Understanding Ketamine Therapy

Understanding Ketamine Therapy

What is Ketamine Therapy?

Authored by Jane Squire MSc

Edited by Hugh Soames B.A.

Reviewed by Michael Por, MD

Ketamine is a drug that has received thousands of negative headlines. It has been used and abused by millions of people and contributed to deaths of individuals who have overdosed. Ketamine sedates the individual that takes it, or it is administered to, and can cause significant memory loss. Due to its ability to sedate and cause amnesia in the taker, Ketamine has been used as a date rape drug.


Despite all the negativity that has surrounded Ketamine for years, it is being hailed as a positive medication in the medical industry, and researchers belive Ketamine could help psychiatry immensely in the treatment of patients suffering from major bouts of depression.


Depression (and specifically treatment resistant depression) may not be the only disorder that Ketamine can help. Research has found that it could improve the lives of individuals suffering from obsessive-compulsive disorder, PTSD, and more treatment-refractory neuropsychiatric disorders.


Is Ketamine Therapy in use for Psychiatric Treatment?


Once a drug vilified for its effects on individuals who used it for recreational purposes, Ketamine looks set to be reborn as a drug that improves the lives of millions of people. Ketamine is already available in a Pharmaceutical grade product called Esketamine, although incidentally Esketamine has been in use medically since 1997.


Initially psychiatrists had to prescribe Esketamine off label for use in treatment resistant mental health disorders though in 2019 the drug was approved for use with other antidepressants, for the treatment of depression in adults in the United States. Esketamine is sold under the brand names Ketanest and Sprevato, with a months treatment costing around $5,000 per month.


What is the effect of Ketamine on the body?


Scientists working for the Park Davis Company discovered Ketamine in 1962.1https://en.wikipedia.org/wiki/Parke-Davis It was developed as an anesthetic and went into trials just two years later. Scientists realized ketamine has an ability to alter the mind and consciousness of the taker during early clinical trials. Interestingly, Ketamine was an often-used drug on the battlefields of the Vietnam War. Field doctors would use it to reduce pain in patients and as an anesthetic.


It is this altered consciousness on the Ketamine user that has led to it being used as a recreational drug. However, thanks to new research it has been found that the same anesthetic state is what helps individuals suffering from mental health issues. Scientists discovered that Ketamine blocks the NMDA receptors in the brain.2https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4910398/ NDMA receptors usually activate neurons, but Ketamine blocks them and prevents neurons from triggering.


A small dose of Ketamine can produce a state of hypnosis, altered perception of sounds and sights, and pain relief. The three altered states are mild at low dosage. Mild doses offer patients an experience similar to other psychedelic drugs. If the dosage is increased to higher levels, it can case almost full paralysis, sedation, and memory loss. Ketamine does not alter breathing and that is the main reason it is seen as an ideal anesthetic.


Ketamine Therapy for Depression


Scientists seeking to find a non-resistant depression treatment and a medication that can combat major bouts of depression in patients, could turn to Ketamine therapy. Although research is still ongoing, the results thus far have been significant.


Ketamine has been found to have strong, quick working, and long-term impacts on individuals suffering from depression. During the initial stages of research3https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1860851, scientists found that 0.5mg/kg of Ketamine administered to patients began working within four hours of taking it. The effects of the drug peaked at the 72-hour mark and continued on for up to two weeks.


Further research has continued the belief that Ketamine therapy can help patients suffering from depression-resistant medication. Individuals who are resistant to depression medication are at risk of organ failure and suicide due to using the typical monoaminergic-based depression therapy medication.


Over the course of the last 20 years, scientists at Yale University have studied Ketamine therapy and experimented by administering it intravenously in controlled studies. The subanesthetic doses of the drug were given to patients suffering from severe depression. These same individuals failed to overcome their mental health disorders by taken the typically prescribed anti-depressants given out by doctors. Studies have shown that many of the patients given Ketamine therapy showed no signs of depression within 24 hours.


What is Ketamine Therapy like?


Patients experience unique effects to their minds and bodies during Ketamine therapy. The drug’s effects can often be felt in as few as five minutes. Ketamine therapy’s effects can last around 90 minutes. Patients may feel tingling in their bodies and energy levels can change depending on the person. Individuals may become incredibly relaxed while others gain a wave of energy. Patients typically experience an increase in both blood pressure and heart rate.


While it is easy to describe the effects Ketamine therapy has on the body, it is not quite as simple to explain the way it alters the mind. A typical description of the feeling Ketamine therapy gives patients is it ‘disconnects their mind’. Patients may feel like they are looking at themselves from the outside, and it can be compared to floating above their bodies looking down during the experience. Other aspects can be altered such as an individual’s concept of time and space.


