What Is Ketamine? Uses, Treatment Types, And Average Price

What Type of Drug is Ketamine?

Ketamine is a dissociative anaesthetic, developed in 1962 as a safer alternative to phencyclidine (PCP). It works by disrupting the brain’s perception of pain and the environment, inducing a dissociative state often described as a dream-like or out-of-body experience.

When administered by a medical professional, ketamine can be used in various ways:

• High doses: Produce sedation and anaesthesia for surgical procedures.
• Lower doses: Provide analgesia and dissociation during painful procedures, such as setting a dislocated bone or dressing burns.

The U.S. Food and Drug Administration (FDA) approved ketamine for use in 1970. It was notably used during the Vietnam War as a field anaesthetic for wounded soldiers.

While ketamine can produce psychedelic-like effects at subanesthetic doses, it is important to remember that it is primarily classified as an anaesthetic, not a psychedelic or opioid. Its unique effects on the brain have led to ongoing research into its potential for treating mental health conditions like depression and chronic pain.

Ketamine exerts its effects by interacting with a variety of receptors in the brain, most notably the N-methyl-D-aspartate (NMDA) receptors.

Other receptors involved include opioid receptors, monoaminergic receptors, muscarinic receptors, and voltage-sensitive calcium ion channels.

The effects of ketamine are dosage-dependent:

• Anesthetic doses: Induce sedation and anesthesia, making it suitable for surgical procedures.
• Subanesthetic doses: Produce a dissociative state, characterized by a sense of detachment from reality, one’s body, and emotions. This can be helpful for managing pain and anxiety during medical procedures.

Recent research has focused on ketamine’s potential as a rapid-acting antidepressant. Studies suggest that ketamine can alleviate depressive symptoms within hours, with effects potentially lasting for weeks or even months. This is thought to be due to its unique mechanism of action:

• NMDA receptor blockade: Ketamine blocks NMDA receptors, which are involved in learning, memory, and emotional regulation. This blockade can lead to increased glutamate activity in certain brain regions.
• Glutamate and neuroplasticity: Glutamate is a neurotransmitter that plays a crucial role in neuroplasticity, the brain’s ability to form new neural connections. By influencing glutamate signaling, ketamine may promote neuroplasticity, potentially contributing to its antidepressant effects.

Types of Ketamine

Ketamine exists in three different forms: R, S, and RS (racemic). These forms, known as isomers, have the same chemical formula but differ in their three-dimensional spatial arrangements. This difference influences how they interact with receptors in the brain and body, leading to variations in their effects.

RS-ketamine

This is the racemic mixture, containing equal parts of R- and S-ketamine. It was the first form of ketamine approved by the FDA in 1970 and is marketed under the brand name Ketalar. RS-ketamine is widely used in healthcare settings as an anaesthetic and is available in various formulations, including intravenous, intramuscular, and oral.

S-ketamine

Also known as esketamine, this isomer has a more potent psychoactive effect compared to R-ketamine. It was approved by the FDA in 2019 under the brand name Spravato as a nasal spray for treatment-resistant depression and in 2020 for major depressive disorder with suicidal ideation. Spravato is typically used in conjunction with an oral antidepressant. Due to its potential for abuse and misuse, S-ketamine is administered under the supervision of a healthcare professional in a clinical setting.

R-ketamine

Also called arketamine, this isomer is not yet FDA-approved. However, it is currently undergoing clinical trials for the treatment of severe depression. R-ketamine is thought to have a higher affinity for NMDA receptors and potentially a longer-lasting antidepressant effect compared to S-ketamine. Research suggests it may offer therapeutic benefits with fewer psychotomimetic side effects, making it a promising option for individuals seeking relief from depression.

What is Ketamine Used for Medically?

Ketamine is a versatile medication with applications in anesthesia and the treatment of various mental health conditions. It is commonly used as a sedative to induce general anesthesia, especially in emergency situations and for short procedures. Additionally, ketamine has shown promise in treating conditions such as severe depression, chronic pain, and certain cases of anxiety and epilepsy.

Ketamine Therapy for Depression

In recent years, ketamine has gained recognition as a potential treatment for individuals with severe, treatment-resistant depression who have not responded adequately to traditional antidepressant medications. Unlike conventional antidepressants, which can take weeks or months to show effects, ketamine often provides rapid relief, with improvements sometimes observed within hours of administration.

