Ketamine Education

Ketamine therapy is a medical treatment provided by a licensed clinician and is not a substitute for ongoing mental health care. Ketamine has been used in medical settings since the 1960s and is included on the World Health Organization’s List of Essential Medicines for its role as an anesthetic and analgesic. Over the past two decades, ketamine has also been studied extensively for its effects on mood, cognition, neuroplasticity, and stress regulation.

Esketamine, a derivative of ketamine, has received FDA approval for treatment-resistant depression in conjunction with an oral antidepressant, reflecting the clinical evidence supporting its efficacy in this population. At Awaken, ketamine is administered via intramuscular (IM) or intravenous (IV) injection under clinical supervision. The use of IM and IV ketamine for mental health conditions, including but not limited to treatment-resistant depression, anxiety, and trauma-related distress, is considered off-label. This means it is not FDA-approved for these indications but is supported by clinical research and professional practice when prescribed by a licensed clinician. Non-therapeutic use of ketamine is never advised, illegal, and can lead to worsening mental health conditions. It is not a safe or effective strategy for mental health relief.

Dosing of Intramuscular (IM) and Intravenous (IV) Ketamine

Ketamine is given in repeated doses to achieve cumulative effects. Awaken’s protocols typically involve six sessions, usually scheduled twice weekly over three weeks. On occasion, a client may require seven or eight doses, though this is uncommon. Follow-up or “booster” sessions may be recommended to support ongoing symptom management. The need for boosters varies by individual and is not always required.

How Ketamine Works

Ketamine primarily acts on the brain’s glutamate system by modulating N-methyl-D-aspartate (NMDA) receptors. This leads to downstream effects associated with increased levels of brain-derived neurotrophic factor (BDNF), which is linked to neuroplasticity, the brain’s ability to reorganize and strengthen neural connections. Ketamine may also influence the hypothalamic-pituitary-adrenal (HPA) axis, which plays a central role in the stress response. Some individuals experience reduced stress reactivity following sessions. Ketamine can also affect brain regions involved in emotional processing, including the amygdala and prefrontal cortex.

During sessions, clients may experience altered states of awareness, ranging from introspective insight to changes in sensory perception or internal imagery. These experiences are highly individualized. Responses vary, and while many individuals report meaningful insights or symptom relief, specific outcomes cannot be guaranteed.

Evidence Overview: Ketamine and Depression

A 2023 systematic review and meta-analysis published in eClinicalMedicine evaluated randomized controlled trials examining ketamine formulations for major depressive disorder. The analysis included 49 studies involving 3,299 participants. Across the included studies, ketamine was associated with reductions in depressive symptom severity compared with control conditions. Dose was identified as a relevant factor, with higher doses generally associated with greater reductions in symptom severity. Research findings are based on population-level data and do not predict individual outcomes.

Citation: Nikolin, S., Rodgers, A., Schwaab, A., Bahji, A., Zarate, C. A., Vazquez, G., & Loo, C. (2023). Ketamine for the treatment of major depression: A systematic review and meta-analysis. eClinicalMedicine, 62.

Clinical and Ethical Context

Ketamine research continues to evolve. Large-scale, long-term studies are ongoing, particularly regarding optimal dosing, durability of effects, and predictors of response. This evolving evidence underscores the importance of medical supervision, psychological support, and informed consent.

Medication Considerations

Ketamine may be administered alongside certain medications, including SSRIs, SNRIs, lithium, bupropion (Wellbutrin), and aripiprazole (Abilify). Some medications may influence ketamine’s effects, including:

• Higher doses of lamotrigine (Lamictal)

• Benzodiazepines (e.g., Xanax, Ativan, Valium, Klonopin)

• Stimulants (e.g., Adderall)

• MAOIs and central nervous system depressants (e.g., opioids, alcohol)

Never stop or adjust prescribed medications without consulting your healthcare provider. Robin may advise you to hold certain medications on treatment day if indicated.

Contraindications

Absolute contraindications:

• Known hypersensitivity to ketamine

• Uncontrolled hypertension

• Severe cardiovascular disease

• Hemorrhagic stroke or uncontrolled cerebrovascular disease

• Severe liver disease

• Pregnancy

Relative or cautionary contraindications:

• Psychotic disorders or active psychosis

• Seizure disorders

• Severe pulmonary disease

• Active substance use disorder

• Glaucoma or elevated intracranial pressure

• This list is not exhaustive. Medical clearance is determined individually.

Potential Side Effects

Common short-term effects:

• Confusion, disorientation, anxiety, or agitation

• Altered perception, vivid imagery, or dissociation

• Dizziness, sedation, mild tremor

• Headache, blurred or double vision

• Nausea or vomiting

Cardiovascular effects: Temporary increases in blood pressure or heart rate. Respiratory effects (rare at therapeutic doses): Laryngospasm or respiratory depression is more common at higher IV doses. Potential effects with repeated or long-term use: Cystitis or rare elevations in liver enzymes.

Payment Information

Ketamine therapy is not typically covered by insurance. Payment is accepted by credit card. A superbill can be provided at the end of your treatment for you to submit to your insurance company for potential reimbursement. Some clients may qualify for an Advanced Care Card, which offers financing options. Additional information is available at advancecarecard.com.

Good Faith Estimate

Under the No Surprises Act, clients have the right to receive a Good Faith Estimate outlining expected costs for medical or mental health services. This estimate may be requested before scheduling or at any time. If billed charges exceed the estimate by $400 or more, clients have the right to dispute the bill.