In recent years, ketamine therapy has emerged as a promising treatment option for various mental and neurological disorders. Understanding this therapy and its benefits is the first step in figuring out how to choose the right ketamine clinic.

Understanding Ketamine Therapy

Ketamine therapy involves the administration of low doses of ketamine, a drug commonly used in anesthesia. This therapy aims to alleviate symptoms of mental and neurological disorders by reestablishing certain connections within the brain. It’s usually administered intravenously, but other methods may also be used depending on the patient’s needs and the clinic’s protocols.

In a controlled medical setting, ketamine therapy can offer relief from symptoms much quicker than traditional treatments. It’s important to note that this therapy should always be administered under the supervision of a healthcare professional. For a comprehensive list of ketamine clinics, you can check out our article on ketamine clinics.

Who Can Benefit from Ketamine Therapy

Ketamine therapy can potentially benefit individuals suffering from a range of mental health disorders, such as depression, bipolar disorder, and post-traumatic stress disorder (PTSD). It may also help those experiencing chronic pain conditions like fibromyalgia and complex regional pain syndrome (CRPS).

However, it’s crucial to remember that not everyone is an ideal candidate for ketamine therapy. The suitability of this treatment depends on various factors, including the patient’s overall health, the severity of their symptoms, and their response to other treatments. To make an informed decision, individuals should consult with a medical professional and thoroughly research to find the best ketamine clinics.

Important Factors to Consider

When evaluating how to choose the right ketamine clinic, one must consider several crucial factors. These include the level of professional medical supervision available, the clinic’s reputation and reviews, and the clinic’s approach to therapy.

Professional Medical Supervision

The presence of a qualified medical professional during ketamine therapy sessions is paramount to ensure patient safety and efficacy of the treatment. They should be able to monitor vital signs, manage any immediate side effects, and provide comprehensive care during each session.

Inquire about the qualifications and experience of the medical professionals present during the therapy. It’s critical to ensure that they have the necessary training in administering ketamine and managing potential complications.

Clinic’s Reputation and Reviews

The reputation of the clinic plays a significant role in selecting the right ketamine therapy center. Look for reviews and testimonials from previous patients to gauge the quality of care and the effectiveness of the treatments provided. Patient satisfaction and positive outcomes can indicate a reliable and trustworthy clinic.

Online platforms, feedback forums, and social media can provide insights into patient experiences. Pay attention not only to the positive reviews but also to how the clinic responds to any negative feedback. Their responsiveness can indicate their commitment to patient satisfaction and continual improvement.

Clinic’s Approach to Therapy

Different ketamine clinics may have slightly different approaches to therapy, so it’s essential to find one that aligns with your expectations and comfort level. Some clinics may focus exclusively on ketamine infusions, while others may integrate ketamine therapy into a broader mental health treatment plan.

Ask about the clinic’s therapy process, including the initial consultation, frequency and duration of sessions, and any other complementary therapies offered. The clinic should be willing to discuss their methods and rationale, helping you make an informed decision.

Remember, choosing the right ketamine clinic is a personal decision that should be based on your unique needs and circumstances. Taking the time to thoroughly research and evaluate different clinics can help ensure that you find the one that is the best fit for you.

Assessing the Clinic’s Staff

Choosing the right ketamine clinic involves more than just looking at the facility’s features. The staff and their approach to patient care play a critical role in the effectiveness of ketamine therapy. Here are a few key aspects to consider when assessing the clinic’s staff.

Qualifications and Experience of Medical Personnel

The qualifications and experience of the medical personnel at a ketamine clinic are paramount. They should be certified and have a proven track record in administering ketamine therapy. This includes anesthesiologists, psychiatrists, and nurses. Their experience ensures that they can handle any potential complications and adjust treatment plans as necessary.

When researching ketamine clinics, look for information about the staff’s qualifications on their website or ask for this information during your initial consultation.

Approach to Patient Care

The clinic’s approach to patient care is another essential factor in choosing the right ketamine clinic. Staff should demonstrate a compassionate and patient-centered approach. This includes taking the time to understand the patient’s specific needs, explaining the treatment process in understandable terms, and being responsive to any concerns or questions.

High-quality clinics often go beyond just administering ketamine treatments. They should also offer additional support, such as mental health counseling or resources for managing the underlying condition being treated with ketamine.

Staff Accessibility and Communication

Lastly, consider the clinic’s staff accessibility and communication. Staff should be readily available to answer questions or address concerns before, during, and after the treatment. Good communication is key to ensuring that the patient feels comfortable and well-informed throughout the ketamine therapy process.

Look for clinics that offer easy ways to contact the staff, such as through email, phone, or in-person consultations. The best ketamine clinics will have a dedicated team to handle patient inquiries promptly and professionally.

In conclusion, when assessing the staff of a potential ketamine clinic, remember that their qualifications, approach to patient care, and communication skills are just as important as the clinic’s facilities and treatment plans. This comprehensive approach will help ensure that you choose the right ketamine clinic for your specific needs.

Analyzing the Clinic’s Facilities

While selecting the appropriate ketamine clinic for treatment, a thorough examination of the clinic’s facilities is essential. This involves considering factors such as the level of comfort and cleanliness, the standard of equipment and medical procedures, and the safety measures in place.

Comfort and Cleanliness

The environment of the ketamine clinic plays a significant role in the overall treatment experience. A comfortable and clean setting can contribute to a patient’s relaxation, which is important for the effectiveness of ketamine therapy. Check for comfortable seating arrangements, calming ambiance, and overall cleanliness during your visit. This can provide insights into the clinic’s attention to patient comfort and hygiene standards.

Equipment and Medical Standards

The quality of equipment and adherence to medical standards are critical when evaluating a ketamine clinic. The clinic should use state-of-the-art equipment and follow the latest medical protocols for administering ketamine therapy. Additionally, the clinic should maintain a high standard of cleanliness in their treatment areas to prevent infections and other health complications. You can request information about the clinic’s equipment and procedures during your initial consultation.

Safety Measures in Place

Safety should be a top priority when receiving any medical treatment, including ketamine therapy. Ensure that the clinic has robust safety measures in place, such as resuscitation equipment and trained staff to handle emergencies. Ask about the clinic’s medical emergency protocols and how they monitor patients during and after treatment sessions. A clinic that prioritizes safety will be proactive in discussing these measures with potential patients.

In conclusion, the facilities of a ketamine clinic can significantly influence the treatment experience and outcomes. Therefore, it’s important to carefully analyze the comfort, cleanliness, equipment, medical standards, and safety measures of potential ketamine clinics before making a decision. For a list of clinics that have been evaluated based on these criteria, you can check out our article on the best ketamine clinics.

Understanding the Treatment Plan

When evaluating how to choose the right ketamine clinic, understanding the clinic’s treatment plan is an imperative factor. This will involve the initial consultation and assessment, customized treatment plans, and continual monitoring and follow-ups.

Initial Consultation and Assessment

The initial consultation and assessment is the first step in the treatment process. During this phase, the medical team will gather detailed information about the individual’s medical history, current health status, and specific needs. This comprehensive evaluation will enable the team to identify if the individual is a suitable candidate for ketamine therapy.

A reputable clinic will ensure this assessment is carried out by a qualified and experienced healthcare professional who can accurately interpret the results. The initial consultation is also a good opportunity for individuals to ask any questions they may have and gain a clear understanding of the treatment process.

Customized Treatment Plans

Each individual’s needs and responses to treatment will vary. Therefore, the best ketamine clinics will create customized treatment plans for each patient. These plans should be based on the initial assessment and tailored to address the specific needs and goals of the individual.

The treatment plan should clearly outline the frequency and dosage of the ketamine therapy. It should also explain any additional therapies or treatments that may be used in conjunction with the ketamine therapy, such as psychotherapy or lifestyle modifications.

Continual Monitoring and Follow-ups

Continual monitoring and follow-ups are a crucial part of the treatment process. This ensures that the therapy is working effectively and allows for any necessary adjustments to be made.

The medical team should closely monitor the individual during each treatment session to assess their response and manage any potential side effects. Following each treatment, the team should provide a detailed report outlining the individual’s progress.

Regular follow-up appointments should also be scheduled to track the individual’s long-term progress and make any necessary adjustments to the treatment plan. This ongoing support is a key factor in achieving the best possible outcomes from ketamine therapy.

In conclusion, when choosing a ketamine clinic, it’s essential to consider not just the clinic’s reputation and facilities, but also their approach to treatment. A comprehensive and personalized treatment plan, coupled with continual monitoring and follow-ups, can greatly enhance the effectiveness of the therapy. For more information on ketamine clinics, visit our website.

Payment and Insurance Considerations

When considering ketamine treatment, understanding the costs involved and your insurance coverage is crucial. It’s important to consider these financial aspects as part of your decision-making process when choosing a ketamine clinic.

Understanding Costs and Payment Options

The cost of ketamine therapy can vary widely depending on several factors including the clinic’s location, the number of sessions needed, and the specific treatment plan outlined. When researching ketamine clinics, it’s important to ask for a detailed breakdown of the costs associated with treatment.

Here’s a general idea of the potential cost range:

In addition, inquire about the available payment options. Many clinics offer flexible payment plans to make the treatment more accessible. Some may even have partnerships with healthcare financing companies that provide low-interest rate loans for medical treatments.

Insurance Coverage Considerations

Insurance coverage for ketamine therapy is a complex issue. While some insurance providers may cover a portion of the costs, others may not, largely because ketamine therapy for mental health disorders is often considered an “off-label” use of the drug.

Before starting treatment, it’s crucial to speak with your insurance provider to understand what is covered and what is not. You should also check with the clinic to see if they have experience in dealing with insurance companies and if they can provide any assistance in this regard.

When assessing the financial aspects, keep in mind that while cost is an important factor, it should not be the only consideration. The quality of care, the clinic’s reputation, and the expertise of the medical staff should also play a significant role in your decision-making process. Be sure to consider all these factors when deciding on the best ketamine clinic for your needs.

The post Transforming Lives: Choosing the Perfect Ketamine Clinic appeared first on Ketamine Therapy HQ - Find Local Ketamine Therapists.

This in-depth article covers everything you need to know about the benefits of ketamine for anxiety disorders. Learn how it works, is it safe, what are the infusions like, legality, and more. 

In this article, you’ll learn: 

1. What is ketamine?
2. What is an anxiety disorder? 
3. How does ketamine treat anxiety disorders? 
4. What does the research say? 
5. What’s the process of getting ketamine therapy for anxiety disorders? 
6. What are ketamine infusions like?
7. How safe are maintenance ketamine treatments for anxiety? 
8. How much does it cost? 
9. Is it legal?
10. FAQs

Are you dealing with an anxiety disorder that doesn’t respond to treatment? 

Ketamine might be your answer. 

A growing body of scientific evidence highlights the potential role of ketamine — a novel experimental drug — in the treatment of treatment-resistant anxiety disorders. 

Ketamine is a fast-acting medicine that often produces mood changes within hours. This means that if ketamine therapy works for you, you can have your life back in an instant. Read on to find out more about this novel approach to treating severe anxiety disorders. 

What Is Ketamine? 

Ketamine is an FDA-approved anesthetic used to put you to sleep before surgery. This drug prevents pain and discomfort during certain medical tests and procedures. 

Its dissociative properties are helpful during medical emergencies and traumatic injuries. Ketamine causes short term memory loss and relaxes the patient. If a patient comes in with a dislocated shoulder, doctors give him ketamine. That way, he won’t remember when they fix his shoulder. 

As a dissociative anesthetic — even in the lowest doses — ketamine may cause hallucinations or a “mind and body separation.” Due to these effects, people use it recreationally as a “party” drug known as Special K. 

In the past two decades, ketamine became a promising novel drug for mood disorders like treatment-resistant depression, anxiety, and post-traumatic stress disorder.    

What is an anxiety disorder? 

An anxiety disorder is a mood disorder characterized by significant feelings of anxiety, worrying, and fear. According to the Anxiety and Depression Association of America, anxiety disorders impact almost 1 in 5 adults in the U.S. 

Anxious feelings like temporary worry or fear are an expected part of life. You may feel anxious before making an important decision or when facing a problem at work. But, having an anxiety disorder is more than that. 

A person with an anxiety disorder feels constant and excessive worry. It’s intense and can interfere with daily activities, job performance, school, and relationships. The most common signs and symptoms of an anxiety disorder are:

• Excessive worrying
• Agitation
• Restlessness
• Fatigue
• Difficulty concentrating
• Irritability
• Tense muscles
• Trouble falling or staying asleep
• Panic attacks
• Avoiding social situations
• Irrational fears

Major types of anxiety disorders

The main types of anxiety disorders are:

1. Generalized Anxiety Disorder (GAD)
2. Panic Disorder
3. Social Phobia (Social Anxiety Disorder)
4. Selective mutism 
5. Agoraphobia
6. Separation anxiety disorder

Obsessive-compulsive disorders and trauma and stressor-related disorders (like PTSD) are now separate categories in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). These two categories were part of the anxiety disorders group in the past. 

How Does Ketamine Treat Anxiety Disorders? 

Researchers are investigating the effects of this novel drug on the brain. Because of the unknowns, medical professionals recommend ketamine therapy only to people with treatment-resistant anxiety disorder. Individuals diagnosed with treatment-resistant anxiety have gone through standard anxiety disorder treatments, but [1]:

• The treatments were totally ineffective: the patient didn’t respond to the treatment at all. 
• The treatments were modestly effective: the patient responded to treatment, but the condition didn’t achieve remission. 

The treatment options for patients diagnosed with treatment-resistant depression are limited to:

• Anti-anxiety medications (benzodiazepines), 
• Antidepressants (SSRIs and SNRIs), 
• Psychotherapy (cognitive-behavioral therapy), and 
• Beta-blockers (often used to treat high blood pressure).  

Antidepressants increase the serotonin levels in the brain, while benzodiazepines increase the effect of a brain chemical called GABA. This chemical (GABA) reduces brain activity in the areas of the brain responsible for rational thought. 

Around 20-30 percent of people diagnosed with an anxiety disorder don’t respond to these traditional treatments. In addition, an antidepressant and benzodiazepine treatment may take 6 to 12 weeks to work. That’s a long time for a person with a severe anxiety disorder to start noticing improvements, which drives the search for other molecular targets. 

This is when ketamine enters the picture. Unlike these drugs, ketamine is considered a “dirty drug.” That means it may bind to different molecular targets or receptors in the body. Its versatility explains its wide range of effects on various conditions. Most importantly, ketamine works faster than traditional medication. 

Researchers believe that ketamine stimulates the regrowth of synapses (connection between neurons) and rewires the brain. Ketamine affects the serotonin neurotransmitter (the one targeted by antidepressants). But, in general, it acts on the glutamate system. Glutamate is the most common chemical messenger in the brain. It plays a major role in learning and memory. 

A growing body of evidence suggests the involvement of glutamate in anxiety disorders. One study showed that adolescent patients diagnosed with Generalized Anxiety Disorder (GDA) showed a positive correlation between glutamate-related activity and severity in anxiety symptoms. Glutamate may also mediate the brain’s response to stress and formation of traumatic memories [2]. 

More research is needed to determine how ketamine affects the brain and produces anti-anxiety effects. 

Effectiveness of Ketamine Infusion Therapy For Various Anxiety Disorders

Studies on ketamine and anxiety disorders show its effectiveness with general anxiety disorder, social anxiety disorder, and anxious depression. 

Social anxiety disorder

One double-blind, randomized trial published in Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology investigated the effects of this drug on social anxiety disorder. Eighteen adults diagnosed with social anxiety disorder received 0.5mg/kg intravenous ketamine (and placebo) in a random order for 28 days [3]. 

Researchers found that ketamine resulted in a significant reduction in anxiety compared to placebo within the first two weeks following infusion. They measured the progress on the Liebowitz Social Anxiety Scale (LSAS).  

Generalized anxiety disorder

Researchers evaluated the efficacy and safety of ketamine in 12 patients with treatment-resistant generalized anxiety disorder and/or social anxiety disorder who were not currently depressed. They used an ascending single-dose study design (0.25, 0.5, 1mg/kg) at weekly intervals. The study revealed that within 1 hour of dosing, patients reported reduced anxiety, which persisted for up to seven days [4]. 

The patients tolerated the drug well. Researchers concluded that ketamine might be a potential therapeutic alternative for these patients. They also point out the potential efficiency of this drug in disorders characterized by negative emotional states. 

Anxious Depression

Around 67% of patients with a depressive disorder also suffer from anxiety. The presence of two conditions at the same time is known as comorbidity and makes the disorder particularly difficult to treat [5]. 

A study performed by the researchers at the Massachusetts General Hospital investigated the effects of ketamine on 99 patients with treatment-resistant depression, out of which 45 had anxious depression. The patients either received ketamine at one of the four doses (0.1, 0.2, 0.5 or 1.0 mg/kg), or midazolam at a dose of 0.045 mg/kg [6]. 

The study revealed that ketamine is equally effective in treatment-resistant depression with or without anxiety — when measured on the first and third day after infusion. On day three, the non-anxious patients responded significantly better at the lowest dose (0.1 mg/kg) than the anxious group. 

However, within 40 minutes of receiving the infusion, the patients with anxious depression experienced fewer “dissociative” symptoms — memory loss and a sense of detachment — than participants without anxious depression. 

The correlation between dosage and its anti-anxiety effects 

At what dose do patients with an anxiety disorder respond to ketamine? 

A study published in the Journal of Psychopharmacology looked at the dose-related effects of this drug on anxiety symptoms in patients with treatment-refractory anxiety disorders. Researchers noted a dose-response profile of the drug on:

• Anxiolytic effects (anti-anxiety effects)
• Dissociative side effects
• Changes in blood pressure and heart rate

They noticed minor changes at 0.25 mg/kg, and progressively greater and more durable changes at the higher doses. Ten out of 12 patients responded to ketamine dose of 0.5 – 1mg/kg [4]. 

What’s the process of getting ketamine therapy for anxiety? 

Let’s walk you through the ketamine infusion process from beginning to end. 

Step 1: Initial Assessment 

Before starting your therapy, the team in charge of the clinic you choose should schedule an initial assessment. This assessment aims to get a comprehensive mental health screening and a general physical and medical exam. Make sure the clinic you choose is reliable, equipped with a psychiatry team, a certified nurse anesthetist, or an anesthesiologist.

For additional safety, the clinic should ask you to do a urine test to rule out indications of illicit drug abuse. They should ask you for proof of valid prescription for controlled medication. 

This process may seem thorough and burdensome, but it’s of utmost importance that you follow through and keep it honest with the doctors. 

Step 2: Infusion Session

On the day of the infusion session, you’ll meet the anesthesiologist, who will walk you through the treatment process. Then, it’s a relaxing time! They will seat you on a comfortable lounge chair, give you headphones to listen to music, or turn on the TV.

One infusion secession typically lasts from 40-45 minutes, some may last to an hour. An anesthesia professional will closely monitor you and check if you’re feeling anxious or restless. 

Step 3: After Session

The medical staff should give you another assessment after the treatment. They should provide ongoing support and discuss your symptoms in the following days. 

Important: Invite a partner, family member, or a friend to accompany you. Driving is not permitted within the first couple of hours after the session. 

What do ketamine infusions feel like? 

It depends on the person. During the ketamine infusion, you may: 

• Feel like you’ve taken a few glasses of wine
• Experience stronger “dissociative” feeling, or an out-of-body experience
• Hallucinate intense atypical colors and visuals
• Stay clear-headed and grounded, feeling an increased appreciation for life and music
• Have a groundbreaking realization that anxiety doesn’t define you 
• Experience numbness and a tingling sensation in the entire body
• Have control over your thoughts and know that you are safe

You may start feeling anxious. If this is the case, communicate it with the doctor. They will adjust your dose and monitor you further. If the anxiety becomes severe or unpleasant, tell your caregivers. 

After the ketamine infusion, if you respond to the treatment well, you should feel the effects of the drug almost immediately. 

A few hours after treatment or by the next morning, you will feel an overwhelming sense of relief. 

How safe is ketamine for anxiety? 

Ketamine is a pretty safe drug if used in the correct way and under medical supervision. Some patients continue treatment with standard antidepressants or mood stabilizers during ketamine therapy. 

What about benzodiazepines (anti-anxiety medications)?

Some medications for mood disorders affect the same pathways in the brain as ketamine. This means that they may affect the efficacy of ketamine. Benzodiazepines like Xanax, Ativan, and Kloponin, are a common anxiety therapy. 

Using benzos during a ketamine treatment might reduce the effectiveness of this drug. This means a longer time to see improvement in mood and feeling better. One study found that “benzodiazepines attenuate ketamine’s antidepressant effect in patients with major depressive disorder [7].” 

As with any therapy, ketamine may cause some minor side-effects. If you experience serious side-effects within 24 hours after therapy, tell your caregivers immediately. 

Serious side-effects include:

• Severe confusion
• Hallucinations
• Unusual thoughts
• Extreme fear
• Painful or difficult urination

Most common side-effects:

• Dream-like feeling
• Dizziness
• Drowsiness
• Nausea
• Vomiting
• Loss of appetite
• Blurred vision
• Double vision
• Sleep problems (insomnia)

Risks of ketamine infusion

You should not undergo ketamine therapy if you have untreated or uncontrolled high blood pressure. This drug increases blood pressure and heart rate in some people, so take extra precautions if you have any cardiovascular problems. 

If you’ve had any issues with psychosis in the past, this drug might make it come back. If the psychosis is undiagnosed, it might make it worse.  

In high doses, ketamine may cause severe urinary problems that may lead to bladder removal. 

Never take alcohol, opioids, or other substances that may depress breathing during treatment. 

Long term, frequent use may cause cognitive impairment and memory problems. Occasional use (once or twice a month) is fine [8]. 

Why do some patients experience anxiety during ketamine treatment for depression? 

One study demonstrated that patients with major depressive disorder who respond negatively to the treatment experience higher anxiety during ketamine infusions. In the study, 31 patients received three ketamine infusions per week. The dosage was the standard 0.5mg per kg and the patients received this therapy for two consecutive weeks. 

“After six infusions, 17 of 31 patients (55%) showed a response to ketamine treatment, while 14 patients (45%) had no response. Anxiety-related experiences induced by ketamine were significantly higher in non-responders [9].”

Maintenance ketamine treatments for treatment-resistant anxiety? 

The main unresolved question of ketamine therapy for mood disorders is: how to maintain improvement in symptoms? 

Researchers don’t know how long-term use of this drug affects the brain. So, most clinics schedule maintenance treatments between longer intervals while considering patients’ needs. 

The first few ketamine treatments are stabilization treatments. Most patients report recurrence of anxiety symptoms within a week after dosage. So, to keep the symptoms at bay, doctors recommended maintenance treatments. 

One 2018 study published in the Journal of Psychopharmacology evaluated the safety and efficacy of maintenance ketamine treatment in patients with treatment-resistant generalized anxiety (GAD) and social anxiety disorders (SAD) [10]. 

Twenty (20) patients received one or two weekly ketamine doses (1mg/kg injected subcutaneously or under the skin) for three months. Fifteen patients (75%) met criteria for generalized anxiety disorder and 18 (90%) for social anxiety disorder. 

“Ketamine was administered as a subcutaneous injection in the upper arm, using each individual patient’s highest tolerated dose. Dosing frequency was based on duration of response to ketamine: those who remained free of anxiety for 5 days or longer were dosed once weekly, whereas those with shorter duration of response could be dosed twice weekly.”

RESULTS: 

• Researchers concluded that maintenance treatment of 1-2x weekly dosing (1mg/kg) up to 3 months is safe and well-tolerated. 
• Eighteen patients completed 3 months of maintenance therapy, and all of them reported improvements in social and work environment. 
• Twenty-five (25) percent of patients remained anxiety free after the treatment. 
• Patients tolerated the treatment well, making improvement in work and social functioning. 
• Researchers noted the same side effect as during the first treatments, including nausea, dizziness, and blurred vision.  

The most striking benefit of ketamine maintenance treatment was the improvement in work and social functioning. 

Ketamine treatments enabled patients to make substantial changes to their lives. Some of them got jobs or boosted work performance. Others went back to school and experienced significantly better social lives. All of these changes seemed impossible before the treatments. 

Anecdotal evidence shows that people who have been taking ketamine therapy for mood disorders for over a decade — typically via a muscle injection — haven’t seen major side-effects. They do feel dependent on it, just like when taking anti-anxiety medication or antidepressants. But, aside from that, individuals who respond to ketamine therapy continue to roll safely with it.  

Cost of ketamine therapy for severe anxiety

What is the out of pocket cost for one treatment of ketamine therapy for severe anxiety?

It depends on the clinic. The lowest price most clinics offer to administer one ketamine treatment is $350 per infusion. At that cost, they typically include:

• The visit (a private or shared room) 
• The infusion (plus supplemental medications you may need during treatment)
• The monitoring (an RN nurse or paramedic to monitor vital signs). 

Before getting an infusion, you need to go through an evaluation that can cost anything from $150-$250. 

If you have insurance that the clinic accepts, you won’t have to pay for the evaluation visit, the main visit to get the drug, the infusion, and monitoring. The only thing you have to pay for, in this case, is the ketamine medication. Most clinics take insurance, but insurance doesn’t pay for the drug. The reason for that is that ketamine is still an off-label medication for anxiety. 

High-end clinics can charge as much as $800 per infusion. For mood disorders like severe anxiety, you’ll need a series of 6 infusions over a 2-3 week period. 

Can I just have one ketamine treatment for severe anxiety? You can, but it might not be enough. Research shows that if the patient doesn’t respond to the first two ketamine treatments, then this medication might not be right for them. So, it’s better to have 2-3 treatments to see if this therapy will help your anxiety. 

Is it legal? 

Ketamine is a Schedule III drug under the Controlled Substance Act, meaning it has a moderate to low abuse potential. Its current accepted medical use is for induction and maintenance of anesthesia. According to this classification, ketamine is safer than cannabis, which is a Schedule I controlled substance. 

This means that your caregiver cannot prescribe ketamine as an anxiety medication. But, they can recommend it off label. This is the premise on which ketamine clinics operate lawfully. Ketamine infusion therapy is an off-label use for mood disorders, like treatment-resistant anxiety disorder and chronic pain.

Off-label use of a drug simply means that a drug is used for another disease in another form than the one approved by the FDA. For example, a drug is:

• Used for a disease or medical condition that it is not approved to treat, such as when a chemotherapy is approved to treat one type of cancer, but healthcare providers use it to treat a different type of cancer.

• Given in a different way, such as when a drug is approved as a capsule, but it is given instead in an oral solution.

• Given in a different dose, such as when a drug is approved at a dose of one tablet every day, but a patient is told by their healthcare provider to take two tablets every day.

It’s important to know that ketamine clinics must have a DEA license and register the medical professionals that administer, store, or distribute the drug. 

Clinics choose how to operate their business. Most rely on clinical research and guidelines like the consensus statement in Regional Anesthesia & Pain Medicine and comprehensive checklists by the American Association of Nurse Anesthetists.

Find a legal ketamine clinic nearby:

• Alabama
• Alaska
• Arizona
• Arkansas
• California
• Colorado
• Connecticut
• Delaware
• District of Columbia
• Florida
• Georgia
• Hawaii
• Idaho
• Illinois
• Indiana
• Iowa
• Kansas
• Kentucky
• Louisiana
• Maine
• Maryland
• Massachusetts
• Michigan
• Minnesota
• Mississippi
• Missouri
• Montana
• Nebraska
• Nevada
• New Hampshire
• New Jersey
• New Mexico
• New York
• North Carolina
• North Dakota
• Ohio
• Oklahoma
• Oregon
• Pennsylvania
• Rhode Island
• South Carolina
• South Dakota
• Tennessee
• Texas
• Utah
• Vermont
• Virginia
• Washington
• West Virginia
• Wisconsin
• Wyoming

Ketamine therapy for anxiety disorders FAQs

The post Using Ketamine Infusion Therapy For Anxiety appeared first on Ketamine Therapy HQ - Find Local Ketamine Therapists.

This in-depth article covers everything you need to know about the benefits of ketamine for depression, including how it works, how it’s used, all about the treatment as well as legality.  

In this article, you’ll learn: 

1. What is ketamine? 
2. How it works and helps severe depression
3. Why do antidepressants fail? 
4. How does ketamine work as an antidepressant? 
5. What is the process to receive ketamine treatment for depression?
6. Dosage and length of treatment
7. Cost of treatment
8. Differences between ketamine infusion and nasal spray
9. Risks and side-effects
10. Legality
11. FAQs

What’s it like to get ketamine therapy for treatment-resistant depression?

To people who have battled severe depression unsuccessfully for years, it feels like the heaviness that consumed their lives has been lifted. Before treatment, they could barely get out of bed. After treatment, they have their life back. 

In the U.S., over 17 million people (7% of adults) are dealing with this condition. While most receive some sort of treatment, about 35% of people who suffered a major depressive episode don’t. 

Patients with major depressive disorder see ketamine as their rescue drug — the last glimmer of hope that can pull them out of the darkness of depression. Research reveals that his drug rapidly improves mood and reduces suicidality compared to placebo or antidepressants. 

What is ketamine? 

Ketamine is traditionally known as an anesthetic with dissociative properties. A dissociative is a drug that causes a trans-like state or mind and body “separation.” 

Doctors use it religiously in the emergency room. If a patient comes in with an injury like a dislocated shoulder — they give him ketamine. Aside from its analgesic effects, this medicine causes brief memory loss. That way, the patient won’t remember when his shoulder popped back into place. The World Health Organization approved ketamine as one of the safest and most efficient anesthetic drugs. 

On ketamine, the user experiences visions and altered physical sensations, which is why it’s often used recreationally. 

The antidepressant effects of this medicine started getting the attention of both psychiatrists and patients two decades ago. A 2000 study published in Biological Psychiatry was the first one to assess the treatment effects of a single dose of ketamine on patients with depression [1]. 

Today, a growing body of researchers and psychiatrists recommends ketamine for treatment-resistant depression, off label. “Off label” means that your psychiatrist can’t prescribe you this medicine for depression yet, because it’s not FDA approved for this condition. So, its current lawful use in ketamine clinics is “off label.” 

How ketamine works and helps severe depression? 

Until more research is done, ketamine is recommended and used on patients with diagnosed treatment-resistant depression. There are several definitions of depression resistant to treatment. But the general consensus is that patients are diagnosed with it when: 

• They’ve tried at least two trials with antidepressants from different pharmacologic classes.
• Both trials were adequate in dose, duration, and compliance. 
• Both failed to produce a significant clinical improvement like remission or at least 50% improvement in mood. 
• The psychiatrist has reassessed the patient to reinforce the diagnosis.  

The treatment options for patients diagnosed with treatment-resistant depression are limited to psychotherapy, medication therapy, and electroconvulsive therapy. The issue with these traditional treatments is that they take too long for the patient to respond to them (if they respond at all) or come with a set of side effects. 

Ketamine is different. As an experimental drug, it has shown one of the fastest prevention of suicidal thoughts in severely depressed patients. Suicide is a major public health concern and a leading cause of death in the U.S., causing more deaths than breast cancer annually.  

One 2006 study looked at the effects of ketamine on 18 patients with treatment-resistant depression. The study performed by the National Institute of Mental Health revealed that ketamine improved depression symptoms in 71% of patients within one day. Twenty-nine percent (29%) of patients saw a complete reduction of symptoms [2]. 

A new study on this drug for depression published in the June 2020 issue of Translational Psychiatry confirmed what doctors already were seeing in patients. Ketamine works extremely quickly and benefits patients with major depressive disorder, even in low doses [3]. 

In the study, researchers used brain scans of 30 participants with a major depressive disorder who have tried antidepressant treatment. After a low dose of ketamine — 0.5mg per kg — the scans showed an increased number of serotonin receptors within 24 to 72 hours. Serotonin is a chemical that contributes to mood regulation and feelings of wellbeing. Such quick results were seen in 72% of participants. 

Its fast-acting qualities make ketamine potentially the first “anti-suicide” drug [4].

Why do antidepressant treatments fail? 

To understand what stands behind the effectiveness of ketamine for treatment-resistant depression, researchers are on a quest to find what actually causes depression. More importantly, what changes in the brain of a depressed person.

To get a better understanding of how this drug works in the brain, we’ll compare it to two traditional types of antidepressants: Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs).  

As the name suggests, SSRIs and SNRIs are two different types of antidepressants that act on different neurotransmitters. Neurotransmitters are chemicals in the brain that help carry nerve signals between neurons. 

The main theory of antidepressants is that they change the levels of the monoamines (a particular group of neurotransmitters) in the brain. The main monoamines are dopamine, norepinephrine, and serotonin.

While serotonin can have both excitatory and inhibitory roles, norepinephrine is a strictly excitatory neurotransmitter (meaning it facilitates happiness).  

Antidepressants prevent the reuptake of these neurotransmitters in the brain. The term reuptake indicates the process of reabsorption of the neurotransmitter by the cell that originally produced it.

The process of reuptake reduces the availability of a neurotransmitter because the brain absorbs it. So, by blocking the reuptake process, antidepressants increase the availability of these neurotransmitters. 

Serotonin helps the body regulate mood. So, when this neurotransmitter is too high or too low, the person may become depressed. Antidepressants increase serotonin levels in the brain, helping the person cope with the symptoms. 

Norepinephrine also regulates mood, as well as sleep, attention, and memory. Low norepinephrine causes poor concentration and potential symptoms of attention deficit hyperactivity disorder (ADHD).

While SSRIs work on the serotonin in the brain, SNRIs work on both serotonin and norepinephrine.

In conclusion, antidepressants work on the monoamine (serotonin, norepinephrine, dopamine) neurotransmitter system. But, here’s the issue. 

Researchers now believe that depression is more than a brain chemical imbalance. 

They’ve found that more important parts of the brain like nerve cell connections, nerve cell growth, and nerve circuits have a major impact on depression. Although they don’t know the whole ordeal yet, they are exploring the potential connection between sluggish production of new neurons in the hippocampus (a complex brain structure that plays a major role in learning and memory) and low moods.

A significant fact that supports this new theory is that antidepressants boost concentration of neurotransmitters (chemical messengers in the brain) immediately, but it takes several weeks for people to start feeling better. Up to two-thirds of patients with major depression do not respond to the first medication prescribed.

Experts have wondered why people don’t feel better as soon as the levels of neurotransmitters (serotonin, dopamine) increase. The new theory is that mood improves as nerves grow and form new connections — this is a process that takes weeks. 

Animal studies show that antidepressants do spur growth and connection of new cells. So, their real value might be in creating new neurons and improving the exchange of information between nerve circuits, known as neurogenesis. If that’s the case, antidepressants should be developed in a way that promotes neurogenesis.

Researchers theorize that this potential process of new brain cell growth has already been happening with ketamine. 

Antidepressant effects of ketamine

Researchers are still investigating the effects of this substance on the brain. The leading theory is that this drug stimulates the regrowth of synapses (connections between neurons) and rewires the brain. An extremely different function compared to antidepressants, because it doesn’t only affect one “monoamine” neurotransmitter like dopamine and serotonin, but acts on an entirely different pathway known as glutamate. 

Glutamate is the most common chemical messenger in the brain and plays a huge role in learning and memory. And this is why researchers believe neuroplasticity — the brain’s lifelong capacity to change and rewire itself in response to the stimulation of learning and experience — to be central to the antidepressant effects of this molecule.

Too much glutamate activity in the brain results in over-excitation (toxicity) of nerve cells. Also known as a glutamate storm, this eventually leads to cell death. In people with depression and other mental health diseases, there is a dysfunction in the glutamate system. Several studies have found decreased glutamate levels in the prefrontal cortex in chronic major depressive disorder compared to healthy individuals. 

Researchers still don’t know how ketamine forms stronger neural circuits. But, they have a hypothesis that suggests that ketamine, a “dirty drug” that may bind to different molecular targets in the brain, causes a short-term explosion of neuronal activity. This activity triggers various biochemical reactions that create stronger brain cell connections [5]. 

In the beginning, researchers believed that ketamine blocked the NMDA receptor in the brain. This receptor is a ketamine-binding receptor that causes neurons to release glutamate. 

But, there’s recent evidence that that’s not entirely true. Researchers now believe that ketamine acts through a different receptor that binds glutamate, known as AMPA. Knowing the receptor this drug acts on will bring them a step closer to developing another drug that acts on that receptor, but with fewer side effects [6].  

Ketamine Therapy for Treatment-Resistant Depression

Wondering if you’re eligible for ketamine infusion therapy? Here are the most important things you need to know if you are interested in getting or suggesting this treatment to your doctor. 

Ketamine is not a first-line treatment. This means that it’s only given to adults age 18 and older who are diagnosed with moderate to severe depression. These patients have not had success with antidepressants and are diagnosed with treatment-resistant depression. If that’s the case with you, contact your therapist or a reliable ketamine clinic for a consult. 

Ketamine doesn’t cure treatment-resistant depression. It provides immediate relief that can last for a few weeks, but its effects wear off afterward. Some patients use the quick “boost” to continue with therapy and other treatments for depression. Others get ketamine muscle injection “boosters” once in a while to keep them going. 

Even in low doses, ketamine can cause vivid hallucinations. During treatment, you may feel extremely relaxed, have an out of body experience, see sensational colors and visuals, and simply appreciate life. Some people compare the effects of the treatment with taking a few glasses of wine. 

What is the process to receive ketamine treatment for depression? 

To get ketamine treatment, you will first go through a comprehensive evaluation. A psychiatrist performs the evaluation by looking at the medical history and basic lab results to ensure this treatment is safe. It’s recommended to choose a clinic with an anesthesiologist on board because they are experts in ketamine.

1. Free consultation. Most ketamine clinics offer a free phone consultation with their specialists. The initial consultation should be about scheduling an evaluation, not scheduling the actual treatment. Please beware of clinics that do not evaluate your mental and physical state before suggesting therapy, this is a huge red flag. 

1. Psychiatric evaluation. Reliable clinics provide a 60-90-minute evaluation by a psychiatrist that specializes in treatment-resistant depression. The psychiatrist will determine if ketamine therapy is right for you or you should move in another direction. 

1. Evaluation of basic lab results. The clinic should also evaluate the basic lab results to ensure this treatment is safe for you.

Dosage and length of treatment

If you get the green light from the experts, you will soon start your ketamine treatment. 

They will determine the dosage and length of therapy. The typical dosage is 0.5mg per kg, as used in most research trials. Some clinics recommend doing six (6) infusions over the course of two weeks, while others recommend 8-12 treatments over 4-6 weeks. With the latter option, patients get two treatments a week within the course of two (2) weeks, with the rest being follow-up “boosters” recommended by a psychiatrist. 

The effects of ketamine are felt immediately after finishing the treatment. But, they start to wear off in a few weeks or months after the last treatment. 

An expensive treatment

Because it’s an experimental treatment, ketamine is not covered by insurance. This treatment can cost anything from $300 to $750 per infusion, which is very expensive, and not everyone can afford to stay on it. As this therapy becomes more accepted, insurance companies are slowly getting interested in it. 

Can I do one infusion? You can, but for better results, you should do at least three. Keep in mind that around 20-30 percent of patients with treatment-resistant depression don’t respond to this medicine. So, if you don’t feel the relief after a few treatments, consider the thought that it may not work for you. 

According to studies, if ketamine doesn’t work after two treatments, it won’t work for the patient. If effective, the patient experiences a significant improvement in symptoms within the first day. Researchers are now trying to find out how long the follow-up periods should last for responsive patients [7]. 

Does it matter if ketamine is administered via IV or nasal spray (esketamine)? 

Yes. An IV infusion always delivers a more precise dose than a nasal spray. Things can get complicated if a person has a cold or their nasal mucosa is damaged. If that’s the case, the nasal spray won’t deliver the same dose as an infusion. The nasal delivery and absorption of a drug depends on the type of drug used, its concentration, dose, and volume. An IV drug administration results in fast delivery of the dosage to the brain and rapid onset of drug effects. 

The most important difference between ketamine and the nasal spray (brand name: Spravato) is that they are not the same. Esketamine (S-ketamine) is the left-facing enantiomer in the ketamine molecule (R-ketamine being the right-facing one). As such, it possesses some of ketamine’s beneficial properties, but not nearly all. 

Esketamine is an FDA-approved form of ketamine for treatment-resistant depression that can be used via a nasal spray. The spray was approved in 2019 and must be administered in a certified doctor’s office or clinic. Why? Experts worry that esketamine is as much habit-forming as regular ketamine. It can be hard for a patient dealing with treatment-resistant depression to control the dosage and may end up over using it. After taking the dosage, patients should be monitored for up to two hours. Legally, patients are not allowed to take the spray at home. 

Despite their differences, both can bring relief to those who suffer from depression. 

In one four-week clinical study, a group of subjects was given Spravato for four weeks vs. an oral antidepressant. Another group took placebo and an oral depressant. The results showed improvement in depression symptoms in the first group, especially within the first 24 hours [8]. 

Is there a price difference between ketamine infusion and esketamine (Spravato) nasal spray?

Yes. Esketamine is generally advertised as less expensive than ketamine infusion. But unless it’s covered by insurance, you’d be surprised to learn that esketamine is actually more expensive. This is because most clinics charge the service of administering the drug in their offices. In some clinics, the cost of the service of administering the medicine can go up to $650. This equals the cost of a single ketamine infusion. 

This doesn’t include the cost of the actual drug, which, again, may be covered by insurance. The cost for Spravato nasal spray — two 28mg sprayers — is around $240 per beginning dose of 56mg. If the dose is increased to 84mg, the patient needs to buy 3 sprayers instead of 2. The patient should get a dose of 84mg twice a week for 4 weeks, which adds up to over $5 000 per course of therapy [9].   

If the medicine is covered by insurance, and you’re administering it at a doctor’s office, it shouldn’t cost you more than $200 for the service per course of therapy. 

Risks and side-effects

Ketamine treatment for depression is administered in low doses, which makes it a safe and effective medicine. You can (and is recommended) to use antidepressants while receiving your therapy. 

There is a risk that the drug will change your blood pressure and heart rate, monitored closely in the clinic. One 2017 JAMA Psychiatry analysis revealed that long term use of ketamine in people who abuse it repeatedly, over long periods, causes memory loss and severe bladder damage [10]. 

You should not mix ketamine with heart meds, alcohol, opioids, or other drugs that depress breathing. 

Common side effects

• Increased blood pressure
• Increased heart rate
• Anxiety (especially in people with underlying psychosis)
• Urinary retention
• Urge to pee more frequently
• Dizziness
• Dissociation
• Confusion
• Lightheadedness
• Loss of coordination
• Bad flashbacks
• Tremors or shaking

Some of these side-effects happen immediately after treatment but wear off pretty quickly. Most patients describe them as insignificant compared to the beneficial effects of ketamine. Ketamine reverses depression in 30% of people with severe depression who don’t respond to other treatments. 

One of the most significant concerns about using ketamine for depression is whether it causes neural damage in the long run. Animal studies show that long-term use may cause neurodegeneration or progressive loss of structure or function of neurons. That’s why medical professionals advise against taking ketamine and microdosing at home without supervision [11]. 

Large doses of ketamine are addictive because this drug can bind to opioid receptors. This raises the alarm that even low doses can lead to dependence if used long term. But, long term use may be the key to maintaining these diseases at bay. Maintenance, length of treatment, and dosage are just a few things that experts don’t know about ketamine therapy for depression. 

Ketamine is NOT recommended for patients who have had or may have psychosis. The effects of this drug (even in low doses) are similar to those of schizophrenia. Ketamine is a strong dissociative anesthetic that causes the person to hallucinate, experience unusual thoughts, and emotional withdrawal. It has shown to exacerbate psychotic symptoms in such patients and may trigger the disorder to come back. 

Are ketamine clinics legal?

Yes, they are! Ketamine clinics operate lawfully by using ketamine for depression off label. What is an off label use of a drug? It’s a very common practice when the doctor prescribes a drug for a medical condition other than the original FDA-approved use. 

For example, Prazosin (Minipress) is approved for hypertension but is also used off label to treat PTSD triggered nightmares. Clonidine (Catapres) is approved for hypertension treatment, but it’s used off label for ADHD, hot sweats, nicotine dependence, migraine headaches, etc. Research shows that about 12% to 38% of all prescriptions are off label. 

Ketamine is a Schedule III drug under the Federal Controlled Substances Acted from 1999. As a Schedule III drug, it shows a “moderate to low potential for physical and psychological dependence.” 

So, if a doctor judges that a patient with treatment-resistant depression should undergo ketamine infusion therapy, they can prescribe it off label. Ketamine clinics must receive a DEA license and consider both state and local laws before opening. 

Find a legal ketamine clinic in your state:

• Alabama
• Alaska
• Arizona
• Arkansas
• California
• Colorado
• Connecticut
• Delaware
• District of Columbia
• Florida
• Georgia
• Hawaii
• Idaho
• Illinois
• Indiana
• Iowa
• Kansas
• Kentucky
• Louisiana
• Maine
• Maryland
• Massachusetts
• Michigan
• Minnesota
• Mississippi
• Missouri
• Montana
• Nebraska
• Nevada
• New Hampshire
• New Jersey
• New Mexico
• New York
• North Carolina
• North Dakota
• Ohio
• Oklahoma
• Oregon
• Pennsylvania
• Rhode Island
• South Carolina
• South Dakota
• Tennessee
• Texas
• Utah
• Vermont
• Virginia
• Washington
• West Virginia
• Wisconsin
• Wyoming

Bottom Line

Major depressive disorder is one of the most disabling mental health conditions. Researchers are on a quest for new therapeutic approaches to treat or delay the onset of this disorder. Ketamine is, so far, proving to be the most effective drug for treatment-resistant depression. This therapy works quickly, in some patients in just a few hours, and delivers significant relief. The most impressive thing about this drug is that it works in patients who have “tried everything” and found no relief.

Ketamine Infusion Therapy For Depression FAQ

The post Ketamine Therapy For Depression – How It Works appeared first on Ketamine Therapy HQ - Find Local Ketamine Therapists.

If you’re brand new to ketamine therapy for mental health disorders — you’re in the right place. 

This guide covers everything you need to know about the benefits of ketamine infusion therapy  for mental health and addiction disorders. Learn how it’s used, potential side-effects, microdosing, safety, and more. 

This Guide Covers the Following Ketamine Therapy Topics:

Part I: Ketamine Overview

• What is ketamine? 
• How does ketamine work as a treatment? 
• How does it affect the brain? 
• The correlation between dosage and beneficial effects
• Is microdosing ketamine safe? 
• Administration methods of ketamine
• Benefits & uses
• Differences between esketmaine and ketamine

Part II: Ketamine Infusion Therapy 

• What to expect: before, during, and after ketamine infusion therapy
• Price of treatment
• Is ketamine treatment covered by insurance? 
• Risks, side effects, drug interactions 
• Is ketamine infusion therapy safe? 

Part III: Legality

• Is ketamine legal?
• Are ketamine clinics legal?
• FAQs

Around the world, ketamine is known in the extremes. Either as a government-approved anesthetic used in both human and veterinary medicine. Or, as a dangerous psychedelic, known in the streets as Special K, Kit Kat, K, or Super Acid. 

The idea that ketamine can safely and effectively relieve symptoms of treatment-resistant depression and mood disorders may sound a little… unexpected.

How can one component have such a profound impact on severe mental health conditions and, at the same time, hold such peril? 

The answer lies in the dosage and, most importantly, how your brain reacts to it.  

In this guide, we touch on everything you need to know about ketamine therapy for depression and mood disorders. We’ll explain legality, benefits, how it affects the brain, how to find treatment, and so much more.    

What is ketamine?  

Ketamine was developed in 1962 as an anesthesia medicine to replace phencyclidine (PCP). Phencyclidine, also known as angel dust, was an anesthetic that worked well but caused a major side effect — hallucinations in people after waking up [1]. 

At first, this drug was tested on animals and became a very effective horse tranquilizer. Today, ketamine is on the World Health Organization’s Model List of Essential Medicines as one of two general anesthetics. This list incorporates “the most efficacious, safe, and cost-effective medicines for priority conditions.” 

Ketamine was tested on prisoners and was given to the soldiers fighting on the Vietnam War battlefields. More recently, it was used during one of the most difficult rescue missions of all time — when 12 boys and their coach were trapped for 10 days in a flooded Thai cave. The 2018 ordeal involved over 10,000 people and the sedative power of ketamine.

At lower doses, this drug can help ease pain and may assist patients need fewer addictive painkillers (like morphine) after surgery. If the limits are crossed, things take a turn. Known as Special K, ketamine is a powerful psychedelic drug. Due to its ability to produce a feeling of dissociation or mind-body separation, it’s a well-known party drug. You might have heard of it as a “date rape” drug because it prevents the sedated person from speaking or moving. 

Even in the lowest doses, this medicine can produce intense effects like vivid hallucinations (typically pleasant ones) or altering the person’s sense of sight and sound. The user may feel confused, out of touch with their surroundings and even with themselves. 

Studies performed in the 1990s compare the effects of ketamine to the symptoms of schizophrenia. Aside from hallucinations, users may experience unusual thoughts, disorganized speech, and emotional withdrawal. This doesn’t mean that the person will become psychotic after taking ketamine. Once the effects of the drug wear off, the person is back to normal [2]. 

How Does Ketamine Work as a Treatment

Here are the five main things that you need to know about ketamine as a treatment for mental health disorders: 

• Ketamine is an experimental treatment for treatment-resistant depression and severe mood disorders. Your doctor cannot prescribe ketamine for depression because this drug is not an FDA-approved medicine for mental health conditions. All ketamine infusion clinics use it off label because, for now, it’s only approved as an anesthetic and a nasal spray.  

• Provides immediate relief typically from an hour to a day after administration. In comparison, antidepressants take weeks to work (if they do). In very low doses, it reverses the depressive state of the person within hours, even if they haven’t felt relief in decades. 

• Ketamine doesn’t cure treatment-resistant depression and other mood disorders permanently. It only provides very effective relief. 

• Not everyone is eligible for ketamine therapy. Ketamine is a strong psychedelic that works only in people with treatment-resistant depression and severe forms of some mental health disorders. It is NOT recommended for patients with schizophrenia and schizophrenic tendencies because it may exacerbate their symptoms. 
• Doctors are against patients experimenting with the drug on their own. That’s unsafe, it can lead to abuse and addiction. 

We’re not at the point where you can be prescribed ketamine for your depression. For now, your doctor can only recommend it as an off label medicine treatment-resistant depression and mood disorders. 

Check the legality section of the article for more info on how ketamine clinics lawfully use this drug off label. 

What ketamine does to your brain? 

The precise mechanisms of action of this drug in the body are still unknown. What science reveals is that ketamine is a so-called “dirty drug.” In pharmacology, that’s a term used to describe a molecule that may bind to various receptors and molecular targets in the body. As a result, it produces a wide range of potential effects and adverse drug reactions. The drug’s ability to act on so many targets is what gives it an advantage and at the same time,  raises concerns. 

Researchers don’t exactly know the exact receptors this molecule targets. The main difference between ketamine and other drugs, like antidepressants, is that ketamine assists neurons and synapses that don’t function properly in patients’ brains. On the other hand, antidepressants focus on increasing chemicals in the brain, as researchers believe that depression is a result of a chemical imbalance.     

The key thing about antidepressants is that they change the levels of monoamines in the brain. Monoamines are a particular group of neurotransmitters in the brain that includes dopamine, norepinephrine, and serotonin. Ketamine does have a mild effect on the serotonin and dopamine system in the brain. 

But, the reason it works so well for treatment-resistant depression is that it influences an entirely different system, known as the glutamate neurotransmitter system. 

Scientists believe that there is a connection between altered glutamate levels in the brain and depression. This neurotransmitter is known as the workhorse of the brain that relays fleeting thoughts and feelings. 

Most importantly, it enables the formation of memories by strengthening synaptic connection. As the brain doesn’t grow new neurons to store memories, glutamate strengthens the connection between existing neurons. Glutamate is the reason why you can still swim years after you’ve learned, even if you haven’t practiced. 

The glutamate system works via several receptors. In  the beginning, researchers believed that ketamine worked through the NMDA (N-methyl-D-aspartate) receptors in the glutamate neurotransmitter system. The main theory was that ketamine blocks the NMDA receptor, and the person gets healthy activity in the brain.  

But, this hypothesis was debunked when several drugs designed to bind with this specific NMDA receptor failed in clinical trials for depression. 

Researchers now believe that ketamine may work through a different receptor that binds glutamate, known as AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid). Discovering the receptor that ketamine acts on is important for researchers to develop a similar drug with fewer side effects [3].   

The benefits are in the dosage

Medical professionals still don’t have all of the answers about the “right dosage” of ketamine that a person should receive. Most clinics follow university research protocols for both guidance and a more unified approach. 

Dozens of studies show that a low dose of ketamine delivered intravenously (IV) can relieve symptoms of depression. Its power to act against the most severe depressive symptoms, like suicidal thoughts, within mere hours, is the most impressive thing about this medicine [4]. 

Low doses are effective for mental health conditions

In essence, the efficacy of ketamine infusion (IV) therapy comes down to microdosing. When you enroll for your treatment (after getting the green light from your doctor), you will be administered a microdose of ketamine — about 0.5mg per kg. The medicine is administered intravenously, within the course of 40-45 minutes. 

Researchers are still debating the effective dosage of ketamine treatment. This molecule produces numerous side-effects (even at subanesthetic dosage levels), so it’s important to administer it in the optimal quantity. 

A 2018 study tested four different dosage levels on patients with treatment-resistant depression. The dosages were in the range of 0.1, 0.2, 0.5, and 1 mg of ketamine per kg of body weight administered intravenously. 

Researchers discovered that single doses of 0.5 and 1 mg/kg were significantly more effective than placebo over a period of three days. After monitoring the patients for 30 days, researchers discovered that there was “little evidence of the meaningful therapeutic benefits after day 5.” When administered at 1 mg/kg, the effects of the drug lasted between 15 and 30 days, with modest effects [5].

