What is ketamine? by Dr. Jack Van Bezooyen
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We have been receiving a lot of questions related to the use of ketamine for the treatment of depression, anxiety, trauma-related disorders, and substance use disorder over the last few months. The following information answers some of the most common questions related to ketamine including what the medication can help with, what to expect from the experience, and the different ways in which it is used.
What is Ketamine?
Ketamine is a "dissociative-anesthetic" medication first developed in the 1960s for use in general anesthesia and was also FDA-approved for the treatment of Major Depressive Disorder in 2019. Ketamine is often prescribed for treating depression when other standard anti-depressants are ineffective or have intolerable side effects. It is unique in that it has a rapid anti-depressant effect in some individuals, typically within hours of administration. For many, there are ongoing beneficial effects of ketamine including improvement in mood, experiencing more pleasure in daily activities, improved sleep, improved energy, and reduced intensity and/or frequency of suicidal ideation. Ketamine does not have an FDA indication for anxiety disorders, trauma-related disorders, obsessive-compulsive disorder, and substance use disorders, however, some studies have suggested efficacy in treatment with ketamine.
The Ketamine Experience:
The more immediate experience of ketamine varies depending on the route of administration (dissolved under the tongue, nasal spray, or injected in the muscle or vein), the dose, one’s pre-existing mental state, and the clinical or home setting in which it is being given. It can range from mild changes in one's experience of reality to full dissociative states in which one feels separate from their body and thoughts. In the latter case, these experiences are defined as non-ordinary states of consciousness, and some studies have suggested that the level of dissociation may improve outcomes for depression. Some individuals find this experience unsettling. However, to optimize the positive subjective effects, ketamine is best administered in a safe, calm, and supportive environment. When needed, common practice is to provide “rescue” medications that alleviate anxiety or unpleasant bodily sensations. Doses of ketamine vary based on the response, phase of the treatment, and the whether it is being used as a stand-alone treatment or coupled with psychotherapy.
Ketamine with Psychotherapy:
In recent years, many have started to couple ketamine with psychotherapy. This has demonstrated, in many cases, to yield a greater benefit than providing medication alone. In this model, a therapist works with the individual to explore non-ordinary states of consciousness, which has the potential to generate more material and new relational experiences essential to garnering more insight and changing behaviors. It also allows for new ways of relating to one’s thoughts and emotions.