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Ketamine

Ketamine

Ketamine is a dissociative anesthetic. This means that it has both dissociative and anesthetic effects. The compound induces a trance-like state, with effects like pain relief, sedation, and amnesia. For this reason, it has become commonly used as a medication and anesthetic for both humans and in veterinary care.

Ketamine was originally synthesized by Calvin Stevens, a professor of chemistry at Wayne State University. In 1970, the Food and Drug Administration (FDA) approved the use of ketamine (sold under the brand name Ketalar) as an anesthetic. Following FDA approval, the drug was used during the Vietnam War to treat wounded soldiers. Ketamine is a fast-acting anesthetic and analgesic, so it proved extremely useful on the battlefield.

Ketamine continues use today as an anesthetic because it, unlike other anesthetics, increases heart rate and blood pressure. This helps with blood loss in the case of certain medical emergencies and procedures.

As a popular recreational drug, the effects of ketamine can range from mild euphoria to a full-blown mystical experience.

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Ketamine Infusion Therapy And Treatment Clinics

So what is Ketamine infusion therapy? It refers to the more recent application of utilizing the treatment for a range of mental health conditions. If you were to undergo ketamine infusion therapy, you would do so because you were experiencing emotional distress that perhaps you have not been able to alleviate through other, more traditional means, such as psychiatric medication, some form of psychotherapy, or lifestyle changes.

This form of treatment is available at dedicated ketamine clinics. Unlike in a traditional medical context, you would receive sub-anesthetic doses of ketamine, so you are not unconscious or completely immune to pain. But you will experience some dissociative and psychedelic effects at this dosage level.

There are many important facets of ketamine infusion therapy that are worth exploring, from all the steps involved in the procedure to what the research tells us about its effectiveness.

What Is Ketamine Infusion Therapy?

As you can see from the name of this treatment, an infusion is involved (and typically more than one in the course of treatment). Infusion here means that ketamine is diluted into a saline solution and then administered either intravenously (IV) or intramuscularly (IM).

Ketamine therapy will usually mean an IV injection, although both have proved to be effective in the treatment of depression, for instance. One reason why people prefer IV is that it has 100 percent bioavailability — meaning you know the exact dosage amount. IM has an impressive level of bioavailability (93 percent), but since it is not 100 percent, you can’t be aware of the exact amount entering the system circulation. Also, with IV, the drug rate can increase, decrease, or can stop at any time. This offers patients more control over the experience.

While the ketamine infusion — and the subjective and biological changes it offers — drives therapeutic benefits, it is not the only relevant factor in someone’s mental health recovery. Ketamine infusion therapy also features a psychotherapeutic component. As with other compounds that have psychedelic effects, it is generally agreed that combining the altered state of consciousness with talk therapy is more effective than the drug’s effects (or the therapy) on its own.

So, as well as receiving a round of infusions, you will spend some time talking with a trained therapist before, during, and after your sessions.

Ketamine-assisted therapy usually includes six rounds of infusions, administered over a period of two weeks. Research tells us this protocol is highly effective in alleviating symptoms of conditions like post-traumatic stress disorder (PTSD).

What Ketamine Treatment Involves

There are several steps to take before getting ketamine infusion therapy. This includes preparing for a session, the administration of the session itself, and then the aftercare a person receives.

Before Undergoing Ketamine Infusion

Upon your first visit to a ketamine clinic, a psychiatry team will assess and evaluate you. If a clinic doesn’t take this step, you should avoid it. The team should carry out a comprehensive mental health screening, as well as a medical and physical exam to ensure that you’re the right candidate.

It’s crucial to understand that some mental health issues don’t mix well with ketamine; the drug can induce psychotic symptoms in people with schizophrenia, for example. Any reputable ketamine clinic that has your well-being in mind should be screening for these types of mental health issues, as well as any physical conditions, lifestyle habits, or medications that may interact negatively with the drug.

Once you have been deemed a suitable candidate for ketamine infusion therapy, you can agree on a treatment plan. This includes knowing how many infusions you will receive (a minimum of six is standard) and when you will have your first.

Preparing For A First Session

Before your first infusion, you should ideally have fasted for at least three hours. This is because some of the known side effects of ketamine include nausea and vomiting. Having food in your stomach can make these possible effects worse.

You should also avoid having any other psychoactive substances in your system before the infusion. These would include depressants like alcohol and stimulants like caffeine, as these drugs can either exacerbate side effects or lead to various physical complications.

Preparing for ketamine therapy should also involve paying attention to your “set”. This is one-half of “set and setting“. It refers to the fact that your mindset influences the quality of a psychedelic experience. This can apply to ketamine, too.

