Ketamine Therapy: What to expect
Ketamine therapy involves three phases:
- Intake
- Induction
- Maintenance
Ketamine therapy involves three phases:
Practitioners gather information about an individual’s physical and mental health. This often includes evaluations to understand needs and identify complications that might affect treatment. The intake process helps the care team determine if ketamine therapy is appropriate for the individual and allows them to tailor the treatment plan to individual needs.
Ketamine is first administered during this phase. Ketamine is typically introduced through a series of 4-8 infusions over the course of 2-4 weeks designed to produce rapid antidepressant effects. Each infusion session is monitored closely by healthcare professionals to ensure safety and efficacy. The goal of induction is to achieve significant symptom relief, setting the foundation for long-term improvement.
After the initial treatment phase, maintenance therapy may be scheduled to prevent relapse. This consists of booster treatments administered periodically, such as every 6 weeks. The frequency and duration of maintenance therapy are individualized based on the response to treatment and ongoing mental health needs. Maintenance therapy aims to sustain the benefits achieved during the induction phase and to manage any re-emergence of symptoms.
The intake process for ketamine therapy involves several steps to ensure the treatment is appropriate and safe, as not everyone is a suitable candidate.
Prospective patients typically begin by filling out a contact form or reaching out to the clinic via phone or email. This initial step allows the clinic to gather contact information for further correspondence. Most clinics then schedule a complimentary 15-minute consultation to discuss the individual's symptoms and medical history, determining if ketamine therapy could be beneficial and if a more comprehensive assessment is appropriate.
The American Society of Ketamine Physicians, Psychotherapists, and Practitioners (ASKP^3) recommends that clinics perform a comprehensive medical assessment to determine suitability. This assessment usually includes both medical and psychiatric evaluations.
Clinicians should obtain written informed consent from patients before starting ketamine therapy. This includes discussing potential side effects and the expected number of treatments needed for improvement. Patients should be informed that most ketamine applications are off-label and provided with safety protocols, such as not driving post-treatment and managing side effects like mood changes. The consent should also cover alternative treatments and indicate that ketamine therapy may require ongoing maintenance, similar to other treatments like oral medications.
Induction refers to the initial phase of treatment where ketamine is administered in a series of sessions to provide rapid relief from symptoms and extend the time-to-relapse.
The most common induction strategy involves 4-8 sessions over 2-4 weeks. This approach is supported by multiple studies using repeated ketamine infusions to extend the antidepressant response (aan het Rot et., al 2010; Cusin et al., 2016; Diamond et al., 2014; Murrough et al., 2013; Rasmussen et al., 2013; Singh et al. 2016). Some clinics administer 8 sessions over 4 weeks, aligning with the recommended dosage of Spravato® and FDA-approved esketamine nasal spray for treatment-resistant depression. Numerous studies have compared the effectiveness of ketamine vs. esketamine.
During an induction session, ketamine is typically administered intravenously (IV) or intramuscularly (IM) at sub-anesthetic doses (~0.5 mg/kg), often referred to as an infusion. Patients are seated in a comfortable chair, and the environment is made relaxing, sometimes with dimmed lights, eye masks, and calming music. The infusion typically lasts 40 to 60 minutes, with continuous monitoring of vital signs such as pulse, oxygen levels, and blood pressure.
Some individuals experience a mild euphoric sensation or a dissociative effect, which can feel like a "warm out-of-body experience." Patients often report feeling deeply relaxed, and the experience may resemble a therapeutic session. Common side effects include a sense of dissociation, where patients feel a separation from their body or a dream-like state. Mild nausea can occur but is manageable with medication if necessary.
After the infusion, patients regain full mental clarity within minutes. They are usually advised to relax for a short period before leaving the clinic and are recommended to arrange transportation home, as driving is not advised until the following day. Some patients may feel tired afterward, while others feel rejuvenated and ready to resume their day.
In ketamine therapy, the maintenance phase helps sustain the therapeutic benefits achieved during induction. Acting as a "tune-up," maintenance therapy prolongs improvements in mood and well-being, ensuring patients continue to experience positive effects over time.
The frequency of maintenance treatments is highly individualized and varies significantly among patients. Some may require booster infusions as frequently as once a month, while others might need them only once a year. This variability is based on the patient's unique needs and symptom recurrence. Healthcare providers work closely with patients to determine the optimal maintenance schedule, ensuring the therapy is both effective and convenient for the individual's lifestyle.
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