Ketamine Therapy Basics
Ketamine has a long history in medicine where it is used as a dissociative anesthetic, sedative, and painkiller and is often used in the operating room or in the emergency department during surgeries or procedures.
More recently, ketamine has gained notoriety for its ability to quickly help a variety of mental health conditions such as anxiety, depression, and post-traumatic stress disorder. Unlike other antidepressant medications, ketamine tends to start working quickly and have a longer duration of treatment effect.
It is also showing promise to work in tandem with antidepressants in patients with treatment-resistant depression who wouldn’t otherwise benefit from traditional antidepressants and therapy. Another reason that it is highly considered is the quick action, meaning that you get the effects much faster than traditional antidepressants.
That is why so many psychiatrists and psychotherapists are paying close attention to the possibilities of this one-of-a-kind medication.
First, you book your first appointment with our physician. Once your booking is complete, you will fill out an intake form in preparation for the first appointment. During the medical evaluation appointment, our physician will assess if Isha Health is a good fit for you based on your past medical history, psychiatric history, medication history, substance use history, and so on. After the initial appointment, our physician will get in touch with your current providers such as a psychiatrist, family physician, or psychotherapist for more information. After this, if our doctor thinks ketamine therapy will be beneficial to you, she will prescribe ketamine and other medications as needed.
Typical patients will start with 1mg/kg ketamine lozenge twice a week. Every 4 weeks, she will meet with you via telemedicine, and review the mood scores and clinical scored which you log via our smartphone app, and adjust your dosage. Once you reach the optimal dosing, you will stay in the dosage for about 6 months, after which we may adjust the frequency and dosage of ketamine. We highly recommend having concurrent psychotherapy sessions on a regular basis along with ketamine treatment to maximize the treatment gain. Research says that psychotherapeutic treatment elongates the effect of ketamine.
When you take your ketamine, make sure that you're in a comfortable and pleasant place. The experience with psychoactive medications including ketamine tends to be affected hugely by your environment. Use the bathroom, put on comfortable clothes, hydrate, and lie down in a comfortable chair or bed. If you have never taken ketamine before, make sure you have a support person near you while you are under the effect of the medication. Check your blood pressure, take a couple of deep breaths, and put ketamine in your mouth. We will also share a music list that you can play during the session to help you relax.
Oral ketamine has lower bioavailability and reaches your brain slower than intravenous forms. It typically takes about 10 to 15 minutes before you start feeling the effect. Once it does take effect, you may feel calm, relaxed, or dreamy with the sensations lasting about 30 minutes to an hour. Throughout the hour, patients typically feel a visible improvement in their mood and many will reach a state where they encounter stored emotions or experience enhanced perception. After 2 hours from the time you take the medication, you are mostly back to where you started although some lingering effect may persist for another few hours.
We generally use a low-dose ketamine regimen which should not cause dissociation. However, the response to the medication varies significantly from patient to patient. When our physician thinks that you need closer monitoring during the ketamine dosing session, she will set up an appointment for the day you take ketamine and guide the session.
After you take the ketamine, you may feel a little more tired than usual. You should not drive or operate heavy machinery at least for 12 hours after you take ketamine.
After the session, many patients report a better mood, increased ability to focus, better sleep, increased activity, socialization, and motivation. Current research indicates that many patients notice some improvements in the first few days, and most feel some benefits of ketamine therapy in the first 6 to 10 sessions, although for others it may take even longer. Once you reach a stable state, the effects of ketamine can last for a few weeks. When you combine ketamine with psychotherapy, the effects can last even longer.
For some people, the initial several sessions are all that are needed for positive, ongoing responses to depression, anxiety, and PTSD. For others, the improvements last for a while before fading and the patients need additional sessions to keep up their progress toward better mental health baseline.
At ISHA, we have experienced physicians and psychotherapists who work together to support patients throughout ketamine treatment. All the medications are shipped to your home, and you can access ketamien therapy from the comfort and privacy of your home. Our physician will also provide an unlimited number of check-ins to make sure you go through this treatment with minimal difficulties.
Griffiths, C., Walker, K., Reid, I., da Silva, K. M., & O'Neill-Kerr, A. (2021). A qualitative study of patients' experience of ketamine treatment for depression: The ‘Ketamine and me’project. Journal of Affective Disorders Reports, 4, 100079