You can mentally prepare for your ketamine experience by bringing yourself to a calm state. This is achievable through techniques like mindfulness meditation, breathing exercises, yoga, ensuring a good night’s sleep before your session, or any other practice that helps you achieve present-mindedness and relaxation.

Getting yourself into a positive frame of mind will also improve your overall experience. Moreover, discussing your upcoming therapy with a loved one who you can trust can help calm any nerves you have. You can plan for this person to take you to the clinic, as well as to pick you up.

The Ketamine Infusion Session

When you go to a ketamine clinic for your first session, you will meet with your anesthesia care providers. The staff will walk you through the whole process. These professionals will also be present during its entirety, controlling and overseeing every step.

They will seat you in a comfortable chair in a relaxing setting, and then hook you up to an IV. You will usually wear headphones so you can listen to calming music during the session. Research is starting to show that the music you listen to in these psychedelic states can alter the direction and quality of the journey. Music falls under the “setting” part of set and setting.

The infusion time will last 45-60 minutes. This is a relatively quick session, especially when compared to psychedelic-assisted therapy involving psilocybin (which lasts around six hours).

What Happens After A Session

When your ketamine infusion session is over, you won’t be experiencing noticeable subjective effects like dissociation or hallucinations, but you may feel some after effects, as well as a change in your emotional state. The team supporting you at the clinic will likely transfer you to a spa-like setting after the session is complete, and then they will assess you before allowing you to go home.

Most clinics recommend that, after infusions, you don’t drive, operate heavy or dangerous machinery, make important decisions, sign legal documents, or engage in risky activities until the day after treatment.

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FAQs

Let’s explore some of the most common questions that people have about ketamine treatment.

How Can I Decide Which Clinic To Use?

Every patient should make sure they only use trustworthy ketamine clinics. You can get a sense of a treatment center’s trustworthiness by checking the following.

  • The credentials of the psychiatrists
  • The kind of staff present and the training they’ve had
  • Positive testimonials (look for reviews that cover factors like safety, cleanliness, care, comfort, transparency, and success rates)

Is Ketamine Dangerous?

Ketamine therapy, like all medical treatments, carries some risks and downsides. As mentioned earlier, during the screening process, a clinician will evaluate prior medical conditions to minimize risks. However, even for suitable candidates, there are still possible risks, such as addiction.

A web-based questionnaire study has also discovered that a small number of people who have used ketamine (recreationally) report hallucinogen persisting perception disorder (HPPD). This is when you have lingering perceptual effects following drug intake and these effects cause psychological distress. HPPD appears to be more common with recreational use of classic psychedelics like LSD, although case reports have documented this condition following the medical use of ketamine.

If you have uncontrolled blood pressure, unstable heart disease, untreated thyroid disease, active substance abuse, current manic phase of bipolar disorder, or active psychotic symptoms (e.g. hallucinations and delusions), then ketamine is not recommended. The drug can potentially worsen all of these conditions.

But, if you don’t have these underlying conditions, then the risk of adverse events will be minimized. Under the controlled setting of therapy, where infusions are limited over a matter of weeks and you receive medical supervision throughout, the risk of any serious short-term or long-term effects appears to be low.

How Successful Is Ketamine Therapy?

About 70-85 percent of patients with severe depression who try ketamine say it’s effective, compared with 58-70 percent of electroconvulsive therapy (ECT) patients. Meanwhile, 59 percent of patients with depression respond to antidepressants after 12 weeks.

Ketamine Therapy Effectiveness

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Compared to TMS (transcranial magnetic stimulation), ketamine’s ability to reduce depression, suicidality, and PTSD is more rapid, but these effects are not as long-lasting.

How Does Ketamine Work?

Ketamine therapy appears to provide therapeutic outcomes in a number of different ways. It appears to help through its effects on glutamate, serotonin, and opioid receptors, as well as the way it affects certain brain regions and the connections between these regions.

Moreover, its capacity to provide dissociative and mystical effects also seems related to the benefits of treatment.

Is Ketamine Covered By Insurance?

Currently, ketamine infusion therapy is not a covered benefit through any insurance plan. This is because the treatment is an “off-label” use of this medication.

The exception is esketamine (Spravato), which is FDA-approved and well-studied to be effective and safe. Therefore, it is almost always covered by insurance.

Ketamine Aspects

Once purely a recreational drug, ketamine is used as a promising treatment for a range of mental health conditions and pain syndromes.

If you’re unfamiliar with this compound, you may be wondering what kind of drug it is, what kind of experience it offers, and — if you’re seeking relief from emotional distress — where the treatment is legal. We will now explore these various aspects, so you know what makes ketamine distinct from other psychoactive drugs.

What Is Ketamine?

