Ketamine Treatment for Depression

Ketamine is a type of psychedelic drug that has been used in anesthesia for decades. Recently, it has grown in popularity as a treatment option for people with treatment-resistant depression (TRD). While typical oral antidepressants like SSRIs may take weeks to work, ketamine can act in as little as 1 hour.^1,2

Ketamine treatment is not for everyone. There are ongoing debates about how safe and effective it is for treating depression. But it may be a faster solution for people with TRD.^1,2

How does ketamine treat depression?

Ketamine is a drug related to phencyclidine (PCP). It acts on the brain's signaling system to trigger:¹

• Strong feelings of well-being (euphoria)
• Pain reduction
• Disconnecting from reality (dissociation)
• Forgetfulness

Nasal spray ketamine treatment

In 2019, the US Food and Drug Administration approved a prescription nasal spray version of ketamine called esketamine (Spravato®) for TRD. It was approved only for use along with oral antidepressants. In 2020, esketamine was approved to treat major depressive disorder (MDD) and acute suicidal ideation or behavior.¹

Under the FDA guidelines, esketamine is only approved for use under the supervision of a healthcare provider in a certified doctor's office or clinic. People who undergo ketamine treatment must also be monitored for at least 2 hours following treatments.³

Ketamine is not used as a first-line treatment for depression. Ketamine treatments are thought to treat symptoms, not cure TRD. Typically, they are an option only when long-term treatments have not been effective.¹

How effective is ketamine for depression?

A dose of ketamine has been shown to significantly improve depressive symptoms after around an hour. Compare this to oral antidepressants, which may take several weeks to begin working.^1,2

Many studies show that this improvement continues 1 week after treatments. It is possible that repeated treatments help prolong the antidepressant effects. One study showed continued, steady improvement in symptoms with repeated treatments. In another study, ketamine taken with an oral antidepressant helped people stay in remission 16 weeks after treatments started.¹

However, the euphoria that ketamine causes can lead to "expectation bias" in studies. In a study where people were given ketamine under anesthesia (so they would not feel the euphoria), there were no lasting effects on depression. The long-term effects of ketamine use for TRD are also still being investigated.^1,2,4

Who is a good candidate for ketamine treatments?

Ketamine is generally considered safe when given in a clinical setting under the supervision of a healthcare provider. But it can cause side effects, including:^1,3

• Dissociation
• Nausea or vomiting
• Dizziness
• Sedation
• High blood pressure
• Quickened heartbeat

Because of these side effects, ketamine treatments are generally not given to the following groups:¹

• People with psychosis or schizophrenia, because dissociation may make these disorders worse
• People with a history of substance use disorder
• People who are pregnant or breastfeeding
• Teenagers and adolescents
• Older adults with dementia symptoms

These are not all the possible side effects of ketamine. Talk to your doctor about what to expect when undergoing ketamine treatments.

How to access ketamine treatment for depression

Ketamine is usually taken with other drugs to reduce symptoms in the short term. Ketamine treatments may be given at a medical institution, like a hospital, or at outpatient clinics. Often, ketamine treatments are not covered by insurance.^1,3

After ketamine was approved by the FDA for TRD in 2019, outpatient ketamine clinics started to open across the United States. Ketamine clinics typically include medical professionals like psychiatrists, anesthesiologists, nurses, and/or social workers. They are privately run, and their safety precautions may vary.¹

If you have TRD, ketamine treatments may be an effective, fast-acting option when other drugs have not worked on their own. Talk to your doctor about the potential risks and side effects of ketamine treatment, and where to safely access care.