What is Ketamine Therapy like?

The first thing to know is that ketamine therapy is a totally different, some would call it “novel” approach to treating mental illness. This is one reason why there is not a lot of literature covering the use of ketamine in this respect.  Most of the drugs in psychiatry (stimulants, antidepressants, antipsychotics, anxiolytics….) do not have any such effects. They do not cause neurogenesis (nerve growth), which helps a person create different connections in their brain. Traditional medications act more in a way to help a person cope, whereas ketamine therapy involves a more profound effect that, with guidance, helps a person to address the issues that are preventing their general improvement and actually want to do things differently. Ketamine therapy is a form of treatment that uses low doses of ketamine—an FDA-approved anesthetic—often for conditions like depression, anxiety, PTSD, and chronic pain. It’s usually offered when other treatments have not been effective. In my practice, for some illnesses, it might be a first-line treatment. The typical structure of ketamine therapy in my office includes:

1. Preparation Stage – we have an initial evaluation where I will assess your mental and physical health, review your history, and explain what to expect. The therapy takes place in my office, where you should feel safe and calm. Since many complain of nausea because of the ketamine, the patient begins with approximately 8mg of Zofran (anti-nausea) so this won’t occur.
2. Ketamine – Currently, you can get an IV infusion (a slow drip over 40-60 minutes), an intramuscular injection (IM), which is a shot in a muscle, a sublingual/oral tablet dissolved under the tongue, or a nasal spray (FDA-approved esketamine (Sprivato), administered in a clinic¹.
3. The first time, a “recreational dose” is given, to give the person the experience of ketamine (especially if they never had this or anything similar before) as well as gauge the amount for the next session. Typically, people take even more ketamine than the first time.
4. The experience: within minutes (some feel this very quickly, others may take 10 minutes or so), where they start to feel: a. Detachment from your body (a “floating” sensation), b. Altered perception of time and space, c. Visual or auditory changes (e.g., colorful imagery, sounds become enhanced². These sorts of feelings are typically described as: – Calming – a sense of relaxation or peacefulness – Euphoric—lightness or a relief from mental heaviness – Introspective—insights about your thoughts, traumas, or behaviors. The duration is typically about 40 minutes to an hour, depending on the route of administration. In my office, we use RDTs (“rapidly dissolving tablets”) which are placed under the tongue. The effects typically last about 40-60 minutes.

The objective is to make use of the dissociative state, where the person may feel detached from reality, thoughts, or identity. This is where a lot of the “work” takes place. In my office, people will do approximately 7-8 sessions, typically twice per week, and while they may feel changes right away, most find that it takes about 4 sessions before these changes are more obvious. After the “trip”, it takes about an hour, more or less, for the person to return to “normal”.  Since they were sedated in my office, they should not operate heavy machinery, so they need a ride home. The first time typically lasts longer, but then the person reconstitutes quicker³.

Afterwards, during the recovery period, we begin to work on the integration, trying to make sense of any insights or emotions that arose. Most people report that they feel more “clear-headed,” relieved, or emotionally lighter in the days following treatment. The antidepressant effects of ketamine can occur within hours and may last for days to weeks. Of the 30 or so patients who have done this in my office over the past 1.5 years, all have said this was “the greatest thing I’ve ever done” and only one patient has been returning for a “booster” of one session every 3 months. Of course, that is subjective.

Ketamine can create a unique and sometimes profound experience, described as being in a dream-like, meditative state where the usual “mental noise” fades. For some, it can bring up repressed thoughts, memories, or feelings in a way that feels safe to explore. I consider this an additional tool. Many drugs can help a person’s mood, but ketamine (and lithium) are the quickest. For people who have been very depressed, suicidal, or anxious, this feeling is unbearable and the sooner it can be remitted, the better⁴.

 

Footnotes:

1. Brown, R., & Lee, K. (2019). A Review of Esketamine in Clinical Practice. New England Journal of Medicine.
2. Johnson, M., & Walker, D. (2021). Understanding the Dissociative Effects of Ketamine. American Journal of Psychiatry.
3. Hernandez, L. (2022). Patient Experiences with Ketamine. Psychiatry Research Quarterly.
4. Smith, J. (2020). Neurogenesis and Psychiatric Treatments. Journal of Clinical Psychiatry.