Ketamine As An Anesthetic

Traditionally, ketamine has been a medication for inducing and maintaining anesthesia.

It induces dissociative anesthesia, a trance-like state offering patients pain relief, sedation, and amnesia. What makes the drug unique as an anesthetic is that breathing and airway reflexes are preserved, and heart rate and blood pressure increase. Other anesthetics decrease heart rate and blood pressure, making them unsuitable for certain medical procedures.

The ‘Off-Label’ Use Of Ketamine

Ketalar (ketamine hydrochloride) is the brand name of the medicinal product. It comes in liquid form, with a person receiving an injection. At sub-anesthetic doses, ketamine can act as an effective analgesic and antidepressant. The use of IV ketamine for depression and PTSD, as well as studying its applications to treat other mental health conditions, is off-label.

This means that, once a drug gains FDA approval, doctors can use the drug for a different purpose.

It Is A Recreational Drug

Due to its euphoric and perceptual effects, many people use ketamine recreationally, in a variety of settings like festivals, clubs, parties, or at home with friends. Many people also like to combine ketamine with other drugs. The most popular being MDMA, marijuana, and classic psychedelics like LSD.

It Is A Drug Of Abuse

As well as an anesthetic agent, pain reliever, and antidepressant, ketamine can be a drug of abuse. When used recreationally, it can lead to feelings of euphoria, and for some may become a way of self-medicating emotional pain.

If starting to use ketamine regularly as a recreational drug, or you rely on it for relief, you might potentially increase the dosage as your tolerance goes up. This will help achieve the desired effects. This puts you at a higher risk for various health complications.

Is ketamine addictive? It is possible to become addicted to the drug, which for users means they will continue to use it despite negative impacts on their body, mental health, work, and relationships.

Yes, ketamine therapy remains a promising alternative mental health treatment. But, overall, the drug carries greater physical risks and a higher potential for abuse than, say, psilocybin.

It As An NMDA Antagonist

Ketamine is an NMDA receptor antagonist, meaning that it works to antagonize (or inhibit) the N-Methyl-D-aspartate receptor (NMDAR). This is one of three types of glutamate receptors, the other two being AMPA and kainate receptors.

Glutamate is the brain’s most abundant neurotransmitter. It is also the main excitatory neurotransmitter, meaning it makes it more likely that a neuron will fire an action potential (an electrical signal that is sent down an axon, away from the cell body).

A Very Brief History Of Ketamine

1956

We can also understand what ketamine is by taking a brief look at its history. Ketamine’s history begins with phencyclidine (PCP), another dissociative anesthetic and hallucinogenic drug, which chemists at Parke Davis Company first synthesized in 1956. PCP was shown to be a safe and reliable anesthetic in humans, but the problem was that it also caused an intense, prolonged state of delirium, ultimately making it undesirable for human use.

1962

Efforts were then made to synthesize shorter-acting analogs of PCP that would have similar anesthetic effects but cause less delirium. In 1962, Calvin Stevens, a Parke Davis consultant and organic chemist, developed one such agent, identified then as CI-581, which we now call ketamine. This structural analog had one-tenth the potency of PCP. Subsequent human trials demonstrated it was safe and effective for clinical anesthetic use, with a limited duration of effect and a lack of severe delirium.

Ketamine Dosage

Dosage is one of the most important factors to think about when taking any drug. In therapeutic settings, only safe ketamine doses will be administered. These are quantities that avoid damage to the organs and that are non-lethal.

Doses of ketamine can vary, based on both the context (medical or recreational), as well as the route of administration (ROI): IV, IM, insufflation, or oral.

Anesthetic Dosages

When using ketamine to induce anesthesia, an average dose of 2 mg/kg IV leads to around five to 10 minutes of dissociation.

If a patient needs to be unconscious and insensitive to pain for longer, a medical professional can safely administer more medication.

Recreational Dosages

The range of recreational ketamine dosages, based on different ROIs, are as follows.

  • IV Injection: 50 to 100mg
  • IM Injection: 75 to 125mg
  • Insufflation (intranasal or snorting): 60 to 250mg
  • Oral: 200 to 300mg
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Therapeutic Dosages

In a clinical setting, ketamine never comes in a powder form, which is how people typically take it recreationally. At a clinic, you will receive an injection of a solution through IV or IM infusions.

A solution-based prescription nasal spray called Spravato is also available.

Dosages for conditions like depression and PTSD are sub-anesthetic. This means they don’t render you unconscious and unable to feel pain. Doctors use higher, anesthetic doses of ketamine for operations.

