What Is Ketamine Therapy? How It Works for Depression

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Ketamine therapy works by increasing neuronal activity to produce a surge of glutamate in the brain, providing fast-acting relief for treatment-resistant depression. Learn more about...

Ketamine therapy works by increasing neuronal activity to produce a surge of glutamate in the brain, providing fast-acting relief for treatment-resistant depression. Learn more about this innovative treatment and find out if it’s right for you.

Key Takeaways

  • Ketamine therapy is an innovative solution for treatment-resistant depression and major depressive disorder. It may also treat other mental health conditions and chronic pain, though research is limited.
  • The therapy works differently than traditional antidepressants. Rather than increasing serotonin, it floods the brain with glutamate to promote structural synaptic changes and produce rapid results.
  • Ketamine can be administered as a nasal spray, an infusion, or an intramuscular injection. Clinical oversight is necessary to reduce complications.
  • Insurance is typically available for Esketamine nasal spray only, as that’s the only FDA-approved administration type. However, coverage varies by plan and provider.

Table of Contents

Introduction

For years, SSRIs and SNRIs have been the gold standard for treating depression- but they don’t work on everyone. That’s where ketamine treatment comes in.

Unlike traditional antidepressants, which target serotonin, ketamine floods the brain with glutamate, producing results in minutes, not weeks. Additionally, rather than addressing a chemical imbalance, it brings structural changes to synapses, getting to the root of the problem, providing fast relief for treatment-resistant depression.

Learn more about its effects and how it’s administered in a clinical setting.

How Does Ketamine Therapy Work for Depression?

Ketamine therapy works by targeting glutamate, not serotonin, producing fast results in people who haven’t responded to traditional antidepressants.

SSRIs and SNRIs increase the availability of serotonin in the brain. Ketamine works on the brain’s glutamate system, the primary excitatory network. It blocks NMDA receptors in the network to produce a glutamate surge.

The release of glutamate activates receptors, setting off a cascade effect that ultimately forms new synaptic connections in regions involved in mood regulation, specifically the hippocampus and prefrontal cortex. It provides fast results, often providing relief within 24 hours.

How Is Ketamine Administered?

Ketamine can be administered through IV, intramuscular injections, or as a nasal spray, and requires a clinical setting and careful oversight.

  • IV (intravenous) ketamine infusions: Typically over 40 minutes to an hour
  • Intramuscular (IM) injections: A less common alternative to IV administration
  • Esketamine nasal spray (Spravato): A form of ketamine specifically approved by the FDA for depression

What Does a Ketamine Therapy Session Look Like?

Typically, therapy sessions require an initial screening. They last up to an hour with a follow-up monitoring period. The course of treatment takes 2-3 weeks and often requires maintenance sessions. It is typically integrated with talk therapy.

  • Initial Screening: The client undergoes a full medical and psychiatric evaluation to confirm treatment-resistant depression and rule out contraindications.
  • Setting: Ketamine is always administered under clinical care as it can cause dissociative effects and changes in blood pressure.
  • Administration: Ketamine infusion therapy is administered by a professional, while intranasal Esketamine is self-administered. Both processes take 40-60 minutes, and patients are carefully monitored for the following two hours before leaving the clinic. Driving is not advised, so patients should arrange transportation in advance.
  • Course of Treatment: Treatment typically involves multiple sessions over the course of 2-3 weeks. Maintenance sessions are spread further apart based on the patient’s response.
  • Integration: Ketamine therapy is often integrated with talk therapy, as the combination is believed to enhance neuroplasticity.

Who Is a Good Candidate for Ketamine Treatment?

Ketamine therapy is often prescribed for people with treatment-resistant depression, major depressive disorder with suicidal ideation, and other specific psychiatric disorders.

