You may think of ketamine as “Special K,” the club drug from 1990s rave culture. No, just me? A legal version of ketamine has been FDA approved as an anesthetic since the ‘70s. So why do you keep hearing about it now? Today, as research about psychedelics expands across the country from institutions like Johns Hopkins Center for Psychedelic Research and UC Berkeley Center for the Science of Psychedelics, the drug is gaining new life in an off-label use as ketamine therapy for treatment-resistant depression, anxiety, suicidal ideations, chronic pain and PTSD, with more on the horizon. It’s pretty exciting stuff and the medical and mental health communities are all abuzz.
Here’s a ketamine therapy 101 overview to learn more about this buzzy treatment and if you might be a candidate for it.
What is ketamine-assisted therapy and where can you get it?
Ketamine therapy can be administered intravenously (IV) or as a shot. It is also available as a lozenge or a nasal spray (the FDA-cleared Spravato). “It must be administered by a clinician and the prescriber must have a DEA license and ACLS [Advanced Cardiovascular Life Support] training. JAMA Psychiatry put out the only guideline and consensus model that is available in 2017,” says Jason A. Duprat, nurse anesthetist and founder of Ketamine Academy, which provides ketamine therapy training for licensed health care professionals, such as nurse practitioners and physicians.
Most clinics, such as Invictus Clinic in Atlanta, that are doing ketamine therapy range from 40-minute to 4-hour treatments in an outpatient setting where a clinician is with you the whole time to monitor blood pressure and heart rate increases. Hospitals also will treat chronic pain in an in-patient setting with possibly longer infusions.
Additionally, beware that there are some businesses capitalizing on rules that changed during Covid where it was made possible to prescribe certain drugs without having to see a patient in person. “This is hugely controversial for ketamine, but it’s technically legal,” says Catherine Egenes, licensed marriage and family therapist at Your Therapy Journey, who would caution going the route of a quick telehealth visit to obtain ketamine for a virtual or in-person therapy session.
Is ketamine therapy legal?
Yes, ketamine is an FDA-approved anesthetic. It is typically given during the perioperative period in a traditional setting. It is not yet FDA approved for chronic pain or mental health—these are considered off-label uses in the U.S., says Duprat, who previously worked in labor and delivery, where ketamine was often given as a dissociative anesthetic for C-sections, offering good pain relief during a major surgery while the patient stayed awake.
Who can get ketamine therapy?
“The Ketamine Papers,” a compilation of essays with an all-star lineup of ketamine experts, is a great resource for potential patients and professionals alike to learn more about the research and history.
Duprat says it’s important to know that ketamine is not a first-line treatment. If you have pain or anxiety, your doctor or therapist isn’t going to (or shouldn’t…) immediately recommend going out to get ketamine. If you battle depression, it’s typically recommended only after you have done talk therapy with a professional therapist and have tried at least two traditional antidepressants that didn’t provide relief. According to The American Journal of Psychiatry, “fewer than half [of depressed patients] achieve even 50% relief with typical first-line medications.”
“The results based on available studies are astounding and phenomenal. The research is showing that ketamine therapy is effective for treatment-resistant depression and that people have found a 50% reduction in their symptoms of depression,” says Duprat. “Ketamine can also rapidly terminate suicidal ideations.”
In the future, there may be ketamine-assisted psychotherapy used for addiction treatments or trauma therapy. “These aspects are being studied,” Duprat says.
What does ketamine feel like?
I haven’t tried ketamine personally (just been watching all the documentaries!), but Egenes, who is becoming certified in psychedelic-assisted therapies through Boulder-based Integrative Psychiatry Institute and is now part of the Field Trip Atlanta team, recently traveled to Colorado to experience ketamine as part of the coursework. Though every experience is unique, she described the feeling like this: Ketamine—remember, it’s an anesthetic and dissociative so it separates the body and mind—frees the mind to travel and bring to the forefront things that are in the subconscious, including repressed memories.
