Ketamine Infusion Therapy 101
Ketamine is an FDA-approved anesthetic thats been widely used around the world for more than five decades. Its also a medication with fast-acting antidepressant properties that mental health experts have been studying with deep interest for over 20 years.
While ketamine isnt considered a first-line therapy for chronic pain, depression, or any other mental health disorder, it can be used off-label to treat severe cases of depression, anxiety, and PTSD that havent responded to conventional medications or therapies.
When ketamine is administered through a slow, constant intravenous drip, it has calming and extremely therapeutic effects on the regions of your brain that control mood and behavior.
With its ability to provide quick and lasting relief for even the most persistent cases of TRD, ketamine has been called the most important breakthrough in the treatment of depression to come along in recent memory.
What Does It Look Like
Ketamine prepared for medical use is a colourless, tasteless and odourless liquid that can be injected. Ketamine is usually converted into a white powder before it is sold illegally. It may also be sold as capsules or tablets. The powder can be snorted, mixed into drinks or dissolved for injection. The liquid can be added to drinks or to or tobacco.
Ketamine Intoxication Effects On The Brain
Ketamine can cause confusion, delirium, and amnesia.
Ketamine can be taken orally, snorted, or injected and the routes of administration play a critical role in the dose dependent ketamine effects on the brain. As a contributor to increased dopamine levels, ketamine can produce euphoria and pleasurable senses that enhance musical, sexual, and other sensory perceptions. At adequate doses it produces a paralyzing and trance-like state that many refer to as the k-hole where the dissociative or out of body experiences take place.
Ketamine effects on the brain are a lot like alcohol in affecting moods and impairments of motivations, learning, memory, and emotions. Although it affects multiple receptors in the brain and central nervous system , it particularly affects NMDA receptors that are able to block or enhance activity in neurotransmissions including those involving serotonin and norepinephrine which are necessary contributors to healthy brain functioning. This contributes to many of the psychedelic ketamine effects on the brain including the:
- Anesthesia and dissociative effects
- Confusion, delirium, hallucinations, altered perceptions of sight, touch, and sound
- Sense of slowing things down, paralyzing, trance-like, or lifeless state
- Schizophrenic-like symptoms and behaviors
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Statistical Model Defines Ketamine Anesthesias Effects On The Brain
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Based on brain rhythm measurements from nine human and two animal subjects, the new model published in PLOS Computational Biologydefines the distinct, characteristic states of brain activity that occur during ketamine-induced anesthesia, including how long each lasts. It also tracks patterns of how the states switch from one to the next. The beta-hidden Markov model therefore provides anesthesiologists, neuroscientists, and data scientists alike with a principled guide to how ketamine anesthesia affects the brain and what patients will experience.
In parallel work, the lab of senior author Emery N. Brown, an anesthesiologist at MGH and the Edward Hood Taplin Professor of Computational Neuroscience at MIT, has developed statistical analyses to characterize brain activity under propofol anesthesia, but as the new study makes clear, ketamine produces entirely different effects. Efforts to better understand the drug and to improve patient outcomes therefore depend on having a ketamine-specific model.
Now we have an extremely solid statistical stake in the ground regarding ketamine and its dynamics, says Brown, a professor in MITs Department of Brain and Cognitive Sciences and Institute for Medical Engineering and Science, as well as at Harvard Medical School.
Making a model
The National Institutes of Health, the National Science Foundation, MGH, and the JPB Foundation provided funding for the study.
Are There Different Types Of Ketamine
Two main types of ketamine are used to treat major depression that hasnt responded to two or more medications .
- Racemic ketamine, which is most often given as an infusion into the bloodstream. This is sometimes called intravenous, or IV, ketamine. It is a mixture of two mirror-image molecules: “R” and “S” ketamine. While it was approved decades ago as an anesthetic by the FDA, it is used off-label to treat depression.
- Esketamine , which the FDA approved in March, is given as a nasal spray. It uses only the “S” molecule.
