Ketamine Therapy

Ketamine therapy uses a medicine called ketamine hydrochloride to manage certain mental health conditions and chronic pain. Ketamine is a fast-acting anesthetic. It can make you feel relaxed or slightly detached from your surroundings for a short time.

In your brain, there’s a chemical called glutamate that helps nerve cells talk to each other. This chemical helps your brain control your mood, memory and decision-making skills. But when there’s too much glutamate, it can hurt brain cells and slow down areas that affect mood, stress and anxiety.

Ketamine works by blocking certain glutamate signals in your brain. This helps protect brain cells and allows them to form new, healthy connections. It’s a process called synaptogenesis. These new connections may improve your mood and reduce symptoms.

Your provider may recommend this therapy when other treatments haven’t worked. You may receive it through an IV (infusion) or as a nasal spray. During treatment sessions, your healthcare provider will watch you closely to make sure you’re safe and comfortable.

What is ketamine therapy used for?

Ketamine is a controlled substance. The FDA approved ketamine treatment for several medical uses, including:

• Treatment-resistant depression: A nasal spray made from ketamine (esketamine) may help adults with major depression who haven’t improved with other treatments. It’s often used with an antidepressant.
• General anesthesia: Used alone or with other medicines, it will help you stay asleep.
• Sedation for surgery or procedures: Sometimes, it’s used to strengthen the effects of other anesthesia medicines that don’t require you to be fully asleep, like nitrous oxide.

Your provider may also prescribe ketamine for other reasons that aren’t FDA-approved. This is called off-label use. In these cases, ketamine may help when other treatments haven’t worked. These include:

• Mental health conditions: It may ease symptoms of anxiety or post-traumatic stress disorder (PTSD).
• Pain: Low doses may relieve severe pain from injuries, surgery or chronic conditions. It may reduce the need for opioids.
• Suicidal thoughts: It may quickly lower suicidal thoughts during a mental health emergency.
• Seizures: In hospitals, ketamine can help when seizures don’t stop with other medicines (a condition called status epilepticus).

Who is a good candidate for ketamine therapy?

Ketamine therapy is usually for people who haven’t found relief with other treatments. For example, if you have major depressive disorder, you may have tried several medicines or types of therapy without much improvement. This is sometimes called treatment-resistant depression — when symptoms don’t get better even after trying different options.

If you’re interested in ketamine therapy, talk with your healthcare provider. They’ll review your medical history and help you decide if this treatment is safe and could work well for you.

Who is not a good candidate for ketamine therapy?

Ketamine treatment isn’t safe or recommended for everyone. Your healthcare provider may suggest other options if you have or had:

• An allergy or bad reaction to ketamine
• An aortic dissection or aneurysm
• A history of psychosis
• A history of substance use disorder or a high risk of addiction
• A recent or current heart attack
• High blood pressure (unmanaged)
• Increased intracranial pressure
• Liver disease or serious liver problems

Talk to your provider if you’re pregnant or breastfeeding. Small amounts of ketamine can pass to the fetus during pregnancy or through breast milk.

Your provider may also suggest other options if you take certain medications, like:

• Monoamine oxidase inhibitors (MAOIs)
• Aminophylline
• Theophylline

Even if you see something on this list that applies to you, don’t rule it out on your own. Talk with your provider first. They’ll let you know if this is right for you.

How do I prepare for ketamine therapy?

Before starting ketamine therapy, you’ll meet with a healthcare provider. They’ll review your medical history to make sure the treatment is safe. Depending on your health, you may also need clearance from other specialists, like a heart, brain, eye or kidney doctor.

Your provider may order lab tests, like liver and kidney function tests, to see how your body handles medications. They’ll explain how the treatment works, what to expect during your first sessions and check for any reasons why ketamine might not be safe. You may also get medicine ahead of time to prevent side effects.

Sometimes, your provider will start with a trial session to see how your body reacts to ketamine. If the trial goes well, you can begin regular treatments.

To get ketamine therapy, you may have to:

• Pass random drug screenings: Some substances, including alcohol and certain non-prescription drugs, can be dangerous when combined with ketamine. These screenings are for your safety.
• Have a psychiatric prescriber: You must be under the care of a mental health provider to receive ketamine therapy. If you stop seeing them, treatment will pause until you have a new provider.
• Follow fasting guidelines: You may need to avoid eating for at least two hours before treatment and avoid drinking anything for 30 minutes before. This helps prevent nausea. The exact timing may vary by clinic.
• Make transportation arrangements: The medication can slow your thinking and reaction time. You’ll need someone to drive you home after each session. Tell your care team who your driver will be before your appointment. On treatment days, avoid making big decisions, going to work or using heavy machinery.