“People will say they’re in the ocean or in space. I was traveling by boat,” Egenes says. “Psychedelics, including ketamine, are amplifiers of what is currently within a person. Your intention that you bring into your experience will alter where you go and what happens. For instance, if you go in with the intention of ‘I want to feel what it’s like to have calm and peace,’ you might get to float into space and have calm and peace. In the same trip, you might get launched back into an anxious state.”
Duprat adds that people describe it in different ways: “It’s somewhat dose dependent. For mental health disorders, most patients are wide awake, not sedated and are talkative. In most cases, they are responding to all normal questions. They may seem like they’ve had a few cocktails. Some have described their legs or arms feeling numb or like they’re floating, and their minds are somewhat disconnected from their bodies.”
Ultimately, you don’t have control of what’s happening, which is why Egenes recommends fully knowing what you are walking into, being prepared by educating yourself, setting an intention for grounding and choosing the right setting and professionals as guides to feel and be safe.
How long does a ketamine-assisted therapy trip last?
With the ketamine IV treatment or shot at a therapeutic dose (anywhere between 0.5 to 0.75 milligrams per kilogram of body weight), a typical range is 40 minutes to 2 hours, says Egenes, whose own experience lasted 1.5 hours. “Some people come out really quickly based on the rate of metabolization. When you take it orally or via nasal spray, it’s a different beast. Doses are variable depending on the route of administration,” she explains.
So what does ketamine do to the brain?
The popular book “How to Change Your Mind” gained more fame once it was made into a Netflix documentary series. As with most books turned into TV or movies, the book is better.
It increases neuroplasticity. To explain this in a very basic way, neuroplasticity is the connections a brain is making across different sections of the brain. “Most mental health treatment, no matter which one, is aiming for increased neuroplasticity. Ketamine promotes that,” says Egenes. “Markers of good mental health are flexibility and adaptability, when your brain fires with more connections and has the ability to re-wire itself. When your neural pathways are too rigid or fixed over time, functioning declines.”
Different antidepressant medications work on different receptors of the brain. A lot of pharmacology research has focused on dopamine and serotonin receptors. Traditional SSRI drugs such as Lexipro and Zoloft are working on your serotonin receptors, while medications such as Wellbutrin and Aplenzin activate dopamine receptors. Ketamine, on the other hand, works on the N-methyl-d-aspartate (NMDA) receptors, just like a recently FDA-approved prescription oral medication, Auvelity. Expect more in the future as researchers continue to explore this novel receptor and mental health treatment.
Who should NOT receive ketamine therapy?
Anyone with a history of hallucinations, schizophrenia, bipolar disorder, drug-seeking behavior or drug abuse should not receive ketamine therapy. “Ketamine in higher doses can be hallucinogenic. We don’t want to initiate some sort of episode like that,” says Duprat. If you are at risk for high blood pressure, you need to be monitored closely for an increase during the therapy. “A clinician can stop an infusion quickly if an issue arises and the patient will be back to normal in 20-30 minutes, as ketamine quickly metabolizes,” Duprat says.
Some medications can dampen or reduce the effects of ketamine, so that’s something else to consult a doctor about. “Some people have to wean off of medications temporarily to do it,” Egenes says.
Where can you find a legit clinic to administer ketamine?
“There hasn’t been a national organization to come up with a certification process yet. It’s in the works, which is why we created the Ketamine Academy,” says Duprat. “Start with someone who has training from a reputable program based on medical literature because there are some that don’t. Don’t do the experiential retreats.”
Final Thoughts
Ketamine-assisted therapy has great promise. The fact that it can snap people out of the will to end their life and offer an alternative for treatment-resistant depression is incredible. But is it for everyone? No—or at least not yet. It’s not like a neighborhood hemp shop selling Delta 8 that can’t do much harm. This is still a major drug that is being studied for all of its applications, and you should consult with your health care providers to make sure it’s a good fit for you before booking a trip.
Stay tuned for more coverage of psychedelics in future articles. Need help with an energy shift? Discover the benefits of holistic reiki here.