Reviewed by Dr. Kate Daly, MD, MPhil, and Jason Thompson
Ketamine assisted therapy has recently risen in popularity as a mental health treatment that can support clients with various symptoms and conditions. Medical professionals can use ketamine in different dosages, forms, and settings to create a customized treatment plan for clients.
In the US, SPRAVATO ketamine nasal spray is an FDA-approved treatment for depression in conjunction with an oral antidepressant. Providers can also use ketamine-assisted therapy as an off-label treatment for post-traumatic stress disorder, obsessive-compulsive disorder, and generalized anxiety disorder.
It’s easy to see why ketamine has become a valuable tool for treating mental health disorders. However, it’s important to note that ketamine alone is not a cure for these disorders; the best treatment is a multi-pronged approach. Providers often combine ketamine-assisted therapy with several other evidence-based treatments to improve the likelihood of success.
We’re exploring how ketamine has been used in clinical settings and sharing more about the potential benefits and applications of ketamine-assisted therapy.
What Is Ketamine?
Ketamine has been used for decades as an anaesthetic and pain reliever. This psychoactive drug can induce a trance-like state, lowered pain response, and even amnesia. At higher doses, ketamine can have several psychedelic effects, including vivid auditory and visual hallucinations. As such, ketamine has been misused as a recreational drug.
Many scientists believe ketamine’s effects result from its antagonistic action on the NMDA receptor in the brain. The NMDA receptor is involved in various cognitive functions, including learning, memory, communication between nerve cells, and cell survival.
A Brief History of Ketamine
Ketamine was first patented for use as an anaesthetic in the US in 1963 and became more popular in the 1970s. It was frequently the anaesthetic of choice for veterinarians and became a popular pre-hospital and battlefield anaesthetic for mass casualty events during the Vietnam War¹.
Still, ketamine came with a few challenges: it had to be quickly administered in a large dose via IV for use as an anaesthetic. Further, many people began to abuse ketamine for its psychedelic effects, increasing concern about ketamine’s widespread use. Ultimately, ketamine was replaced by propofol in the 1980s and high-dose opioids in the 1990s as anaesthetics of choice.
Despite its shortcomings, scientists in the 80s and 90s made promising discoveries about ketamine outside its anaesthetic effects. When administered in a clinical environment, they observed that ketamine had a high rate of success in:
- Improving depressive symptoms
- Reducing end-of-life anxiety
- Reducing pain
- Significantly decreasing suicidal thinking
In recent years, further research has determined that ketamine-assisted therapy is a viable and effective treatment for several mental health disorders. Ketamine-assisted therapy helps clients access a more subdued state and feel more comfortable addressing sensitive topics and memories to work through their mental health barriers.
The Rise of Ketamine Assisted Therapy
Doctors first observed ketamine’s potential as a mental health aid after patients recovering from surgery reported rapid relief from depression symptoms. After additional research, scientists found ketamine to be an effective tool for quickly reducing depressive symptoms. And unlike other antidepressants, ketamine can work almost immediately, providing much-needed relief for clients struggling with suicidality.
In 2019, the FDA approved the nasal spray form of ketamine, SPRAVATO (esketamine), to treat depression in adults with treatment-resistant depression in conjunction with an oral antidepressant. This approval solidifies ketamine as a safe and evidence-based application.
How Does Ketamine Work?
Ketamine treatments come in many forms. The dose, environment, route of administration, and adjunctive therapies can all differ depending on a client’s diagnosis and goals. As such, there are several ways that ketamine can help in the treatment of mental illness.
Low-dose ketamine has been prescribed off-label for years as a treatment for postoperative pain, typically delivered in an outpatient treatment setting. At very low doses, ketamine can produce a mild dissociative state, improving depressive symptoms such as suicidality.
Ketamine is most commonly delivered in a higher dose using a nasal spray, nebulizer, IV, pill, or transdermal patch. At higher doses, patients can experience the full dissociative effects of this psychoactive chemical. During ketamine assisted therapy, people with anxiety or post-traumatic stress disorder can let their guard down or access distressing memories without feeling overwhelmed.
