Ketamine Therapy: What You Need to Know

    Ketamine is used both as a medicine and as a party drug. In recent years, it has gained popularity as a potential mental health treatment, particularly for severe depression. However, its long-term effects are still largely unknown, and it may still be very risky to use without medical supervision.  

    Read on to learn more about the medical use of ketamine. For information on recreational ketamine, click here. 

    What is ketamine?

    Ketamine is manufactured as a liquid that can be injected into the body, inhaled through the nose or taken through a tablet. It’s a form of hallucinogen which means that it can cause a person to feel detached from reality – like you’re living in a movie or a dream.  

    It is used as a general anesthetic[1] during medical procedures to make a patient unconscious. For example, it can be used in emergency departments when fixing broken bones or painful wounds. In low doses, it can be used by doctors to treat severe pain. It is also used in veterinary clinics for animals.  

    Does ketamine treatment work for depression?

    Recent research[2] has found that ketamine therapy can help to relieve severe depression other treatments have not helped. This is often called “treatment-resistant depression.” Although there are different definitions of treatment-resistant depression, it generally means that antidepressant(s) or other common therapies have not worked to reduce symptoms.  

    In 2019, the FDA approved a ketamine nasal spray.  It is called esketamine[3] and is sold under the brand name of Spravato. It is recommended to treat major depression, suicidal thinking and treatment-resistant depression for adults over the age of 18. It is only available by prescription and must be taken at a certified doctor’s office or clinic. Because of the risks associated with the medication, patients must be monitored by their healthcare provider for at least two hours after receiving a dose. 

    Many studies have shown that ketamine therapy can effectively treat depression. The benefits can be felt very quickly, sometimes within 40 minutes, though this depends on the way it is administered (through an IV, the nose, etc.). The effects generally do not last very long, peaking at a few hours and generally impacting a patient for a few days to a week, which also depends on how it is administered. As a result, it is not yet known if this treatment is effective in the long term, or if it can only provide temporary relief from depression symptoms. On-going maintenance treatment may be needed, depending on the patient.  

    Small research studies[5] show that it may be safe and effective for treating depression in adolescents between the ages of 12 and 17. However, more research is needed to determine if this can help young people. Spravato is not approved for children.  

    Ketamine therapy for depression does not work for everyone. Stephen Petrow[6], a contributing writer for the Washington Post, shared his experiences with ketamine after years of treatment with antidepressants and talk therapy. “In the days that followed I still didn’t feel like myself. Detached. Untethered. Scared. In a world of my own. Several friends noticed this difference in me, with one asking me directly if I was at risk of self-harm.” 

    Can ketamine be used to treat other mental health disorders, including substance use?

    Ketamine therapy may be able to treat autism,[7] OCD,[8] bipolar disorder[9] and chronic pain. Its effect on these disorders is currently being studied.  

    Ketamine is also being researched to treat alcohol use disorder. In one study,[10] people with severe alcohol problems who were given ketamine with counseling had more non-drinking days than a control group. 

    Ketamine therapy may be useful in preventing people from returning to heroin use.[11]  It has been shown to be helpful in controlling cravings for people using cocaine. While ketamine therapy shows a great deal of promise for addiction treatment, more research is needed. 

    Where can people get ketamine therapy?

    In addition to the certified doctors and clinics[12] mentioned for esketamine, ketamine clinics are emerging around the country to provide therapy. In many cases, they may offer treatment “off-label,[13]” which means it is not specifically approved to treat mental health issues.  

    Therapy can happen in many different ways. These include: 

    • Medical:  This treatment will usually take place in a hospital or clinic setting. The ketamine is given via an IV or through the nose, typically by an anesthesiologist. 
    • Psycholytic: In this treatment, ketamine is used along with therapy such as cognitive behavioral therapy (CBT) or psychoanalysis. 
    • Psychedelic: High doses are given to the patient to create a “mystical experience.” In this treatment, the mind is thought to be able to heal itself, and a therapist is used only as support. 

    Some clinics are legitimate and certified, but some are not. It is important to thoroughly research treatment centers to make sure that they are as safe as possible and have certified doctors on hand.  

    Mail-in kits are also available at a lower cost from companies such as Mindbloom[14]. Through these programs, participants are sent a kit with instructions to do their sessions themselves. These sessions are not supervised and may only come with limited support from a professional. 

    What does it cost?

    Ketamine is not taken as a daily pill like some medications. Usually multiple treatments are required over a period of weeks or months which factors into costs. Also, on-going maintenance doses may be needed. 

    Ketamine treatment can be expensive and is often not covered by insurance, especially if it is used off-label. It’s best to ask insurance companies if they will pay and how much. They may also require a pre-authorization. The company that offers Spravato provides payment assistance[15] for some insurance plans.  

    At a clinic, sessions can generally cost between $500-1000 per session, depending on how the drug is given (for example, IV treatments may be more expensive). Mail-in kits are generally cheaper, with weekly costs starting at around $80-100 dollars. However, these kits do not include as much support as a clinic might offer.  

    Because these treatments take place over the course of several sessions – often at least six – they can get very expensive. Full sessions of self-administered[16] treatment can cost upwards of $3000. A course of treatment in a clinic can cost up to $5000.

    Is it safe?

    Ketamine can be a safe treatment if supervised by a certified doctor or clinic. They provide monitoring and are trained to address any concerns that might arise. Side effects can include feeling an upset stomach, problems thinking, dizziness, increased blood pressure, and trouble breathing as well as seeing or hearing things that are not real.  

    Many ketamine clinics are not regulated and are not in a medical setting. Because this is such a new treatment, and there are so many ketamine clinics – perhaps thousands – across the country, it can be difficult to know what their standards are for safety. Treatment is not always monitored, leaving room for non-FDA-approved and unsafe treatments. 

    Because there is still so much ongoing research on the topic, and there are limited guidelines for all the possible uses, it can be hard to properly train[17] enough providers to provide ketamine treatment. 

    Long-term use[18] can also cause bladder damage and cognitive impairment, meaning problems with thinking, memory and focus. Other negative side effects include mood swings, changes in blood pressure and dizziness. There is also the risk of dependence and misuse, although this is more unusual in legitimate treatment programs. 

    If you believe that your loved one could benefit from ketamine treatment, speak to a doctor and/or psychiatrist first. It is best used under medical supervision. Remember that there are many approved forms of treatment for depression. Help your loved one find what works best for them.