Get the help you need from a therapist near you–a FREE service from Psychology Today. Log in or create an account for a personalized experience based on your selected interests. Alan Schatzberg, MD, Kenneth T. Norris Jr. professor of psychiatry and behavioral sciences, Stanford University.
Ketamine is granted FDA approval as a general anesthetic
Because of potentially enhanced brain plasticity from the drug, you may be better able to make changes to your thought patterns and lifestyle that ultimately move the needle toward improved mental health. But the excitement of ketamine therapy may, in some instances, be outpacing the demand. Just as quickly as ketamine treatment centers have opened, many have closed. Two nationwide companies in particular, Ketamine Wellness Centers and Field Trip Health & Wellness, have abruptly stopped operating in some states, according to Behavioral Health Business. Especially since the news media reported that ketamine played a significant role in the death of actor Matthew Perry, a lot of patients wonder if ketamine/esketamine is actually safe. The most important one is that ketamine/esketamine should be administered while the patient is in a clinic (as opposed to at home).
To find optimal benefit and transformation from ketamine, a conversation is usually best had at a later date. One of the things that makes this process so difficult is when the patient cannot participate or is resistant to authentically participating. Ketamine has been shown to be a great asset in removing a patient’s resistance to psychotherapy and allowing them to recall past events and relate to their innermost feelings without the mask of ego.
- It is important to distinguish between the valid medical uses and the nonmedical uses of the drug.
- The amount of ketamine found in Perry’s deceased body was fairly high (anesthetic level), to the point that it would have caused him to lose consciousness.
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- There is no standard recommendation for when or if people need a booster.
In fact, research has shown that 70% of patients who have not responded to previous trials of antidepressants will respond to ketamine. According to both providers and patients, these trance-like states that ketamine can produce relax the walls that often come up when trying to address painful emotions. With these walls down, patients can access these things in a controlled environment without fighting against the mind’s natural defenses. In many cases, the medication will be in the form of a lozenge that dissolves under the tongue and takes about 10 minutes to kick in. Other methods include a nasal spray or a series of injections, depending on the patient, the therapist, and the treatment setting. Today, KAP is most often used in treating major depressive disorder (MDD) and PTSD but has made appearances working with issues like substance use disorders and obsessive-compulsive disorder (OCD), among others.
Hundreds of studies are taking place around the globe to unlock the mental health applications for ketamine
Given over 10 years of experience with ketamine as a researcher and physician, in this article I try to answer some basic questions prospective patients often have about ketamine/esketamine. In addition, if you have depression, anxiety, or PTSD and are interested in ketamine therapy, talk to your primary care doctor and mental health provider about it, in conjunction with your usual medications for mental health. It also may be indicated for patients acutely experiencing major depression with suicidal ideation. Finally, you have a process by which the patient receives ketamine first and then, usually within a few days, has a session with their psychotherapist. In this instance, the ketamine has enabled the patient to have moments of realization independently and then discuss them with a mental health professional when not under the influence of the medication. All three can be beneficial, though most of the clinical research proving ketamine’s effectiveness for mental health conditions has been conducted with IV infusions of ketamine without psychotherapy at the same time.
May Treat Substance Use Disorders
Ketamine and esketamine, on the other hand, are thought to create more connections (synapses) between brain cells, a process thought to ease depression and decrease suicidal thoughts. One recent study in the Journal of Clinical Psychology estimated that almost a third of the nearly 9 million people in the United States treated for depression each year have TRD. Given how common TRD may be, limitations in medication options — typically a crucial component of depression treatment plans — are a significant roadblock. Typically, the only ketamine-derived treatment for depression that insurance will cover is the FDA-approved nasal spray called esketamine (Spravato).
How to Get Started With Ketamine Infusion Therapy
Justin Laube, MD, is a board-certified integrative and internal medicine physician, a teacher, and a alcoholic ketoacidosis smell consultant with extensive expertise in integrative health, medical education, and trauma healing. The National Institutes of Health is increasingly devoting resources and attention to psychedelic medicine. Check back for information on their monthly virtual meetings, which feature guest speakers and reviews of new studies in psychedelic medicine.
The FDA has approved ketamine for general anesthesia only, but the drug has some off-label uses. General anesthesia denotes a sleep-like state, while dissociative refers to the effect of feeling disconnected. If you have commercial insurance coverage, you may only need to pay $10 for Spravato through a savings program, according to the company. Monitoring sessions after the medication are required; after a rebate, this may cost $0. You will have to sign up for this benefit, and you can learn more at the link above. But there are concrete skills you can use to hone your assertiveness and advocate for yourself.
He was the fellowship director at the Center for East-West Medicine and led courses for physician fellows, residents, and medical students. Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions. To learn more about specific psychedelic drugs that may play a role in medicine, check out the Resource Library from the Psychedelic Medicine Association, which is made up of physicians, therapists, and healthcare professionals. These are psychotherapy appointments with a licensed therapist who can talk to you about what you experienced during your ketamine session.
After two or three sessions, people are typically more relaxed and open to let go and let the experience take them where it will,” Uribe says. At your ketamine treatment appointment, you will be how to make myself pee prepped appropriately (you may be weighed to determine dosage; if you’re receiving it intravenously, an IV will be started). You will lie down in a room in a comfortable position with an eye mask and headphones to decrease noise and light from your surrounding environment. If you have any of the health concerns listed above or are pregnant or breastfeeding, you should avoid ketamine therapy.
First, if you want to pursue ketamine therapy, you’ll need to get cleared by your physician. For people with the certain mental health concerns mentioned above, ketamine therapy is generally considered safe and effective when practiced under the care of a licensed therapist or doctor. Another review in Therapeutic Advances in Psychopharmacology in March 2023 came to similar conclusions. Ketamine may work by helping people dissociate from unhealthy thought patterns, clearing space for deeper processing of traumas, per a systematic review and meta-analysis. Its rapid delivery system means depression symptoms can ease within several hours. Esketamine is administered as a squirt in each nostril, followed by a two-hour monitoring period.
Moving forward, other drugs could join ketamine in the realm of legal psychedelic medicine, as the FDA released draft guidance in June 2023 for clinical researchers in the field. It pertains to the use of psychedelic drugs as a music therapy for addiction potential treatment for psychiatric or substance use disorders. One pain point is the need for more standardized clinical studies on these substances, and the guidance advises on study design through drug development of psychedelic medicines. (This is currently in draft form, and the public has a chance to comment before the final version is released.) In other words, the field of psychedelic therapy — both in research and legislation — is rapidly evolving. IV-infused ketamine is an FDA-approved anesthetic for surgical and medical procedures. In recent years, ketamine has increasingly been used as an antidepressant to treat TRD — considered off-label use.
Perhaps tapping into positive memories could also lead to increasing pathways of joy. I believe there will be much research in the future as to how patients may leverage this neuroplastic window. It is likely that there are different answers to this question based on each individual’s neurobiology, preferences, and particular suffering they are looking to overcome. There has been evidence showing the later method—receiving a ketamine treatment separate from psychotherapy—as more effective for several reasons. The first is that ketamine is administered intravenously as opposed to routes like intramuscular injections, sublingually, or intranasally.
There are various ways ketamine can be given (IV, orally, nasally), yet clearly established protocols and standards are not available and there is variability in how clinics provide ketamine therapy. It’s important that the clinic you go to, or the company you use, screens your physical and psychological health prior to treatment to determine if it’s appropriate for you. In addition, though ketamine can be given with or without psychotherapy, experts say that a combination of ketamine and therapy, called ketamine-assisted therapy, provides the greatest benefits.