings and making a person more adaptable and open to therapy methods. The brain’s chemical makeup and wiring are often negatively impacted by depression or due to depression, and this can be improved with a different sort of drug like ketamine.

Cost & Insurance of Ketamine Therapy

Reporters say that ketamine sessions cost between $300 and $1,500 per session without insurance, and many providers recommend more than one appointment.

Some smaller insurance companies, like Enthea, can provide comprehensive coverage for ketamine therapy as delivered by a provider. However, other insurance companies may not.

If you’re considering ketamine therapy, ask the provider about the costs you’re expected to pay. Then, contact your insurance company and ask how much you might pay for your sessions.

What Are the Different Types of Ketamine Therapy?

There are two main types of ketamine therapy: ketamine infusions involving racemic ketamine (R,S ketamine) and ketamine nasal spray using esketamine (S-ketamine). Ketamine lozenges and dissolvable tablets are also available, but these are less common and not as well researched.

Ketamine Infusions (IV)

The racemic version of ketamine, R,S ketamine is given through an IV infusion at a specialized clinic. You will typically sit in a comfortable chair and listen to music for about 40 minutes while the infusion completes. Intramuscular injections of ketamine are also available. 

The number of treatment sessions can vary, but it is typically recommended to have six treatments over two to three weeks initially. Therapy sessions are also often included once the effects of ketamine dissipate. 

IV ketamine is not FDA-approved to treat depression, and it is therefore being used off-label during ketamine infusions or injections. Since ketamine infusions for depression are not FDA-approved, they will not be covered by insurance. 

Racemic ketamine is 100 percent bioavailable, meaning that the entire dose is available to be used by the brain, which can make it more effective. When getting ketamine infusions, you will also need someone to drive you home after the session.

Ketamine Nasal Spray

S-ketamine, or esketamine, is FDA-approved for treatment-resistant depression under the brand name Spravato when administered in a clinical setting under the supervision of a health care provider. It is commonly covered by insurance for eligible individuals for whom other types of depression treatments are not working. 

Ketamine nasal spray is usually given twice a week for the first month. Then, it’s given once a week for the next month. 

S-ketamine is a more potent psychoactive drug that can have more dissociative side effects, which can lead to more feelings of detachment from the body and sense of self. Due to the nature of the potential side effects, you will need to be observed for about two hours after taking Spravato. 

The nasal spray version of ketamine is less bioavailable than the infusions. Because of this, it may be less effective for some people. However, it can also be effective in relieving depressive symptoms for longer when taken in conjunction with an oral antidepressant.

What Are the Risks & Side Effects of Ketamine Therapy?

Ketamine can have some side effects. The most common include the following:

• Dissociation
• Heightened blood pressure
• Sedation
• Dizziness
• Headache
• Blurred vision
• Nausea
• Vomiting
• Anxiety
• Intoxication
• Perceptual disturbances

In some cases, ketamine therapy can cause agitation, negative feelings, sensory and perception distortions, and an unpleasant and scary “out of body” experience. It is important that ketamine therapy be closely monitored during the session and for a period of time following it to ensure patient safety.

Ketamine therapy is not recommended for people with a history of psychosis, as it can make these symptoms worse. It also is a drug of abuse and has some potential for dependence and addiction potential. Therefore, it should be avoided by people with a history of drug abuse or addiction.

Will I Get Addicted to Ketamine Therapy?

Ketamine therapy is administered in specialized clinics or medical settings under the direction and supervision of a trained professional. As such, the medication is less likely to be misused, and doses can be altered to avoid complications or side effects. 

Still, ketamine does have addictive properties, and it is possible to develop dependence on and addiction to ketamine. You are much more likely to develop these issues when misusing ketamine than when taking it as directed through a structured ketamine therapy program.

If you have a history of drug abuse or addiction, ketamine therapy is likely not the optimal treatment option for you. Ketamine use can cause euphoria, or a “high,” that can then trigger a potential relapse. 

Again, ketamine therapy should only be used as directed while monitored by a trained health care professional.

Eligibility for Ketamine Therapy

Are you a good candidate for ketamine therapy? Guidelines from the American Psychiatric Nurses Association can help you understand how teams determine whether or not the ketamine treatment is appropriate.

These are issues your provider might discuss:

• Your condition: Issues like depression, suicidal thoughts, bipolar disorder, and personality disorders might be appropriate for ketamine treatment.
• Your treatment past: Your team might ask if you’ve used traditional therapies like counseling before trying ketamine.
• Your health: Issues like psychosis, pregnancy, high blood pressure, heart disease, or active substance abuse could make ketamine dangerous.

How Does Ketamine Therapy Work?

While every provider is a little different, most follow a similar procedure. Understanding the steps could help you prepare for the experience.

These are the typical steps:

1. Intake: Your doctor asks about the suitability for ketamine therapy and explains what treatment might involve.
2. Supervised intake: Your doctor provides ketamine via an injection, spray, or other improved method. You might listen to music or meditate during the session.
3. Monitoring: Your team asks you to stay for several minutes after you take ketamine to ensure you don’t have a negative reaction.
4. Going home: You can’t drive after ketamine, so someone might help you get home. Driving or operating heavy machinery isn’t safe, and you shouldn’t tackle these tasks for the rest of the day.
5. Integrate: Use a journal to help you make sense of what happened. Set new goals based on the changes you feel.
6. Get support: If your therapy brought up uncomfortable feelings or sensations, ask your friends or family to help you process. If that doesn’t help, talk to your counselor.

Frequently Asked Questions

These are a few of the questions we often hear about ketamine therapy: