What Is Ketamine?
Ketamine is a dissociative anesthetic medication that was first developed in the 1960s and approved by the U.S. Food and Drug Administration (FDA) in 1970 for use in medical and veterinary procedures. Originally synthesized in the United States as a safer alternative to phencyclidine (PCP), ketamine works by blocking N-methyl-D-aspartate (NMDA) receptors in the brain, which are involved in pain perception and consciousness. At higher doses, it produces a dissociative state where patients remain conscious but feel detached from their environment and physical sensations, making it valuable for surgical anesthesia and pain management. The drug has a relatively short duration of action and is considered safer than many other anesthetics because it doesn’t significantly suppress breathing or blood pressure.
To learn more about Ketamine and Ketamine Therapy, contact Balanced Mind of New York to schedule a free, 15-minute consultation.
What Is Ketamine Therapy?
Ketamine therapy refers to the controlled medical use of low-dose ketamine for treating various mental health conditions, particularly treatment-resistant depression, anxiety, post-traumatic stress disorder (PTSD), and chronic pain disorders. Unlike its use as an anesthetic, ketamine therapy involves much smaller doses administered in clinical settings under professional supervision. The treatment has gained significant attention in recent years because it works differently from traditional antidepressants, often providing rapid relief within hours or days rather than weeks.
During ketamine therapy sessions, patients typically receive the medication through intravenous infusion, intramuscular injection, sublingual lozenge, or nasal spray (such as the FDA-approved esketamine nasal spray called Spravato) while being monitored by healthcare professionals. The therapy usually involves a series of treatments over several weeks, and many patients report significant improvements in mood and mental clarity.
What Can Ketamine Therapy Treat?
Ketamine therapy represents a breakthrough approach to treating mental health disorders, particularly for individuals who have not responded well to traditional treatments. This innovative therapy works by targeting the brain’s glutamate system rather than serotonin pathways like conventional antidepressants, offering hope for patients with treatment-resistant conditions. The rapid-acting nature of ketamine makes it especially valuable for severe cases where immediate intervention is crucial, such as individuals experiencing suicidal ideation or severe depressive episodes.
Clinical research has demonstrated ketamine’s effectiveness across several mental health conditions, with many patients experiencing significant symptom relief when other treatments have failed. The therapy is typically reserved for cases where standard medications and psychotherapy have been insufficient, making it a critical option in the mental health treatment landscape.
Depression
Ketamine therapy has shown remarkable effectiveness in treating severe depression, particularly in cases that have proven resistant to traditional antidepressants. Patients often experience a significant reduction in depressive symptoms, such as persistent feelings of sadness, hopelessness, and emotional numbness. The therapy can help alleviate the overwhelming fatigue and lack of energy that make daily activities feel impossible, while also improving concentration and mental clarity that depression often impairs. Many individuals report decreased feelings of worthlessness and guilt, along with the restoration of interest in activities they once enjoyed. Importantly, ketamine therapy has demonstrated rapid effectiveness in reducing suicidal thoughts and ideation, which makes it particularly valuable for patients in crisis situations where immediate relief is essential for safety.
Anxiety
For individuals struggling with anxiety disorders, ketamine therapy can provide relief from the intense physical and psychological symptoms that interfere with daily functioning. Patients often experience a significant reduction in persistent worry, racing thoughts, and the constant sense of impending doom that characterizes anxiety conditions. The therapy helps decrease physical manifestations of anxiety such as rapid heartbeat, shortness of breath, muscle tension, and the overwhelming fight-or-flight response that can be triggered by everyday situations. Many people report improved ability to handle social situations and reduced avoidance behaviors that anxiety typically creates. Ketamine can also help break the cycle of catastrophic thinking and rumination that keeps anxiety disorders active, allowing patients to develop better coping mechanisms and experience greater emotional stability.
Post-Traumatic Stress Disorder (PTSD)
Ketamine therapy offers significant benefits for individuals suffering from PTSD by helping to reduce the intensity and frequency of traumatic memories and flashbacks that can dominate daily life. Patients often experience decreased hypervigilance and the constant state of alertness that makes it difficult to feel safe in everyday environments. The therapy can help reduce emotional numbing and detachment that prevents individuals from connecting with loved ones and engaging in meaningful relationships. Many people report improved sleep quality and reduction in nightmares that frequently accompany PTSD, along with decreased startle responses and anxiety triggers related to trauma reminders. Ketamine therapy can also help individuals process traumatic experiences more effectively when combined with psychotherapy, potentially reducing the overwhelming emotional intensity associated with trauma memories and creating space for healing and enhancing well-being.
Who Prescribes Ketamine Therapy?
Ketamine therapy is typically prescribed by licensed medical professionals such as psychiatrists, anesthesiologists, or other physicians with specialized training in its use for mental health or pain management. In many clinical settings, these professionals must evaluate a patient’s medical history and current condition to determine whether ketamine is an appropriate treatment option. Depending on the jurisdiction and treatment model, nurse practitioners, physician assistants, or other clinical staff with proper certification may also be involved in administering the therapy under a doctor’s supervision. Due to the controlled nature of ketamine, its prescription and administration are subject to strict regulations and medical oversight.
How Are Ketamine Treatments Given?
Ketamine therapy can be administered through several different methods, each with its own advantages and considerations depending on the patient’s specific needs and medical circumstances. The choice of administration method is typically determined by factors such as the severity of symptoms, patient preference, medical history, and the clinical setting. All forms of ketamine therapy require medical supervision and are administered in controlled healthcare environments to ensure patient safety and optimal therapeutic outcomes.
The three primary methods of ketamine administration for mental health treatment include intravenous infusion, intranasal delivery, and oral formulations. Each method has different onset times, duration of effects, and bioavailability, which healthcare providers consider when developing individualized treatment plans. Regardless of the administration method chosen, patients are closely monitored throughout the treatment process to track progress and manage any potential side effects.
Ketamine Infusion Therapy (IV Ketamine)
Intravenous ketamine infusion is considered the gold standard for ketamine therapy and involves the direct delivery of ketamine into the bloodstream through a small IV catheter, typically placed in the arm. This method provides the most precise dosing control and highest bioavailability, meaning nearly 100% of the medication reaches the bloodstream and brain. Treatment sessions usually last between 40 to 60 minutes, during which patients recline in a comfortable chair while the ketamine is slowly infused at a carefully calculated rate based on their body weight and medical history.
The IV method allows for real-time dose adjustments if needed and produces the most consistent therapeutic effects. Patients typically begin to feel the medication’s effects within minutes of starting the infusion, and the dissociative effects usually subside within 30 to 60 minutes after the infusion is complete. This method requires the most medical oversight and is typically administered in specialized ketamine clinics or medical facilities with trained staff who monitor vital signs and patient comfort throughout the session.
Intranasal Ketamine
Intranasal ketamine, most commonly available as the FDA-approved medication Spravato (esketamine), is administered through a nasal spray device under medical supervision in healthcare settings. This method involves patients self-administering the medication by spraying it into each nostril while being observed by medical staff, with the entire process taking only a few minutes. The medication is absorbed through the nasal membranes and reaches the brain relatively quickly, though not as rapidly or completely as IV administration. Patients must remain in the healthcare facility for at least two hours after administration for monitoring, as the effects can include dizziness, dissociation, and changes in blood pressure.
The intranasal method is often preferred by patients who are uncomfortable with needles or IV procedures, and it’s typically administered twice weekly initially, then less frequently as treatment progresses. This form of ketamine therapy requires patients to follow specific preparation instructions, including avoiding food and drink for a period before treatment and arranging transportation home, as driving is not permitted on treatment days.
Oral Lozenges (Also Called Ketamine Troches)
Ketamine troches or lozenges are dissolvable oral formulations that are placed between the cheek and gum, allowing the medication to be absorbed through the oral mucosa rather than being swallowed and processed through the digestive system. This sublingual and buccal absorption method bypasses much of the liver’s metabolism, resulting in higher bioavailability than traditional oral medications, though still lower than IV or intranasal methods. The lozenges typically take 15 to 30 minutes to fully dissolve, during which patients should avoid swallowing saliva to maximize absorption through the mouth’s tissues.
This method offers greater convenience and can sometimes be used in home settings under specific medical protocols, though initial treatments usually occur in clinical settings. The onset of effects is generally slower than other methods, taking 20 to 45 minutes to begin, and the duration of therapeutic effects may be longer. Ketamine troches can be particularly useful for maintenance therapy or for patients who prefer oral administration methods.
What Are the Side Effects of Ketamine Therapy?
Ketamine therapy, while generally well-tolerated when administered under proper medical supervision, can produce side effects that patients should be aware of before beginning treatment. Most side effects are temporary and occur during or shortly after the treatment session, typically resolving within a few hours as the medication is metabolized and eliminated from the body. The intensity and duration of side effects can vary significantly between individuals and may depend on factors such as the dose administered, method of delivery, individual sensitivity, and overall health status.
Common immediate side effects include dissociation or feeling detached from one’s surroundings, dizziness, nausea, blurred vision, and temporary increases in blood pressure and heart rate. Some patients may experience vivid dreams or altered perceptions during treatment, while others report feeling drowsy or confused afterward. Less common but more serious potential side effects can include severe hypertension, respiratory depression in rare cases, and psychological distress during the dissociative experience. Long-term or frequent use may carry additional risks, which is why ketamine therapy is carefully monitored and administered according to specific protocols. Healthcare providers conduct thorough medical evaluations before treatment and continuously monitor patients during and after sessions to ensure safety and address any adverse reactions promptly.
Is Ketamine Therapy FDA Approved?
