What is Ketamine Therapy? The Process, The Risks, and Complementary Lab Testing

Ketamine use can be a dividing topic depending on the circle you’re in. The word brings up a multitude of different reactions, such as – is it safe? Is it addictive? And even more commonly – isn’t it a horse tranquilizer? 

While veterinarians do use the drug as an anesthetic, it is used in a variety of animals and in humans as well. Most recently, it has been gaining traction as an effective treatment for conditions such as depression.

In this article, we will take an unbiased look at what ketamine therapy is, what the process of ketamine therapy looks like, and what lab testing can help support an individualized treatment plan.

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What is Ketamine Therapy?

Ketamine therapy is an approach in treatment that utilizes minimal amounts of ketamine, a dissociative anesthetic substance, for managing a range of mental health disorders such as resistant depression, anxiety-related disorders, and post-traumatic stress disorder (PTSD). First created in the 1960s, ketamine initially served as an anesthetic for both people and animals. The medical industry applauded its superb pain-relief qualities, and it was heavily employed for surgical anesthesia during the Vietnam War (1). 

As time passed, the potential of ketamine in the realm of mental health treatment was uncovered by researchers. Over the last twenty years, it has been proven that lower-than-anesthetic doses of ketamine exhibit swift and enduring antidepressant impacts. There's growing research indicating the beneficial effects of ketamine across various psychiatric disorders. Ketamine functions by inhibiting the N-methyl-D-aspartate (NMDA) receptor's activity, a brain receptor that plays a pivotal role in modulating mood, cognition, and the perception of pain. It's been reported by numerous patients that they notice a positive shift in their symptoms within a few hours or days following the therapy (2). 

Typically, ketamine therapy is provided via injections or infusions in clinics that specialize in this form of treatment. While it's not officially FDA-endorsed for treating mental health disorders, "sub-anesthetic" doses of ketamine are administered "off-label" to address depression, pain, and other mental health/substance use problems. It's crucial to understand that ketamine therapy needs to be delivered and overseen by suitably trained medical personnel, like anesthesiologists, to guarantee safety and efficacy (2).  

What Are The Different Forms of Ketamine Administration?

There are several forms of ketamine administration, including intravenous (IV), intranasal, and oral.

Intravenous (IV) Administration: 

IV ketamine is typically administered in specialized clinics and involves injecting the medication directly into the bloodstream. This method allows for rapid onset of the drug's effects and precise control over the dosage. However, it requires medical supervision and can be more invasive than other methods.

Intranasal Administration: 

Intranasal ketamine is administered as a nasal spray, which is absorbed through the nasal mucosa. This method is less invasive than IV administration and has been approved by the FDA for use in treatment-resistant depression. Intranasal ketamine is typically administered in a supervised clinic setting to ensure safety and monitor the patient's response to the treatment.

Oral Administration: 

Oral ketamine is taken in the form of tablets or capsules. This method is less invasive than IV or intranasal administration and can be more convenient for patients. However, the bioavailability of oral ketamine is lower than that of IV or intranasal administration, which means that a higher dose may be required to achieve the desired therapeutic effects. Additionally, oral ketamine may have a slower onset of action compared to other methods.

Each form of ketamine administration has its advantages and disadvantages, and the choice of method depends on factors such as the patient's specific condition, the desired therapeutic effects, and the patient's preferences.

What Are The Benefits of Ketamine Therapy?

Ketamine therapy has shown promising results in providing rapid and effective relief from treatment-resistant depression. In a study, more than half of the participants with depression who did not respond to antidepressants experienced an improvement in their symptoms after receiving twice-weekly ketamine infusions. Ketamine is believed to reactivate existing connections and grow new ones in the brain, helping to alleviate depressive symptoms.

In addition to its antidepressant effects, ketamine therapy has shown the potential to improve mood, cognition, and overall mental well-being. It has been found to "reshape" the brain, potentially explaining why antidepressant medications that did not work in the past may become effective after ketamine therapy (11). 

Ketamine therapy has also demonstrated promising results in treating anxiety disorders, bipolar disorder, and post-traumatic stress disorder (PTSD). Although more research is needed, ketamine's ability to block NMDA receptor signals and create new pathways in the brain may contribute to its effectiveness in treating these conditions. A detailed structural analysis has revealed the mechanisms by which ketamine inhibits NMDA receptors, which may play a role in its antidepressant effects. Additionally, ketamine may activate neuroplasticity- and synaptogenesis-relevant signaling pathways, which could help rebalance the excitatory/inhibitory transmission and restore neural network integrity that is compromised in depression.

Moreover, ketamine therapy has potential as an alternative treatment for chronic pain and migraines. In a systematic review, subcutaneously administered ketamine showed statistically significant relief over saline placebo for acute migraine, and intranasal ketamine significantly reduced pain scores in chronic migraineurs. Ketamine's analgesic effects are thought to be due to its inhibition of the N-methyl-D-aspartate receptor, among other mechanisms.

