The medication Ketamine was developed in the 1960’s and became more widely used beginning in the 1970’s as a dissociative anesthetic. Its safety led to its use as a field anesthetic during the Vietnam War. In the 1990’s it was classified by the DEA as a schedule III non-narcotic controlled substance in response to its growing use as a recreational drug. Today it continues to be used as anesthesia and for emergency procedures. Its antidepressant properties have been observed since the 1970’s, although it wasn’t until the 2000’s that ketamine was studied more extensively at lower, sub-anesthetic doses to treat conditions such as depression, suicidality, anxiety, PTSD, and chronic pain.

Ketamine is believed to work differently from traditional antidepressants by targeting the brain’s glutamate system, which is involved in mood regulation. Through the glutamate pathway, ketamine may also create greater neuroplasticity, which supports learning. It can lead to rapid improvement in symptoms for some individuals, including for some who have not responded well to other treatments.

Ketamine therapy has shown promise in treating major depressive disorder (MDD), bipolar depression, post-traumatic stress disorder (PTSD), and anxiety disorders.

No. I take a conservative approach to the use of ketamine. As a board-certified psychiatrist, I am guided by current research and provide medicine only when the science suggests it may be helpful, and for patients whose psychiatric conditions fall within my scope of practice. I do not provide ketamine treatment for chronic pain, substance use disorders, or mental health difficulties or diagnoses for which there is a lack of evidence of its potential benefit.

No. I do not prescribe ketamine at all for home use. I only administer ketamine in my office by IM injection. I believe in-office treatment is the safest, most clinically appropriate use of this powerful medication and IM administration allows for more predictable absorption and response.

Sessions typically last about two hours and take place only under in-person medical supervision. After I measure vital signs and provide a brief check-in, ketamine is administered intramuscularly (IM), similar to a vaccine. Some people will experience pain at the injection site at during the injection itself. This typically resolves quickly. It can take anywhere from a minute to several minutes to experience the initial effects of the medication. During the session patients may experience a range of effects that can be thought of as non-ordinary states of mind. These may include a temporary loss of sense of self, or a transitory feeling of dying or being dead. Some will experience feelings of awe and dissolution into a larger universe, which some describe as transcendent or deeply spiritual. Not everyone experiences this profoundly altered, liminal state of mind during treatment and there is no evidence that dramatic change in consciousness is needed to get the full benefit from ketamine therapy. People sometimes have experiences that are surprising, frightening, or upsetting during treatment with sub-anesthetic ketamine. Prior to treatment I discuss at length how to navigate distress during and after your treatment session.

The duration of a session can vary but most sessions last about two hours. Most people experience a peak altered mental state for about 30 minutes after the ketamine is administered. This can vary from individual to individual. Patients gradually return to a “regular” state of mind over the next hour or two and are monitored after the initial peak response to ensure safety and comfort.
The number of sessions needed varies from person to person. A typical course consists of six sessions over two to three weeks. The duration of the benefits vary and some patients who get initial benefit may feel best with periodic booster sessions after the initial treatment course. Together with my patients, I develop individualized treatment plans.

Talk therapy during ketamine treatment sessions has not been shown to provide substantial additional benefit. It is my belief that during the treatment itself patients benefit most from a professional, quiet, low-stimulation environment where they are free to focus on their internal experience. My highest goal during ketamine treatment is to keep my patients safe and comfortable and to protect them from external experiences that might interfere with their treatment goals and healing while they are in a vulnerable state.

Therapy prior to and after ketamine treatment sessions may help extend the duration of benefit and support the development of a healing narrative around the experience that ketamine can facilitate. Ketamine is a powerful medicine and therefore it may create challenging internal experiences for some people. It is important to me that my patients have ongoing mental health support around their ketamine treatment. I can provide preparatory sessions prior to and integration sessions after ketamine treatment and/or coordinate with my patients’ other providers to foster a durable and meaningful healing experience.

Maybe. There is incomplete information about which medications may interact with ketamine. However, most mental health medications are considered safe to continue while receiving a course of ketamine. I discuss specific medications and possible interactions during the initial assessment. I do not provide medication management for ketamine patients with whom I do not have a previously established treatment relationship. I require all of my patients to have ongoing care established with a mental health provider prior to starting a course of ketamine.

Maybe. Ketamine is not effective for everyone. While I screen carefully to identify patients who I believe have difficulties that have the best chance of responding to ketamine, there is no sure way to know prior to treatment whether any individual patient will benefit and to what degree. I discuss with all patients the possibility that they will not improve during ketamine treatment and we create a plan together to navigate that disappointing possibility, typically in coordination with their other mental healthcare provider/s.

When administered by a medical professional in a clinical setting sub-anesthetic ketamine treatment is generally safe for most people. However, like any medication, it carries potential risks. I discuss these with each patient during the initial assessment. In some cases I will decline to provide ketamine treatment if there are medical or mental health conditions that put a patient at higher risk of serious side effects.

Common side effects may include temporary dissociation (a feeling of being separated from one’s body), dizziness, nausea, loss of appetite, and changes in perception. Many people experience a transitory increase in blood pressure, a feeling of heaviness in their body, slurred speech, and impaired motor activity. These effects typically resolve shortly after the session ends. There are potentially serious side effects that are rare with medically monitored ketamine treatment at sub-anesthetic doses. These can include an allergic reaction, increased pressure inside the eye, ulcerations and inflammation in the bladder, and risk of drug abuse or dependency.

Possibly. Coverage for ketamine therapy varies depending on the insurance provider and specific policy. Some insurance plans may cover ketamine therapy for certain conditions, while others may not. It’s important to check with your insurance provider to understand your coverage options and potential out-of-pocket costs. I do not bill insurance directly for ketamine treatment but can provide you with a superbill for possible reimbursement. In some cases, I may be able to bill your insurance directly for the initial assessment and any other therapy sessions outside of the ketamine treatment itself.

It can take at least several hours for the medication itself to leave your system. People may feel clumsy, uncoordinated, or tired, or may have nausea, vomiting, or blurry vision. Most people return to feeling completely normal by the end of the day. There can be some minor bruising or bleeding at the injection site; this usually less intense than the local discomfort experienced after many vaccines.

Some patients report feeling immediate relief or improvement in symptoms shortly after a ketamine therapy session. The large majority of people who benefit from ketamine therapy will notice improvement by the fourth treatment session. Individual responses can vary, however. Some people have a passing period of increased anxiety or irritability in the immediate hours after a session, but do not appear to be any less likely to experience improvement in their symptoms after this initial discomfort. During follow-up visits patients are encouraged to discuss their experiences, including any changes in symptoms, so that their treatment plan can be adjusted as needed.