High doses are dangerous

When abused as a recreational drug, this substance is injected in large quantities, about 1-2 mg per kilogram of body weight (compared to 3mg per kg for anesthesia). At such high doses, it produces an intense experience that lasts for approximately an hour. After being injected, the effects kick in in less than five minutes. If it’s an oral application (as a liquid drug taken by mouth), it kicks in after 30 minutes. The effects wear off after two to three hours. 

Higher doses of ketamine get the recreational user into a K-hole. This is nothing less than the user feeling the anesthetic effects of this substance. So, the user is nearly fully sedated and describes the experience as “out-of-body,” or “near-death.” The awareness of the physical environment and body dissolves. The person experiences vivid internal feelings and a distorted sense of time. The dosage to get into a K-hole is from 0.75 mg/lb injected or 1mg/lb insufflated. 

The side effects of high doses of ketamine are paranoia and hallucinations, breathing problems, muscle twitches, dizziness, slurred speech, vomiting, and nausea. Loss of balance, numbness, poor vision, and weakness causes people to get injured. This substance has strong anesthetic properties, and for that is also known as a “date rape” drug. 

Can you overdose on ketamine?

Any substance taken at very high doses can be dangerous. Ketamine is a safe anesthetic, which means it does not suppress respiration, but it’s a strong sedative. 

If used in high doses, you may overdose on ketamine. In medical settings, the dosage is controlled according to people’s body weight. If combined with alcohol or other central nervous system depressants, like opioids and benzodiazepines, it affects breathing and may even cause death.    

What may lead to ketamine overdose is the setting in which this substance is consumed. Most commonly at parties, when it’s mixed with alcohol or other drugs like ecstasy or cocaine.

Is microdosing ketamine safe? 

Microdosing ketamine is a sensitive topic with divided opinions. For now, most doctors recommend ketamine to be taken only in a medically controlled environment, where a team of professionals supervises you. 

What doctors are doing with ketamine for mental health is considered microdosing. They are using about 0.5mg per kg, which is considered a tiny dose compared to over 3mg per kg used during anesthesia. 

According to Dr. Domenick Sportelli, a double Board Certified Psychiatrist, “daily microdosing is a very bad idea.” He recommends that regardless of the dose, patients should only use this drug when supervised.

Studies show that the risk of addiction to ketamine is very minimal if administered in a tiny dose. But, there is a lot of space to abuse this medicine because it’s a dissociative — it helps the person leave reality for a little while. 

“This drug is the perfect addictive substance for someone with a history of mental health conditions,” he adds. Long term use does negatively affect memory. The person also may develop a quick tolerance and become dependent on the medicine. As a result, one may easily become self-destructive. 

Dr. Sportelli is specific that ketamine therapy should be used to get the depressed person out of the storm. And assertive that that’s where we need to keep the treatment for now, until further research. “I don’t think that this should be promoted as something you’re gonna need to be on for the rest of your life and you’re going to have to keep coming back to the ketamine clinic getting monthly boosters.” 

Ketamine Administration Methods

Some people are getting ketamine through an injection, others intravenous in a clinic. Where possible, you might find it as a liquid medicine taken by mouth. 

The major difference between all of these treatments is the cost and efficacy. One 2019 study on ketamine for depression assessed the antidepressant effects of oral ketamine. The study found that in oral form, it displays significant antidepressant effects with good overall tolerability. But, the effects are not as rapid as when taken intravenously [6]. 

There is a lot of uncertainty around the administration methods of ketamine. Most doctors recommend that the treatment should not be administered without medical supervision, consisting of an anesthesiologist. 

Benefits & Uses of Ketamine Treatment

What makes ketamine such a popular anesthetic is that it stimulates circulation despite being a nervous system depressant. Unlike other anesthetics, it doesn’t cause low blood pressure, making it useful for treating people with head injuries [7]. 

What’s ketamine used for? 

It’s used as a legal drug for induction and maintenance of anesthesia. Now, it has been incorporated into the treatment of psychiatric disorders. This includes major depression disorder (MDD), bipolar disorder, and post-traumatic stress disorder. It’s also used for chronic pain management and addiction disorders. 

Ketamine for major depressive disorder

Most of the studies and evidence on ketamine as a treatment for mental health conditions are on treatment-resistant depression.

One 2006 study performed by the National Institute of Mental Health looked at the effects of this substance on 18 treatment-resistant depressed patients. They found that, within 1 day, the treatment improved the depression symptoms in 71% of patients. Twenty-nine percent (29%) of patients noticed a complete reduction of depressive symptoms [8]. 

Patients diagnosed with major depressive disorder: 

• Have tried two antidepressant treatments at an adequate dose for an adequate duration
• And have not responded to treatment

Up to two-thirds of patients with major depression do not respond to the first medication prescribed.

Image Source: https://knowablemagazine.org/do/10.1146/knowable-032819-1/feature/media/G-depression-treatment-full.svg

The most significant concern about patients with treatment-resistant depression is that they are suicidal. The success rate of this molecule on depression speaks volumes — almost double of traditional antidepressants. It works even if the patients have persisted for decades without any relief [9]. 

It shows unmatched efficiency in eliminating suicidal thoughts in a quick and reliable way. This makes ketamine the first potential emergency “anti-suicide” drug [10]. 

Ketamine for post-traumatic stress disorder (PTSD)

Like depression, PTSD can often be found to be treatment resistant. As a novel drug for this condition, ketamine has shown positive results. According to one report, “ketamine has been shown to result in a near-complete resolution of symptoms over the short term and seems to have similar findings to the use of ketamine in major depressive disorder [11].” 

The findings are based on limited data on animal studies and randomized trials. More research is needed to uncover the potential of this medicine for PTSD. 

Ketamine for addiction disorder

A 1997 study revealed that this treatment has the power to imprint new memories about substance abuse in addicts and alcoholics.The study found that around 66% of chronic alcoholic patients remained sober one year after treatment, compared to 24% of chronic alcoholic patients in conventional treatments [12]. 

After the treatment, the researchers noticed that the patients under ketamine therapy identified more strongly with positive self-image than before they started. The patients also had a newfound sense of meaning or purpose, likened to a spiritual or religious conversion.

This medicine also activates the limbic system, potentially strengthening the interaction between conscious and subconscious levels of the mind. Three sessions of ketamine-assisted psychotherapy have also helped heroin addicts keep their sobriety after rehab. The study showed that patients who received more frequent ketamine sessions had significantly higher abstinence rates than those who didn’t [13]. 

Difference between esketamine and ketamine? 

Ketamine is not FDA-approved for depression, so your doctor cannot prescribe it as an antidepressant. What they can do is recommend it to you (after assessment, of course) off label. What they can prescribe for depression is the FDA-approved esketamine — a form of ketamine available as a nasal spray. This medicine was approved by the FDA in March 2019 [14]. 

Ketamine and esketmaine are different. Esketamine is one of the two molecules that form ketamine. Ketamine is a water-soluble PCP derivative that has two enantiomers: an S(+) isomer, also known as “esketamine” and an R(-) isomer, known as “arketamine [15].” 

Esketmaine has a different molecular makeup than ketamine and is made up of just the S form of ketamine. Interestingly, this form binds roughly four times as effectively as R-ketamine to the NMDA receptor. But despite its potent acting on the NMDA receptor, studies show that S-ketamine is a less powerful antidepressant than R-ketamine, when tested in animals. 

What to expect: before, during, and after ketamine treatment 

What is the process to receive a ketamine treatment? 

You first need to talk to your physiatrist and get their thoughts on the treatment. 

Next step, finding a clinic. The best tip for anyone looking for a reliable ketamine clinic is to search for one that has an anesthesiologist on board. Anesthesiologists have studied and used ketamine for years. They are the best people around when it comes to safely getting the treatment. 

A reliable ketamine clinic should also have a psychiatrist involved. You should have a consultation with the specialist to schedule an evaluation. After the evaluation, the doctor should determine if ketamine is safe for you.      

Before the treatment

This therapy is recommended ONLY for patients with treatment-resistant depression, chronic pain, and severe cases of mood disorders like PTSD, anxiety, bipolar, and addiction disorders. 

So, it is of utmost importance to look for a clinic that does a proper assessment of your condition. They should take the entire history of the disease into consideration. 

Let’s say you call a ketamine clinic and ask to make an appointment. They agree to take you straight to the therapy chair without a thorough assessment. If that’s the case, we urge you to find another clinic. This is a huge red flag and can be extremely dangerous for your health. 

You should talk to a psychiatrist that will be involved in the process and share everything about your condition. Anything from the medications you’ve used to the symptoms and struggles you’ve faced. Your collaboration during the assessment is vital for the success of the therapy, so being upfront about your condition is very important. 

You should also be asked to get a ride home to be safe after the treatment. You may feel dizzy, or your coordination may be off for a few hours after. 

During the treatment

You are comfortably seated on a chair. You might be given a blanket to keep you warm and headphones to keep you in the moment. During the treatment — that typically lasts for about 40-45 minutes — the staff will come to check up on you, ask questions, and make sure you are not experiencing any side-effects.  

