Getting Started With Ketamine

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Medically reviewed: Paloma Lehfeldt, MD
a woman participating in ketamine therapy

Understanding KetamineKetamine is a dissociative anesthetic drug widely used across the globe in short-term procedures for adults and children. First developed in the 1960s for veterinary applications, ketamine gained FDA approval for human use in 1970. Initially, ketamine saw use in battlefield hospitals across Vietnam, where it quickly became the preferred drug of field surgeons due to its strong safety profile and relatively low risk of abuse.(1)

After ketamine’s successful deployment in Vietnam, most U.S. hospitals adopted the drug for surgical applications. This popularity is due in part to ketamine’s comparative safety for most people. Unlike many other anesthetic compounds, ketamine does not suppress a patient’s respiratory function, making it an ideal drug for use with children, the elderly, and anyone with a heightened risk of respiratory complications.(1)

What is Ketamine Therapy?

Ketamine-assisted therapy involves using sub-anesthetic doses of ketamine paired with psychotherapy and/or integrative counseling to create a new treatment modality for certain mental health conditions. Some studies indicate that ketamine treatments can be highly effective. In one case, ketamine helped up to 70% of patients with treatment-resistant depression.

Ketamine has also been shown to be effective for 89% of individuals suffering from a general anxiety disorder. These very promising early results show that ketamine has real potential as a new tool for managing some mental health disorders.

What is Ketamine Used For?In recent years, ketamine has seen widespread use outside the surgical suite. Beginning in 2002, ketamine gained popularity as an off-label treatment for a range of mental health conditions, such as anxiety, depression, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). A variation of the ketamine compound, Spravato, has received FDA approval to treat treatment-resistant depression and major depressive disorder with suicidal thoughts or actions.(2)

Typically, ketamine is prescribed off-label, meaning outside its original FDA-approved usage, to help manage treatment-resistant conditions. Treatment-resistant conditions have different criteria. Depression, for example, is considered treatment-resistant when patients fail to respond to two or more distinct treatment modalities.

a woman listening to music during ketamine treatment

How Does Ketamine Work?

Unlike selective serotonin reuptake inhibitors (SSRIs), which work on the body’s serotonin system, ketamine directly impacts glutamate neurotransmission, causing an alteration in glutamate-glutamine production and cycling. Recent studies show a potential glutamate increase of up to 13%.(3) This is important because glutamate is the brain’s most prominent excitatory chemical messenger, and ketamine directly affects it.(4)

This modulation of glutamate production may be partially responsible for ketamine’s therapeutic properties, particularly when it comes to mental health conditions. By changing the available levels of glutamate in the brain, ketamine spurs the development of new neural bridges (the brain’s information highways) and may repair damaged connections, in what is referred to as neuroplasticity.(5)

How is Ketamine Administered?

Providers administer ketamine in a variety of ways. These include intravenous (IV) drip, intramuscular injections (IM), nasal sprays, and oral lozenges/tablets.
  • Intramuscular Injections (IM) – Ketamine is delivered through an injection, usually into one of the body’s large muscle groups.
  • Intravenous Drip (IV) – Ketamine is delivered via IV, similar to how saline or other IV medications are administered. 
  • Dissolvable Tablets/Lozenges – A sublingual (under-the-tongue) or oral tablet containing a dose of ketamine. 
Once administered, patients can feel ketamine’s effects within four minutes of using intramuscular injection or within seconds if using an intravenous drip. Typically ketamine has a duration of 15 to 30 minutes per intramuscular injection. Most providers who use a low-dose IV drip administer a ketamine therapy session over one to two hours. This timeframe does not include integrative counseling or other psychotherapy services.(6)

Other methods, such as nasal sprays or lozenges, have very different onset of action and durations. A ketamine nasal spray like Spravato can last between 20-40 minutes. Lozenges take five to ten minutes for their effects to be felt and can last from one to three hours, or four to five if the tablet is swallowed.(7)

Researchers and clinicians have observed the rapid onset of ketamine benefits in as little as one hour after administration. Ketamine may cause rapid relief from depression, anxiety, OCD, and PTSD symptoms in just one session. However, not all patients will experience similar results. Many patients may need to undergo a full set of six infusions to experience ketamine’s full potential. Ketamine’s positive effects can last as long as six weeks.(9)

What Does Ketamine Feel Like?Among ketamine’s various effects are its potent dissociative properties. Dissociative medicine can cause patients to experience feelings of being detached from themselves, viewing themselves or their actions and experiences from an outside perspective. They may also experience a moderate to heavy body load (a sensation of feeling weighed down), euphoria, a distorted sense of time, and lowered inhibitions.

Many patients report that they’re able to think about trauma, anxiety, or depression symptoms in new ways, which includes an ability to view them objectively. This shift in how they perceive symptoms allows some patients to experience breakthrough moments in therapy.

a woman undergoing ketamine therapy

What are the Risks of Ketamine Therapy? Ketamine is considered to be a safe compound when used properly. However, there is some risk. Most medical practitioners do not recommend ketamine therapy for people with certain mental health conditions, such as schizophrenia.(9) 

Other risks include:

  • Anxiety
  • Raised Blood Pressure
  • Nausea
  • Headache
  • Dizziness
  • Confusion
  • Loss of Appetite
  • Liver Injury
It’s important to note that most felt side effects subside within a few hours of treatment. 

One of ketamine’s other side effects is known as a k-hole. This event is where a person who has taken ketamine has a unique experience notable for loss of bodily control and a distorted sense of time. Often this can involve feelings of timelessness, separation from self, and ego dissolution. The k-hole phenomenon can happen to anyone, but when used correctly in a medical setting, you are less likely to encounter an adverse event. While all ketamine does have some associated risks, it has a long track record of safe, clinical use. Ketamine also has a relatively low risk of dependency and addiction.(9)

Are Ketamine Treatments Right For You?Ketamine therapy represents real hope and change for individuals dealing with addiction, pain, and treatment-resistant mental health conditions. While ketamine may not be right for everyone, it could be the treatment you’ve been looking for to help you on the road to healing. 

Most providers require a diagnosis or referral to begin ketamine treatment. Speak with a medical professional to determine if ketamine is the right therapy for your condition. If you’re interested in learning more about ketamine, you can find a ketamine treatment provider near you.

Where to Find
Ketamine TreatmentLocate outpatient ketamine clinics and at-home ketamine service providers in the U.S. that offer care for pain, depression, anxiety, PTSD, OCD, and addiction.