Project Description

Ketamine Therapy – Q&A

Ketamine was initially developed as a dissociative anesthetic in 1962, and was originally used for children’s surgery and emergency pain control on the battlefield during the Vietnam War. More recently, it has been used to treat intractable chronic pain, treatment-resistant depression, anxiety disorders, and as an adjunct to therapy for patients with posttraumatic stress disorder and chemical dependency disorders.

It can be given intravenously, intramuscularly, sublingually, orally. Most recently, it has been FDA approved for in-office intranasal use for major depression under the brand name Spravato. 

The most common chronic pain conditions that respond well to ketamine include migraines and other headache disorders; central nervous system pain arising from fibromyalgia, genetic disorders, and brain injuries; peripheral nerve pain conditions such as neuropathies, neuralgias, and spinal pain; and pain arising from musculoskeletal disorders or mixed pain states such as pelvic pain, rheumatologic pain, and gastrointestinal pain. Complex regional pain syndrome and neuroinflammatory disorders respond well to ketamine therapy in many patients. 

Ketamine is widely known to rapidly improve various psychiatric disorders such as major depression, suicidal thinking, obsessive compulsive disorders, generalized anxiety, bipolar disorders, and symptoms of posttraumatic stress disorder. Ketamine has also been utilized to treat the sequelae of brain injuries and various other brain disorders. Ketamine has recently shown great promise as adjunctive treatment to psychotherapy. 

The duration of therapy will depend upon the individual condition for which the therapy is being conducted. For chronic pain conditions, most patients will have a two-hour treatment protocol, and the ketamine is generally combined with other types of medications. For emergency respite care, sessions may last one hour. For the most treatment-resistant neurological conditions, sessions may last up to three to four hours. For the treatment of depression and anxiety, sessions may range from 40 minutes to an hour and a half; however, the majority of treatment sessions will  last an hour.

 For treatment of depression and anxiety disorders, treatment may involve one-hour sessions two to three times a week for two to three weeks. In general, eight sessions over the first month and an additional four sessions the second month.  Some patients will not need any further sessions. Other patients may be treated with a tapering protocol with treatment conducted from every two weeks, to every month, to every quarter, to every six months. 

Ketamine treatment may benefit multiple conditions at the same time. It is not uncommon to find patients who are dealing with multiple types of intractable chronic pain, depression, anxiety, and trauma, and ketamine therapy may help with all these conditions. Ketamine therapy is also useful for many other types of intractable conditions, which presently otherwise have no safe and effective treatment. Ketamine therapy may also help in terms of medication tapering, drug withdrawal states, and reducing tolerance and dependence on opioid medication. Patients with severely painful conditions, who are not able to discontinue opioids, may find the pain medications work much better after undergoing ketamine infusions, as the ketamine will desensitize a patient’s nervous system.

Ketamine is  classified as an NMDA antagonist. Many types of medications for pain and depression that are currently being researched utilize this mechanism of action. Ketamine also appears to modulate the opiate receptors in a patient’s nervous system in such a way that physical dependence, addiction, and intolerance is less likely to develop.  Ketamine may also serve as a catalyst to improve the efficacy of other treatment modalities, including theta-burst stimulation and medication switching in treatment-resistant conditions. 

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