Who can benefit from Ketamine Therapy?

When most Americans hear the word “ketamine” they either think of horse-tranquilizers or party drugs. But ketamine has grown a following of enthusiastic practitioners and patients in the last few years, and with good reason. It’s given relief to thousands of people with diagnoses from depression to chronic pain. Learn more about who can benefit from Ketamine Therapy?

Ketamine for mental health is administered under two different models: Infusion only or combined with Therapy. 

Ketamine infusion practitioners are typically anesthesiologists and CRNAs (Certified Registered Nurse-Anesthetists). Infusions are typically offered in a clinic or pain center setting, and patients usually don’t have an ongoing relationship with their provider outside of infusion appointments. 

Ketamine therapy is usually delivered by licensed therapists, and integrates psychotherapy with a ketamine regimen. The ketamine therapy model not only re-wires the brain, but the mind as well. We believe that psychotherapy and ketamine is the best way to combine the psychedelic experience of ketamine for the best chance at long-term solutions for mental health. 

Ketamine works through synaptogenesis, or creating new neural pathways. While SSRI’s work by stimulating neurotransmitter activity, ketamine actually repairs damage. It’s also thought to reduce inflammation which can contribute to mood disorders [1, 2]. Let’s talk about what diagnoses have been most responsive to ketamine therapy. 

Ketamine Therapy for Treatment-Resistant Depression

Depression is a leading cause of worldwide disability [3]. Up to a third of people with depression do not respond to one or more treatments  [4]. Psychotherapy and psychopharmacology often take months to work, if patients ever even find success with these methods. Trial-and-error medication management can leave patients adrift and hopeless. 

These patients are at an increased risk for self-harm and suicide. About a third of patients with TRD will attempt suicide at some point in life [5]. This group of patients is often unstable, and need faster intervention than psychotherapy and medication can allow. 

Ketamine therapy can provide much faster relief for patients with TRD. It works by repairing damage in the brain made by cortisol and other stress hormones. It also brings down inflammation, which could be a cause of mood disorders [6]. By acting quickly and effectively, ketamine can be a bridge treatment for people with TRD. 

Ketamine Therapy for Anxiety

Anxiety rates have increased substantially over the course of the COVID-19 pandemic, as our population deals with more uncertainty and stress [7]. We now believe anxiety originates from overactive brain circuits that fire off despite a lack of stimulus [8]. By forming new connections in the brain, ketamine could be a better solution for people with general and social anxiety. 

There’s less evidence currently for ketamine and anxiety, but the research we do have is very promising. In a systematic review of ketamine treatments for anxiety, four out of six trials found significant benefits for ketamine compared to placebo treatment [9]. 

One 2018 study compared ketamine with midazolam (versed) [10]. Patients completed a fear questionnaire and underwent electroencephalogram studies. Ketamine decreased frontal theta waves, which are thought to be active during executive functioning and task performance. By doing so, ketamine brought down the intensity of phobic thoughts and decreased patient’s fear questionnaire results. 

Some evidence even shows that Ketamine could increase resilience to stress, as shown in rats [11]. As our population deals with more uncertainty, ketamine could help us manage and treat anxiety. 

Ketamine for Patients with PTSD

Almost 9% of Americans suffer from PTSD [12]. It remains a debilitating illness for survivors of trauma and veterans, and significantly contributes to disability. Combined psychotherapy and anti-depressant medications may offer some relief, but ketamine could give patients with PTSD more immediate breakthroughs. 

Some researchers believe that the distressing thoughts and memories in PTSD may come from changes in synaptic activity. Ketamine’s ability to build new synaptic connections could provide long-term relief for people with PTSD [13]. Ketamine-assisted psychotherapy works in a similar way to MDMA therapy where the substance helps the person process traumatic memories during therapeutic sessions.

When compared to midazolam, ketamine has performed better at treating PTSD. It’s effects are also generally longer, and improve depressive symptoms as well as flashbacks [14]. Ketamine could provide relief to our veteran population, who has been failed by traditional mental health treatments. 

Ketamine Therapy for Bipolar Disorder

Ketamine could be a useful stabilizer for patients with acute bipolar disorder. Patients with bipolar disorder have the highest risk of suicidality across the lifespan [15]. Like in TRD, ketamine could significantly reduce suicidal ideation in this population. 

Research has given good support for ketamine’s ability to stabilize bipolar depressive swings. A systematic review with bipolar patients found that one dose of ketamine decreased suicidal ideation within a day [16]. 

Aside from alleviating suicidality, ketamine could treat bipolar disorder in several ways. It’s believed to increase neuroplasticity, as well as synapse growth. There’s also some limited evidence that it could decrease inflammation and prevent autoimmune diseases, which are prevalent in patients with bipolar. It could even prevent depressive swings by increasing good gut flora [17]. 

Ketamine’s stabilizing ability could give needed relief to this underserved population.

Ketamine Therapy for Chronic Pain

In the intraoperative setting, ketamine is already being used to prevent chronic postoperative pain, particularly in those with opioid tolerance [18]. At low doses, it’s also effective for treating chronic neuropathic pain [19]. 

Unlike other pain management methods like opioids, ketamine doesn’t cause physical dependence. However, it can still become psychologically addictive if taken frequently. Ketamine therapy could also yield more long-term pain relief than other medications by helping the patient cope better with what they are experiencing.

The duration of pain relief from ketamine varies. Relief can be short-term, only as long as the infusion lasts. Some evidence shows that prolonged ketamine infusion could give relief for up to three months [19]. 

While the basic infusion method is typically used to treat chronic pain with ketamine, combined psychotherapy could be a better option. Cognitive-behavioral therapy has been rigorously researched in its ability to treat chronic pain [20]. By combining physiological relief with psychological support, we can give lasting pain management for people suffering from chronic pain. 

Who is ketamine therapy not appropriate for?

Ketamine is not indicated for patients in acute mania or active psychosis. The psychedelic effects of ketamine can elevate these unstable mental states. 

It’s also not good for patients with unstable cardiovascular disease, because it elevates heart rate and blood pressure. This stress on the heart muscles could exacerbate heart problems [21]. 

Patients with a history of opioid and alcohol addiction should also be aware of the risk for ketamine abuse. Since ketamine therapy happens under the direct supervision of a medical provider, the risk of addiction is relatively low in medical settings. However, patients who have struggled with abuse could be triggered by ketamine infusion. 

Unfortunately, right now ketamine is also not practically appropriate for patients who can’t afford it’s steep costs. Ketamine infusions and therapy are for the most part not covered by insurance, so patients are having to shell out what is often hundreds of dollars per session. 

Despite its widespread use, we still have a lot to learn about best practices for ketamine therapy. Route of administration, timing, dosage, and treatment frequency likely have big effects on outcomes [22]. With time, we’ll know more about how to best administer ketamine to meet the needs of specific patients and their diagnoses.  Ketamine training for physicians and mental health providers is essential for safe and effective use.

Despite evidence for ketamine and a lot of anecdotal support from patients, there’s still resistance to this substance that is still associated with abuse. With more clinical research, we hope to better understand ketamine and its ability to help people with mental health diagnoses. 

If you’re enrolled in ketamine therapy, learn more about how to get the most out of your ketamine experience. Practitioners who are interested in adding ketamine therapy to their practice can check out our online ketamine course. 

References:

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