How Does Ketamine Treatment Work?

Ketamine is becoming increasingly popular for treating mental health conditions. There are different treatment methods provided by health practitioners with various skill sets. Learn more about the frameworks of treatment, costs, risks, and how to find ethical providers before you start ketamine treatments.

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How does ketamine treatment work you ask? There are 2 vital things to understand first.

First, what is ketamine?

Secondly, what are the differences between the 3 main ketamine treatment methodologies?

Until you have a basic understanding of what ketamine is and what ketamine does, you can’t truly distinguish between the 3 distinct treatment methods. You must know the difference to answer the question…

How does ketamine treatment work best for me?

We’ll start with a basic rundown of what ketamine is. Then we’ll provide the key info you need to choose the best type of ketamine clinic for you. Finally, once you can answer “how does ketamine treatment work”, we’ll tell you exactly how to locate it.

How does Ketamine Treatment Work – Ketamine 101

Don’t know what ketamine is?

Don’t know what ketamine treatment is for?

Backup this session for a few minutes to jump over here to learn more about ketamine, its history and what ketamine treatment is for. 

Ketamine is primarily used in 3 different ways: 

1. For anaesthesia
2. To treat pain
3. To increasingly treat treatment-resistant depression, suicidal thinking, anxiety, mood disorders, PTSD, and addictions among other conditions.

The clinical use of ketamine is on the rise, partly due to its Schedule III status. This means a drug has “a moderate to low potential for physical and psychological dependence,” according to the Drug Enforcement Agency (DEA). But most importantly, this allows doctors to legally prescribe ketamine for patients.

Now that we’re up to speed, you know that ketamine was first used as an anesthetic, both in humans and animals. The height of ketamine’s pain killing career came during the Vietnam War. Since then, ketamine has taken an interesting journey. 

Nowadays, ketamine sees use in treatment of treatment-resistant depression, mood disorders, addictions, and PTSD. 

When advertising ketamine treatments, it’s likely to be in treatment of these mental health issues, among others, or for pain management. Ketamine has become popular in recent years, and it’s not uncommon to see a ketamine treatment billboard. 

Ketamine’s unique journey provides 3 different treatment types:

• The first treatment is ketamine for pain management.
• The second is ketamine infusion therapy. 
• The third treatment is ketamine-assisted psychotherapy (KAP). 

Let’s talk about the 3 approaches, the difference and the pros and cons.

Ketamine for Pain Management

One of the primary driving forces of ketamine’s surge in popularity is its use for pain management. Ketamine works by blocking specific pain receptors in your brain. Patients can go to a clinic and receive intravenous (IV) ketamine treatments for a variety of illnesses. These painful conditions include:

• Complex regional pain syndrome
• Traumatic spinal cord injury
• Selected nerve and back pain
• Certain forms of cancer-related back pain
• Neuropathic pain
• Fibromyalgia

Successful ketamine infusions, can relieve pain and sometimes last much longer than with other treatments. Relief may last for days, weeks, or even months, depending on the type of pain being treated.

The ketamine infusions take place in an office or clinic, and the process usually takes anywhere from 45 minutes to five hours, depending on the specific condition. 

The main takeaway here is that ketamine infusions for pain relief employ a much lower dosage than the amount used for surgical anesthesia. Any type of hallucinatory or dysphoric “side effects” are viewed as unwanted.

Ketamine IV Infusion vs. Ketamine-Assisted Psychotherapy

Which brings us to ketamine IV infusion therapy and ketamine-assisted psychotherapy for mental health treatment.

That’s a lot of big, scary sounding stuff there so let’s break this down into simple to understand terms. 

There are 2 very different types of ketamine therapy for mental health. One type is ketamine IV infusion and the other is ketamine-assisted psychotherapy. What’s the difference between the 2?

First, ketamine IV infusion relies primarily on a neurobiological approach with no therapy involved and is popular among anesthesiologists. Whereas, ketamine-assisted psychotherapy addresses the underlying psychological distress through talk therapy and integration after the main drug effects wear off. 

Secondly, we must talk about ketamine’s risk to know the difference.

Ketamine does have the potential to lead to tolerance and addiction. However, it is far more psychologically addictive than physically addictive. Also, since you’ve now read up on ketamine’s background, you know that ketamine can be used in very different ways. Ketamine has dual uses at lower doses or at higher doses as a psychedelic. At smaller doses of ketamine, a person may still be able talk during the experience and explore their inner psyche. At higher doses, ketamine works more like a hallucinogen. Difference in dosage and the presence of talk therapy, are the primary differences between the 2 therapy types. 

Ketamine IV Infusion

In addition to treating pain, and even things like Lyme Disease, ketamine IV infusion treatments are used for: treatment-resistant depression, PTSD, suicidal ideation, bipolar disorder, obsessive-compulsive disorder and other mood disorders. Ketamine is seen as a last resort after other treatment methods like SSRIs, have not worked.

Ketamine therapy should not be for the initial treatment of psychiatric disorders or chronic pain management. Furthermore, considering ketamine should only follow the failure of standard treatment.

Ketamine infusion therapy works by IV in the arm and effects generally last anywhere from days to two weeks. The treatment starts with an induction phase. Patients receive a series of six infusions (or more) over two to three weeks (or more). The induction sequence tapers treatments from 3 in the first week, to 2 in the second, and once a week after that for example. Afterwards, a maintenance phase begins that may average one treatment a month.

The main goal of this treatment type is a neurobiological one. There are likely several ways it works in the brain, but inducing neuroplasticity is a documented effect. The ketamine infusion treatments stimulate new synaptic growth in the brain that helps to repair broken or out of sync neural connections resulting from mental health illnesses. Since the focus is on new synaptic growth and a neurobiological process, this treatment method lacks talk therapy.

Ketamine infusions also exempts people in the following groups:

-Active substance abuse (alcohol, cannabis, non-prescribed medications, etc.)

-Negative urine toxicology screening prior to the initiation of treatment to prevent risk of precipitated mania

-History of psychosis

-History of increased intracranial pressure

-Pregnancy (current)

-Uncontrolled hypertension

-Acute or unstable cardiovascular disease

-Previous negative response to ketamine

Following the infusion treatment, effects of the drug usually wear off after hours to 10 days. This means most patients need to get infusions on a regular basis.

Ongoing treatments may pose health risks as some research studies have demonstrated that chronic ketamine use can be toxic to brain cells and cause bladder damage.

PLEASE CONSULT YOUR DOCTOR BEFORE CONSIDERING KETAMINE THERAPY. If your doctor approves you for ketamine IV infusion therapy, here’s what to expect.

How does Ketamine Treatment Work with a Pain Clinic?

You will likely go to a pain clinic or anesthesiologist for your ketamine infusion treatments. A clinic like this uses a mix in the intravenous solution. For example, “A variety of medications can be used including lidocaine, ketamine, and magnesium.” This “infusion cocktail” can include a sedative like a benzodiazepine.

The added benzodiazepine offsets the hallucinogenic and dysphoric effects of ketamine. Preempting the onset of hallucinogenic effects is a critical distinction of the type of treatment. Hallucinogenic effects are seen as undesirable. Additionally, “Benzodiazepines [Valium, Xanax, Adivan] may blunt the antidepressant effect of ketamine.”

The intravenous session usually lasts a few hours. The benefits of low-dose intravenous ketamine treatment have a relatively short window. The duration of treatment benefits lasts somewhere between days to a few weeks. This short duration of therapeutic effects should be considered. 

Ketamine IV infusion therapy may require patients to return for further treatments for an unknown duration of time. This means more money spent on treatments and increased risk on side effects from repeated dosing.

Ketamine IV infusion treatments cost anywhere between $400-$2000 and most are not covered by insurance yet. Generally speaking, ketamine IV infusion therapy for mental health issues runs around $400-$500 per treatment. If buying a package of treatments, the per treatment cost might decrease. 

Therefore, if a patient doesn’t see long-lasting benefits to ketamine IV infusion treatment, the cost of this therapy type can begin to add up quickly, especially depending on the frequency of treatment. If treatment frequency is high, the cost can run into the thousands of dollars. 

In the end, one must ask, “Is this therapy type really solving the underlying condition?”

Now, after reading this, you will begin to see a clear distinction in the use of ketamine. 

Ketamine-Assisted Psychotherapy

Ketamine-assisted psychotherapy (KAP) is yang to the yin of ketamine IV infusion therapy. Ketamine-assisted psychotherapy has an entirely different approach and foundation. It takes a 180 turn away from ketamine IV infusion therapy, although it treats the same conditions like depression, mood disorders, etc.