The FDA approval status of ketamine therapy is somewhat complex and depends on the specific form and indication being considered. Traditional ketamine has been FDA-approved since 1970 for use as an anesthetic in medical and veterinary procedures, but its use for mental health conditions represents an “off-label” application, which is legal and commonly practiced in medicine when physicians determine it’s appropriate for their patients. However, in March 2019, the FDA made a landmark decision by approving esketamine nasal spray (marketed as Spravato) specifically for treatment-resistant depression in adults, marking the first FDA-approved ketamine-based treatment for mental health conditions. This approval was later expanded to include major depressive disorder with suicidal ideation in 2020. The FDA approval of Spravato was based on extensive clinical trials demonstrating its effectiveness and safety profile when used under medical supervision in certified healthcare facilities.
While IV ketamine infusions and other forms of ketamine therapy for mental health remain off-label uses, they are widely accepted and practiced by qualified healthcare providers who follow established protocols and safety guidelines. The distinction between FDA-approved esketamine and off-label ketamine use is important for patients to understand when discussing treatment options with their healthcare providers.
What Does the Research Say About Ketamine Therapy?
Research on ketamine therapy for mental health conditions has shown consistently promising results, with numerous clinical studies demonstrating its effectiveness for treatment-resistant depression, anxiety, PTSD, and other psychiatric disorders. Multiple randomized controlled trials have found that ketamine can produce rapid antidepressant effects, often within hours to days, compared to traditional antidepressants, which typically take weeks to show benefits. The research has been particularly compelling for individuals who have failed multiple previous treatments.
Long-term follow-up research suggests that the benefits of ketamine therapy can be sustained with appropriate maintenance protocols, though the duration of effects varies among individuals. Neuroimaging studies have provided insights into ketamine’s mechanism of action, showing that it promotes neuroplasticity and the formation of new neural connections, particularly in brain regions affected by depression and trauma. While most research has focused on depression, emerging studies on anxiety disorders, PTSD, chronic pain, and other conditions continue to expand our understanding of ketamine’s therapeutic potential and optimal treatment protocols.
How Frequently Is Ketamine Taken/Prescribed?
The frequency of ketamine therapy varies depending on the individual patient’s needs, the severity of their condition, the method of administration, and their response to treatment. Most ketamine therapy protocols begin with an induction phase consisting of multiple treatments over a relatively short period, typically involving 6 to 8 sessions administered twice or three times per week over 2 to 4 weeks. Following the initial induction phase, patients often transition to a maintenance schedule with treatments spaced further apart, such as once weekly or monthly, depending on how long the therapeutic effects last for each individual. For esketamine nasal spray (Spravato), the typical protocol involves twice-weekly treatments for the first month, then weekly treatments for the second month, followed by treatments every other week or monthly thereafter.
Some patients may require more frequent treatments initially or during periods of increased symptoms, while others may be able to extend the time between sessions as their condition stabilizes. The goal is to find the minimum effective frequency that maintains symptom relief while minimizing potential side effects and treatment burden. Healthcare providers work closely with patients to adjust treatment schedules based on symptom monitoring, side effect profiles, and individual response patterns, recognizing that ketamine therapy often requires personalized dosing and timing strategies.
How Long Does Ketamine Therapy Take to Work?
One of the most remarkable aspects of ketamine therapy is its rapid onset of action, which distinguishes it dramatically from traditional psychiatric medications. Many patients begin to experience improvements in their symptoms within hours of their first ketamine treatment, with some reporting noticeable changes during or immediately after the session. While the peak therapeutic effects often occur within 24 to 72 hours after treatment, the timeline can vary based on factors such as the severity of symptoms, previous treatment history, and individual brain chemistry.
Unlike conventional antidepressants that typically require 4 to 8 weeks to show meaningful benefits, ketamine’s effects on mood, anxiety, and suicidal thoughts can be observed within the first few days of treatment. However, it’s important to note that while some patients experience dramatic improvements after a single session, most individuals require a series of treatments to alleviate symptoms and to achieve optimal, sustained results. The initial rapid effects may be temporary, lasting anywhere from a few days to several weeks, which is why the induction phase typically involves multiple closely-spaced treatments to build upon and stabilize these early improvements.
Research suggests that the cumulative effects of multiple ketamine treatments tend to produce more durable improvements, with many patients experiencing sustained benefits that last weeks to months between maintenance sessions. The speed of ketamine’s action makes it particularly valuable for patients in crisis situations or those who have been suffering from severe, treatment-resistant symptoms for extended periods.
How Do I Pay For My Ketamine Therapy?
Balanced Mind of New York is a private pay practice and does not accept insurance. We believe in providing individualized, high-quality care without the restrictions or limitations often associated with insurance-based treatment.
If you have out-of-network benefits, we’re happy to provide a superbill upon request, which you can submit directly to your insurance provider for potential reimbursement. Please consult your provider to understand your coverage and eligibility for out-of-network mental health services.
Contact Details for Balanced Mind of New York Ketamine Therapists
Please contact us at [email protected] or 646-883-5544 to schedule an appointment and take the first step toward a healthier you.