“The gradual, continuous intravenous infusion of ketamine is one of the critical components of effectively using ketamine for mental health conditions,” said Dr. Steven Mandel of Ketamine Clinics of Los Angeles. “As an anesthetic, ketamine is given in substantially higher doses and a s a bolus, all at once. The total dose, route of administration, and rate of administration are separate, essential aspects of achieving the desired outcome.”

Here are the different types of sub-anesthetic dosages.

  • IV Injection. Research shows that IV infusions for depression are effective in the range of 0.1 mg/kg to 1 mg/kg. The normal dose for depressive symptoms, which clinics administer, is between 0.25 mg/kg and 0.5 mg/kg. However, patients who don’t respond to 0.5 mg/kg may receive a higher dose.
  • IM Injection. The dose of IM infusion for depression is similar. Studies have demonstrated that IM dosages of 0.25 mg/kg and 0.5 mg/kg are safe and effective, and these are the doses that clinics will typically use.
  • Intranasal. Spravato’s ketamine spray (targeted for depression) provides a lower dosage (28mg).
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Therapeutic ketamine dosages are generally safer than recreational doses. Factors that help to increase the safety of doses include the below.

  • Medical supervision and care
  • IV injections are controllable, so a patient can say whether the experience is too intense and the clinician can then decrease the dosage
  • A limited number of doses
  • A safe and controlled environment (you stay still during the high-dose experiences)
  • The use of pure ketamine, free from adulterants
  • Taking the drug on its own, not in combination with any other substances

Factors That Can Determine Dosage

Trying to achieve the desired effect is not the only factor that determines ketamine doses. Other relevant factors include age (children metabolize ketamine faster than adults, so the latter need higher doses), whether the person has taken it before, and weight.

Can You Overdose On Ketamine?

A lethal dose (LD50) is the amount of a drug that results in the death of 50 percent of animals in a laboratory setting.

It is estimated that the median lethal dose of ketamine for humans is 600 mg/kg or 4.2g for a 70kg person.

So yes, you can overdose on ketamine.

But, clearly, this sort of dose is far higher than the amount you would receive at any clinic or hospital. Recreational dosages also won’t usually approach this amount.

Concerns About Repeated Doses

As mentioned earlier, when repeatedly taking ketamine, this may turn into abuse or addiction. However, there is still a lot we don’t know about the safety of repeated infusions, administered in a clinical context. This is because ketamine therapy for conditions like depression is a relatively new treatment.

Some researchers have raised concerns about repeated infusions, noting that clinical and preclinical reports indicate repeated infusions of low doses may have addictive properties.

There is also a concern that this form of treatment may result in some cognitive-impairing effects.

However, a 2022 study published in BMC Psychiatry found that 8-10 repeated infusions did not impair cognitive performance in patients with treatment-resistant depression. More research needs to be done, of course.

Is Ketamine Legal?

Ketamine became an FDA-approved medication in 1970, to be used on its own to provide anesthesia or pain relief during medical/surgical procedures, or alongside other medications to put someone to sleep before a procedure.

It was first used on the battlefield, given as an anesthetic to American soldiers during the Vietnam War. Since then, it has also been legal and commonly used around the world as an anesthetic and analgesic for humans and non-human animals.

Up until the late 1980s, psychedelic enthusiasts (like the psychonaut John C. Lilly) were primarily using ketamine to explore consciousness. In high enough doses, it can lead to a “k-hole“, which is when strong hallucinogenic, emotional, and out-of-body experiences can occur, including a range of mystical effects.

From around the late ’80s or early ’90s, however, ketamine became a popular recreational drug of choice in the rave subculture. In these settings, users mainly do “bumps” — doses in the form of a small lump.

The Drug Is Classified Differently Around The World

As with other club drugs, the use of ketamine surged during the 1990s. In 1999, in response to the increase in recreational use, the U.S. federal government reclassified the drug as a Schedule III substance, still available for medical purposes but illegal to possess or use outside of that context. Other Schedule III drugs include anabolic steroids, buprenorphine (a semi-synthetic opioid), and LSA (lysergic acid amide), a naturally occurring psychedelic.

In 2006, in the UK, ketamine entered a similar legal classification: it became a Class C drug following the increase in its use in the club scene.

Across the globe, ketamine is also a controlled substance, except when used medically. Currently, the off-label use of ketamine is legal in specific contexts, such as for treating major depression and treatment-resistant depression. This means you can find legal ketamine clinics throughout North America and Europe (although the greatest number of them are in the U.S.).

