Long used as an anesthetic, the use of ketamine as a possible therapeutic agent for treating mental health conditions was first explored in the 1970s. While it has never been approved by the FDA for this purpose, ketamine is now widely used off-label as a medication for mental health therapy.
In the 1990s and early 2000s, ketamine therapy was successfully tested for possible use as a treatment for depression1 and addiction using intravenous infusions. It was also investigated as a possible medication for relieving chronic pain and alleviating anxiety in terminally ill patients2 .
Since then, a significant body of research has established ketamine therapy as a rapid-acting treatment for conditions that often do not respond well to conventional therapies such as Major Depression and Treatment-Resistant Depression (including both unipolar and bipolar), as well as PTSD, OCD, and anxiety. It is also being investigated as a possible intervention to address substance abuse disorders3 .
Things to Know
- Ketamine as a possible therapeutic agent was first explored in the 1970s.
- Research is showing the potential efficacy of ketamine-assisted therapy to treat conditions such as Major Depression, treatment-resistant depression, PTSD, OCD, and anxiety.
- While ketamine is often administered alongside psychotherapy, some providers administer ketamine for mental health conditions without therapeutic support.
- The expansion of telehealth ketamine has raised concerns about insufficient patient oversight.
The Growing Ketamine Clinic Industry
Esketamine, which is an enantiomer of ketamine, was approved by the FDA and European Medicines Agency in 2019 as a nasal spray treatment for depression and is sold commercially as Spravato. In recent years a growing industry of ketamine clinics has emerged providing both ketamine infusions and lozenges which can be ingested at home. A growing number of therapists also provide ketamine-assisted therapy to patients as part of their practice.
Research findings suggest that ketamine therapies can provide shorter total treatment durations than more conventional therapies which some believe may lower healthcare-related costs. Research suggests that ketamine treatments could be significantly more effective than SSRIs or other more conventional medications for depression. Some practitioners report that ketamine-assisted therapy accelerates the therapeutic process.
Some of the major challenges of ketamine therapy are the duration of its antidepressant effects and clinics that provide access to the drug, but not concurrent psychotherapy which has been shown to significantly improve patient outcomes. The expansion of online prescribing of ketamine that began during the Covid pandemic has also raised concerns about insufficient patient oversight and the nonclinical use of ketamine which has created a robust black market for users who self-medicate with the drug.
Process of Ketamine-Assisted Therapy
Ketamine-assisted therapy typically involves a psychological exam prior to the administration of ketamine to ensure a patient is qualified for such treatment. Often providers require talk-therapy session ahead of the ketamine treatment, where a therapist and patient review why the patient is seeking treatment and discuss intended outcomes. A patient then makes an appointment to visit the clinic to receive an infusion — administered either intravenously or via intramuscular injection. Some patients receive lozenges by mail from a telemedicine ketamine provider which they consume under specific directions. Some ketamine providers also require a talk therapy session post-treatment or make psychotherapy available during the ketamine session itself. .
Some ketamine clinics and providers offer ketamine without psychotherapy. Most practitioners who administer the drug without onsite therapy recommend that patients combine the treatment with outside professional therapeutic support before or after administration in order to get the greatest benefit from the treatment.
What constitutes the best or most appropriate psychotherapy for ketamine use is still evolving and is the subject of some research. A growing number of practitioners are concerned that patients who receive ketamine without sufficient clinical oversight or therapy risk additional mental health challenges.