Ketamine Therapy

About

Ketamine Therapy

What is ketamine therapy?  

Ketamine therapy is used to treat major depressive disorder, other mental illnesses, and chronic pain.  This medication is prescribed once other more traditional treatment options such as medications and psychotherapy have failed.  Originally ketamine was developed and used as an anesthetic.  

What medical conditions can ketamine therapy treat?

Ketamine therapy has been shown to be beneficial for a variety conditions such as:

  • Major depressive disorder  
  • Bipolar disorder
  • Obsessive-compulsive disorder
  • Post-traumatic stress disorder
  • Post-operative pain
  • Chronic pain management
  • Suicide
  • Personality disorders

More research and treatment protocols are underway for these various illnesses. 

What are the different types of ketamine therapy available?  

There are two different types of ketamine therapy currently available.  They include:

  • An IV infusion option known as racemic.
  • A nasal spray option called Spravato.

What else should you know about ketamine therapy?

Ketamine is traditionally an anesthetic, but it has shown great effectiveness in treating depression when given at lower doses.

Mechanism of action

How does ketamine work against depression?

The exact way ketamine works against depression is still not fully understood.  There is agreement among researchers that ketamine acts directly at the N-methyl-D-aspartate (NMDA) receptors in the brain, helping them communicate more efficiently.  This receptor is known to play a role in the regulation of depression. 

How is ketamine therapy different from other antidepressants? 

Ketamine avoids long signaling chains within the brain seen with traditional antidepressant medications. This allows for a more rapid response in reducing depression symptoms.

Administration

How is ketamine administered?

IV ketamine is given as a slow, continuous intravenous drip.  Each infusion takes about 40 minutes to administer.  The treatment protocol with IV ketamine consists of three infusions the first week, two infusions during the second week, and only one infusion the last week.  Maintenance treatment is usually one infusion per month, but more research is needed to determine whether maintenance therapy is effective and required.

Where can you receive ketamine?

Ketamine therapy must be administered at an outpatient clinic or hospital setting.  This is required as there must be supervision from a licensed medical professional due to its dissociation properties within minutes of administration.  Patients are asked that they do not drive after the administration of ketamine, but there are no other restrictions for this medication. 

How long does ketamine therapy last?  

Ketamine has been shown to reduce depression symptoms within 40 minutes after infusion.  Treatment benefits can last up to 14 days.  More research is needed on the benefits of receiving multiple infusions for maintenance treatment of ketamine therapy.

Candidates for ketamine therapy

Who should use ketamine therapy?

About 7% of Americans suffer from major depressive disorder.  However, a third of those suffering from depression do not receive relief from traditional medical treatment.  Ketamine therapy is an alternative and should only be used once the first-line treatment has failed.  Because more research is needed, other treatment options such as electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS) can be considered first.

Who should avoid using ketamine therapy?

Although Ketamine therapy has many known benefits, it may not be suitable for the following patients:

  • Patients with poorly controlled blood pressure. 
  • Patients with uncontrolled cardiovascular disease. 
  • Patients with prior history of stroke.
  • Patients with prior history of psychosis.
  • Patients with prior history of liver damage.
  • Patients who are pregnant.
  • Patients who are actively abusing alcohol, drugs, and cannabis.
  • Patients with a prior history of adverse effects from previous use of ketamine.

Is ketamine safe?

What are the potential side effects of ketamine?

Ketamine is a safe and effective way to manage depression or other mental illnesses.  However, the best results occur when it is administered in a safe environment under the guidance of a licensed healthcare professional.  There are various side effects associated with the use of ketamine that should be considered.

Some include:

  • Dissociation 
  • Confusion
  • Elevated blood pressure
  • Euphoria
  • Dizziness
  • Increased sex drive
  • Nausea
  • Vomiting
  • Fatigue
  • Rash
  • Shortness of breath
  • Blurred vision
  • Potential for abuse or dependency
  • Withdrawal symptoms after long term use

Most patients notice side effects reducing after 80-110 minutes after administration of the medication.

Cost

How much does ketamine therapy cost?

Ketamine therapy can run $300-450 for each infusion provided.  This may be an expensive treatment option, especially initially when multiple infusions are required.    

Does insurance cover ketamine therapy?  

Some insurance providers recognize the benefits of ketamine therapy.  However, not all insurance providers may cover this type of therapy for treatment-resistant depression as it is considered experimental.  Our healthcare experts at TeleMed2U can provide guidance on which insurance providers offer coverage and payment options for those without the help of their health insurance company.

Summary

Have you tried many different treatments for your chronic depression but have not successfully found the right method to manage your symptoms?  Ketamine therapy may be a realistic option if you are looking for an alternative solution to treat your depression.  The first step is to speak to a healthcare expert such as ours at TeleMed2U.

References

Aan Het Rot, M., Zarate, C. A., Jr, Charney, D. S., & Mathew, S. J. (2012). Ketamine for depression: where do we go from here?. Biological psychiatry, 72(7), 537–547. https://doi.org/10.1016/j.biopsych.2012.05.003 
Black, R.  (2021, February). Ketamine for Depression.  Psycom. https://www.psycom.net/ketamine-depression 
Corriger, A., & Pickering, G. (2019). Ketamine and depression: a narrative review. Drug design, development and therapy, 13, 3051–3067. https://doi.org/10.2147/DDDT.S221437 
Liebrenz M, Borgeat A, Leisinger R, Stohler R. (2007). Intravenous ketamine therapy in a patient with a treatment-resistant major depression. Swiss Med Wkly. 137(15-16):234-6. PMID: 17525879.
Mayo Clinic. (2017, March). Ketamine: Exploring continuation-phase treatment for depression. https://www.mayoclinic.org/medical-professionals/psychiatry-psychology/news/ketamine-exploring-continuation-phase-treatment-for-depression/mac-20430307 
Meisner, R.C. (2019, May). Ketamine for major depression: New tool, new questions. Harvard Health Publishing. https://www.health.harvard.edu/blog/ketamine-for-major-depression-new-tool-new-questions-2019052216673

With Insurance

Behavioral Health

Your copay
Depending on insurance

Without Insurance

Behavioral Health

$240

Initial Visit

$99

Follow Up

Information

Medically reviewed by:

Dr Roy Kedem, MD

Dr Roy Kedem started his premedical studies at Harvard, and research in genetics and gene sequencing at Harvard, Beth Israel. He attended medical school in the UK at the Cambridge Overseas Medical Program in 1998.  Dr Kedem then completed his residency in Internal Medicine at Columbia College of Physicians and Surgeons in Stamford, Connecticut and his fellowship in Hospital Medicine at the Cleveland Clinic in Cleveland, Ohio.

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Affordable –
with or without insurance

With Insurance

Behavioral Health

Your copay
Depending on insurance

Without Insurance

Behavioral Health

$240

Initial Visit

$99

Follow Up