How To Get A Prescription

  • You need to have a relevant mental health condition or pain syndrome that a ketamine clinic is set up to treat. (Note: the esketamine nasal spray — Spravato — has only been FDA-approved for those with treatment-resistant depression and major depression with acute suicidal ideation or behavior.)
  • Get a referral from your family doctor, who will tell the ketamine specialist what you are being treated for and what treatments you have previously tried.
  • Have a ketamine clinic carry out its own evaluation to determine whether ketamine-assisted therapy is the appropriate treatment for you.
  • After you have undergone the psychiatric and medical evaluation, and received clearance, you can then receive ketamine infusions.

Types Of Ketamine

There are three different types of ketamine, each with unique properties and applications. These are R,S-ketamine, S-ketamine, and R-ketamine. To better understand ketamine, we need to elucidate these three types of ketamine and how they differ from each other.

It Comes In Different Forms

Like other synthetic drugs, ketamine is chiral. This means it exists in several isomeric forms. Isomers are molecules with the same bonded atoms, however, they differ in their three-dimensional orientation.

Ketamine can come in the form of both right- and left-handed mirror-image isomers known, respectively, as R(+) and S(-) ketamine. These are called enantiomer forms of ketamine, and they are non-superimposable (in the way that your right and left hand don’t match up when you place one on top of the other).

Due to their different spatial arrangements, R and S ketamine bind in the brain differently. This changes their pharmacological activity, as well as how they are metabolized in the body. Despite this, both work in the brain by blocking, to varying degrees, the NMDA receptor. By targeting this receptor, ketamine increases glutamate in the brain.

In light of the differing properties of R and S ketamine, pharmaceutical companies have developed various types of ketamine, with their own specific uses.

R,S-Ketamine

When manufacturers make ketamine in the lab, they create a 50/50 mixture of R and S enantiomers. The generic form of racemic (equal amounts of left- and right-handed enantiomer) ketamine is R,S-ketamine. It is still sold under the brand name Ketalar. And it has the longest history of medical use (over 50 years of use as an anesthetic and analgesic).

Most people who use the drug recreationally will use ketamine powder in its racemic form. Typically, users snort the powder, although some will take it orally when the powder is pressed into tablets. A minority of users also inject the drug. In a medical context, this type of ketamine is available in a variety of forms, including oral, sublingual, nasal, rectal, subcutaneous, and as IV and IM injections.

S-Ketamine

S-ketamine (esketamine), sold under the brand name Spravato, is the S-enantiomer of ketamine. On March 5, 2019, the FDA approved the nasal spray for treatment-resistant depression (a form of depression that has not responded to antidepressant medications).

The FDA approved the treatment after reviewing a few clinical trials looking at Spravato for treatment-resistant depression. In the trials, patients experienced statistically significant antidepressant effects compared to placebo and also enjoyed remission from depression longer than patients given a placebo nasal spray plus an antidepressant.

On August 3, 2020, the FDA also approved Spravato for the treatment of major depressive disorder featuring acute suicidal ideation or behavior.

Janssen Pharmaceuticals, Inc., a subsidiary company of Johnson & Johnson, produces esketamine, selling it as a prescription medication under the brand name Spravato. It is only available to patients in presence of a healthcare provider in a medical setting. You cannot get a prescription for Spravato and take it home with you.

Compared to R-ketamine (explored below), S-ketamine is a more potent psychoactive drug. It creates stronger dissociative effects and more dopaminergic activity. So, if you take the drug, you’ll be more likely to experience feeling detached from your body, surroundings, and your sense of self.

Its affinity for the NMDA receptor and anesthetic potency is four times greater than that of R-ketamine. Moreover, the body removes S-ketamine more quickly than racemic ketamine or R-ketamine.

R-Ketamine

Unlike S-ketamine, the FDA has not approved R-ketamine (arketamine) as an antidepressant. However, pre-clinical research and open-label trials indicate that R-ketamine may be superior to S-ketamine in the treatment of depression.

Arketamine shows weaker activity at the NMDA and sigma receptors, which means fewer hallucinogenic and dissociative effects. Studies have suggested that greater dissociative and mystical-type effects lead to better therapeutic outcomes.

But if a type of ketamine can still benefit people without inducing intense subjective effects, this could appeal to patients who are put off by the psychoactive effects of ketamine.

Furthermore, arketamine shows less dopaminergic activity than esketamine. This may, therefore, translate to lower abuse potential. Many drugs, including ketamine, have the potential to be addictive because they increase dopamine levels in the brain, which feels rewarding. Following this feeling, there can be an increased motivation to seek out the drug again.

Studies also show that arketamine is able to stimulate the formation of new neural connections (known as synaptogenesis), which may contribute to its antidepressant effect.

What The Different Types Of Ketamine Cost

Spravato is the most expensive type of ketamine. It costs $590-885 per dose, and the recommended frequency of dosing is twice per week for four weeks. So the overall cost of treatment would be around $4,720-7,080.

