If you live with a major depressive disorder, you know just how challenging it can be to find a treatment plan that works well, continues to provide relief as time goes on, and doesn’t come with unwanted side effects. At Bespoke Treatment, we know that traditional antidepressants and regular therapy sessions aren’t always the best answer — and they’re certainly not the only answer. That’s why we’re committed to providing innovative, evidence-based solutions for people who are affected by treatment-resistant depression (TRD), including ketamine infusion therapy. Let’s explore how ketamine works, and the real pros and cons of this groundbreaking treatment for TRD, post-traumatic stress disorder (PTSD), debilitating anxiety, suicidal ideation, and even OCD.
Ketamine infusion therapy 101
Ketamine is an FDA-approved anesthetic that’s been widely used around the world for more than five decades. As of 2023, it is still the most commonly used pediatric anesthetic, and it is even used often in veterinary medicine, which goes to show just how safe ketamine is as a medication. It’s also a medication with fast-acting antidepressant properties that mental health experts from Yale, Columbia, UCLA, and other institutions have been studying with deep interest for over 20 years.
While ketamine is not considered a first-line treatment for mental health disorders, its use in off-label applications has gained attention, especially for individuals who have not experienced relief from conventional medications or therapies. Ketamine is sometimes explored as a treatment option in particularly challenging cases, where other interventions have proven ineffective. This emerging approach highlights ketamine’s potential for addressing mental health issues such as:
- Depression: Unlike typical medications, which can take weeks to show effects, ketamine works quickly—sometimes within hours—by targeting glutamate receptors in the brain, offering a new pathway for alleviating symptoms. This rapid response can be particularly beneficial for individuals experiencing suicidal thoughts or other urgent mental health crises. However, its long-term effectiveness and potential risks are still under study. Ketamine’s use for depression is usually part of a broader treatment plan, often combined with therapy and other interventions to support sustained mental health improvements.
- Anxiety: For individuals with treatment-resistant anxiety disorders, ketamine may offer relief when other medications have proven ineffective. By affecting different neurotransmitter systems than traditional anxiety treatments, ketamine can help reduce feelings of overwhelming worry, panic, and fear in certain patients. Some individuals may experience immediate symptom relief, making ketamine a potential option for those facing debilitating anxiety that severely impacts their daily lives. Despite its promise, ketamine’s role in managing anxiety is still in the experimental stages, with more research needed to fully understand how it can be effectively integrated into anxiety treatments. It is generally used under close medical supervision to monitor its effects.
- PTSD: Post-traumatic stress disorder (PTSD) can be particularly difficult to treat, especially in cases that do not respond to standard therapies. Ketamine has emerged as a potential alternative for reducing the intensity of PTSD symptoms, such as flashbacks, hyperarousal, and intrusive thoughts. It works by altering brain pathways associated with fear and memory processing, potentially offering relief where traditional treatments like cognitive behavioral therapy (CBT) and medications may not be enough.
Its use is closely monitored by medical professionals due to its potent effects and potential risks, and it is generally incorporated into a broader, multifaceted treatment plan to maximize its benefits while minimizing any adverse effects.
When ketamine is administered through a slow, constant intravenous (IV) drip, it has calming and extremely therapeutic effects on the regions of your brain that control mood and behavior. With its ability to provide quick and lasting relief for even the most persistent cases of TRD, ketamine has been called the most important breakthrough in the treatment of depression to come along in recent memory.
Ketamine works differently than any other FDA-approved antidepressant. Most antidepressants target neurotransmitters that have been linked to mood regulation such as serotonin, dopamine, and norepinephrine, but ketamine instead targets glutamate—the fastest working excitatory neurotransmitter in the brain. Ketamine is technically an NMDA antagonist, and it works by tricking the brain into producing more glutamate. This increase in glutamate leads to a cascade of effects in the brain such as increased synaptogenesis (the creation of new connections between neurons) and reduced inflammation.
Ketamine infusion advantages
Depression is the leading cause of disability worldwide and the primary mental health disorder that gives rise to suicidal tendencies. Approximately 40% of people who suffer from major depression eventually achieve lasting symptom remission with conventional antidepressants and therapy; most do not. For people with TRD, debilitating anxiety, PTSD, or cPTSD, ketamine infusion therapy offers several key advantages, including:
Fast-acting symptom relief
Ketamine infusions work very quickly — often within hours — to ease depressive symptoms because of its glutamatergic effects. Researchers are still trying to pinpoint the exact mechanisms behind this powerful effect, but they do know that glutamate is the major catalyst that leads to reduced inflammation, increased brain-derived neurotrophic factor (BDNF), and neuroplasticity.
As emphasized before, glutamate plays a fundamental role as a neurotransmitter in brain function, especially when it comes to promoting healthy neural connections. It is particularly important in cases where brain pathways have been impaired by depression. Below are the key benefits of glutamate’s role in brain health and recovery:
- Encourages Synapse Growth: Synapses are crucial for transmitting signals between neurons, and healthy synapse growth supports efficient brain function. By encouraging the proliferation of these connections, glutamate helps improve the brain’s ability to process information and adapt to new stimuli. This process is especially beneficial in neuroplasticity, where the brain rewires itself in response to learning or injury. Synapse growth also plays a pivotal role in cognitive functions like memory, problem-solving, and emotional regulation, all of which are vital for overall mental well-being.
- Restores Neural Connections in Depression-Affected Areas: Depression often leads to the disruption of neural connections in key areas of the brain, particularly in regions responsible for mood regulation and emotional processing. Glutamate helps restore these damaged or weakened connections, which can become impaired during prolonged depressive episodes. By facilitating the repair of neural pathways, glutamate supports the recovery of brain function and emotional balance. This restoration process is vital for improving mental health, as it helps reverse the neural changes associated with depression, leading to enhanced mood regulation and a reduction in depressive symptoms. The ability of glutamate to restore these crucial connections offers hope for long-term mental health recovery.