What Does the Ketamine Therapy Process Look Like?  

The ketamine therapy process typically involves several steps, including initial consultation, a personalized treatment plan, therapy sessions, and a supportive therapeutic environment during those sessions.

Initial Consultation

The first step in the ketamine therapy process is an initial consultation with a healthcare professional. During this consultation, the patient's mental health condition and treatment history are assessed to determine if ketamine therapy is appropriate for them. The healthcare professional will discuss the patient's symptoms, previous treatments, and any potential contraindications to ketamine therapy.

Personalized Treatment Plan

Based on the initial consultation, a personalized treatment plan is developed, which includes determining the appropriate dosage and administration method for ketamine. The treatment plan may involve intravenous (IV) infusions or esketamine nasal spray, depending on the patient's needs and the healthcare professional's (7,17). 

Therapy Sessions

Ketamine therapy sessions typically involve a series of treatments, with the frequency, duration, and number of sessions varying based on the patient's needs and response to the therapy. For example, a common treatment schedule for IV-infused ketamine may start with two doses a week for 2 to 3 weeks, followed by once weekly, then once monthly, and eventually tapering off. The treatment sessions are conducted under the supervision of a healthcare professional in a clinic or doctor's office (1,17) 

Supportive Therapeutic Environment

It is essential to provide a supportive therapeutic environment during ketamine therapy sessions, as the drug can cause dissociative effects and alter perception. The healthcare professional administering the treatment will closely monitor the patient's progress and ensure their safety during the session. Patients may also benefit from additional therapeutic interventions, such as psychotherapy, to enhance the overall effectiveness of the treatment (7,16). 

What Are The Potential Side Effects and Considerations?

Ketamine therapy may have some potential side effects and considerations that patients should be aware of.

Temporary Dissociative and Psychedelic Effects

One of the most well-known side effects of ketamine is dissociation, which refers to a temporary mental state in which a person detaches from their surroundings and feels disconnected from their body. This dissociative state is usually mild and temporary, lasting only during the ketamine treatment.

Rare But Possible Side Effects

Some rare but possible side effects of ketamine therapy include nausea, dizziness, and increased blood pressure. These side effects are generally mild and resolve within a few hours after the treatment (18).

Safety Precautions and Monitoring

During ketamine therapy sessions, patients are closely monitored by healthcare professionals to ensure their safety. Vital signs, mental status, and overall well-being are assessed throughout the treatment process.

Importance of a Trained Medical Professional

Working with a trained medical professional in a controlled environment is crucial for the safe and effective administration of ketamine therapy. A healthcare professional will assess the patient's mental health condition, treatment history, and potential contraindications to ketamine therapy during the initial consultation. They will also develop a personalized treatment plan, monitor the patient's progress, and provide a supportive therapeutic environment during ketamine administration. 

Functional Medicine Labs That Can Provide Complementary Information For Patients Utilizing Ketamine Therapy

Functional medicine labs offer a variety of tests that can help tailor treatment to patients, allowing providers to optimize management strategies.

Neurotransmitter Testing

Neurotransmitters play a pivotal role in our mood regulation and overall mental health. With this test, imbalances in neurotransmitters that could be contributing to mental health conditions like depression, anxiety, and mood fluctuations can be identified. This is crucial when utilizing ketamine therapy as ketamine acts on glutamate, a critical neurotransmitter. Understanding the neurotransmitter balance can provide valuable insight into the patient's potential response to this treatment.

Hormone Testing

This comprehensive urine test helps uncover key hormonal imbalances that can impact mental health and well-being. As hormonal imbalances can worsen or contribute to mental health conditions, understanding the patient's hormonal profile through testing can offer valuable context and complementary information when utilizing ketamine therapy. 

Stool Testing 

The GI-MAP test allows for an in-depth evaluation of the gut microbiome, an essential contributor to overall health, including mental health. A balanced gut microbiome plays a significant role in mood and cognitive function, and imbalances can potentially exacerbate conditions like anxiety, depression, and fatigue. 

Inflammation Testing

Inflammation and immune function are increasingly recognized as key factors in mental health. Ayumetrix's Inflammation Panel tests for various markers of inflammation and immune function, will offer insights into the patient's inflammatory status. Since research indicates that inflammation could be involved in mental health conditions such as depression, understanding a patient's inflammation status can guide the use of ketamine therapy (23). 

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Summary

In summary, ketamine therapy has emerged as a promising treatment approach for several mental health conditions, including treatment-resistant depression, anxiety disorders, and PTSD. The mode of administration and dosage is customized for each individual based on their specific needs and responses to the therapy. 

While ketamine therapy is generally well-tolerated, potential side effects and considerations need to be thoroughly discussed with healthcare professionals. Moreover, to optimize the outcomes of this treatment, functional medicine labs provide essential complementary information on neurotransmitter balance, hormone levels, gut health, and inflammation status, all of which can impact the efficacy of ketamine therapy and mental health.