In contrast, the cost of ketamine infusions is $400-800 per infusion, and usually, treatment involves six infusions spread out over two to three weeks. A round of ketamine infusions costs, therefore, about $2,400-4,800.

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Arketamine isn’t yet available as a treatment option, so the choice really comes down to racemic ketamine and esketamine. They are both effective at treating depression, although the former has 100 percent bioavailability while the intranasal bioavailability of the latter is approximately 48 percent. With Spravato, absorption rates also differ from person to person.

Based on the differences in bioavailability, absorption rates, and price, many people prefer to opt for IV ketamine.

Buying ketamine illicitly is another matter. Whether buying from a street dealer or on a darknet market, a gram of ketamine — in the form of a crystalline powder — can cost $20-60.

Ketamine Effects

We have already mentioned some of the key effects of ketamine, including euphoria, dissociation, hallucinations, and mystical effects. Let’s now describe the ketamine experience, as well as side effects, in more detail.

The kind of experience you’ll have from ketamine depends, to a large degree, on the dose you take.

Low Dose Effects

Physical changesPerceptual changesEmotional changes
Slight dilation of pupilsThe edges of objects appear more distinctPositive mood
Mild stimulation or drowsinessThings look like they’re in high definitionCalmness
Slight increase in heart rate and blood pressureMusic and external sounds have a different quality to themAnxiety
A light body highIncreased appreciation for music

Medium Dose Effects

Physical changesPerceptual changesEmotional changes
More dilated pupilsDouble visionEuphoria
A further increase in heart rate and blood pressurePerspective distortion (far away objects can appear close to you, while close objects can appear far away)Feeling content or peaceful
Stronger body highObjects can appear smaller or bigger than normalAnxiety
Muscle weaknessYou might see some geometric patterns and images with your eyes closedConfusion
NumbnessSounds become noticeably distorted
Slight nausea
Slurred speech
Drowsiness

High Dose Effects

Physical changesPerceptual changesEmotional effects
Possibly more nauseaVisions of imagery and scenes with eyes closed, or the feeling of traveling to an alternate realityEcstasy
More numbnessSeeing objects and people morph in strange waysEuphoria
Finding it difficult to talkDislocation from your body, resulting in an out-of-body experience. When this occurs, it can feel like you can look at the world from a location outside of your body or observe your body from a different vantage point in the roomJoy
Loss of coordinationBliss
Feelings of fear, dread, or panic

At high doses, ketamine can result in mystical-type effects, which include the following.

  • A feeling of sacredness or the “divine”
  • Unity, or feeling a sense of interconnectedness, often accompanied by ego dissolution
  • Transcendence of time and space
  • Ineffability. You cannot put into words what you experienced

Ketamine Side Effects

The side effects of ketamine are the secondary and (usually) undesirable effects of the drug. We have included some of ketamine’s side effects in the lists above, but here are all of the most common ones that people experience.

Common side effectsInfrequent side effectsRare side effects
DizzinessSlow heartbeatIncreased pressure in the eye
LightheadednessLow blood pressureNystagmus, or involuntary eye movements
NauseaDecreased lung functionMuscle spasm
VomitingFlushing or redness of the skinA skin rash
Lack of coordinationDifficult or painful urination
Diplopia (double vision)Urine leakage
Drowsiness
Slurred speech
Muscle tremors
High blood pressure
Fast heartbeat

How Long Does Ketamine Last For?

How long a ketamine experience will last depends on different factors, such as dosage, the ROI, and if additional doses are taken.

Recreational Ketamine

If taking ketamine recreationally (snorting ketamine powder), you can expect to feel effects for 30 minutes to an hour. The onset occurs within five minutes.

IV Ketamine Infusion

IV infusions typically last one hour, but they can be extended up to five hours based on the clinician’s recommendation. The onset is rapid, occurring within 30 seconds.

IM Ketamine Infusion

The effects of an IM infusion range from 1-3 hours. The onset occurs within 3-4 minutes.

Sublingual Tablets Or Troches

Tablets or troches are another way of taking ketamine. The company Mindbloom, for instance, uses rapid dissolving tablets, which are held in the mouth for direct oral absorption and removed after a point of maximum absorption. The subjective effects last around 30-60 minutes, and the average onset is 5-10 minutes.

Intranasal Spray

The effects of Spravato last 1-3 hours, with the onset typically occurring within 5-10 minutes.

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Users Experience A Relatively Brief Altered State Of Consciousness

Relative to other compounds used in psychedelic-assisted therapy, the ketamine experience is brief. Here is the duration of other compounds for comparison.