You should start feeling the effect of the drug within 5-15 minutes. Each patient reacts differently to ketamine therapy. For some, this drug can induce a feeling of dissociation (out of body experience), even in the lowest doses. Others compare it to having a few glasses of wine. Some people have an out of body experience.     

The dissociation makes you extremely relaxed, giving you a feeling of weightlessness, relief, and overall happiness. You may start seeing out-of-this-world colors and visuals. Some patients are clear-headed and go deep into their thoughts, feel grounded, and have an enhanced appreciation for life and music. 

Some patients experience numbness, a tingling sensation in the entire body, particularly in the hands, feet, and head. Many people experience anxiety. The patient should communicate this side-effect with the doctor, and they will slow down the dose. 

After the treatment 

You should be able to feel the effects of ketamine almost immediately after the treatment is done. Patients that have found success in this treatment report “less heaviness” after a few hours or the next day after the treatment. Patients feel that life is worth living. 

Here is a video of an experience of ketamine infusion therapy in a ketamine clinic

Price of treatments + Does insurance cover it? 

Insurance doesn’t cover ketamine infusion treatment. First, it’s not FDA-approved for mood disorders and it’s considered an experimental treatment. 

The cost of each treatment can range anywhere from $300 to $600 per infusion. You can do one infusion, but for better results, it’s recommended to have at least three.

If you don’t respond to the treatment, you might revisit the thought that it might not work for you as it doesn’t work for around 20-30% of patients with treatment-resistant depression and mood disorders. 

Because the effects of long-term use of ketamine are unknown, most doctors recommend patients to use this treatment as the push they need to take them out of the rut.

This treatment is not permanent, so each patient needs to continue work with their psychiatrist and go to therapy. You should still make efforts to change your lifestyle, incorporate a healthy diet and exercise, lower stress levels, and get good sleep. 

Risks, side effects, and drug interactions 

The data on ketamine’s interaction with other drugs is limited. Like all medications, it comes with a set of side effects. Before starting ketamine treatment, it’s critical to discuss the potential side-effects and drug interactions with your doctor. 

When going into it, you should understand that this medicine is not FDA approved for any mental health condition, but only as an anesthetic. For a drug to be experimental, it means that the FDA hasn’t done a vast amount of trials to approve it for the purpose of healing mental health conditions. 

Most common side-effects 

• • Cardiovascular – increases blood pressure for a very short period in some people. In others, it increases heart rate. People with cardiovascular problems need to take extra precautions before taking ketamine. 
  • Psychiatric – people with underlying psychosis or similar issues will experience more anxiety. If these issues were in the past, ketamine might make their psychosis come back or even make it worse.
  • Urinary problems – urge to pee frequently, urinary retention.

• Dizziness

• Lightheadedness

• Dissociation

• Confusion

• Loss of coordination

• Agitation

• Nausea

• Bad flashbacks

• Tremors or shaking

These side effects happen right after the treatment is finished. But, the patient feels so much relief that these effects fall behind. It’s incredibly rare, but it happens for the patient to feel emotionally low. 

Less common side-effects are: 

• Depression in heart rate and blood pressure
• Seizures
• Laryngeal spasms which can lead to suffocation

Can I mix it with other drugs?

You can (and is advised) to keep taking antidepressants while receiving ketamine therapy. Antidepressants in the group of SSRIs, like Prozac, don’t interact with it in a negative way. Most medications are safe with ketamine, except for heart medicine. 

Never mix it with drugs that depress breathing, like alcohol, anesthetics, opioids and tramadol. Other risky combinations are cocaine and amphetamines. This drug appears to be safe when used with cannabis, but it’s advised against [16].  

Is Ketamine Infusion Therapy Safe? 

When used occasionally and under medical supervision, ketamine is a safe medication. The risks appear when this drug is abused as a recreational substance. High doses of this drug cause schizotypal symptoms like delusions, dissociation, flashbacks, superstitious thinking [17]. 

Recreational use causes bladder pain, incontinence, blood in urine, and cystitis to the point that the user needs to remove their bladder. 

One of the long-term risks of ketamine use that researchers point out is neurodegeneration (progressive loss of structure or function of neurons). Animal studies show that prolonged intravenous exposure to the drug (over 9 to 24 hours) caused brain cell death in rhesus monkeys [18].  

Frequent use affects thought and memory due to cognitive impairment. Occasional users (once or twice a month) don’t experience such problems [19].

Is ketamine legal?    

Federally, ketamine is a Schedule III drug under the Federal Controlled Substances Act adopted in August 1999. Schedule III drugs are drugs with a “moderate to low potential for physical and psychological dependence.” This means that its abuse potential is lower than Schedules I and II. Aside from ketamine, this group includes testosterone and anabolic steroids. 

Given that ketamine is a controlled substance, how can one lawfully open a ketamine clinic for infusion therapy? 

It all comes down to ketamine being used “off label.” What does off label mean? When a drug becomes approved by the FDA, it has an indication for a specific use. Off label indicates the act of prescribing the drug for something else than its original FDA-approved use. 

When your doctor prescribes medications, sometimes, they are not intended for the original, approved, researched use.

For example, they prescribe you Clonidine (Catapres) for ADHD. Clonidine is originally FDA-approved to treat high blood pressure. This blood pressure drug has many other off label uses like hot sweats, opioid withdrawal, migraines, etc. 

Doctors prescribe this medicine for ADHD because they’ve seen positive results in their patients. They know it works. But, because it hasn’t been FDA-approved for that condition, it’s the only way to give it to someone. 

The question you might be asking is: Can doctors actually do that? 

The answer is yes, they can. According to research, about 12% to 38% of all prescriptions are off label.

As stated by the FDA, “Once the FDA approves a drug, healthcare providers generally may prescribe the drug for an unapproved use when they judge that it is medically appropriate for their patients.” 

If the medical provider judges that there isn’t a drug approved to treat a condition or no other medication has worked for the patient, they can prescribe drugs off label. Ketamine infusion therapy fits into the legitimate off-label use for mental health conditions that are not effectively treated by drugs available on the pharmaceutical market.  

Source

The FDA approved a ketamine nasal spray for depression. Does this make ketamine legal? 

You might read online that the approval of esketamine (Spravato) made ketamine a legal substance, but that’s incorrect. Esketamine is a form of ketamine that’s legal only in that form, as a nasal spray. According to the FDA, “Because of the risk of sedation and dissociation, patients must be monitored by a health care provider for at least two hours after receiving their Spravato dose.”

The patient can self-administer the nasal spray under the supervision of a healthcare professional in a certified doctor’s office or clinic. The patient cannot take the spray at home. 

Are Ketamine Clinics Legal? 

Yes. Ketamine clinics are 100% legal. It’s wise to get your ketamine infusion or injection therapy in a reputable ketamine clinic. To operate with ketamine, these clinics must have a DEA license.

One cannot open a clinic without the standard outpatient requirements, including state medical board licenses, OSHA insurance coverage, all of the requirements that come with storing a controlled substance, as well as county/city licensing. They must take into consideration both state and local laws when opening a clinic. 

Each clinic must register the medical professionals that will be administering, manufacturing, storing, or distributing the drug with the DEA.  

Now, because there are no federal regulations on who will do the oversight and control of ketamine clinics, they choose how to operate their business. Most clinics rely on guidelines like the consensus statement published in JAMA Psychiatry or the consensus statement in Regional Anesthesia & Pain Medicine. 

There is also the comprehensive ketamine infusion therapy checklist by the American Association of Nurse Anesthetists. Organizations like the American Society of Ketamine Physicians (ASKP) put efforts into educating medical professionals in the field on the latest evidence-based treatments. So, it’s up to the team in each clinic to carefully screen patients and provide the safest and most appropriate treatment. 

Find a legal ketamine clinic in your state:

• Alabama
• Alaska
• Arizona
• Arkansas
• California
• Colorado
• Connecticut
• Delaware
• District of Columbia
• Florida
• Georgia
• Hawaii
• Idaho
• Illinois
• Indiana
• Iowa
• Kansas
• Kentucky
• Louisiana
• Maine
• Maryland
• Massachusetts
• Michigan
• Minnesota
• Mississippi
• Missouri
• Montana
• Nebraska
• Nevada
• New Hampshire
• New Jersey
• New Mexico
• New York
• North Carolina
• North Dakota
• Ohio
• Oklahoma
• Oregon
• Pennsylvania
• Rhode Island
• South Carolina
• South Dakota
• Tennessee
• Texas
• Utah
• Vermont
• Virginia
• Washington
• West Virginia
• Wisconsin
• Wyoming

Bottom Line

After decades of stagnation, the mental health field is focused on the use of novel drugs in a safe and effective way. Ketmaine’s ability to rapidly reverse symptoms of treatment-resistant depression and severe mood disorders makes it a powerful medicine. 

One of the biggest advantages of ketamine therapy is that it’s fast-acting and works in the lowest dosage.

Traditional medication, like antidepressants, take weeks or months to begin working. For a person with a severe mental health disorder, that’s not good enough. Research is still in its infancy but headed in the right direction — to relieve the stigma around psychedelics and use their full potential.

Ketamine Therapy FAQs

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