Many people want to know about ketamine, a drug used for treatment-resistant depression. This medication has been used in many different ways over the years.

In 1970, ketamine was approved as anesthesia and is still used for that purpose. Decades later, ketamine (dubbed Special K) was a popular drug at nightclubs.

“Ketamine can cause a sleep-like state and forgetfulness – ideal as an anesthetic,” says psychiatrist Eric Alcera, M.D., network medical director for Behavioral Health at Hackensack Meridian Health. “But with that, it can make people feel disconnected from their bodies – appealing for a party drug.”

Researchers became interested in the effects that ketamine has on the brain. A number of studies have shown that it helps to fight depression.

Ketamine may also help patients with these conditions, although more research is needed:

• Anxiety
• Bipolar disorder
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Eating disorders
• Alcohol use disorder
  
  

Different Ways to Take Ketamine

Ketamine can be given intravenously or intranasally, or sometimes by tablet or lozenge.

When doctors prescribe intravenous (IV) ketamine for treatment-resistant depression, it’s done off-label. This means that it isn’t approved for that specific purpose but can be used that way.

In 2019, esketamine – which is derived from ketamine – was approved as a nasal spray. This medication was approved as a therapy for treatment-resistant depression.

Ketamine, a Schedule III non-narcotic drug, is a controlled substance. Because it can cause dependence, ketamine and esketamine must be administered under a doctor’s care.

Despite these concerns, some doctors and patients consider ketamine a lifesaver.

“Some patients who have not responded to antidepressants get relief from their depression,” says Dr. Alcera.

When administered by doctors, ketamine is considered safe, even for people who are suicidal.

How Ketamine Combats Depression

Ketamine therapy works differently than other medications for depression. 

Antidepressants may slowly build up levels of the neurotransmitter serotonin in the brain. Ketamine increases levels of the neurotransmitter glutamate in the brain, according to research.

“People with depression typically have low levels of glutamate in the brain,” Dr. Alcera says. “Increasing their levels may help to improve depression.”

Ketamine helps the brain form new neural pathways, according to research. These pathways may enable people with depression to develop more positive thoughts. 

Unlike traditional antidepressants, which typically take weeks to have an effect, ketamine is quicker. Some people who undergo ketamine therapy notice a change within hours.

“Because ketamine may work quickly and relies on a new mechanism, people are interested,” Dr. Alcera says. “However, ketamine therapy is not for everyone with depression.”

When is ketamine used to treat depression?

Ketamine is not recommended for all people who experience depression. It should only be used when other medications to treat depression have failed. 

Intranasal esketamine may only be prescribed if:

• At least two antidepressants have not been effective
• Doctors have prescribed those antidepressants at appropriate doses
• Patients have taken those antidepressants for the appropriate period of time
  
  

Intravenous ketamine is prescribed off-label, so there are no hard-and-fast rules. But doctors do not prescribe it as a first-line treatment for depression.

Ketamine therapy is not intended to treat depression on its own. Patients who receive ketamine or esketamine must also take antidepressants.

“Some people who have heard about ketamine want to try it, instead of antidepressants,” Dr. Alcera says. “Doctors shouldn’t prescribe it by itself – only with antidepressants, if other treatments aren’t effective.”

Side Effects of Ketamine

What does ketamine therapy feel like, when someone receives this treatment? It varies, but most people have these experiences during appointments:

• They may feel drowsy and/or relaxed
• Their perception of reality may be distorted
• They may notice changes to their visual field, including double vision
• They may experience mild, pleasant hallucinations
• The experience may be emotional for them
  
  

Some people experience side effects, which resolve on their own or may need to be treated, including:

• Elevated blood pressure
• Nausea
• Headache
• A sensation similar to being drunk
• Feeling detached from reality
  
  

Ketamine therapy is not typically covered by insurance. Out-of-pocket costs may add up; each session may cost hundreds of dollars.

Next Steps & Resources:

• Meet our source: Eric Alcera, M.D.
• To make an appointment with a doctor near you, call 800-822-8905 or visit our website. 
• Learn more about mental health services at Hackensack Meridian Health

The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.