MDMA: 3-6 hours
Psilocybin: 4-6 hours
Ayahuasca: 4-6 hours
LSD: 8-14 hours
Mescaline: 8-16 hours
Ibogaine: 8-24 hours

The Duration Of Antidepressant Effects

Ketamine provides a rapid antidepressant effect, peaking at the 24-hour mark and lasting for 1-2 weeks after a single infusion.

However, for many people, this alleviation of depression can wear off in a matter of days. This is why the recommendation is a series of infusions, as this produces longer-lasting relief.

For many patients, multiple ketamine infusions can result in remission from depression lasting for several months, and sometimes for longer than a year.

What Warrants A Prescription?

As we have seen, physicians can prescribe a drug for a condition that is not FDA-approved. This is called off-label use.

Other common examples of off-label treatments include quetiapine (Seroquel) for insomnia and clonidine (Catapres) for attention deficit hyperactivity disorder (ADHD).

Since ketamine infusions for mental health conditions are not FDA-approved, insurance companies aren’t likely to fund them. This doesn’t mean the treatment is unsafe. But it might mean that the long-term effects need to be studied more closely before the FDA gives its approval.

Furthermore, FDA approval is a long and expensive process. There is little incentive for pharmaceutical companies to fund the research as ketamine is an old, generic medication. So it may take some time before insurance companies cover the cost of ketamine infusions.

If traditional treatments haven’t worked for you and you can’t currently afford ketamine therapy, this doesn’t mean you have no options. TMS is another alternative treatment that can effectively treat mild to moderate depression, severe depression, treatment-resistant depression, and PTSD. And, crucially, insurance providers can cover the costs.

Which Insurance Companies Cover Ketamine Infusion Costs?

Some insurance plans now cover IV ketamine infusions for treatment-resistant depression. These include Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of Vermont, and some regional insurance plans in Utah.

The tide is changing and we will certainly see more providers cover the ketamine treatment cost as time goes on.

While an insurance company probably won’t cover the entire cost of ketamine therapy, part of the treatment may still get coverage. Each insurance company will cover different amounts, and different patients will see different results — even from the same insurer.

To give yourself the best chance of getting some coverage, you want to visit a ketamine clinic where a psychotherapist or psychiatrist is providing ketamine-assisted therapy.

There are over 100 ketamine clinics in the U.S., and many will have trained therapists and psychiatrists who are specialized in the treatment of depression. But even then, reimbursement will usually require the following.

  • Pre-authorization attempt
  • Medical peer-to-peer discussions
  • The appeal of a denial Having failed a lot of previous treatments

In a nutshell, it takes a lot of work. This is why most ketamine clinics do not accept insurance at all, or they lack the resources to assist the patient.

Some patients are able to get certain aspects of ketamine treatment covered, such as the consultation fee. There may be some patients who are reimbursed for the total ketamine treatment cost, but this is rare.

Covering Costs Without Insurance

Without coverage from your insurance provider, the cost of ketamine-assisted therapy can seem daunting. After all, for many patients, 6-8 infusions are not necessarily the total cost. They may need maintenance infusions, further raising the overall cost of treatment.

Most ketamine clinics, however, accept credit cards and may offer financing options. Another option would be to enroll in a clinical trial, which of course you may not find to be a reliable option. But, at the same time, many participants in these trials gain significant help from the treatment.

So, if you do find a trial that you are suitable for, and which you can feasibly join, that is worth keeping in mind.

Esketamine Is Covered By Insurance

To reiterate, insurance companies will tend to cover esketamine (Spravato) because it is an FDA-approved treatment. However, it has only been approved for treatment-resistant depression and depression featuring suicidal ideation (thoughts or desires to take your own life) and behavior (plans or attempts to end your life).

Between 10-30 percent of those with depression have the treatment-resistant type, but it may be more than 30 percent. People with depression with suicidality are also in the minority of those living with the condition.

This doesn’t mean that patients who might respond to antidepressants or who aren’t suicidal wouldn’t benefit from Spravato. But based on the nature of the FDA’s approval for esketamine, it does mean insurance providers can only cover the treatment in the specific cases outlined.

You can get a prescription for Spravato if you show proof of treatment-resistant depression, for example. Additionally, it’s only available through a restricted distribution system under a Risk Evaluation and Mitigation Strategy (REMS).

You should also be aware that the FDA has only approved the esketamine nasal spray in conjunction with an oral antidepressant. So while an antidepressant by itself may not have benefited certain patients, to receive coverage for Spravato, it is necessary to still be taking an antidepressant (SSRI or SNRI) at the same time.

Do Insurance Companies In Other Countries Cover The Cost Of Ketamine Treatment?

There are ketamine clinics elsewhere in the world. Many are in Europe. But there are also clinics in Latin America, in countries like Panama and Mexico, as well as in Canada.