Ketamine-assisted psychotherapy helps a person address psychological issues and develop skills for longer term therapeutic benefit. When using this approach, this type of therapy is similar to MDMA-assisted psychotherapy.
KAP entails taking a lozenge, or ketamine injections, usually combined with a 2 to 3 hour psychotherapy session.

The combination of therapy with ketamine “may accelerate the process of growth and change. Sessions last longer than traditional therapy, and are conducted with medical support and psychological counseling to ensure you are well cared for throughout your experience.”

Mail order ketamine is becoming increasingly popular. Again, the risk of dependence must be considered here. Ketamine is a powerful medicine and repeated use presents risk for serious adverse effects. While these mail order services are less expensive and easy to access, it is exactly these factors that can set the stage for dependence, misuse, and accidents. Professional support and oversight is critical for safe and effective use for positive outcomes.

Here’s a brief explanation of how KAP works from war correspondent and KAP patient, Ben Anderson.

Results of KAP

Above all, KAP can produce “shifts in consciousness such as expanded states of awareness, novel ways of viewing life concerns, and freedom from the worries and anxieties of our ordinary mind-states. Psychotherapy offers real-time reflection on this experience to enhance growth and change.” Furthermore, this treatment type may “…facilitate psychedelic experiences such as expanded consciousness and spiritual connection.” 

It’s through this unique approach that KAP distinguishes itself from IV infusion therapy. By shifting consciousness (and perhaps inducing psychedelic experiences) when combined with therapy, the treatment empowers the patient with the tools and skills to address their mental health issues. It bears repeating that KAP addresses psychological issues and develops skills for longer term therapeutic benefit.

However, KAP isn’t cheap either. A single psychotherapy session with ketamine lozenge can cost $600. Some cost as low as $225 to $350 depending on if the session is attended by a therapist or doctor. This price may not include other costs, like follow-up therapy sessions for example. You can also choose at-home sessions which run around $2,900 for two treatments. Alternatively, at-home Zoom sessions are available for $1,000. For a good example of KAP pricing, learn more here.

In the end, you see a clear distinction. One therapy gives a man a fish. The other therapy teaches a man how to fish. One treatment doles out an injection in a sterile context and setting. The other nurtures the human spirit with the aid of professionals. 

How does Ketamine Treatment Work – For Pain or Spirit?

Ketamine’s popularity has reached a point that you can drive down a Florida highway and see a roadside billboard advertising IV ketamine treatments, or be targeted by social media ads for mail order ketamine. The billboard and ad suggests the treatment for anxiety, bipolar disorder, PTSD, treatment-resistant depression and even suicidal ideation. So finding a ketamine clinic or a mail order prescriber might be easier than you realize. However…

There’s a BIG “but.”

Usually these billboards and social media ads are from anesthesiologists or prescribers with little training on psychedelic experiences. Ketamine training for providers is essential for safe and responsible therapeutic use. Pain clinics, like spinal centers for example, conduct these types of treatments. Does pain management and a brief online doctor consult sound right for mental health issues? Not necessarily. 

This is especially true of Florida and other states, where “pill mills” were a problem in the past. Pill mills were rampant in Florida and other states years ago. They were quack clinics where doctors slung painkiller prescriptions with no questions asked. They primarily catered to opioid addicts.

Ketamine’s Gray Area

The key point is that anesthesiologists aren’t likely to be combining treatments with psychotherapy and/or any type of mental health care provider. They tend towards being experts in pain and not so much in mind and spirit. Moreover, profit may drive their practice more than anything else.

That said, sure, there probably are pain management clinics that do successfully treat mental health conditions with ketamine. They may have success too. However, mental health is not an anesthesiologists area of expertise. Do you see a podiatrist about a rash?

Anesthesiologists can get in on the growing popularity of ketamine because they have a license to administer pain management drugs. This shouldn’t be conflated with their ability (or possible inability) to properly treat mental health conditions. So this creates a gray area without clear distinction in the United States.

That gray area can be risky. Seeing as how ketamine has become a “phenomenon” according to this excellent piece, the floodgates are now wide open. Ketamine is seen as a near miracle drug that can treat anything. A psychiatrist in the article mentions “people getting fleeced.” If you want to learn more about how to identify snake oil in the ketamine industry (untrained providers with minimal patient screening), read that article for sure.

