What Is Ketamine?
Ketamine is a medication that was originally developed in the 1960s as an anesthetic for surgery. It belongs to a class of drugs called NMDA receptor antagonists, which means it blocks certain receptors in the brain that are involved in transmitting signals between nerve cells. For decades, ketamine was primarily used in operating rooms and emergency departments to put patients under anesthesia or provide pain relief. However, doctors noticed something interesting: patients who received ketamine often reported improved mood after their procedures, even if they had been depressed before surgery.
In recent years, scientists have discovered that ketamine works very differently from traditional antidepressants like Prozac or Zoloft. Instead of targeting serotonin systems like most antidepressants do, ketamine affects glutamate, which is the brain’s main excitatory neurotransmitter. This unique mechanism allows ketamine to potentially help people who haven’t responded to other depression treatments. The Food and Drug Administration (FDA) approved a nasal spray version called esketamine (brand name Spravato) specifically for treatment-resistant depression in 2019.
What Is Treatment-Resistant Depression?
Treatment-resistant depression (TRD) is a term used when someone’s depression doesn’t improve significantly after trying at least two different antidepressant medications at adequate doses for sufficient periods of time (usually six to eight weeks or more each). This doesn’t mean the person is noncompliant with treatment or avoiding getting better. It means their major depressive disorder hasn’t responded to standard first-line treatments. About one-third of people with major depression fall into this category, making it a significant public health concern.
People with treatment-resistant depression often feel frustrated and hopeless after trying multiple medications without success. They may have experienced some improvement with traditional antidepressants but still have significant mental health symptoms that interfere with their daily life, work, and relationships. TRD can also include cases where people initially responded to an antidepressant but then stopped responding over time, or where they couldn’t tolerate the side effects of medications that might have been helpful.
Criteria for Treatment-Resistant Depression
Mental health providers typically diagnose TRD when a patient has tried at least two different classes of antidepressants (such as SSRIs, SNRIs, or tricyclics) without achieving remission or significant improvement. Some definitions require that patients have also tried psychotherapy, such as cognitive-behavioral therapy, in addition to medications. The key is that these treatments must have been tried at adequate doses for several weeks to be considered a fair trial.
Why Is Ketamine Used to Treat Depression?
Ketamine represents a major breakthrough in depression treatment because it works through a completely different pathway than traditional antidepressants. Most conventional antidepressants work by increasing levels of neurotransmitters like serotonin, norepinephrine, or dopamine in the brain. Ketamine blocks NMDA receptors and affects the glutamate system, which leads to increased production of a protein called BDNF (brain-derived neurotrophic factor). This protein helps brain cells grow new connections and can essentially help “rewire” neural circuits that have become dysfunctional in depression. These demonstrated effects of ketamine therapy have paved the way for medical professionals to increasingly recommend it as an option to treat depression.
The most remarkable aspect of ketamine therapy for depression is its speed. While traditional antidepressants typically take four to eight weeks to show effects, many patients experience improvement in their depression symptoms within hours or days of receiving ketamine. This rapid action can be life-saving for people with severe depression or suicidal thoughts. Research suggests that ketamine may help restore normal communication between different brain regions and reverse some of the brain changes associated with chronic depression, such as reduced connectivity in areas responsible for mood regulation.
The Glutamate Connection
Scientists believe that depression involves problems with glutamate signaling in the brain. Glutamate is the brain’s primary excitatory neurotransmitter, meaning it helps neurons communicate and fire signals to each other. In depression and other mental health conditions, this system can become imbalanced, leading to reduced neural plasticity – the brain’s ability to form new connections and adapt. By temporarily blocking NMDA receptors, ketamine appears to reset this system and promote the growth of new neural connections (called neuroplasticity), which may explain why it can work so quickly and effectively.
What Is a Ketamine Clinic?
A ketamine clinic is a specialized medical facility that provides ketamine therapy for mental health conditions, primarily depression. These clinics have emerged as ketamine therapy has become more widely available, offering a controlled environment where patients can receive treatment safely under medical supervision. Most ketamine clinics are staffed by psychiatrists, anesthesiologists, or other physicians who have received specialized training in administering ketamine for psychiatric purposes.
Ketamine clinics typically offer different forms of treatment, including intravenous (IV) ketamine infusions, intramuscular injections, an FDA-approved nasal spray, or sublingual tablets (called lozenges or troches). The setting is usually designed to be comfortable and calming, often with reclining chairs, soft lighting, and peaceful music, since patients remain conscious during treatment and may experience mild dissociative effects. Many clinics also provide integration services, which might include therapy sessions before or after ketamine treatments to help patients process their experiences and maximize the therapeutic benefits.