When administered intravenously, ketamine’s antidepressant effects can be felt within minutes. The frequency and duration of ketamine infusions for depression vary depending on individual needs and treatment protocols.

Some individuals may receive a series of infusions over a few weeks, while others may require ongoing maintenance treatments. It’s important to note that while some people experience significant improvement early on, the response to ketamine therapy can vary, and it may take several infusions to determine its effectiveness.

Ketamine Therapy for Anxiety

While research is ongoing, ketamine has shown promise in treating anxiety disorders. A 2017 study indicated that ketamine could be a potential treatment option for individuals with social anxiety disorder. Further research is needed to determine its effectiveness for other anxiety disorders and to establish optimal treatment protocols.

References

• Taylor, J. H., Landeros-Weisenberger, A., Coughlin, C., Mulqueen, J., Johnson, J. A., Gabriel, D., Reed, M. O., Jakubovski, E., & Bloch, M. H. (2017). Ketamine for Social Anxiety Disorder: A Randomized, Placebo-Controlled Crossover Trial. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 43(2), 325–333. https://doi.org/10.1038/npp.2017.194

Ketamine Therapy for Pain

Ketamine can be an effective treatment option for patients suffering from chronic pain. Studies have demonstrated its analgesic properties, particularly in neuropathic pain conditions. However, it’s important to be aware of potential side effects, including dissociation, dizziness, nausea, and cognitive impairment. Long-term use of ketamine for chronic pain requires careful monitoring and consideration of potential risks and benefits.

References

• Niesters, M., Martini, C., & Dahan, A. (2014). Ketamine for chronic pain: risks and benefits. British journal of clinical pharmacology, 77(2), 357–367. https://doi.org/10.1111/bcp.12094

Ketamine for PTSD

Ketamine therapy may offer a new approach for treating post-traumatic stress disorder (PTSD). A study found that individuals with PTSD who received repeated ketamine infusions showed greater improvement in their symptoms compared to those who did not receive ketamine. While these findings are encouraging, more research is needed to confirm the long-term effects and establish optimal treatment strategies.

Ketamine for Bipolar Disorder

Ketamine is also being investigated as a potential treatment for bipolar disorder. Given its rapid antidepressant and anti-suicidal effects, ketamine may offer a new avenue for managing depressive episodes and reducing suicide risk in individuals with bipolar disorder. However, further research is needed to determine its efficacy and safety in this population.

Ketamine for Sedation

Ketamine is frequently used as a sedative in healthcare settings, particularly for painful procedures and emergencies. It provides effective sedation and analgesia, allowing for patient comfort during medical interventions. The dosage of ketamine used for sedation is typically higher than that used for other therapeutic applications.

Is Ketamine Used to Treat Depression?

Depression is a complex mental health condition involving a multitude of factors, including neurobiological changes in the brain. Ketamine, with its unique mechanism of action, has emerged as a potential treatment option for individuals with depression, particularly those who have not responded to traditional antidepressants.

Esketamine, the S-isomer of ketamine, is available as a nasal spray (Spravato) and is FDA approved for use in treatment-resistant depression under strict medical supervision. While ketamine can be misused, it’s important to differentiate its legitimate medical use from its potential for abuse.

Ketamine’s antidepressant effects are thought to be related to its interaction with NMDA receptors and its influence on glutamate signaling. Glutamate is a neurotransmitter that plays a crucial role in neuroplasticity, the brain’s ability to adapt and form new connections. By modulating glutamate activity, ketamine may promote neuroplasticity, potentially contributing to its antidepressant effects.

It is crucial that ketamine be administered in a controlled medical setting under the supervision of a healthcare professional. This is because ketamine can cause dissociative effects, perceptual distortions, and other side effects that require careful monitoring.

Is Ketamine Used to Treat Anxiety and Panic Attacks?

Anxiety disorders are characterized by intense worry, fear, or apprehension that can significantly interfere with daily life. Common anxiety disorders include generalized anxiety disorder, social anxiety disorder, specific phobias, and separation anxiety disorder. Treatment typically involves a combination of psychotherapy and medications, such as antidepressants and antianxiety medications.

Ketamine has emerged as a potential treatment option for anxiety disorders. While research is ongoing, several studies have shown promising results. For instance, ketamine has been found to reduce symptoms of social anxiety disorder and generalized anxiety disorder. Although ketamine has not been specifically studied for panic attacks, its potential efficacy for anxiety suggests that it may also be beneficial for managing panic attacks, which are a common feature of some anxiety disorders.

