How Ketamine Infusion Works
So you’ve decided to try out a ketamine therapy and you don’t really know what to expect? Here’s all you need to know about how a ketamine infusion works.
Ketamine is one of the most popular psychedelics nowadays, especially as it gains more attention from the mainstream media. Likewise, given its positive testimonials, it’s no wonder why more ketamine clinics are opening around the world.
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As a dissociative anesthetic, ketamine has also been classified as a hallucinogen. These types of drugs alter consciousness, involving acute changes in somatic, perceptual, cognitive, and affective processes. Therefore, it produces a psychedelic effect.
Technically, it is not classified as psychedelic because it doesn’t produce it’s effect via activation of the 5HT2A receptor like classic psychedelics (LSD, Psilocybin, etc.) However it definitely produces a psychedelic like experience/effect through dissociation, so it is often called one.
Psychedelics are gaining popularity these days for their healing capabilities. Psilocybin (or magic mushrooms), ayahuasca, and MDMA aren’t the only ones getting the attention. Ketamine is generating much of the interest, causing a revolution in alternative treatment options.
With positive results concerning anxiety and depression, questions about ketamine treatments have been popping in many psychotherapists’ offices, in hopes that this alternative treatment will finally help them get some relief they’ve been desperately waiting for but none of the current therapies provide.
When it comes to ketamine treatments, there are two different ways one can go about it.
- Esketamine. This type of ketamine is taken as a nasal spray (Spravato). Patients still need to visit a doctor prior to receiving treatment. And They are required to do all Spravato treatments at a doctor’s office, not just prior to receiving treatment. The doctor or health care clinic has to be a certified to provide Spravato as well. Esketamine is typically prescribed in conjunction with a conventional oral antidepressant, as it may enhance the effect of those drugs.
A little more background on Spravato:
The FDA guidance states that the person should be on any antidepressant, while starting Spravato. So if you are not on one, then you are supposed to be started on one, or just keep taking what you already take. However, this is not an absolute requirement. If you’ve failed multiple medications in the past, or if you start one and it causes side effects for example, the doctor can still take you off the antidepressant and continue with Spravato.
Spravato doesn’t “enhance” oral antidepressants. Because the major research studies conducted by Janssen Pharmaceuticals to prove Spravato’s efficacy involved a design where both control group and Spravato group were on antidepressants, that’s why the FDA put that language in the Spravato label.
- Intravenous Infusions. This type of ketamine treatment includes six or more doses spread out over three weeks. This may then be followed with booster infusions once a month, if necessary. Unlike Esketamine, ketamine infusions aren’t regulated or approved by the FDA. Since it enters the bloodstream directly, this is typically much stronger, often yielding better results.
A little more on intravenous infusions:
Booster infusion requirements can vary between patients. It can range from every 2 weeks to every 6 months. The overwhelming majority of patients require ongoing maintenance infusions (i.e, booster infusions) to maintain benefits.
What About the Lack of FDA Regulations?
It’s not accurate to connect lack of FDA approval to uncertainty or speculation. The lack of FDA regulation definitely allows some room for ketamine to be administered in different ways (and some of the ways clinics do it, may not be very safe or effective). Ketamine actually has more research studies behind it compared to esketamine, over a longer period of time. Esketamine definitely had larger scale study for the purpose of presenting to FDA for approval. Overall Ketamine is more effective than esketamine.
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Ketamine Infusion 101
Similar to any IV, a ketamine infusion is attached to a vein through a tube. It then enters the bloodstream and disperses throughout the body.
Before getting a ketamine infusion, the patient needs to go through a thorough checklist in order to determine eligibility.
The checklist includes a severe diagnosis of several mental health issues like bipolar disorder or personality disorder.
Ketamine Therapy Exclusion
Those who are not eligible for to receive a ketamine infusion are those with the following.
- Active substance abuse (Alcohol, cannabis, non-prescribed medications, etc.) Ketamine infusions are very helpful for active substance use disorders (specifically alcohol, cocaine, opioid withdrawal, benzodiazepine withdrawal). Some clinics will treat these conditions, usually when administered by psychiatrists or addiction medicine specialists
- Active manic episode
- Active psychosis
- History of increased intracranial pressure
- Pregnancy (current)
- Uncontrolled hypertension
- Acute or unstable cardiovascular disease
- Previous negative response to ketamine
Once the provider deems the patient eligible for receiving treatment, a pre-treatment consultation is the next step. And most of the time the eligibility to receive treatment is happening the same time as the pre-treatment medical clearance consultation. This is where they receive all the necessary information about the ketamine infusions — like what to expect. Info regarding symptoms and recovery. As well as obtaining medical clearance based on their situation.
Following approval, treatment begins. It usually lasts around 45 minutes, with the typical frequency of 2-3 infusions per week over the course of 2-3 weeks. (Basically 6 infusions over 2-3 weeks.)
Throughout the infusion, the clinic closely monitors the patient. Vital signs include heart rate, blood pressure, respiratory rate, oxygen saturation, level of consciousness, signs and symptoms of potential ketamine toxicity, and dissociative effects, as ketamine impacts everyone differently.
Once ketamine therapy is complete, the clinic still monitors the patient in case any new symptoms occur. He/she is then able to leave with a designated driver, as side effects do occur.
Common Ketamine Side Effects
Below are some side effects from ketamine treatment.
- A dream-like feeling and/or drowsiness
- Double vision or blurred vision
- Jerky muscle movements
- Vomiting or nausea
- Loss of appetite
- Sleep disturbances or insomnia
- High blood pressure
Recovery includes vital signs trending down to baseline, resolution of the more intense effects such as dissociation. Once a patient feels more embodied, and able to remain steady on their feet, then they can be discharged with designated driver. Some perceptual changes can linger for another few hours in some people, which will resolve after they get a good night sleep. For others, they may feel back to baseline completely very quickly.
RELATED: What Does Ketamine Feel Like?
So, How Does Ketamine Infusion Actually Work?
Researchers aren’t yet entirely sure how ketamine works. It behaves like an antidepressant in the way that it helps manage severe depression, especially in situations when other treatments fail. But it is a verified fact throughout clinical literature that ketamine works through an entirely different mechanism than antidepressant medications, therefore explaining its efficacy.
Ketamine reduces signals that trigger inflammation, which often aligns with mood disorders such as depression and anxiety. It also appears ketamine effects the communication across specific areas within the brain, targeting specific receptors.
Ketamine IV infusion targets the NMDA receptors in the brain and it binds to them, increasing the amount of a neurotransmitter glutamate in the space between neurons. Glutamate then activates the connections in a different receptor called the AMPA receptor. Working in unison, these NMDA and activated AMPA receptors release additional molecules that help neurons communicate along new pathways. This complex process is synaptogenesis, and it affects mood, cognition, and thought patterns.
Ketamine does a lot to the human body. While this is a main reason why researchers are bullish about its positive results, further studies are necessary. There are lots of pros and cons, but still plenty to learn about the therapeutic effects of the psychedelic.