Ketamine FAQ

Ketamine Facts And Questions (FAQs)

Most frequent questions and answers


It is a medication primarily used as an anesthetic producing dissociative anesthesia. It can produce analgesia or pain relief, sedation, hypnosis, and amnesia.
It primarily works through NMDA antagonism, increasing glutamate levels, elevating brain-derived neurotrophic factor (BDNF) levels, and activating the AMPA receptor, all of which help neurons communicate through new synapse formation in the brain. To be honest, we don’t fully understand the exact mechanisms, although there are likely additional multiple effects, including those on inflammation.
Depression is the leading cause of disability worldwide, with over 16 million adults suffering an episode of major depression each year. Emerging data have demonstrated positive results in many patients treating severe depression refractory to medications, reducing suicidal thoughts and multiple somatic complaints seen in patients with severe depression.

Yes, ketamine can be very effective in patients suffering from PTSD, anxiety, bipolar disorder, substance abuse disorder, and OCD, as well as many chronic pain disorders.

Ketamine can be administered through many routes, including oral, rectal, sublingual, and subcutaneous. The pharmacological properties of ketamine are unique in many respects, including its high bioavailability through multiple routes. Despite this, the oral route results in metabolism by the liver before it is circulated to the brain and peripheral nervous system, where it causes its effects. As a result of this metabolism, much less medication is available, and multiple substances are created (metabolites), some of which have adverse effects. Sublingual and intranasal dosing relies on many variables, leading to inconsistent drug absorption and lower-than-expected therapeutic medication levels. Consequently, daily dosing is sometimes needed, and effects may take weeks to achieve. Many clinics use these routes, supported by research, and allow physicians not trained in anesthesia to use ketamine safely. It also reduces the time, expense, and expertise required for IV placement, monitoring, and management of adverse effects associated with higher doses and titration. Intramuscular dosing is a good alternative to IV infusion in cases where starting an IV may be difficult or is the patient’s preference. Almost 80% of the medication is absorbed and available to work at sites in the brain and nervous system. Since the entire dose is administered at one time, there is little control over the onset and degree of adverse effects such as hallucinations. The advantage of intravenous administration is that over 90% of the medication is available immediately, which provides precise dosing, rapid effects, consistent medication levels, and the ability to titrate and adjust dosing on a minute-to-minute basis. The effects are seen within minutes compared to over 30 minutes when administered by mouth or nose.

The Experience

The exact effects and feelings differ from patient to patient due to many factors, including the dose, route, rate of administration, medications, genetics, and various other factors. Some patients experience sedation and relaxation, while others can experience distortions in the perception of sight and sound, including hallucinations, feelings of floating, out-of-body experience, amnesia, relief from pain, and even agitation, among other effects.

Ketamine can potentially provide rapid relief; within hours after the first infusion, many patients feel relief. This is described as feeling “normal again,” as if “the weight has been lifted,” or “there is something to look forward to again.” Depression and other mood disorders are hard to describe because they vary amongst individuals, but 50-80% of patients will feel improvement in their symptoms. Most patients develop a sense of Ketamine will be helpful after the first infusion, but it can take between 3 and 6 infusions before some patients experience relief. As a result, we recommend at least three infusions to determine if ketamine will be helpful for you. We also can discuss the results with your mental health provider and determine if changing doses, extending infusions, or adding KAP might be helpful. We will follow your results objectively with validated depression questionnaires to help determine if you are achieving your goals for therapy.

During your comprehensive evaluation, we will discuss the goals and outcomes of your ketamine treatment. We will subsequently discuss and counsel you on using other medications to relieve these potential adverse effects. There continues to be controversy about whether the “experience,” including hallucinations and changes in perception, is required to obtain benefits from ketamine therapy. We are not convinced now, and more research is being performed. We have treated patients with and without using short-acting sedatives, both with success. While high, the success rate is very dependent on the individual and many other factors. We will work with you to develop the best individual plan for the first and subsequent treatments to maximize your expectations, minimize unpleasant experiences and optimize your results.

Ketamine Safety

Yes, when administered by health care providers skilled in the use and management of the potential and rare adverse effects associated with ketamine. Our board-certified CRNA or anesthesiologist will perform an extensive medical history and evaluation before administration to ensure that you can be given the medication safely. Moreover, they will personally administer and monitor you, including your vital signs and breathing, throughout the infusion and afterward. Furthermore, they may adjust or titrate your Infusion to minimize adverse effects and maximize the beneficial feelings/effects.

Ketamine can cause elevations in blood pressure and/or increased heart rate, nausea/vomiting, dizziness, headache, uncontrolled emotions including crying or tearfulness, an out-of-body experience, and can worsen psychosis in patients with schizophrenia or a history of psychosis. Effects such as muscle cramping and bladder problems are typically seen only with long-term use.

