Ketamine therapy is a new approach to therapy that targets symptoms of anxiety disorders. Originally designed as an anesthetic, therapists and researchers praise ketamine for its success in promptly reducing symptoms of anxiety, depression, and post-traumatic stress disorder (PTSD) in assisted therapy sessions.
Since its recent approval by the FDA, ketamine-assisted psychotherapy stands as a potential bright spot in mental health. This is especially true when you compare ketamine to antidepressants and cognitive-behavioral therapy, which don’t yield a remission of PTSD symptoms in many patients.
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Ketamine in Conjunction With Individual Therapy
- Encourage healthy brain activity
- Assist patients that suffer from OCD in breaking a cyclical feedback loop
- Encourage patients to manage or overcome obsessive thought patterns
- Increase neural activity, which is beneficial for the brain and leads to a more normal function
- Allow patients that suffer from depression and anxiety to avert their minds from negative thoughts
- Allow patients with substance addictions to create new thoughts or habits outside of their unhealthy behaviors
Ketamine therapy provokes an experience of dissociation, temporarily detaching patients from their surroundings. The combination of a therapist walking the patient through old memories or traumas and a patient being in a trance-like state sometimes offers a breakthrough experience. A proper dosage of ketamine will let patients explore their unconscious states of mind.
Many attribute the success of ketamine therapy in a controlled environment to the access it gains into the subconscious mind. Trauma causes people to create barriers or defense mechanisms. Humans naturally do this because some memories or emotions may feel intolerable. Ketamine can diminish those barriers. Thus, through proper individual therapy, patients can sort through the traumas or difficult emotions that aren’t usually readily accessible to them.
How Does Ketamine Therapy Work?
Ketamine therapy is an entirely new treatment approach. Ketamine causes an antidepressant result in many patients. The reason for this isn’t entirely understood. The result of this is through a new mechanism that assists people in managing depression, PTSD, and other anxiety disorders when other treatments haven’t worked.2
Many patients often have success with ketamine therapy due to its ability to create new pathways in the brain, according to Dr. Robert C. Meisner, medical director of the ketamine service in the psychiatric neurotherapeutics program at McLean Hospital in Massachusetts.
Experts believe that ketamine increases glutamate within the spaces between neurons in the brain. Ultimately leading to a release of other molecules, which create new pathways. “This process likely affects mood, thought patterns, and cognition,” said Dr. Meisner.2
This process allows patients to view their traumas from a more objective or disconnected point of view. Sometimes leading the patients to sort out their possibly intolerable emotions within standard consciousness.
Studies show that ketamine works in multiple ways simultaneously. It might act as an anti-inflammatory, reducing signals involved in the process of inflammation within the brain. A topic still studied, this type of inflammation is linked with certain mood disorders.2
Side Effects of an Antidepressant Dose of Ketamine
In the context of a therapeutic dose of ketamine, researchers at the National Institutes of Health found that the low dosage of ketamine that’s used for treatment-resistant depression was relatively free of side effects. Furthermore, the NIH found that the mild dosage of ketamine that’s lower in dosage than what would cause anesthesia can quickly relieve the symptoms of depression. This relief can occur within only hours for individuals who haven’t responded to conventional antidepressants.
The NIH analyzes one common short-term ketamine side effect. This side effect is patients feeling strange or loopy within an hour of receiving ketamine. After two hours though, this strange and loop feeling ceases.
NIH researchers gathered data from 188 patients and actively monitored their potential ketamine side effects. 163 of the patients had bipolar disorder or other major depressive disorders, while 25 of the patients participating were part of the healthy control group. The structured surveillance was conducted in an inpatient setting using both a standard rating scale and clinician interviews.
During the study, none of the symptoms persisted over four hours and researchers didn’t note any drug-related cravings. Eight symptoms occurred in about half of the patients: “feeling strange, weird, or bizarre; feeling spacey; feeling woozy/loopy; dissociation; floating; visual distortions; difficulty speaking; and numbness.”3 This study in particular didn’t address potential side effects with long-term ketamine use.
- Decreased sociability
- Impaired memory recall
- Attention deficit or dysfunction
In high doses, ketamine can trigger mental health predispositions such as schizophrenia or similar psychosis. Abuse of ketamine can also lead to long-term physical harm that damages the bladder, kidneys, and heart. Chronic ketamine abuse often leads to permanent damage to the bladder due to inflammation in the organ.
Ketamine vs. Esketamine
In March 2019, the FDA approved Spavato, which is a nasal spray containing esketamine. The nasal spray was approved for people with treatment-resistant depression. Ketamine and esketamine are very similar but have molecular differences. Esketamine is also more potent than its counterpart.
Developed in 1962 and approved in 1970, ketamine was and currently is mainly used as an anesthetic. People with PTSD using ketamine isn’t unordinary in retrospect, since soldiers with PTSD preferred this anesthetic during the Vietnam War.
Ketamine is presently valuable within the veterinary field. In fact, it’s one of the fields most commonly used drugs.
In a study conducted last year, researchers analyzed and compared the efficacy of both ketamine and esketamine. This particular study found that ketamine does indeed play a therapeutic role in certain mental disorders, most notably depression. It’s less clear which version of the pharmaceutical brings more success.
The researchers looked for a response in alleviation from suicide, depression, and its severity. The researchers ultimately concluded that intravenous ketamine seemed to yield more success than intranasal ketamine when it came to treatment for depression.7
Though the aforementioned scientific review found the benefits of intravenous ketamine greater, the FDA currently only has submitted approval for esketamine. Thus any prescription of racemic ketamine, specifically for the treatment of depression, is an “off-label intervention.”7
Who is a Good Candidate for Ketamine Therapy?
Studies suggest that ketamine treatment and medication should only be available to adults. This form of therapy is also not a “first-line treatment” for depression. In fact, most of the research done on ketamine therapy revolves around patients with treatment-resistant depression. This means that the patient hasn’t responded to several rounds of antidepressant medication.
Also, studies suggest that ketamine therapy shouldn’t be available to those with a history of substance or alcohol abuse. Research doesn’t show the long-term side effects of ketamine therapy. If abused though, ketamine therapy could cause a person serious harm.
It’s important to note that ketamine therapy is a specific treatment with calculated doses that are significantly lower than what’s used for anesthesia or recreational use. Ketamine medications are also synthesized and specifically designed to target symptoms of depression, PTSD, and anxiety disorders.
Most patients who undergo ketamine therapy suffer from anxiety, depression, PTSD, or bipolar disorder. Ketamine therapy can sometimes be immediately helpful, granting relief of these disorders’ symptoms or of suicidal ideation. Similar to drugs like Prozac, the harmful ketamine symptoms often come back though. Thus, monthly ketamine therapy sessions are often needed.
It’s imperative to educate yourself so that you understand if ketamine therapy is suitable for you. Since its recent approval by the FDA for therapeutic use, ketamine therapy requires more research and data.
Ultimately, the potential benefits of ketamine therapy are a bright spot within the world of mental health and therapy. Therefore, if you or a loved one could benefit from ketamine treatment, please contact us today.
Dr. Balta is the Medical Director at FCR for more than 10 years. Dr. Balta is Board Certified in Psychiatry and Addiction Medicine, Certified Psychoanalyst. As well, as having Psychiatric Training at The Albert Einstein School of Medicine Psychiatric Residency Program In New York City and Psychoanalytic Training at The William Alanson White Institute in New York City. While working in New York City, gained funding Grants for the treatment of Substance Abuse Disorders from SAMHSA , HRSA and the City of New York.