Ketamine is an anesthetic that has been found to have potential benefits for treating a variety of mental health conditions. Recent studies have found that ketamine can have long-lasting positive effects on depression.¹ It works by causing physical growth in areas of the brain associated with emotion regulation and mental health disorders. It also establishes new connections among neurons while repairing damaged cells.² A study published in the Journal of Clinical Psychiatry found that people who received intravenous ketamine treatment at three private ketamine infusion clinics had “significant improvement” in symptoms of depression, anxiety and suicidal ideation.¹ Another study published in the British Journal of Psychiatry found that ketamine had significant anti-depressant and anti-suicidal effects.³ However, ketamine's usefulness for other mental health conditions is less clear. While it may quickly alleviate depression and thoughts of suicide, its use is not without hazards.³ One potential hazard is its side effects. Common side effects of ketamine include having a dream-like feeling, blurred vision, double vision, jerky muscle movements, dizziness, drowsiness, nausea, vomiting, loss of appetite, or sleep problems (insomnia). More serious side effects may include high blood pressure and fast heartbeat.⁴ For most people, these side effects are minor and transient, but for those with underlying medical conditions such as heart disease it is especially important to have a thorough medical evaluation before starting ketamine treatment.

How long does it take for ketamine to work?

Ketamine is known for its fast-acting effects on depression symptoms. Some people experience ketamine’s antidepressant effects in as little as two hours. One study showed that at 24 hours, 71% of patients positively responded to a single dose of ketamine.⁵ Patients who benefit from intravenous (IV) ketamine have experienced onset of clinical antidepressive response lasting on average three to 14 days.⁶ It's important to note that everyone's experience with mental health treatment is unique. What works for one person may not work for another. If you're considering ketamine therapy as a treatment option, it's important to discuss it with a qualified healthcare professional.

Who should avoid use of ketamine

Ketamine is typically not recommended for use during pregnancy due to a lack of data from controlled studies in humans. For this same reason, the Federal Drug Administration has not assigned a pregnancy risk category to ketamine. The pharmaceutical provider of Spravato, the ketamine nasal spray approved for treating depression, has recently warned of the potential risk of fetal toxicity if the drug is administered to pregnant women.⁷

Ketamine is generally avoided or used with extreme caution in people with a history of psychosis or schizophrenia, as there is concern that the dissociation ketamine produces can make psychotic disorders worse. Ketamine is also avoided or used with caution in people with a history of substance use disorder because ketamine can cause euphoria (likely by triggering the opioid receptors) and some people can become addicted to it (which is called ketamine use disorder).⁸

How is ketamine different from SSRIs and other traditional antidepressants?

One way that ketamine differs from traditional antidepressants like SSRIs (selective serotonin reuptake inhibitors) is in how it works. SSRIs work by increasing levels of serotonin in the brain. Serotonin is a neurotransmitter that helps regulate mood. Ketamine works differently by causing physical change and growth (neuroplasticity) in areas of the brain associated with emotion regulation and mental health disorders.² Ketamine also works immediately or after a few doses, versus SSRIs which can take up to six weeks to have noticeable effects. Another major difference is that ketamine can be used interventionally, or just once or a few times (weekly, for example). SSRIs require daily consumption to work. In addition, patients can suffer from dangerous withdrawal symptoms if they do not wean off SSRIs carefully. SSRIs, tricyclic antidepressants and SNRIs can cause chills, muscle pain, excessive sweating, nausea and headache and insomnia. They can also cause dizziness or electric shock sensations during a too-rapid withdrawal period, so it is important to come off of such medications with the help of a medical professional.⁹

Conclusion

It's important to remember that ketamine may not work for everyone, and its usefulness for mental health conditions other than depression or suicidality is less clear. While it may quickly alleviate depression and thoughts of suicide, some may experience side effects, such as a dizziness, drowsiness, nausea, among others listed above. More serious side effects may include high blood pressure and fast heartbeat.⁴ It's important to discuss potential treatments with a qualified healthcare professional to determine what may be best for you.

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References:

1. Oliver, P.A., Snyder, A.D., Feinn, R., Malov, S., McDiarmid, G., Arias, A.J. (2022). Clinical Effectiveness of Intravenous Racemic Ketamine Infusions in a Large Community Sample of Patients With Treatment-Resistant Depression, Suicidal Ideation, and Generalized Anxiety Symptoms. The Journal of Clinical Psychiatry. 2022;83(6). Retrieved from https://pubmed.ncbi.nlm.nih.gov/36112599/
2. Silverstone, P. (2022). Ketamine: A new psychedelic treatment. Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/the-promise-psychedelics/202208/ketamine-new-psychedelic-treatment
3. Walsh, Z., Mollaahmetoglu, O.M., Rootman, J., et al. (2021). Ketamine for the treatment of mental health and substance use disorders: comprehensive systematic review. BJPsych Open. Retrieved from https://doi.org/10.1192/bjo.2021.1061
4. Davis, K. (2021). Ketamine: What is it, uses, treatments, effects, and more effects. Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/302663
5. Zarate, C.A., Singh, J.B., Carlson, P.J., et al. (2006). A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Major Depression. Archives of General Psychiatry. 2006;63(8):856. Retrieved from https://pubmed.ncbi.nlm.nih.gov/16894061/
6. Mayo Foundation for Medical Education and Research. (2017). Ketamine: Exploring continuation-phase treatment for depression. Mayo Clinic. Retrieved from https://www.mayoclinic.org/medical-professionals/psychiatry-psychology/news/ketamine-exploring-continuation-phase-treatment-for-depression/mac-20430307
7. Kaliszewski, M. (2022). Is it safe to use ketamine during pregnancy? American Addiction Centers. Retrieved from https://americanaddictioncenters.org/ketamine-abuse/is-it-safe-to-use-ketamine-during-pregnancy
8. Grinspoon, P. (2022). Ketamine for treatment-resistant depression: When and where is it safe? Harvard Health. Retrieved from https://www.health.harvard.edu/blog/ketamine-for-treatment-resistant-depression-when-and-where-is-it-safe-202208092797
9. Smith, L. (2019). How to avoid antidepressant withdrawal symptoms. Patient.info. Retrieved from https://patient.info/news-and-features/how-to-avoid-antidepressant-withdrawal-symptoms

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Cover photo by Gaelle Marcel on Unsplash