Thus far, most research has been on ketamine infusions.
The two forms of ketamine interact differently with receptors in the brain. The delivery of ketamine and the type given affect drug effectiveness and side effects. We dont yet know which type is more effective or how much side effects may differ. Further research comparing effectiveness and side effects is needed.
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They May Deny The Problem
A depressed spouse may deny that they have any problem at all, Ben-David says.
âMany people with depression or mental health issues donât want to be âfixed.â They may just want to be heard. If in the process of listening to your partner, if you hear things that are too hurtful for you to handle, then turn to a professional for help,â he says. âYour spouse may not identify their behaviors as depression. If theyâre acting out with sex, drinking, drugs, or food, they may say, âI need this. It eases my stress.ââ
Encourage your spouse to get help and a diagnosis from a mental health professional. They can start with talk therapy and, if they need it, prescription medication, Barber says. Make an appointment with a psychologist, psychiatrist, counselor, or family doctor for a diagnosis, and begin therapy.
âPsychotherapy plus medication has shown to work better for depression than just medication. Medication without talking is not going to help,â says Barber, who adds that medication may be more appropriate to treat people with severe depression.
Some couples choose to have therapy together, especially if depression has led to sexual issues in the marriage, such as an affair, Ben-David says. Your depressed partner may prefer to do solo therapy. If theyâre struggling with addiction, they need to treat that before tackling their depression, he says.
The Uses Of Ketamine: A Timeline
Ketamine is a medicine that was initially employed for anesthesia and analgesia and for minor surgery. It is not new. In fact, ketamine was first synthesized in 1962. Since then, it has had an interesting history. Ketamine was first patented for use as a human anesthetic in Belgium and Germany in 1963, followed by the United States in 1966. In 1970, the drug was approved by the U.S. Food and Drug Administration and quickly became the most widely used battlefield anesthetic during the Vietnam War.
Unfortunately, as ketamine grew in popularity, people started to use it recreationally. Known popularly as Special K, Kit-Kat, Super Acid, Jet and Cat Valium, ketamine became popular as partygoers and others sought out its dissociative effects. Often used in clubs, users typically choose to snort ketamine, but it can also be injected or taken orally. The immediate effects of the drug, known on the street as being in the K-hole, are a sense of being outside the body. Side effects include reduced awareness of the environment, reduced pain perception, sedation, and hallucinations.
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How Does Ketamine Work
Its not entirely clear how ketamine works. Because it exerts an antidepressant effect through a new mechanism, ketamine may be able to help people successfully manage depression when other treatments have not worked.
One likely target for ketamine is NMDA receptors in the brain. By binding to these receptors, ketamine appears to increase the amount of a neurotransmitter called glutamate in the spaces between neurons. Glutamate then activates connections in another receptor, called the AMPA receptor. Together, the initial blockade of NMDA receptors and activation of AMPA receptors lead to the release of other molecules that help neurons communicate with each other along new pathways. Known as synaptogenesis, this process likely affects mood, thought patterns, and cognition.
Ketamine also may influence depression in other ways. For example, it might reduce signals involved in inflammation, which has been linked to mood disorders, or facilitate communication within specific areas in the brain. Most likely, ketamine works in several ways at the same time, many of which are being studied.
Ketamine And Depression Treatment
Many psychiatrists and psychologists have been exploring the use of ketamine in the treatment of depression. One study conducted at Yale found out that ketamine can trigger glutamate production in the brain, stimulating fresh neural connections.
Earlier, it had been found that depressed people had some abnormality in their brains glutamatergic system. This is where the idea of the use of ketamine on depressed people sprung from.
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The Legal Status Of Ketamine
Ketamine is scheduled in many jurisdictions. Below are some examples of the legal status of ketamine internationally.