What happens during ketamine therapy?

The steps may vary slightly depending on where you receive care. Here’s what a typical visit looks like:

1. Check in and review symptoms: When you arrive, you’ll fill out a short symptom questionnaire. Then, you’ll meet with a member of your care team. You’ll discuss how you feel and review your treatment plan.
2. Get ready for treatment: Depending on the type of ketamine you’re receiving, you’ll either learn how to use the nasal spray or have a small IV placed in your arm for the infusion.
3. Begin treatment: You’ll give yourself the nasal spray, or your provider will start the IV infusion.
4. Monitoring during treatment: Your care team will check your vital signs during the session and for 30 to 120 minutes afterward. They’ll be nearby and can give you medicine if you have any side effects.
5. After treatment: If you have an IV, your care team will remove it and complete post-treatment checks. They’ll make sure you’re feeling well and ready to go home.

Your surroundings can affect how ketamine makes you feel. It helps to keep your space calm and quiet during treatment. Try to avoid phone calls or long conversations while you’re getting therapy. If you need to talk with staff, keep it short so you can stay relaxed and focused.

You can use your phone during treatment, but turn off the sound. If you’d like, bring headphones to listen to calm music or soothing sounds. Many people find that this makes the experience more peaceful and comfortable.

Your visit will usually last two to three hours, depending on the type.

What does ketamine therapy feel like?

Everyone experiences ketamine therapy a little differently. Many people describe it as an out-of-body or dream-like feeling. You’ll be in a quiet room and fully aware that you’re there, but it might feel like you’re floating or watching yourself from outside your body.

You may notice that lights, colors or sounds feel stronger or more vivid. When you close your eyes, you might see shifting patterns or shapes. Time can feel slower. It may be hard to tell where you are.

Some people feel their mood lift or chronic pain ease for a short time. You might also notice slower speech, double vision, lightheadedness or a tingling, numb feeling in your arms or legs.

These sensations can feel strange at first, but they’re temporary. You’ll be in a medical setting with trained providers who stay with you the entire time. If you feel uncomfortable, they’ll help right away.

After treatment, you may feel groggy or tired, like waking up from a deep nap or dream. It can take about 30 minutes to feel fully alert again. Mild dizziness or fatigue can last for the rest of the day, but most people feel like themselves again by the next day. You may have some symptom relief starting soon after treatment.

Ketamine therapy benefits

Common benefits of this treatment may include:

• It helps when other options haven’t worked. Ketamine may be effective when traditional medications or therapies don’t bring results.
• It improves certain mental health symptoms. It may manage conditions like PTSD, social anxiety and more.
• It reduces suicidal thoughts quickly. It may help ease suicidal thinking within hours or days.
• It enhances therapy outcomes. When used with psychotherapy (called ketamine-assisted therapy), it may strengthen and extend the benefits.

Is ketamine therapy safe?

Ketamine therapy is safe when given under medical supervision. Before you start, your care team will check for any health conditions that might make ketamine unsafe. During treatment, they’ll carefully control your dose and how quickly you get it.

Serious side effects are rare.

Long-term use is another safety concern. Because ketamine is a controlled substance, it’s only given in a clinic under supervision. Dependence is uncommon when used occasionally in a medical setting. Your care team will follow your response to treatment to make sure you’re safe.

Ketamine therapy side effects

Most people have few or no side effects. When side effects do happen, they’re usually mild and go away soon after each session.

Common side effects may include:

• Anxiety or restlessness
• Blurred vision
• Feeling detached (dissociated)
• High blood pressure
• Nausea or vomiting

Rare side effects may include:

• Allergic reaction
• Bladder or liver problems
• Hallucinations

Researchers are still studying the long-term safety of ketamine for depression and other mental health conditions. Because of this, there may be long-term effects that aren’t yet fully known.

How long do I need ketamine therapy?

The exact schedule depends on why you’re getting treatment and how your body responds.

Some people notice improvement within hours, but those effects can fade within days or weeks. You may need more sessions to keep feeling better.

Your healthcare provider will make a plan that fits your needs and adjust it as you go. If you’re unsure how long treatment will last, your provider can explain what to expect and answer your questions.