About the Medicine
Ketamine treatment is not the "cure" for depression or prolonged experiences of challenging emotions or feeling states in our bodies that so many people struggle with; there is no single cure for any such ongoing challenge. But, the utilization of prescribed ketamine and, in the future, other legally prescribed “psychedelic medicines” will likely be the next step toward a more holistic approach to healthcare.
Ketamine is an anesthetic medication that has been FDA-approved since 1970 for anesthesia during surgery, but has also been used for decades for acute pain relief and sedation in a variety of settings. Since its early use, researchers have noted that lower doses of ketamine can produce rapid antidepressant and anti-suicidal effects. Ketamine used at sub-anesthetic doses (well below the dose for anesthesia) can induce “psychedelic” (dream-like) experiences, or “non-ordinary states of consciousness”, and this effect is short lasting and ends in approximately an hour or two. But ketamine also enhances neuroplasticity, or the ability of your brain’s neural pathways to interact and connect in new ways, allowing new ways of thinking or feeling or reacting. This effect can be longer lasting and it is this relative freedom to respond in new ways to the world around you (and to your own thoughts and feelings) that greatly accelerate your process of healing and personal growth.
Please note: it is important to understand that there are inherent risks to taking ketamine, including the risk of having challenging psychological experiences, the risk of your symptoms worsening, the risk of adverse effects such as dizziness, nausea, headache, bladder dysfunction, and many other possible side effects. There is also a risk for developing an addiction to ketamine. The decision to receive (or to prescribe) ketamine treatment requires careful consideration of potential risks versus benefits, and not everyone will qualify to receive this treatment.
Methods of Administration
Ketamine for nervous system disorders such as depression is an "off label" use of this medication. It can be given via IV (intravenous) infusion over 40 minutes, IM (intramuscular) injection, or by SL (sublingual) tablet that dissolves in the mouth. At Nurse Log NeuroHealth, we’re happy to coordinate if you have an established therapist who you would like to attend your treatment session. All three treatment methods require a person to agree not to drive for the remainder of the entire day following the medicine session, as the after effects (drowsiness, dizziness, vision changes, slow reaction times) will last several hours. Most people will be able to drive the next day, but if your treatment occurs in the evening, it is essential to use caution and monitor yourself for any after effects the next morning.
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Much of the research on ketamine for the study of effectiveness has been performed using the IV method of administration. The dissociative effects of ketamine (a feeling of leaving the body, or of “forgetting” that you have a body or a separate Self) can begin within moments, but generally take several minutes to begin and can be more gradual with the IV infusion. IV provides the most predictable method for controlling the “depth” of your experience, and the “under medicine” effect of this method of administration is the shortest in duration (usually 90-120 minutes; longer for some people).
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This method involves an injection (or a “shot”) of ketamine into your upper arm. This method produces a rapid change of consciousness. The dissociative effects can be felt within 3-5 minutes and sometimes can feel very sudden. The recovery time during which you are returning to a normal state of consciousness can last longer than the IV infusion method.
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This means “under the tongue”, and this form comes as a lozenge or as a rapidly dissolving tablet. It can take from 5 to 15 minutes to dissolve completely (depending on the form), the patient swishing the dissolving solution around the mouth, and then the patient can swallow or spit out the remainder. This method can require 20-25 minutes for the medicine effect to begin, with a gradual rather than sudden onset. The bioavailability of SL ketamine is approximately 20-30% that of IV or IM (in some people it might be higher so always proceed with caution), so its effects are generally more mild for most people.
The form of ketamine described above is known as racemic ketamine (“racemic” is a chemistry term referring to a particular chemical structure of a drug molecule) and it is now widely prescribed for off-label use by specially trained clinicians for a variety of nervous system disorders such as depression, anxiety, PTSD and substance use disorders. A single enantiomer form of ketamine was FDA approved for certain mental health conditions under the brand name Spravato in 2019. Spravato is not available through Nurse Log NeuroHealth. If you are interested in Spravato, you can search here for a treatment provider.
Current research indicates that the following treatments are supported by the available evidence:
ketamine for depression
ketamine for anxiety
ketamine for PTSD
ketamine for addiction (with caution - not for active addiction to drugs)
ketamine for OCD
psychedelic therapy for depression
psychedelic medicine treatment for alcohol addiction