Types of Ketamine Administration
Different ketamine clinics may offer various methods of administration. IV ketamine infusions are often considered the gold standard because it allows for precise dosing and rapid onset, but it requires the most medical oversight. Intramuscular injections and lozenges are options that some clinics offer. Additionally, some clinics work with the FDA-approved nasal spray esketamine (Spravato), which must be administered in a certified healthcare setting with observation periods afterward.
How Long Does Ketamine Treatment Take To Work for Depression?
One of the most striking features of ketamine treatment is how quickly it can work compared to traditional antidepressants. Many patients begin to notice improvements in their mood, energy, and motivation within hours to days of their first ketamine session, rather than the weeks or months typically required for conventional antidepressants to take effect. Some people report feeling a significant lift in their depression within 24 hours of treatment, though the timeline can vary from person to person.
However, it’s important to understand that ketamine therapy usually requires multiple sessions to achieve lasting results. A typical initial treatment series might involve six sessions over two to three weeks, with each session building on the previous one. The effects of a single ketamine treatment often last several days to a week, which is why multiple sessions are needed to create more sustained improvement. After the initial series, many patients transition to maintenance treatments, which might occur every few weeks or months, depending on their individual response and needs.
Treatment Timeline and Maintenance
The initial rapid antidepressant effects of ketamine are often followed by a gradual return of depressive symptoms, which is why repeated dosing over several sessions is usually necessary. Most treatment protocols start with an intensive phase of multiple sessions close together, followed by a maintenance phase with treatments spaced further apart. Some patients may need maintenance treatments every two to four weeks, while others might go longer between sessions. The goal is to find the minimum effective frequency to maintain positive effects of ketamine while minimizing exposure and cost.
What Are The Side Effects of Ketamine?
Ketamine treatment can cause several side effects, though most are temporary and occur primarily during or shortly after the treatment session. The most common acute effects include dissociation, which can feel like being disconnected from your body or surroundings, mild nausea, dizziness, and changes in blood pressure or heart rate. Some people describe a floating sensation or having altered perceptions during treatment, which typically resolve within an hour or two after the session ends. These effects are generally considered manageable and are closely monitored by medical professionals.
Long-term or more serious side effects are less common but can include bladder problems with frequent use, potential for psychological dependence, and temporary cognitive effects such as difficulty concentrating or memory issues. Most side effects are dose-dependent, meaning higher doses are more likely to cause problems than low doses. This is why ketamine for depression is always administered in controlled medical settings with careful dosing and monitoring. Patients are typically observed for at least two hours after treatment to ensure they’re safe to leave the clinic.
Managing Side Effects
Healthcare providers take several steps to minimize side effects and ensure patient safety. This includes starting with lower doses and adjusting based on individual response, providing a comfortable environment during treatment, and having patients arrange for transportation home since driving is not safe immediately after ketamine treatment. Pre-treatment assessments help identify patients who might be at higher risk for certain side effects, and some clinics provide anti-nausea medications or other supportive care as needed.
Can I Still Use Other Mental Health Treatments for Depression While Taking Ketamine Treatment?
Yes, ketamine treatment is often used alongside other depression treatments rather than replacing them entirely. Many patients continue taking their regular antidepressant medications while receiving ketamine therapy, and this combination approach is generally considered safe and potentially more effective than either treatment alone. However, it’s crucial that all treatments are coordinated by your healthcare team to avoid any potential interactions or complications.
Psychotherapy, such as cognitive-behavioral therapy, can be particularly beneficial for treating depression when combined with ketamine treatment. Some research suggests that the neuroplasticity effects of ketamine may actually make therapy more effective during the period following ketamine sessions. This is why many ketamine clinics offer or recommend concurrent therapy services from licensed mental health providers. Other complementary treatments like exercise, meditation, or lifestyle changes can also continue alongside ketamine therapy and may enhance overall treatment outcomes.
Coordinating Care
The key to successfully combining ketamine with other treatments is good communication between all members of your healthcare team. Your ketamine provider should know about all medications you’re taking, including over-the-counter supplements, and should coordinate with your psychiatrist or primary care physician. It is essential to let your provider know about other medical conditions you may have, including any history of substance use disorder. Some medications may need to be adjusted or temporarily held around ketamine treatments, so professional oversight is essential for safe and effective combination therapy.
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.