The editorial team at therapist.com works with the world’s leading clinical experts to bring you accessible, insightful information about mental health topics and trends. During treatment, clinicians may adjust ketamine dosages to achieve various states of consciousness.12 Dosages and frequency of administration may vary, and psychotherapy may be provided before, during, or after ketamine administration. Ketamine has a robust and rapid effect on depression, which was seen immediately after the administration of ketamine and sustained at the end of 1 month.
- Recently, North American print media have shifted to portraying ketamine as a therapeutic antidepressant rather than a substance of abuse41.
- Before starting ketamine therapy, candidates should undergo thorough medical and psychological screening by licensed clinicians and health care providers to ensure they’re suitable candidates.
- However, ketamine administered intravenously—sometimes called intravenous ketamine (IV ketamine) or ketamine infusion—has yet to receive FDA approval for use in treatment-resistant depression.
- In this systematic review, the included five RCTs evaluated ketamine via either the intranasal, subcutaneous, or intravenous routes of administration.
Ketamine for Suicidal Ideation
The antidepressant effects observed at week 3 did not endure, with each study group reporting relapse rates of 83.3% (10/12) and 80% (4/5), respectively 25, 32. There is a need to identify multimodality strategies that are safe and capable of prolonging the efficacy of ketamine in adults with TRD. No treatment modality, other than repeat-dose IV ketamine infusion therapy: techniques and efficacy ketamine, has demonstrated ability to significantly prolong the acute efficacy of IV ketamine in TRD.
While potential side effects exist, most are manageable and short-lived when the treatment is administered under proper medical supervision. By understanding these potential side effects and implementing effective management strategies, patients and healthcare providers can work together to maximize the benefits of ketamine infusion therapy while minimizing risks. Ketamine’s therapeutic effects offer a potential alternative treatment for depression, suicidal ideation, SUD, and PTSD. Ketamine has shown to be an effective treatment in rapidly decreasing depressive symptoms in those with depression. However, more studies should be done to determine ketamine’s role in the inpatient setting and its effectiveness in those with other psychiatric comorbidities such as anxiety and bipolar disorder. Ketamine may likely play a larger role in treating those with depression now that esketamine, a nasal form of administration, has been approved by the FDA.
Clinical data
Always consult your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine appointment with one of our providers to discuss these alternatives in detail. One of our patients, an adolescent with multiple hospitalizations who failed ECT prior to beginning ketamine, was surreptitiously using cannabis on a frequent basis. He had a history of intermittent cannabis use prior to beginning treatment though this was not disclosed. Upon discovery of his use, further ketamine treatments were contingent upon his abstinence, which he was not able to maintain.
Quality of the evidence
- Significant improvement at 1st h of the first dose was seen in depression and anxiety and not for illness severity.
- The therapy typically involves a series of intravenous infusions in a clinical setting under medical supervision.
- The study identified randomized trials and nonrandomized cohorts that compared IV ketamine to control interventions in patients diagnosed with chronic pain.
- Ketamine coma, and indeed oral ketamine and ketamine combined with nerve block, are cited in the UK Guidance document under ‘Experimental research’ with insufficient evidence for their efficacy at present (Goebel et al. 2012) and are not included in the Dutch guidelines 31.
Meanwhile, the use of racemic ketamine for depression is increasing across public and private sectors as a cost-efficient off-label approach. Each administration route presents distinct advantages and challenges relating to bioavailability, effect duration, practicality and patient comfort. Importantly, none of these treatment modes for racemic ketamine has received regulatory approval for on-label use for any psychiatric indication. Some evidence from single-dose studies reported that using 0.5 mg/kg as well as 1.0 mg/kg showed efficacy without superiority of 1.0 mg/kg over 0.5 mg/kg.
During the first infusion, one patient transiently had a DBP of 110, which normalized within 30 minutes post-infusion. No patient had DBP values of 110 or greater during the second, third, or fourth infusions. Ketamine has emerged as a rapid-acting antidepressant, though controversy remains regarding whether sufficient data exist to justify its use outside of research protocols.