This begins to sound eerily similar to the second edition of pill mills. It definitely doesn’t seem to be sound mental health care that attends to the mind and spirit.

Ketamine as Psychospiritual Benefactor

On the other hand, a growing number of licensed, mental health care professionals offer ketamine-assisted psychotherapy (KAP) treatments for a variety of mental health issues. It’s this demographic that’s working hard to enforce and bring more legitimacy to ketamine therapy. They’ve already released a Hippocratic Oath of sorts for ketamine therapy.

The “ketamine oath” starts like this:

“The ethical ketamine clinician recognizes that therapeutic ketamine is a mental health treatment. In this document, “therapeutic ketamine” refers to ketamine that is administered to a patient primarily for a psychiatric indication, psycho-spiritual exploration, and/or psychological work. Therapeutic ketamine does not include ketamine that is administered primarily for anesthesia or pain management, which are considered separate fields (specialties) from therapeutic ketamine.

The ethical ketamine clinician recognizes that ketamine is a powerful psychoactive medicine with prominent dissociative and psychedelic properties. The ethical ketamine clinician recognizes that therapeutic ketamine patients require specialized psychological care before, during, and after receiving ketamine.”

If this is the type of ketamine therapy that interests you, reading the rest of the “ketamine oath” from KRIYA Institute is a must to help you sort out the grifters.

Learn from the KAP Expert

Dr. Raquel Bennett, a clinical psychologist and founder of the KRIYA Institute, is one of the foremost leaders in the practice of ethical ketamine therapy. She has herself directly benefited from ketamine therapy.

In this contribution to MAPS, Dr. Bennett describes the journey ketamine has been on.

“For many years, ketamine was overlooked as a therapeutic agent because of the bias in Western medicine against psychedelic or psychospiritual experiences. However, in recent years, there has been a resurgence of interest in the therapeutic properties of ketamine…”

Rational materialism has ruled as the West’s most dominant paradigm for centuries. This paradigm has blanketed every aspect of science and medicine for as long as anyone can remember. It’s this view that has precluded the West from identifying the benefits of psychedelic and/or psychospiritual experiences. This is changing quickly, thanks to the United States undergoing “Psychedelics 2.0” and the mainstream resurgence of psychedelics.

Different Ways Ketamine is Used

Dr. Bennett continues to discuss the benefits of ketamine therapy in this psychospiritual capacity. She notes the 2 different ways that the drug can be used in a psychotherapy context. 

“A different way of working with ketamine is to use it as a lubricant in the psychotherapy process. The basic idea here is to offer the ketamine session(s) in the context of an ongoing psychotherapy relationship, in order to help the patient talk about material that is too painful or shameful to discuss otherwise.”

In addition to being used as a “lubricant” for psychotherapy, Dr. Bennett also describes ketamine’s other use. 

“Another way of working with therapeutic ketamine is to use it to purposefully induce mystical and psychedelic experiences. When clinicians choose to work in this way, they are working in a psychedelic and shamanic paradigm, in which the mystical visions are valued.”

As you can see, using ketamine within a shamanic paradigm is entirely different than using it either as a psychotherapy lubricant or in a pain management clinic. Employing ketamine in this way enables potential, deep, psychospiritual healing to occur that otherwise normally would not. 

How Does Ketamine Treatment Work Best for Me?

As you can see, ketamine can be used in a wide variety of ways. Everyone’s situation and circumstances differ, so only you can know what’s best for you. Still wondering how does ketamine treatment work best for you?

If you’re still not sure, definitely read Dr. Bennett’s MAPS article. She’ll help you to understand what type of treatment may be best for you, and keep in mind, ketamine is appropriate for everyone. Lastly, if the cost of ketamine IV infusion vs. KAP is a concern, check out this helpful cost comparison. Together with her insights and the advice of your physician you should be able to identify the best ketamine clinic that suits you nearby. Above all, please consult your physician before starting any ketamine therapy regardless of the type.

When you do figure out what type of ketamine therapy is best for you, where do you go? How do you find a provider? The Psychedelic Support Network is an excellent resource to find vetted, ethical mental health providers who provide ketamine-assisted psychotherapy. Contact a provider today to learn more about their services.

Cover image by Ostap Senyuk