Ketamine is scheduled differently within and between countries. Below is a brief overview of the legal status of ketamine in a number of key jurisdictions. Within Australia prior to December 2003 ketamine was a scheduled drug in New South Wales under the Poisons and Therapeutic Goods Act, which meant that there were strict regulations on the sale and distribution of the substance. In response to increasing trends in ketamine use, the government added it to the list of prohibited drugs in New South Wales. This means that it has now been listed under the Drug Misuse and Trafficking Act 1985, ensuring that tougher penalties are in place for dealing with its illicit use. New penalties for those caught manufacturing or supplying the drug include fines between AU$5500 and AU$550 000 and anywhere from 2 years to life imprisonment or both. These penalties particularly apply to veterinary and medical practitioners who have an authority to purchase ketamine for legitimate purposes and then supply it to others for illicit use. Similar laws apply in some other states of Australia, however, in other states it remains legal to possess ketamine.
Ketamine is treated as a medication and is not in List 1 or 2 in the Netherlands.
David H. Chestnut MD, inChestnut’s Obstetric Anesthesia, 2020
Ketamine Effects On The Central Nervous System
The effects of ketamine on the brain have a direct impact on central nervous system functions. The central nervous system regulates:
- Nerve signal transmissions throughout the body
- Heart functions
- Respiratory functions
- Movement and coordination
Ketamine not only numbs the brain, but also slows central nervous system functions, which can pose dangerous consequences when taking large doses of the drug. The numbing effects had on the body free the mind to enter an expanded state of consciousness.
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Ketamine For Major Depression: New Tool New Questions
- By Robert C. Meisner, MD, Contributor
First things first: You may be asking yourself, “What is ketamine?” Well, it was once used mainly as an anesthetic on battlefields and in operating rooms. Now this medication is gaining ground as a promising treatment for some cases of major depression, which is the leading cause of disability worldwide. In the US, recent estimates show 16 million adults had an episode of major depression in the course of a year. Suicide rates rose substantially between 1999 and 2016, increasing by more than 30% in 25 states. Because of its rapid action, ketamine could have a role to play in helping to prevent suicide.
Mixing Ketamine With Other Drugs
It is important to be aware that mixing ketamine with other drugs can be dangerous. Mixed with a stimulant drug such as cocaine or ecstasy, ketamine could put too much pressure on your heart. Taking it with a depressant can increase the risk of unconsciousness, and can lead to breathing problems and suffocation.
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Cleaning Up Ketamines Action
Ketamine is a dirty drug that acts on many receptors withmany side effects, and is thought to be addictive. But the researchers think itmay be possible to find a cleaner, safer antidepressant that acts through theNMDA receptor, and specifically through the 2A subunit.
Henschs lab is also interested in exploring the potentialusefulness of modulating parvalbumin circuits in psychosis and other conditionsin which these cells are altered. Abnormalities in these cells are believed to playa pivotal role in autism, schizophrenia and other neurodevelopmental disorders.
Were interested in how these cells develop faster orslower in different diseases, says Hensch.
The study was funded by the Silvio Conte Center of the National Institute of Mental Health , the University of Tokyo International Research Center for Neurointelligence , the Rett Syndrome Research Trust, Rett syndrome.org, the National Institute of Neurologic Disorders and Stroke , the National Eye Institute , Pfizer, the Nancy Lurie Marks Family Foundation and the Canadian Institute for Advanced Research.
Can You Get Addicted
Yes. People who become addicted to ketamine will keep taking it whether theyre aware of the health risks or not. Others will attend drug treatment services to help them stop.
People who use ketamine regularly can develop a tolerance to it, which could lead to them taking even more to get the effects theyre looking for.
There are no physical withdrawal symptoms with ketamine, so ketamine addiction is sometimes called a psychological dependence.
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Effects Of Ketamine On The Brains Chemical Processes
According to Columbia Health, ketamine works through its interactions with glutamate-producing brain cell receptor sites. Glutamate, a vital neurotransmitter chemical, helps regulate information processing and overall communications between the various regions of the brain and body.