What to Know About Ketamine Therapy for Pain Management
This raises the overarching question of whether this ketamine therapy can yet be advocated as an evidence-based, cost-effective, rational, safe and practicable therapy for CRPS. From October 2014 through February 2017, our service provided ketamine as a clinical treatment to 54 patients, 14 of whom have received long-term infusions of 12 treatments or more. Infusions given at 0.5mg/kg over 40 minutes are generally well tolerated, with one patient requiring premature cessation of infusion prior to completion due to intolerable dissociative effects, and one for transient hypertension. Notably, our response (50%) and remission (27.3%) rates following a 4-infusion protocol are lower than those reported in most clinical trials.1, 3–5, 9 We found no effect of acute dissociative symptoms, age, gender, and history of failed or inability to tolerate ECT on response. Among the subsample receiving long-term treatment, there was no correlation between number of infusions and change in cognition.
Finding the right people who experience unique pain types that respond to ketamine therapy is integral to helping people find pain relief. Rodriguez, intent on searching for better, faster treatments for her patients like Rivas with OCD, took note. There was an emerging theory that ketamine affects the levels of the neurotransmitter glutamate in the brain and increasing evidence that glutamate plays a role in OCD symptoms, she says. But researchers like Rodriguez are intrigued about the drug’s potential to help them identify a whole new line of medicines for fast-acting treatment of mental health disorders. Additional to its effect at the NMDAR, ketamine interacts with other receptor systems as well, including opioidergic, muscarinic and monaminergic receptors.
Two independent researchers identified randomized double-blind and non-randomized trials that compared IV Ketamine infusions with controls. A control group comprises participants who do not receive the intervention under investigation, providing a basis for comparison to ascertain the intervention’s effectiveness. Excluding studies lacking a control group helps establish a cause-and-effect relationship between the intervention and observed outcomes. Of the 28 investigations, 19 (7 randomized controlled trials and 12 open-label trials; 818 participants) were included in the meta-analysis as well. Though ketamine is administered in a variety of ways (e.g., oral, intranasal, intravenous), the only form of ketamine approved by the FDA for use in depression is in the form of a nasal spray (esketamine; brand name Spravato). He is now present and able to complete work without the invasive memories of the past.
Assessment of the risk of bias in included studies
With their help, patients are more likely to have a positive, transformative experience rather than one that feels jarring or unproductive. A trained therapist or facilitator is crucial in these moments, with the expertise to guide patients through their experiences with empathy and support. They can help patients navigate overwhelming feelings, offering grounding techniques to keep them safe and focused so that the experience remains beneficial rather than distressing. Their presence provides a safe space for the journey, ensuring the individual feels supported as they process challenging emotions or memories.
Trying to talk with a patient during their ketamine experience can be a somewhat futile effort. To find optimal benefit and transformation from ketamine, a conversation is usually best had at a later date. Once the infusion is over, you will likely still feel a little out of it as the ketamine wears off.
It has been postulated that ketamine, due to its anesthetic and anti-depressive effects, could be the ideal anesthetic for use in ECT. However, at this time there is a lack of sufficient evidence that demonstrates that ECT in conjunction with ketamine as an anesthetic is more efficacious than using typical anesthetics during ECT to treat depression 12,13. Alternatively, ketamine alone has been shown to have an antidepressant effect within 40 minutes of administration with a single intravenous (IV) infusion in those with MDD, with maximum efficacy occurring at 24 hours post-infusion. However, this beneficial effect of ketamine on depression has been shown to disappear one to two weeks after initial treatment 14.
Furthermore, it is difficult to determine whether all these effects are directly linked to the use of ketamine per se since illicit drug users often misuse several drugs of abuse simultaneously (e.g. XTC, cocaine). Still, we should also keep in mind that chronic pain patients, treated with ketamine for longer periods of time, might experience similar adverse effects. Therefore, patients should be monitored closely and ketamine treatment should be terminated immediately when severe adverse effects are observed. Ketamine, a dissociative anesthetic, has gained widespread use in various medical contexts, including anesthesia, pain management, and treatment-resistant depression. Despite its therapeutic potential, concerns regarding its safety profile have prompted ongoing research and regulatory guidance. This comprehensive literature review explores the current safety considerations of ketamine, summarizing its adverse effects, particularly on cardiovascular, neuropsychiatric, and dependency effects.