Ketamine therapy is coming to the forefront of the psychedelic medicine conversation, over other classical psychedelics and compounds.
While it’s increasingly becoming recognized in the mainstream over other options, ketamine therapy has a number of factors that are putting it at center stage in the world of psychedelic medicine. Kristin Arden, psychiatric nurse practitioner and Lead Clinician at Mindbloom, helps explain some of the components that make this treatment option so promising.
It’s Already Being Used in Medical Practices
For decades, ketamine has been used in a clinical setting for anesthesia and to help treat pain. As a result, there’s plenty of science that validates the safety of its use in a medical context.
“In thinking about treating off-label, for things like depression and anxiety, we have a medication that's scientifically validated as being safe,” Arden says. ”We have a large body of research that has validated its safety for treatment indications that often require higher doses than we typically use in a mental health setting.”
Medications face a lot of barriers before they can be accessed for general use. They go through an extensive review process by the FDA and are scheduled by the DEA. Ketamine is scheduled by the DEA as a Schedule III controlled substance, which is defined as “drugs with a moderate to low potential for physical and psychological dependence.” Some examples of Schedule III substances are anabolic steroids, supplemented testosterone, and pain-relief products containing less than 90mg of codeine.
At this time, other psychedelics such as psilocybin (mushrooms) and MDMA are classified by the DEA as Schedule I, which by definition means drugs with no currently accepted medical use and high potential for abuse. This is despite the fact that those compounds are currently in various phases of FDA trials for their medicinal applications.
“The regulatory barriers for utilizing ketamine in the treatment of mental illness aren’t there as they would be with other substances at this time,” Arden says.
The FDA already has indications for the use of ketamine for treatment of conditions like treatment-resistant depression and depression with suicidality.
Ketamine has a Relatively Short Half-Life, Which Means Quick Recovery
When you are treated with ketamine, the acute, disassociating effects wear off quickly, and the side effects dissipate rapidly as well. When comparing ketamine to other psychedelics available, the more acute phase of the ketamine treatment generally lasts about an hour. Generally, it takes about three hours after someone who has done the treatment to return to their baseline mental status and physical status.
This is significantly shorter compared to treatments with other psychedelic compounds, which can last anywhere from four to eight hours during the acute effects of the medicine, followed by a much longer recovery time.
“When we think of ongoing maintenance treatment, or a course of several treatments for conditions like depression and anxiety, ketamine is really on the up side of that, just based on sheer time commitment or time burden for the individual,” Arden says.
It also doesn’t have lingering effects, so you won’t need to take time off to recover from the treatment process.
It Doesn’t Interfere with Traditional Treatments for Depression / Anxiety
Another promising aspect of ketamine, especially those using it for depression and anxiety, is the way it works neurobiologically.
Unlike SSRIs and SSNIs, which are active in the serotonin pathways, ketamine works through different brain receptor pathways, known as the NMDA (N-Methyl-D-aspartic acid). Other substances like LSD, psilocybin, MDMA/ecstacy have a very high serotonin burden. This means there’s more potential for drug to drug interactions.
For example, if someone on Prozac wanted to try psilocybin to help treat their depression, they would have to taper off their antidepressant treatment, as there would be risk of serotonin syndrome. This is a life threatening condition that can lead to extreme nerve activity and dangerous symptoms like confusion, agitation, and heart arrhythmias. With ketamine, there isn’t that risk, since it works on a different neurotransmitter and pathway of the brain.
“For people who are on antidepressants, they may feel 50 percent better,” says Arden. “Ketamine works really great as an adjunct, to add on, to treat that other 50 percent.”
It has the Potential to be Affordable
While it’s not clear how accessible ketamine will be in the future from a regulatory standpoint, there’s a good chance that it will be a more affordable option than other psychedelic medications. Arden suspects that once synthetic versions of psilocybin hit the market, they will have the potential to be pricey.
However, while there is a relatively expensive ketamine product currently on the market —ketamine-derived nasal spray Spravato for treatment-resistant depression— generic ketamine is already being used in many practices, such as through Mindbloom.
“We have generic ketamine that we can use, and that significantly reduces the price point in that it’s already in that generic group of medications, as far as classifications go,” says Arden.
It has Fewer Barriers to Treatment
There’s a lot of steps to follow when prescribing a drug like Spravato. It’s logged into the drug safety program, Risk Evaluation and Mitigation Strategy (REMS), which the FDA requires for many medications with safety concerns. This is to help make sure the benefits outweigh the risks.
Once it’s prescribed, a doctor has to follow very specific steps to ensure the patient’s safety. With generic ketamine, there are less barriers to allow access.
“Ketamine is in a special place in that we’re using it off-label in its generic form, and it removes step-by-step legislations where you have to go through all these [measures] to prescribe it safely,” says Arden.
Currently, clinical studies involving psilocybin and MDMA have a very high clinical burden. Patients are monitored for eight hours and must have two clinicians with them, which adds up in terms of time and expenses. With generic ketamine, there are less clinical burdens.
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This article is for informational purposes only and is not intended to be a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. If you are in a life-threatening situation, call the National Suicide Prevention Line at +1 (800) 273-8255, call 911, or go to the nearest emergency room.
Important FDA Safety Information
Ketamine is not FDA-approved for the treatment of depression or anxiety. Learn more about off-label uses here.
Side effects of ketamine treatment may include: altered sense of time, anxiety, blurred vision, diminished ability to see/hear/feel, dry mouth, elevated blood pressure or heart rate, elevated intraocular or intracranial pressure, excitability, loss of appetite, mental confusion, nausea/vomiting, nystagmus (rapid eye movements), restlessness, slurred speech, synesthesia (a mingling of the senses).
Do not proceed with ketamine treatment if any of the following apply to you:
- Allergic to ketamine
- Symptoms of psychosis or mania
- Uncontrolled high blood pressure
- CHF or other serious heart problem
- Severe breathing problem
- History of elevated intraocular or intracranial pressure
- History of hyperthyroidism
- Other serious medical illness
- Pregnant, nursing, or trying to become pregnant
Ketamine has been reported to produce issues including, but not limited to, those listed below. However, lasting adverse side-effects are rare when medical protocols are carefully followed.
While ketamine has not been shown to be physically addictive, it has been shown to cause moderate psychological dependency in some recreational users.
- In rare cases, frequent, heavy users have reported increased frequency of urination, urinary incontinence, pain urinating, passing blood in the urine, or reduced bladder size
- Ketamine may worsen problems in people with schizophrenia, severe personality disorders, or other serious mental disorders.
- Users with a personal or family history of psychosis should be cautious using any psychoactive substance, including ketamine, and discuss potential risks with your MindBloom clinician before proceeding with treatment.
- The dissociative effects of ketamine may increase patient vulnerability and the risk of accidents.
To promote positive outcomes and ensure safety, follow these ketamine treatment guidelines:
- Do not operate a vehicle (e.g., car, motorcycle, bicycle) or heavy machinery following treatment until you’ve had a full night of sleep
- Refrain from taking benzodiazepines or stimulants for 24 hours prior to treatment
- Continue to take antihypertensive medication as prescribed
- Avoid hangovers or alcohol intake
- Refrain from consuming solid foods within 3 hours prior to treatment and liquids within 1 hour prior to treatment
- Ketamine treatment should never be conducted without a monitor present to ensure your safety