There’s a lot of talk about ketamine these days, not as a recreational drug, but as a treatment for various mental health conditions. But what exactly is it and how does it work to treat depression, anxiety, and trauma?
What Is Ketamine Assisted Therapy?
Ketamine is a dissociative anesthetic drug and psychedelic agent. Ketamine Assisted Psychotherapy (KAP) combines the use of ketamine with psychotherapy.
In KAP, controlled doses of ketamine are given under medical supervision. The patient experiences altered states of consciousness. The trance-inducing and pain-relieving properties of ketamine help patients access and process difficult emotions, thoughts, or traumas. Throughout the session, a trained therapist provides guidance and support as patients navigate inner experiences.
Is Ketamine Assisted Therapy Legal?
Recreational use of ketamine is illegal. Ketamine is a Schedule III controlled substance in the US. It is FDA-approved in high doses as an operating room anesthetic. When prescribed by a licensed healthcare provider, ketamine is legal for this and other medical uses.
Ketamine’s use is considered “off-label” for mental health conditions such as depression, anxiety, and Post-Traumatic Stress Disorder (PTSD). This is a common and legal practice where doctors prescribe medications for conditions other than their FDA-approved uses. However, ketamine clinics and providers must adhere to federal and state regulations, including DEA registration and proper medical licensing.
How Does Ketamine Assisted Therapy Work?
The science of ketamine therapy is complex and not completely well understood as research continues. There are many factors at play:
NMDA and Glutamate: Ketamine targets different neurotransmitters than conventional antidepressants, primarily affecting glutamate levels in the brain. It is believed to work by binding to the NMDA receptor, which increases the amount of glutamate, a neurotransmitter, in the space between neurons [1].
Neuroplasticity: Glutamate activates the AMPA receptor. It releases molecules that help neurons communicate along these new pathways involved in the regulation of mood, cognition, and pain perception [2]. The thinking is that this promotes the regrowth of synapses (neuroplasticity), enabling improved communication between neurons.
This may explain ketamine’s ability to alleviate symptoms of depression, typically within hours or days. This compares with SSRI antidepressants, which can take 4 to 6 weeks to take effect.
Default Mode Network Reduction: Ketamine also reduces the activity in the default mode network (DMN), a network of brain regions active when the mind is at rest. In depressed individuals, this is often overactive, leading to excessive rumination and negative self-talk. Ketamine has been shown to reduce this activity, helping break the cycle of negative thoughts and images.
Anti-inflammatory benefit: Ketamine has been shown to reduce the effects of inflammation in the brain which is linked to a wide range of mental health conditions, including depression and anxiety.
BDNF and Serotonin Increase: Ketamine has been shown to increase the production of brain-derived neurotrophic factor (BDNF). This is a protein that plays a key role in neuroplasticity and the growth of new neurons, including the production of serotonin, a neurotransmitter often associated with feelings of well-being and happiness.
Katamine’s ability to rapidly modulate several key neurotransmitter systems makes it an effective treatment across these conditions.
How Is Ketamine Therapy Administered?
There are four ways ketamine therapy is administered [3]:
- Intravenous (IV) infusion: A low dose of ketamine is delivered directly into the bloodstream through a vein in the arm, with sessions lasting 40-60 minutes.
- Intramuscular: A low dose of ketamine is delivered into an appropriate muscle where it is absorbed by the blood system.
- Lozenge: A lozenge is taken by mouth.
- Intranasal spray: Esketamine, an FDA-approved formulation for depression, is administered as a nasal spray in a clinical setting.
For depression and anxiety, the initial treatment process typically involves a series of six doses over a six-week period. Following this, patients may receive maintenance doses every four to six weeks to maintain the therapeutic effects.
What To Expect During Ketamine Therapy?
There is a range of effects during the treatment, including a:
- Dream-like state
- Sense of detachment from your body and surroundings
- Sense of calm and relaxation
- Floating feeling
- Trance-like state
Usually these effects subside within a few hours after the ketamine is taken. Patients can return to their normal activities soon afterwards [2].
How Much Ketamine Is Used in Therapy?
Ketamine is given in carefully controlled doses. A specific dose, customized based on the pre-treatment assessment, is delivered directly either intramuscularly or intravenously over a period typically lasting between 40 to 60 minutes. This controlled administration allows for a gradual onset of the medication.
One large-scale study reported initial dosing through intramuscular injection was 25–50 mg with a possible increase beyond that if clinically indicated. Subsequent visit doses were often gradually increased higher into a typical range of 50–100 mg. The starting dose for lozenges was 200 mg with the option to increase by 50–100 mg per visit up to 500 mg [4].
Is Ketamine Addictive When Used Medically?
Ketamine can be addictive, even when used medically. The risk depends on dosage, frequency, and individual factors. When administered under medical supervision at typical low doses, the risk of addiction is much lower than with recreational use.
