Ketamine is a medicine that was developed as an anesthetic to block pain during surgery. It has been used this way for the last 50 years and is safe and effective. It is on the World Health Organization’s list of Essential Medications as an anesthetic.
Over the last 20 years, ketamine has been examined in smaller doses to treat psychiatric disorders, including major depressive disorder (MDD) in individuals who have not responded well to conventional treatments. Several short-term studies have shown that ketamine is effective for people with treatment resistant depression however there are limited long-term studies completed at this time. Compared to another drug or no drug at all, ketamine reduces the following in the short-term:
Ketamine is thought to impact neurotransmitters in the brain including glutamate. Research suggests that these changes improve mood and thinking, which are impacted by depression.
To be eligible for ketamine treatment you must:
You should not get ketamine if:
Our program uses intravenous ketamine (through an IV line). While ketamine can also be given in other ways, giving ketamine through an IV has been studied the most and shows the most benefit so far. If you have significant improvement after one series of the IV treatment, you could be considered for use of other forms of ketamine for maintenance therapy. Our program does not cover the costs of the other forms of ketamine for maintenance therapy.
The most common dose is 0.5 mg/kg infused over 40 minutes. Your psychiatrist will decide if you need a different dose.
You will receive your IV ketamine treatment 2 times per week for 3 weeks. In total, you will receive 6 treatments over 3 weeks.
About one third of patients have significant improvement (their depressive symptoms largely go away) by the end of one series of IV treatments. About one third of patients do not improve with ketamine treatment. The other third usually have some improvement.
You may feel the effects within a few hours to 24 hours of a single treatment, however it often takes a few days to feel better. It has been shown that benefits improve with repeated treatments.
We do not know this with certainty. Here is what research has shown so far for patients who have significant improvement:
The doses of ketamine that are used for depression are much lower than the dose used for anesthesia. This makes it quite safe and side effects are usually limited. Any side effects usually appear within 2 hours of infusion and go away between 4 to 24 hours afterwards.
The most common short term side effects of ketamine used for this purpose include:
These symptoms appear during treatment and disappear shortly afterwards on their own. We can provide treatment for nausea during the infusion. We will monitor for these symptoms throughout the treatment.
If you have side effects more than 24 hours after your treatment, or if the side effects are getting worse:
Short-term ketamine use (in lower doses for a limited number of treatments) has the side-effects listed previously, however there is limited literature on long-term side-effects. If you are considering maintenance treatments for a longer period of time, speak to your doctor about potential side effects.
Ketamine treatment is safe to receive when taking most antidepressants. Some studies suggest that ketamine treatment may not work as well if you are also taking benzodiazepines and NMDA receptor antagonists. Your psychiatrist will review your medications to decide if ketamine treatment is right for you.
Yes, you need a referral from your regular doctor. Our program does not provide long-term follow-up after completion of the IV ketamine treatments. You will need to follow-up with your doctor for ongoing care.
Talk to your doctor if you want more information about ketamine IV treatments.