Ketamine is a powerful antidepressive drug that has been studied for its potential to treat mental health conditions such as depression, anxiety, and post-traumatic stress disorder (PTSD). IV ketamine therapy has been shown to have short-term effectiveness for the treatment of nonpsychotic, treatment-resistant unipolar and bipolar major depression. Within hours of receiving treatment, patients who benefit from IV ketamine have experienced onset of clinical antidepressive response lasting on average three to 14 days. In one study, 85% of patients experienced a remission in their depressive symptoms (defined as at least a 50% reduction in symptoms).¹

If you're considering this treatment, there are several things you should consider before getting started.

Finding a Qualified Provider

Ketamine is fortunately legal for medical use across the U.S. However, it's essential to find a qualified provider who has experience in administering IV ketamine treatment. Look for a licensed medical professional, such as a psychiatrist or anesthesiologist, who has received specialized training in ketamine therapy. Legally, any licensed physician with current unrestricted DEA registration (schedules II-V) can administer ketamine treatments. A physician can also delegate administration to a certified registered nurse anesthetist (CRNA). However, because ketamine is a scheduled drug, the physician must be present during the administration.²

The medical provider giving you the IV ketamine will also conduct a thorough medical examination and supervise your experience on the day of your treatment. This is important to ensure no medical adverse events occur as a result of your ketamine treatment.

Specific regulations may differ depending on your city or state, so it is important to go to a practitioner who is licensed to conduct legal IV ketamine care in your region.

Understanding the Risks

IV ketamine treatment is generally considered safe when administered by a qualified provider. However, there are risks associated with the treatment, including side effects such as nausea, dizziness, and confusion, as well as the potential for addiction and abuse if the drug is misused. Luckily, these symptoms tend to last only during the treatment or shortly afterwards, if they happen at all. If any linger for a prolonged period, such as for longer than a few hours after the treatment, it is important to reach out to a medical provider to determine whether or not they need to be addressed.³

Knowing the Cost

IV ketamine treatment can be expensive and is not covered by insurance in most cases. The cost of IV ketamine therapy is typically around $500-$650 per infusion with a session lasting around 40-60 minutes. The cost of treatment can vary depending on the provider, the location, and the duration of treatment. Be sure to ask about the cost upfront, so you know what to expect.⁴

Notably, IV ketamine may require repeat sessions to produce antidepressive responses. Those with adequate responses, however, may have lasting benefit for anywhere from weeks to years.⁵

Much of the cost of IV ketamine treatment comes from requiring a doctor to be physically present and the setup for an infusion center. More affordable options for ketamine treatment include intranasal and sublingual treatments, which may be possible to take at home.

Preparing for the Experience

IV ketamine treatment is administered through an IV drip and can last anywhere from 30 min to 2 hours. During the treatment, you may feel disoriented, dizzy, or hallucinate. This is part of the intended psychedelic experience in most cases, but can be frightening if a person is not emotionally prepared.

Other than the logistical steps mentioned above, preparation for IV ketamine, especially if optimizing for a productive psychedelic session, includes:

1. Learn about how the ketamine session will go - the subjective experience differs for everyone but developing some level of comfort with the most common possibilities is important.
2. Prepare an intention for your session, either on your own or with a coach or therapist.
3. Find someone you trust to drive you home afterward.
4. Set up integration following treatment, either on your own or with a coach or therapist.
5. Get a good night’s sleep the night before.
6. Fast for 3-6 hours prior to your treatment, with only sips of water. You may be given slightly different specific instructions but the purpose is to decrease nausea and the desire to urinate during your session.
7. Wear comfortable clothing for the treatment.

By being properly prepared for your experience, you will optimize your comfort and outcomes from the ketamine treatment.

Discussing Your Medical and Mental Health History

Before starting IV ketamine treatment, it's essential to discuss your full medical and mental health history with your provider. This includes any current or past mental health conditions, medications you are taking, and any substance use history. Ketamine is not recommended for individuals with certain medical conditions, such as uncontrolled hypertension, active substance abuse or dependence, and some heart and liver conditions. Moreover, it is not advised for individuals with a history of psychotic disorders, including schizophrenia and uncontrolled bipolar disorder, or for those with a history of dissociative disorders.

Considering Other Treatment Options

IV ketamine treatment may not be the right option for everyone. It's important to discuss other treatment options with your provider, such as therapy or traditional medication, to determine the best approach for your mental health. As mentioned previously, IV ketamine can be costly and, without adequate support, may have limited positive effects for each infusion.

General Steps to Take for IV Ketamine Treatment

1. Schedule a consultation with a qualified provider to discuss your mental health and determine if IV ketamine treatment is right for you.
2. If the provider recommends IV ketamine treatment, schedule your first session.
3. Prepare for your treatment as above.
4. Arrive at the appointment on time and follow the provider's instructions for the treatment.
5. After the treatment, rest and allow yourself time to recover. You may feel disoriented or dizzy, so it's important to take it easy.
6. Integrate your session with a trusted partner, friend, or professional.

Optimizing and supporting ketamine care

Preparation, intention-setting, set and setting, and integration are all important considerations for IV ketamine treatments. Preparing for the treatment educating yourself about the effects of ketamine, arranging for someone to drive you home, taking the day off from work or other activities. Intention-setting involves identifying your goals for the treatment and discussing them with your coach, therapist, or other provider. Set and setting refer to the mindset and environment in which the treatment takes place, respectively. It's important to create a safe and psychologically supportive environment for the treatment. Finally, integration involves reflecting on the experience and incorporating any insights gained into your daily life. By considering these factors, you can increase the effectiveness and safety of IV ketamine treatments.

In conclusion

IV ketamine treatment can be an effective option for individuals struggling with mental health conditions. However, it's essential to find a qualified provider, understand the risks and costs, and be prepared for the experience. By considering these factors and working closely with a provider, you can take steps toward improving your mental health and overall well-being.

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References

1. Mayo Foundation for Medical Education and Research. (n.d.). Psychiatry and psychology. Mayo Clinic. Retrieved from https://www.mayoclinic.org/medical-professionals/psychiatry-psychology/news/ketamine-exploring-continuation-phase-treatment-for-depression/mac-20430307
2. Moeller, M. (2022) What You Need to Know About Therapeutic Ketamine Laws. American Med Spa Association. Retrieved from https://americanmedspa.org/blog/what-you-need-to-know-about-therapeutic-ketamine-laws
3. Ketamine (Injection Route). (2023). Side Effects. Mayo Clinic. Retrieved from https://www.mayoclinic.org/drugs-supplements/ketamine-injection-route/side-effects/drg-20075559
4. Smith, A. (2021). How Much Does Ketamine Treatment Cost? Frshminds. Retrieved from https://frshminds.com/ketamine-treatment-cost/
5. Andrade C. (2017). Ketamine for Depression, 4: In What Dose, at What Rate, by What Route, for How Long, and at What Frequency? The Journal of Clinical Psychiatry. 2017;78(7):e852-e857. Retrieved from https://doi.org/10.4088/jcp.17f11738

‌Cover photo by Marcelo Leal on Unsplash