- Promotes Beneficial Changes in Brain Circuit Function: When new synapses and neural connections form, they lead to an improvement in the way different areas of the brain communicate with each other. This enhanced connectivity helps normalize brain circuits that may have become dysfunctional due to depression or other mental health issues. Improved circuit function supports better emotional regulation, cognitive flexibility, and overall mental clarity. As these circuits become more efficient, individuals may experience improved mood stability and a better ability to cope with stress, which is vital for long-term emotional health.
By supporting synapse growth, restoring connections, and enhancing brain circuits, glutamate plays a vital role in improving brain health, particularly in individuals affected by depression. These changes help restore cognitive and emotional function, leading to better overall mental well-being.
High rate of success
Ketamine infusion therapy is still being studied, but research shows that it has a high rate of success when it comes to treating moderate to severe depression, anxiety, PTSD, and bipolar depression. Several studies indicate that over half of the people with TRD achieve significant symptom relief after a single infusion and many more find relief after two or three infusions. However, most people do have to complete a minimum series of 6 to ensure that the results last after the series is over.
An excellent efficacy rate is a major part of what makes ketamine infusion therapy so beneficial for people who haven’t been able to achieve lasting relief through traditional medical solutions. The success rate of ketamine in research is around 70%, compared to just 40% for oral antidepressants. Unfortunately, as the STAR-D trial has demonstrated, ketamine
Lasting symptom remission
Ketamine infusion therapy isn’t a “one-and-done” treatment that “cures” depression in a single session, but it’s also not like conventional antidepressants that must be taken daily for years on end (or for as long as they work). Instead, ketamine infusions stimulate beneficial brain changes that lead to lasting symptom relief throughout a single treatment cycle. For the average patient, the acute phase of ketamine infusion therapy calls for a series of six infusions spaced out over three weeks. This initial treatment is followed by a long-term maintenance phase that includes occasional booster infusions as needed. A recent study in 2023 found that after a series of ketamine infusions, over 55% of patients felt relief after 6 months without any booster sessions.
Ketamine infusion drawbacks
Even though ketamine offers major benefits in the treatment of persistent depression, no treatment is perfect. The drawbacks of ketamine have to do primarily with its dissociative effects, slight potential for addiction, and cost. Although ketamine infusion therapy uses sub-anesthetic doses to relieve depression, it can still induce certain temporary side effects during the experience, including mild hallucinations, floating sensations, fuzzy vision, and dizziness. Because of this, ketamine infusion therapy must be:
- Comprehensive Evaluation Required: This evaluation typically involves an in-depth assessment of the individual’s mental health history, current symptoms, and potential treatment goals. The purpose is to determine whether ketamine is the right fit for the person’s unique circumstances and whether other treatments might be better suited. This also includes a review of the patient’s physical health to rule out any conditions that could increase risks during treatment. Without such careful evaluation, the likelihood of adverse reactions or inappropriate treatment is significantly higher, which is why this step is essential for ensuring safe and effective use.
- Certified Clinical Setting: Such facilities are designed to handle the specific medical needs that arise during treatment, including managing any side effects that may occur. Certified clinics adhere to strict regulatory standards, ensuring they have the necessary equipment, protocols, and trained staff to provide the therapy safely. This controlled environment minimizes the risks associated with side effects, ensuring that any adverse reactions are promptly and effectively managed. Administering ketamine outside of a certified clinic could increase the risk of complications, making it essential that the therapy is received in a properly equipped medical facility.
- Monitored By Experienced Provider: A qualified professional will not only ensure the correct dosage but will also monitor the patient’s vital signs and overall response throughout the session. This level of supervision is critical, especially considering the potential for mild hallucinations or feelings of dizziness during the infusion. An experienced provider can quickly recognize if a patient is experiencing more severe side effects or complications and take immediate action to address them. Careful monitoring helps ensure the treatment’s effectiveness while prioritizing patient safety, reducing the risk of negative experiences or adverse outcomes.
The potential for immediate side effects also means that someone else must drive you to and from your treatment session. Even though the mild dissociative side effects of ketamine tend to diminish quickly, the treatment can leave you feeling tired or groggy until you’ve had a good night’s rest. While many individuals find the experience itself to be euphoric, there is a subset of individuals who don’t particularly enjoy the feeling of ketamine infusions. They can sometimes bring up deep-rooted traumas, and in facilities without properly trained mental health professionals, individuals can become very dysregulated afterward.
Ketamine isn’t the right solution for everyone with TRD — because it has potentially addictive properties, it may not be a suitable option for those who have a history of serious substance abuse or a diagnosed addictive disorder. However, as of 2023, several research studies have shown that ketamine-assisted therapy can be one of the more effective treatments for individuals suffering from substance abuse disorders. Sometimes other options, such as TMS Therapy, might be explored first because of the small potential for ketamine to trigger certain individuals.
Last, the cost can be a substantial burden for individuals seeking ketamine treatment. Other than very small companies like Enthea (which our Los Angeles ketamine clinics are contracted with), ketamine infusions are not covered by insurance. Since people with depression and PTSD are usually not working and barely scraping financially, the cost of ketamine infusions can be a serious burden. Luckily, other options allow for patients to receive ketamine treatments by using insurance: Spravato, a relatively new esketamine nasal spray, and the psychedelic medicine track of our IOP, where patients can enroll in ketamine-assisted therapy online. To find out how ketamine can help you get your life back, call your nearest Bespoke Treatment office in Los Angeles, Santa Monica, or Las Vegas, or click online to schedule a visit today.