Providers facilitate this process by creating a secure container and a supportive environment for clients. They will use the relaxed and dissociative state induced by ketamine to help people process their feelings and emotions, analyse their behavioural patterns, and help them learn new coping skills.
The goal of ketamine-assisted therapy is to help clients struggling with depression find relief from the overbearing weight of their symptoms and get to the root of their troubles without difficulty. Although ketamine is not a treatment for substance use disorders, it can help clients talk openly and honestly about their symptoms, thoughts, and behaviours so that their therapist can better address their needs.
In a sense, ketamine serves as a therapy incubator, allowing you and your therapist to gain a deeper level of trust and understanding rapidly, paving the way for future success.
Benefits of Ketamine-Assisted Therapy
Ketamine has been called the “anti-medication” medication because most clients notice improvements in mental health symptoms during treatment rather than after a few months. Clients are more likely to achieve long-lasting results when combining ketamine-assisted therapy with continued psychotherapy.
Several studies have shown that the benefits of ketamine extend far beyond depression alone. Off-label, ketamine can help treat conditions such as:
- Post-traumatic stress disorder (PTSD)
- Obsessive-compulsive disorder (OCD)
- Bipolar depression
What Does a Ketamine Assisted Therapy Session Look Like?
Ketamine assisted therapy happens in three distinct stages. The first stage is preparation: the client meets with the provider to discuss their goals, intentions, and concerns ahead of their session. The provider will explain what to expect and attempt to alleviate any of their fears. They may also offer specific cues related to individual symptoms.
A ketamine-assisted therapy session typically lasts three hours. First, a medical provider administers ketamine in a calm environment with limited stimuli. A therapist, psychiatrist, or nurse practitioner remains in the room and offers support based on the client’s needs.
Clients typically start noticing the effects of ketamine after 15 to 20 minutes. Effects peak for about 40 minutes and slowly dissipate over the following two hours.
Sometimes, challenging emotions and experiences surface during the session. Therapists can respond accordingly and help clients navigate emotional discomfort. As the effects wear off, clients work with a therapist to process emotions and integrate the experience.
A medical provider and therapist work together to monitor progress, make adjustments, and bolster client outcomes throughout the course of treatment. Many clients who complete ketamine assisted therapy refer to the experience as life-changing; this treatment offers another tool to help them transform their lives for the better.
Ketamine-Assisted Therapy at All Points North
Stress, trauma, and depression can create imbalances in the brain and fray essential nerve endings. Ketamine acts as brain fertilizer, reviving essential connections and encouraging healing. Combined with psychotherapy, ketamine can reverse chemical imbalances and help you achieve sustained long-term relief.
Clients at APN typically find a reduction in symptoms within hours of their first treatment and experience a significant decrease in symptoms after six to eight sessions. Contact our team today to find out if ketamine assisted therapy is right for you. We can help connect you with the tools you need to find healing.
- Li, Linda, and Phillip E Vlisides. “Ketamine: 50 Years of Modulating the Mind.” Frontiers in human neuroscience vol. 10 612. 29 Nov. 2016, doi:10.3389/fnhum.2016.00612
- Jones, Jennifer L., et al. “Efficacy of Ketamine in the Treatment of Substance Use Disorders: A Systematic Review.” Frontiers, Frontiers in Psychiatry, 24 July 2018, https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00277/full.
- Trivedi, Madhukar H. “Antisuicidal Effects of Ketamine: A Promising First Step.” American Journal of Psychiatry, American Psychiatric Association, 1 Feb. 2018, https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2017.17111261.
- Mion, Georges. “History of Anaesthesia: The Ketamine Story – Past, Present and Future.” European Journal of Anaesthesiology, Department Anaesthesia, Sept. 2017, https://journals.lww.com/ejanaesthesiology/fulltext/2017/09000/history_of_anaesthesia__the_ketamine_story___past,.2.aspx.
- Xu, Ying, et al. “Effects of Low-Dose and Very Low-Dose Ketamine among Patients with Major Depression: A Systematic Review and Meta-Analysis.” International Journal of Neuropsychopharmacology, Oxford Academic, 17 Nov. 2015, https://academic.oup.com/ijnp/article/19/4/pyv124/2910122.