Most patients have had positive experiences despite the effects of Ketamine therapy sounding strange and scary. Although the experience can be good or bad in the moment, the overall therapy can have a major impact on a patient’s well-being.


Ketamine therapy can be conducted in two different ways. Individuals may be given the drug intravenously or through a nasal mist spray. According to scientists, when Ketamine therapy is given to patients, it must be determined how large of a dose to administer. Doctors want to give individuals a large enough dose to make an impact but small enough to prevent negative side effects.


Ketamine Therapy for Alcohol Addiction


Ketamine can be used to disrupt harmful behaviors, including those associated with alcohol consumption disorders. While one of the negative side effects of ketamine is a memory disorder, this is a positive side effect associated with alcohol – a consumption disorder. In other words, it can be used to destroy the memory and Euphoric Recall that drives alcohol consumption and related behaviours such as alcohol abuse and addiction.


When Ketamine is administered to someone, it erases memory and weakens the triggers associated with alcohol consumption. It blocks a brain receptor called NMDA, which, in addition to treating depressive symptoms, regulates mood and is needed for effective memory formation.


Researchers at University College London tested whether three doses4https://clinicaltrials.gov/ct2/show/NCT00088699 of Ketamine, given in conjunction with psychological interventions, could help people with alcohol use disorders by disrupting the memories associated with drinking. The study hoped to reduce harmful behavior associated with alcohol and have the added side effect of reducing depressive symptoms. The result and conclusions were published in Nature Magazine5https://www.nature.com/articles/s41467-019-13162-w and showed that Ketamine can reduce harmful drinking by pharmacologically rewriting drinking memories.


What if Ketamine is abused?


Ketamine’s long history as a drug of choice for individuals seeking to disconnect has clouded many opinions of it. High doses of the drug taken recreationally can make users feel like they are on the verge of passing out. This sensation is called the “K-hole”. If ketamine is abused, individuals will experience one or more of the following symptoms:


  • Bloody and/or cloudy urine
  • Difficulty urinating or urinating often
  • Pale or blue lips, skin, and/or fingernails
  • Blurred vision
  • Chest pain and/or tightness in the chest
  • Shortness of breath, difficulty breathing, or not breathing
  • Confusion
  • Convulsions/shakes
  • Difficulty swallowing
  • Dizzy, faintness, lightheaded, and/or fainting
  • Irregular heartbeat
  • Hives, itching, and/or rash
  • Delusions
  • Swollen face, lips, eyelids, or tongue
  • Heavy sweating
  • Feeling excited, nervous, anxious, or restless
  • Extreme tiredness and/or weakness


Ketamine is addictive and individuals can overdose when taking large doses of it. Therefore, patients should not try to self-medicate and only experience ketamine therapy through a licensed facility.


References: Ketamine Therapy

1. Andrade C. (2015) Intranasal drug delivery in neuropsychiatry: focus on intranasal ketamine for refractory depression. J Clin Psychiatry 76: 628–631. [PubMed] []

2. Diazgranados N., Ibrahim L., Brutsche N., Newberg A., Kronstein P., Khalife S., et al. (2010) A randomized add-on trial of an N-methyl-D-aspartate antagonist in treatment-resistant bipolar depression. Arch Gen Psychiatry 67: 793–802. [PubMed] []

3. Haile C., Murrough J., Iosifescu D., Chang L., Al Jurdi R., Foulkes A., et al. (2014) Plasma brain derived neurotrophic factor (BDNF) and response to ketamine in treatment-resistant depression. Int J Neuropsychopharmacol 17: 331–336. [PubMed] []

4. Naughton M., Clarke G., O’Leary O., Cryan J., Dinan T. (2014) A review of ketamine in affective disorders: Current evidence of clinical efficacy, limitations of use and pre-clinical evidence on proposed mechanism of action. J Affect Dis 156: 24–35. [PubMed] []

5. Vollenweider F., Leenders K., Oye I., Hell D., Angst J. (1997) Differential psychopathology and patterns of cerebral glucose utilization produced by (S)- and (R)-ketamine in healthy volunteers using positron emission tomography (PET). Eur Neuropsychopharmacol 7: 25–38. [PubMed] []

6. Zhang J., Li S., Hashimoto K. (2014) R (–)-ketamine shows greater potency and longer lasting antidepressant effects than S (+)-ketamine. Pharmacol Biochem Behav 116: 137–141. [PubMed] []

Further Reading

Ketamine is included on the World Health Organization list of Essential Drugs: https://www.who.int/medicines/news/20160309_FactFile_Ketamine.pdf

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Ketamine Therapy
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Ketamine Therapy
Scientists seeking to find a non-resistant depression treatment and a medication that can combat major bouts of depression in patients, could turn to Ketamine therapy. Although research is still ongoing, the results thus far have been significant.
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