  • Treatment-Resistant Depression: This condition is diagnosed in individuals who have had inadequate responses to at least two antidepressant medications taken for an appropriate duration.
  • Major Depressive Disorder with Suicidal Ideation: The rapid results of ketamine assisted therapy make it ideal for people with depressive symptoms in crisis mode.
  • Other Disorders: Some research suggests ketamine therapy may help treat post-traumatic stress disorder ptsd, bipolar disorder, chronic pain, and anxiety. However, research is limited.

Is Ketamine Therapy Effective?

Various studies have shown ketamine to be an effective mental health treatment. For example, a study published by Johnson & Johnson revealed Spravato achieved 22.5% remission rates in people with treatment-resistant depression as compared to 4.76% remission rates for those in a placebo group. Another study, published in the AJMC Journal, showed that esketamine produced significant results in participants when combined with an oral antidepressant, yielding a 2-point change on the MADRS scale.

What Risks and Side Effects Are Associated with Ketamine Treatment?

Ketamine therapy can produce various side effects and may be risky for individuals with certain health conditions.

Side effects include:

  • Dissociation (“feeling detached from reality”) during and shortly after the session
  • Nausea
  • Temporary increases in blood pressure and heart rate
  • Sedation or dizziness

It is also not recommended for individuals with uncontrolled hypertension or certain heart conditions, or a history of psychosis. While it may be integrated into substance use disorder treatment, the process must be carefully monitored, as it is potentially addictive.

Because side effects and risks exist, ketamine is always administered in a clinical setting with ongoing medical supervision. Additionally, esketamine carries a box warning and is only available through a restricted distribution program.

As a comparatively new treatment, there is also limited research on ketamine’s long-term effects.

Is Ketamine Covered By Insurance?

Only the ketamine nasal spray is covered by insurance, as it is the only type of ketamine administration that is FDA-approved. The others are off-label, and without insurance, the full cost of treatment can be several thousand dollars.

However, even if you have insurance, plans vary. Talk to your provider and treatment center to learn what’s covered before starting treatment.

How Can I Find a Reputable Ketamine Therapy Provider?

A reputable ketamine therapy provider should provide multidisciplinary oversight, clear protocols, a thorough intake process, transparency, and care coordination, as follows:

  • A licensed psychiatrist or physician involved in evaluation and oversight, not just administration
  • Clear protocols for monitoring vital signs during sessions
  • A thorough intake process that screens for contraindications
  • Transparency about whether IV ketamine (off-label) or esketamine (FDA-approved) is being offered, and why
  • Willingness to coordinate care with your existing therapist or psychiatrist

BNI Clinics Is One of the Top Providers of Ketamine Therapy in Los Angeles

BNI Clinics is one of the earliest providers of ketamine treatment in Los Angeles. With 20 years of experience, we offer a board-certified, multidisciplinary team, a safe, controlled medical environment, and a personalized treatment plan. Our ketamine therapy is delivered as part of a comprehensive plan that also includes medication and psychotherapy, with treatment adjustments tailored to clients’ unique needs.

Contact our team to learn more about our effective mental health treatments.

FAQs

How fast does ketamine therapy work?

Most patients experience relief within 24 hours, much faster than traditional antidepressants, which may not produce results for eight weeks. However, timelines vary, and most plans require multiple sessions.

How long do the effects of ketamine last?

Effects of a single session are often temporary, which is why the initial course of treatment requires multiple clinical visits and follow-up sessions. However, the duration of effect varies from person to person.

Is ketamine therapy safe?

Ketamine therapy is considered safe with medical supervision. However, it does produce side effects and can cause safety issues in individuals with specific physical and mental health conditions.

Does insurance cover ketamine therapy?

Insurance is only available for Esketamine, the only FDA-approved type of ketamine. Ketamine infusions are prescribed off-label and are rarely covered. However, insurance varies by plan and provider, and it’s always wise to ask about what’s included before beginning treatment.

Who is a good candidate for ketamine treatment?

Ketamine treatment is recommended for individuals with treatment-resistant depression and major depressive disorder with suicidal ideation. It may also be prescribed to treat other mental health and chronic pain conditions, although research is more limited in those applications.

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