The DEA has classified ketamine as a class III controlled substance with low potential for addiction. Over a course of therapy, including maintenance, if required, ketamine has a low potential for addiction.

During your comprehensive medical evaluation, we will evaluate your medications for any interactions or contraindications and adjust your therapy if needed. Ketamine can significantly interact with most schedule I and II substances, such as LSD/cocaine/methamphetamine/oxycodone. Patients should not be taking any of these substances and must not use alcohol within 24 hours of their appointment. Additionally, patients on chronic benzodiazepine medications (particularly high doses) may not benefit as much from the longer-term effects of ketamine.

Preparing for Ketamine Therapy

Typically 3-6 infusions spread over 1-3 weeks are required to achieve results sustained for weeks to months or even longer. Maintenance treatments, if needed, are typically required every 4-6 weeks, and these can be extended with time. Each patient is different, and we discuss your needs to achieve optimal results. Chronic pain patients may require longer and higher dose therapy with several treatments every 6 to 8 weeks, although there is significant variability between patients.

Patients suffering from treatment-resistant depression, anxiety, PTSD, or other mood disorders are prime candidates for ketamine therapy. Patients with schizophrenia or psychosis are, however, not good candidates. Patients with severe cardiac diseases or poorly controlled high blood pressure (hypertension) may require more extensive medical evaluation and optimization of their medical conditions before therapy.

We believe that comprehensive mental health care is pivotal to effectively managing patients with severe depression refractory to treatment, anxiety, and PTSD. Ideally, you should obtain a request from your primary care physician, psychologist, or psychiatrist for ketamine therapy. While we currently do not provide mental health evaluation, we can provide referrals for patients requiring ongoing psychotherapy and/or medical management. Our philosophy is similar to the idea that you wouldn’t go to a cardiologist for your colonoscopy. We provide expertise in using Ketamine, a safe environment, and an individualized plan to optimize the administration of ketamine so you achieve optimal results.

Yes, each ketamine infusion is performed in a private room. Your comfort is very important during therapy. We recommend starting with a quiet, darkened room unless concomitant psychotherapy is occurring. We do individualize therapy and offer silence many options to optimize the environment, including choices for music/sounds, video, and pictures, for example, to ensure your comfort and maximize your ability to achieve the results you desire.

Treatment Day

Yes, we require a driver to accompany you to your appointment. While you might feel clear-headed shortly after your infusion, you shouldn’t drive, operate heavy machinery, participate in significant decision-making, or sign legal documents until the next day.

Typical initial treatments require 2-3 hours, including a short period of observation/recovery after your infusion. Higher doses and some infusions may require an infusion of 4 hours, and the observation/recovery period is extended to 1 hour or more in some cases.

If your therapy plan includes intravenous ketamine, we will start a small IV preferentially in your forearm or hand. If you have a history of extreme pain/discomfort with an IV placement, have “passed out” with IV placement/blood draws, or healthcare providers having difficulty starting an IV or with blood draws, please discuss this with our clinicians. We strive to reduce your anxiety and any discomfort with placing your IV. We have multiple techniques to reduce anxiety and expertly place an IV. Intramuscular injection is an alternative if your desire for this route or IV placement is precluded.

Other Questions

Ketamine is a real anesthetic with the potential to cause complete unconsciousness, decreased breathing, and severe changes in a patient’s vital signs. Every patient is different, and even low doses can cause adverse effects, although these are uncommon. While ketamine is extremely safe, particularly at low doses, patients may not achieve their desired results with limited dose amounts. Titration, dose adjustments, and adjunctive medications may be required to get optimal results. Our clinical team is skilled in the use of high-dose therapy safety, and excellence in every patient encounter is our primary focus. As a result, every ketamine infusion is administered and monitored by a board certified/Practicing anesthesiologist or CRNA. Our team of anesthesiologists/CRNAs have decades of experience with managing the complications and adverse effects of ketamine. Finally, your comfort and privacy are also extremely important to us.

Not at this time. This formulation of ketamine is FDA-approved, although most medical literature primarily documents the effects of intravenous/intramuscular racemic ketamine. As more research is completed, Esketamine may play a bigger role.

Please see our ketamine pricing in the following link.

We understand that treatment is expensive and requires a significant time commitment. That’s why our practice has partnered with Tricare to reduce the price of ketamine infusions as much as possible. Visit their website here to see if you’re eligible for insurance benefits.

Our team focuses on helping patients find relief and improve their well-being, health, and quality of life. As a result, we try hard to reduce costs where we can, but only after we ensure that we provide the safest care possible. This is by creating a team of experts in the management of anesthesia and ketamine, ensuring that the highest standards of care are followed, and providing evidence-based therapy.

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