After trying and failing multiple medications for depression, PTSD or suicidal thoughts, ketamine therapy promises to be a beacon for help. It is an entirely different medicinal approach for rewiring the brain and relieving debilitating symptoms. Ketamine helps build new connections between our nerve cells in the brain, undoing the damage that chronic depression or anxiety can cause. Up to 75% of patients that try it may find relief. For many the effects are immediate, as in within a day or two, but for others it takes more treatments. Why? There are many factors that affect progress. Understanding those up front may lead to a more successful course of ketamine treatment.
Who can get ketamine? Not everyone suffering with depression, PTSD, anxiety, etc is a candidate for ketamine. There is a careful screening process that all patients should undergo before signing up for this treatment. Your doctor will review all medical history, mental health history, and medication list. Ketamine is reserved for those people that have tried multiple medications, therapy, and possibly treatments such as ECT, biofeedback or TMS (to name just a few) and failed to find relief. It should not be used in those with schizophrenia, psychosis or if in a manic state of bipolar disorder. It is strongly emphasized that a person have a physician, either primary care or psychiatrist, or psychologist managing their overall mental health care.
Ketamine is One Tool in the Toolkit for Mental Health
Ketamine is not meant to be a stand alone treatment. Participation from the patient is required, as well as their medical team. For example, ketamine may lift a person out of deep depression within days or weeks, but it does not end there. Medications may be changed or reduced, but in all likelihood at least one prescription will remain.
Ketamine may be the spark for positive change in a patient’s life. Our patients are faced with a host of daily challenges at the start of ketamine therapy. If they are able to get out of bed and out of the house, perhaps they can attend more psychotherapy sessions, get exercise, rebuild relationships that will provide support, and a number of other healing activities. Their mental health provider can help them break out of the sick role into an active participant. An excellent article by Jessica Katzman discusses this emerging emotional response for people when they suddenly start feeling better. See her Article here.
Not knowing what to expect can be anxiety provoking. With such a new treatment modality, it is not likely patients will know someone who has received ketamine. Researching reputable ketamine patient websites are a good resource. Ketamine Advocacy Network is founded and run by ketamine patients and covers a range of topics related to treatment, how to find a provider, cost, and more. ketamineadvocacynetwork.org
Some key takeaways for expectations:
- If you do not believe ketamine will help, it won’t.
- Mood swings are normal after treatment. But, the lows don’t go as low. And, they become less frequent.
- “I don’t feel any different after my first couple infusions.” Often family is the first to notice improvements before the patient. There is a lot of change happening and it may take time to recognize in yourself.
- If you don’t feel better after one treatment, that is okay. While some people may feel better within hours, the entire process may take up to a couple weeks after treatment.
- Don’t compare yourself with someone else. While hearing from other patients can be helpful, remember everyone responds a bit differently.
- You need to participate in your recovery. As you start feeling better, you can start applying positive changes to your routine and therapy. It is gradual, so do not pressure yourself and work with your care team for help.
Schedule and Dosing
A wide range of ketamine scheduling, dosing and method of delivery are used across the United States. Some patients are treated with a nasal spray form in their physicians office. However, many ketamine providers prefer IV infusions.
- Schedule: Six infusions are commonly given over a two or three week period, with a minimum of 48 hrs between any two doses. “Six” is not a magic number, and ketamine providers may offer more or less, and even a schedule that extends longer. Some patients receive prescriptions for ketamine lozenges or nasal spray to use in between treatments after the initial series of infusions.
- Dosing: Ketamine providers typically start at a lower dose and raise the amount given once they see how a patient responds. The goal is to give enough ketamine for an appropriate response without negative side effects. Look for a provider who is willing to give the dose that works for you.
- Boosters: Ketamine is usually not a one time treatment. A booster infusion is often required to maintain the healthy benefits from every 4 weeks to a couple months. More definitive guidelines will emerge as scientists continue to research the long term use of ketamine.
- Concurrent Diagnosis: Many, if not most, patients will have more than one mental health diagnosis. Some ketamine providers have seen varied response rates depending on the combination of diagnosis, such as depression, anxiety, and OCD.
- Medications: Multiple medications can have a profound impact on ketamine. Discuss all medications with your doctor as some may need to be reduced or weaned off. Be sure to include all recreational drugs, if used. For further information, see this blog post.
- Diet: The food you eat can affect your mood. Multiple recent studies show a mind – gut connection, where consuming probiotics to foster “healthy gut bacteria” may improve mood. Vitamin deficiencies, such as B12 and D may also impact depression. Other everyday foods may increase anxiety (caffeine and alcohol) and worsen depression (alcohol). Psychology Today
- Non-Responders: How many of the people who don’t respond can attribute this to native brain chemistry versus any of the factors discussed above? As with most medical conditions, we have so much more to learn.
Make your time and financial investment in ketamine go further. Review some possible changes or additions discussed above and have a more positive result. Always discuss medication changes with your prescribing doctor. Abruptly stopping or reducing some medication can be dangerous. This article is meant for information purposes only, and should not be taken as direct medical advice for anyone. Ketamine is one part to the entire treatment program for strong mental health. Work together with your doctor, therapist, and ketamine provider for an optimal outcome.