It’s important to note that ketamine is not currently FDA-approved for the treatment of anxiety disorders. However, its unique mechanism of action and promising preliminary findings warrant further investigation.

Does Ketamine Help With Seizures?

Seizure disorders can arise from various causes, including genetic factors, brain injuries, infections, and underlying medical conditions. While seizures are not a direct complication of psychiatric disorders like borderline personality disorder (BPD) or schizophrenia, they can occur in individuals with these conditions due to co-occurring factors or medication side effects. It’s important to note that ketamine is generally not recommended for patients with schizophrenia, as it can exacerbate psychotic symptoms.

Ketamine has shown potential in treating refractory status epilepticus, a serious condition in which seizures persist despite standard treatment. A study found ketamine to be effective in managing prolonged status epilepticus, particularly when the patient becomes resistant to conventional anti-seizure medications like phenobarbital. The study suggests that ketamine may be more beneficial in the later stages of prolonged status epilepticus rather than as an initial treatment option.

Does Ketamine help with PTSD?

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after a person experiences or witnesses a traumatic event. Symptoms of PTSD often include intrusive memories, flashbacks, nightmares, avoidance of trauma-related reminders, negative thoughts and mood, and heightened arousal (e.g., hypervigilance, difficulty sleeping). While PTSD is often associated with veterans, it can affect anyone who has experienced trauma, such as accidents, violence, or natural disasters.

Ketamine has emerged as a potential treatment option for PTSD. Several studies have shown that ketamine can reduce PTSD symptoms, including nightmares, flashbacks, and hyperarousal. For example, one study found that individuals with chronic PTSD who received ketamine infusions experienced significant reductions in their symptoms compared to those who received a placebo. While more research is needed to fully understand ketamine’s long-term effects and optimal treatment protocols for PTSD, these preliminary findings are promising.

Ketamine IV Therapy and Postpartum Depression

Postpartum depression (PPD) is a common mood disorder affecting approximately 10-20% of new mothers. It is characterized by feelings of sadness, anxiety, irritability, and fatigue that persist beyond the typical “baby blues” period and significantly impact a mother’s ability to function and care for herself and her newborn. PPD can have far-reaching effects, impacting not only the mother but also her partner, baby, and family dynamics.

Treatment for postpartum depression is crucial and often involves a combination of psychotherapy, support groups, and medication, such as selective serotonin reuptake inhibitors (SSRIs).

In addition to these established treatments, ketamine is being investigated for its potential role in preventing and treating PPD. One study found that administering a low dose of ketamine during anesthesia for women undergoing scheduled cesarean sections significantly reduced the risk of developing PPD. While more research is needed to confirm these findings and establish optimal protocols, this suggests a potential prophylactic role for ketamine in high-risk populations.

Furthermore, preliminary research suggests that ketamine IV therapy may also be a promising treatment option for women who have already developed PPD. Although studies in this area are still limited, the rapid antidepressant effects of ketamine may offer much-needed relief for mothers struggling with this debilitating condition.

How Does Ketamine Work as Anesthesia?

Ketamine’s journey from veterinary anaesthetic to a multifaceted therapeutic agent is a fascinating one. Initially synthesized in 1962 by Calvin Stevens at Parke-Davis and Company, ketamine was first studied for its anaesthetic properties in animals. The first patent for ketamine as a veterinary anaesthetic was filed in Belgium in 1963. Its unique ability to induce a dissociative state, where animals were immobile and insensitive to pain but still retained protective reflexes, made it a valuable tool in veterinary medicine.

Ketamine’s success in veterinary practice paved the way for its use in humans. In 1970, ketamine was approved for human use by the U.S. Food and Drug Administration. It quickly gained prominence as a field anaesthetic during the Vietnam War, where its rapid onset and short duration of action proved invaluable for treating wounded soldiers.

Today, ketamine remains an important anaesthetic agent, particularly in emergency medicine and for short procedures. It is often used in combination with other anaesthetic medications to achieve optimal sedation and analgesia. Ketamine can also be administered in lower doses to provide analgesia and dissociation during painful procedures, such as reducing fractures or dislocations. Its rapid onset and offset make it particularly well-suited for these situations.

Understanding the Recreational Use of Ketamine

Ketamine, while a valuable medication in medical settings, is also unfortunately abused as a recreational drug. Sold on the streets under names like “Special K,” ketamine’s abuse began shortly after its introduction in the 1970s. Its dissociative effects, which can include distortions of reality, hallucinations, and out-of-body experiences, contribute to its appeal among recreational users.

