Ketamine was the go-to anesthetic in the 1960s and 1970s, but researchers have found new applications for the medication — namely, as a powerful antidepressant.
Today, leading psychiatrists like Dr. Karen Giles at Breakthru Psychiatric Solutions in Sandy Springs, Georgia, prescribe intravenous (IV) ketamine for patients with treatment-resistant depression. She also offers Spravato®, an FDA-approved nasal spray containing esketamine (a refined form of ketamine).
Although ketamine isn’t a first-line treatment, it can be a life-changer for those who have tried traditional antidepressant medications with no improvements. Because ketamine influences different neurotransmitters — specifically, glutamate — it triggers changes in your brain’s structure and chemistry that enable you to alter your thought patterns and receptiveness to therapy.
Although the FDA has given its stamp of approval for ketamine as an anesthetic, it’s still considered “off label” for mental health conditions, meaning doctors can legally prescribe it but using it unsupervised can be risky.
Dr. Giles administers ketamine intravenously or via the Spravato nasal spray here in our office, where she can monitor your reaction to the medication and ensure your safety. Although the risks are low, ketamine could trigger negative side effects, such as:
These side effects would only occur while in treatment, which is one of the reasons medical supervision is so important. With an IV treatment, Dr. Giles is able to immediately alter your dose to mitigate any side effects.
An intravenous ketamine session lasts 40-60 minutes and goes to work quickly. You may feel a floating sensation, but you’ll remain conscious. Expect to return two to three times weekly for two to three weeks in the induction phase. At Breakthru, we strongly encourage our patients to follow the induction phase with a 6 treatment taper protocol over 6-12 weeks. This is done to support each patient’s unique response and remission.
Intramuscular ketamine is a shot in your arm. Dr. Giles will recommend intramuscular ketamine if a patient is dehydrated or has difficulty with IV placement. Typically, we only recommend intramuscular in these rare situations as there is less control. However, Dr. Giles adjusts dosage to make treatment safe and effective.
If Dr. Giles prescribes Spravato, she administers the nasal spray and monitors your response just as with the intravenous method. Expect to return for twice-weekly treatments for four weeks, and then once a week for 4 weeks. Breakthru highly recommends a taper protocol following the FDA-approved protocol to support ongoing remission.
Ketamine also comes in an oral lozenge. Dr. Giles neither uses nor recommends this method, and here’s why -
Oral ketamine, also known as ketamine lozenges and ketamine troches, have become popular online because they’re convenient. However, Dr. Giles offers a strong warning about these easily accessible tablets.
Oral ketamine dissolves under your tongue and travels through your oral mucosa (saliva) into your bloodstream. How much of the drug makes it to your blood is called its bioavailability. Intravenous ketamine infusion has 100% bioavailability, so we know exactly how much of the drug you get. Ketamine lozenges have only about 26% bioavailability. Taking oral ketamine is a gamble — you never know what you’ll get.
The risks don’t stop there. Unsupervised oral ketamine use could also lead to:
Research is ongoing regarding the long-term effects of ketamine on developing brains (children and teenagers), pregnant and breastfeeding women, and people with dementia, so taking at-home ketamine treatments is ill-advised for these populations.
To learn more about the benefits of ketamine and determine whether you’re a good candidate for IV ketamine or Spravato, request an appointment online or call us at Breakthru Psychiatric Solutions and work with one of the country’s leading ketamine specialists, Dr. Karen Giles.