In 2021, Awakn Life Sciences opened the first clinic in the UK offering psychedelic-assisted therapy. The clinic is starting with a focus on ketamine treatment. Initial treatment will be private, but the clinical biotech company states that it is working closely with health services and insurance companies to gain approvals.

The National Health Service (NHS) in the country also does not cover ketamine infusions for mental health conditions, and it has rejected the use of the nasal esketamine spray (twice) on its service on the grounds that it’s not cost-effective.

The European Medicines Agency (EMA) has, nonetheless, authorized its use in the EU, as well as in the EEA countries (Norway, Iceland, and Liechtenstein).

In countries like the Netherlands, there are still concerns about the cost-effectiveness of Spravato, but the treatment can be covered by someone’s health insurance plan. Dutch insurance companies are willing to reimburse for the nasal spray.

In general, insurance companies in most countries don’t cover ketamine infusion costs for mental health conditions. It would typically be easier to find coverage for Spravato — since it’s been approved by the FDA and EMA. But, even then, there might be challenges.

Legal Ketamine: As An Anesthetic

Ketamine is legal throughout the world as a general anesthetic — and as a safe and effective way to relieve pain and induce sedation — in medical and surgical procedures.

Legal Ketamine-Assisted Therapy

The off-label use of ketamine is legal when helping treat certain mental health conditions. But the user must receive a prescription from a licensed practitioner for this particular use.

Legally prescribing and using a compound to treat a condition other than the one it was originally intended for is common practice. Off-label prescribing does, nonetheless, need to be consistent with medical standards and regulations.

Legal Ketamine In The U.S.

Legal ketamine-assisted therapy is available in many countries, including the U.S., where there are many ketamine clinics operating.

Any clinic administering this treatment must have a DEA license and, as standard outpatient clinics, they need to meet the following requirements.

  • State medical board licenses
  • Insurance coverage
  • OSHA standards
  • The ability to store and take care of controlled substances
  • Must obtain county/city licensing

States with a relatively high number of legal ketamine clinics include New York, Florida, and California.

Legal Ketamine Outside The U.S.

Legal ketamine clinics are opening all the time throughout the world.

There are over 1000 in ketamine clinics operating in the United States, but more are opening across the globe. Field Trip Health has been working to open more clinics in Canada. We will see the same expansion in other countries across Europe and South America where ketamine therapy centers already exist, as well as in those where the option is currently lacking.

Soon, we may also find that ketamine infusions become an FDA-approved treatment. This would then make this legal treatment available to many more people, and insurance providers will cover it.

Many healthcare providers are starting to see ketamine as an alternative treatment that works for patients when other traditional options have failed. Of course, this does not mean ketamine, even in a clinical context, is without its risks, downsides, and limitations.

Moreover, ketamine is not a magic bullet. Mental health conditions are complex and can have many aspects and underlying causes.

In Conclusion

While a round of ketamine infusions may be incredibly healing for many people, and even life-saving for people who are suicidal, it is often just one part of an overall strategy for looking after one’s mental well-being. Continuing with psychotherapy or using other alternative treatments (like TMS) in conjunction with ketamine may be beneficial, for example.

Finally, while ketamine-assisted therapy is a promising new treatment for a range of issues, this does not mean that you should self-medicate with the drug. This is not necessarily safe and effective in the way that medically supervised use, combined with therapy, is.

It’s important to weigh up the costs and benefits of ketamine treatment. In cases of treatment-resistant conditions, for instance, the price is well worth the relief that someone has been longing for.

Sam Woolfe

View all posts by Sam Woolfe

Sam Woolfe is a freelance writer based in London. His main areas of interest include mental health, mystical experiences, the history of psychedelics, and the philosophy of psychedelics. He first became fascinated by psychedelics after reading Aldous Huxley's description of the mescaline experience in The Doors of Perception. Since then, he has researched and written about psychedelics for various publications, covering the legality of psychedelics, drug policy reform, and psychedelic science.

Abid Nazeer

This post was medically approved by Abid Nazeer

Dr. Nazeer is the Founder and President of APS Ketamine/Advanced Psychiatric Solutions, which he established in 2016 as the first psychiatric outpatient ketamine clinic in Illinois. He is board certified in Psychiatry as well as Addiction Medicine. He completed his psychiatry residency at Louisiana State University Health Sciences in Shreveport where he held the role of Chief Resident. Dr. Nazeer is providing medical oversight to the growth plan of Wesana Clinics, with the model of comprehensive psychiatry clinics specialized ketamine and psychedelic therapies, integrated brain health and wellness centers, and technology utilization of Wesana Solutions remote patient monitoring product.

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