In effect, ketamine blocks glutamate production and essentially shuts off communications between the brain and the body. These chemical interactions produce the anesthetizing effects users experience. Once ingested, ketamine effects can take hold within a minutes time when snorted or injected.
The Positive Effects Of Ketamine
When patients receive Ketamine infusion therapy, the effects will last for approximately thirty minutes to one hour. While it isnt recommended to make important decisions or drive on the day of the treatment, shortly thereafter, patients will be able to return to their normal lives without any trouble. Under most circumstances, the first positive feeling patients experience is an absence of many of the anxious feelings they were previously experiencing. This relief might occur immediately following the treatment. If patients have any feelings of disassociation, they may be able to break down the negative paradigms or social norms that be also be causing them psychological stress.
Any negative after-effects wear off quickly and when patients know what to expect, their experiences are more often pleasant. Because nausea is a common occurrence following therapy, the recommendation is for patients to only drink clear liquids for up to two hours before their treatment, and not to eat for up to four hours afterward.
What Does This Mean for Ketamine Patients?
Do you have more questions about Ketamine? Reach out to us at 833-867-2329. If you or anyone you know needs Ketamine Infusion Therapy, contact us to book your first session today!
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Those Who Have Heard Of Ketamine Probably Recognize It As A Common Club Drug
Ketamine is so popular in the clubbing scene because of its effects on a persons brain and mood. Researchers are even experimenting with the idea of using ketamine as a way to treat major depressive disorder, obsessive-compulsive disorder , and post-traumatic stress disorder . You may be wondering why doctors would even attempt to use a club drug to treat mental illness in their patients. The reason is that theyre most attracted to ketamine effects on the brain and how it can benefit those with a mental disorder.
While ketamine is currently used for sedation, anesthesia, and treatment-resistant depression, it still has a high potential for abuse. As a nationwide addiction and mental health treatment center, we advise against any form of drug abuse or misuse and encourage those who are suffering from addiction to get help immediately.
Ketamine Quiets Abnormal Activity In The Lateral Habenula
The lateral habenula is a center of emotional processing. It is also known as the brains disappointment center. Specifically, the lateral habenula focuses on emotions and feelings that are difficult. In 2017, a study revealed that the lateral habenula in depressed animals and humans functions abnormally and tends to over fire neurons, causing an overwhelming abundance of negative thoughts, feelings and essentially, a depressive episode. Increasing evidence indicates that the aberrant activity of the LHb is associated with depressive symptoms such as helplessness, anhedonia, and excessive negative focus. Ketamine is known to directly affect this area of the brain. and it may serve to reset the brains disappointment center and thus ease symptoms of depression and restore more normal processing of disappointment or emotional pain.
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Effects Of Ketamine On The Brain
Many antidepressants act on single monoamine neurotransmitters . Ketamine, on the other hand, acts on glutamate, the most prominent chemical messenger of the brain, regulating neuroplasticity, emotions, and cognitive thoughts. Glutamate also strengthens and promotes synaptic connections and plays a role in how people learn and respond to and remember experiences. This explains why ketamine is more effective than other antidepressants.
The fact that ketamine targets glutamate means it can rebalance glutamate and Gamma-Aminobutyric Acid levels, which results in improved mental health and low depression levels.
What Are The Possible Side Effects Of Ketamine
All drugs have side effects. When someone is suicidal or severely depressed, possible benefits may outweigh possible risks.
Ketamine given by infusion may cause:
- high blood pressure
- nausea and vomiting
- perceptual disturbances
- dissociation rarely, a person may feel as if they are looking down on their body, for example.
Generally, any changes in perception or dissociation are most noticeable during the first infusion and end very quickly afterward.
Esketamine nasal spray may cause the same side effects. However, the timing and intensity of those effects is different.
Long-term or frequent use of ketamine may have additional side effects. More research on this is needed.
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