Clinically Supervised Protocols (such as intravenous ketamine for depression) minimize potential abuse by controlling dosing and monitoring patients. It’s technically possible to build tolerance to ketamine when used frequently, where the individual would need to take more to have the same effects. However, cases of ketamine dependence are comparatively infrequent.
Who Is Eligible for Ketamine Therapy?
For depression, ketamine therapy is generally considered only when at least two trials of standard antidepressants have failed to alleviate symptoms. As well, patients must be carefully screened for suitability. Certain medical conditions or medications may prevent its use.
Ketamine Therapy for Depression
The effects of ketamine for depression can be rapid and significant, but with varying duration. Initial treatment for depression is a series of six doses over a six-week period. Antidepressant effects may be felt very quickly, often beginning within hours of administration and peaking at around 24 hours. The positive effects can last for several days to a week from a single ketamine dose.
Sustained improvement in depression, anxiety, and illness severity at two weeks and one month after the last dose of ketamine have been reported [4]. For longer-lasting effects, repeated treatments are usually necessary.
Ketamine Therapy for Trauma
Ketamine therapy is a promising treatment for trauma-related conditions, particularly post-traumatic stress disorder (PTSD). This therapy approach has demonstrated lasting reductions in PTSD, depression, and anxiety. Studies have shown effects persisting up to six months after treatment [5] [6].
Benefits of Ketamine-Assisted Therapy
There is a range of benefits including:
- Fast relief from symptoms of depression, anxiety, and PTSD.
- Improved mood, thought processes, and general well-being
- Increased self-awareness and personal growth
- Opportunity to break free from treatment-resistant symptoms
How Long Does Ketamine Therapy Work For?
In one study of ketamine treatment for PTSD, large treatment effects were detected at 3 months and were sustained at 6 months. In one study, 50–75% of patients reported a minimal clinically important difference at 3 months and 48–70% at 6 months [6].
What to Expect from the Process
The process is fairly straightforward with several steps:
How to Prepare for Ketamine Assisted Therapy
Initial Evaluation:
Patients participate in a thorough evaluation. It assesses their mental health history, current symptoms, and treatment goals. The focus is to determine whether ketamine therapy is a viable option, and based on this, the healthcare provider creates a treatment plan tailored to the individual’s needs.
Preparation Session:
The healthcare provider identifies key components aimed at ensuring the safety and efficacy of the treatment. In addition, the patient is mentally and emotionally prepared for the experience by the healthcare provider and therapist.
What Happens After Ketamine Treatment?
Integration and Follow-Up:
After each treatment session, patients participate in integration sessions with their therapist to:
- Reflect on their ketamine experiences
- Explore insights gained during the session
- Develop coping strategies for managing symptoms outside of therapy.
Regular follow-up appointments allow healthcare providers to monitor progress, adjust treatment as needed, and provide ongoing support [7].
Why Choose Corner Canyon Health Centers?
Corner Canyon Health Centers has significant experience administering Ketamine Assisted Psychotherapy. Under the guidance of our resident Psychiatric Nurse Practitioner, we administer ketamine intramuscularly, together with one of our therapists experienced in this approach. Our clients have spoken very positively about the outcomes they experienced.
How Corner Canyon Can Help
Treatment for mental health conditions and trauma is available in Utah. Are you or a loved one looking for a compassionate space to heal from anxiety, trauma, PTSD, other mental health conditions, or addictions? Our licensed trauma-informed professional therapists and counselors at Corner Canyon Health Centers can provide compassionate help using a range of therapeutic and holistic techniques.
Reach out to our Admissions team now at Corner Canyon. We’re in a peaceful setting bordered by the beautiful Wasatch Mountains.
Sources
[1] Frequently Asked Questions. Ketamine Assisted Therapy Association of Canada.
[2] Heinzerling K. 2022. What is Ketamine Therapy? Pacific Neuroscience Institute.
[3] Handoo, I. 2023. Ketamine Infusion Therapy: Understanding the Duration of Treatment.
[4] Mandal S, Sinha VK, Goyal N. Efficacy of ketamine therapy in the treatment of depression. Indian J Psychiatry. 2019 Sep-Oct;61(5):480-485.
[5] Yermus, R. et al. (2024). Ketamine-Assisted Psychotherapy Provides Lasting and Effective Results in the Treatment of Depression, Anxiety, and Post-Traumatic Stress Disorder at 3 and 6 Months: Findings from a Large Retrospective Effectiveness Study. Psychedelic Medicine (New Rochelle, N.Y.), 2(2), 87–95.
[6] Milev R. et al. Combining Ketamine and Psychotherapy for the Treatment of Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis. J Clin Psychiatry 2023;84(2):22br14564.
[7] Jethani, Z. 2024. A New Patient’s Guide to Ketamine-Assisted Psychotherapy.