In 1999, ketamine was classified as a Schedule III controlled substance in the United States, acknowledging its potential for abuse and dependence. While scheduling helps regulate its distribution, ketamine abuse continues to be a concern. The resurgence of ketamine abuse in the early 2000s, coinciding with increased research on its therapeutic uses, highlights the complex interplay between medical and recreational use.

Ketamine can be detected in various bodily fluids, including urine, hair, saliva, and blood. Urine tests can detect ketamine for up to 14 days after use, depending on factors such as dosage, frequency of use, and individual metabolism.

Ketamine Treatment Options and When to Use Them

Ketamine is available in various forms, including intravenous infusions and nasal spray, each with specific applications and considerations. A referral or prescription from a qualified healthcare professional is necessary to initiate ketamine treatment.

Ketamine infusions are often used “off-label” for treatment-resistant depression. This means that while ketamine is FDA-approved for anaesthesia, its use for depression is not yet officially recognized. As a result, insurance coverage for ketamine infusions for depression can be variable and often requires pre-authorization or appeals. Anaesthetic use of ketamine, such as during a surgical procedure, is generally covered by insurance.

IV Infusion

Ketamine infusions are administered in a controlled medical setting by a trained healthcare professional. Due to ketamine’s potential for dissociative and psychotomimetic effects, including hallucinations and perceptual distortions, close monitoring is essential during and after the infusion.

Nasal Spray

Esketamine, the S-isomer of ketamine, is available as a nasal spray (Spravato) specifically for treatment-resistant depression. It is FDA-approved, but only available through a restricted distribution system due to its potential for abuse and misuse. Generally, patients are eligible for esketamine if they have not responded adequately to at least two different antidepressant treatments.

Possible Side Effects of Ketamine IV Therapy

Ketamine infusions can cause various side effects, though not everyone experiences them. Common side effects include:

• Nausea
• Double vision
• Loss of appetite
• Flushing or redness of the skin

• Feeling strange or “out of it”
• Dissociation (feeling disconnected from your body)
• Hallucinations

It’s important to remember that side effects can vary, and some individuals may experience unique or unexpected reactions. It is crucial to use ketamine only under the supervision of a medical professional and to report any concerning symptoms.

Is Ketamine Addictive?

Ketamine, while valuable in medical settings, carries a potential for addiction and overdose, particularly with recreational use. While the exact nature of ketamine addiction is debated, evidence suggests that repeated misuse can lead to dependence, cravings, and compulsive drug-seeking behavior.

Using ketamine under medical supervision and following a doctor’s instructions significantly reduces the risk of addiction. However, it’s important to be aware that even with medical use, there is a potential for dependence, especially with prolonged or high-dose treatment.

Tolerance and Addiction

Repeated ketamine abuse can lead to tolerance, meaning that users require higher doses to achieve the desired effects. This can increase the risk of overdose and other adverse health consequences.

Ketamine Overdose

Ketamine overdose is a serious medical emergency. Symptoms can include:

• Loss of consciousness
• Respiratory depression (slowed or stopped breathing)
• Increased heart rate
• High blood pressure
• Agitation
• Confusion
• Hallucinations
• Seizures

Combining ketamine with other substances, particularly alcohol or central nervous system depressants, significantly increases the risk of overdose and respiratory failure. If you suspect a ketamine overdose, seek immediate medical attention.

Is Ketamine the Right Choice for You?

Ketamine has shown promise in treating certain mental health conditions, but it’s not a one-size-fits-all solution. If you’re considering ketamine therapy, it’s crucial to have a thorough discussion with your doctor or a qualified mental health professional. They can assess your specific situation, discuss potential risks and benefits, and determine if ketamine is an appropriate treatment option for you.

Important Considerations:

• Medical History: Your doctor will review your medical history, including any physical or mental health conditions, to evaluate your suitability for ketamine treatment.
• Current Medications: It’s important to disclose all medications you are currently taking, as some medications can interact with ketamine.
• Treatment Goals: Discuss your treatment goals and expectations with your doctor to ensure they align with what ketamine therapy can realistically offer.
• Alternative Treatments: Explore other treatment options that may be available and appropriate for your condition.

Ketamine is not a suitable treatment for everyone, and it’s essential to make an informed decision in consultation with your doctor.