Ketamine therapy
A rapid-acting treatment option for selected patients with difficult-to-treat depression and related conditions.
What is ketamine treatment?
Ketamine was originally developed as an anesthetic and was later found to have rapid antidepressant effects at much lower doses.
Why consider ketamine?
Potential for rapid relief
For some people, improvement may begin within hours or days—considerably faster than with conventional antidepressants.
An option when previous treatments haven’t helped
Ketamine may help people with depression who have not found sufficient relief from previous treatments.
Supported throughout treatment
An experienced registered nurse provides preparation, support and post-session reflection, with vital-sign monitoring and psychiatrist oversight.
The timing, degree and duration of benefit vary; some patients need several treatments, and some do not respond.
Read more about the evidence
Published research has reported that a single dose of ketamine can produce an antidepressant effect within a few hours, and that this effect may last up to a week for some people. A single dose is not a complete treatment course; multiple treatments are typically considered when ketamine is recommended.
Ketamine has also been studied across several psychiatric conditions, including major depressive disorder, bipolar depression, obsessive-compulsive disorder, anxiety disorders and post-traumatic stress disorder. Evidence, regulatory status and suitability differ by condition.
Support before, during and after every session
An experienced registered nurse helps you prepare for each treatment, supports you throughout the experience and helps you reflect afterward. Your vital signs are monitored alongside your comfort and wellbeing.
Ketamine is administered intramuscularly by a registered nurse under the supervision of a psychiatrist.
01
Before treatment
Feel prepared
Before every session, your nurse explains what to expect, discusses any concerns and helps you approach treatment with realistic expectations.
02
During treatment
Feel supported
Your nurse provides reassurance and support as the experience unfolds, while monitoring your vital signs and how you are feeling.
03
After treatment
Make sense of the experience
After the session, your nurse helps you reflect on the experience, discuss any difficult feelings and consider what may be helpful in your daily life.
How ketamine works
Ketamine’s therapeutic effects are thought to involve changes in glutamate signalling and neuroplasticity. Its precise antidepressant mechanisms remain an active area of research.
Read more about proposed mechanisms
- Unlike conventional antidepressants, which often take weeks to have an effect, ketamine may act quickly—often within days—by temporarily changing how NMDA receptors work. These receptors help control communication between brain cells.
- Ketamine may increase glutamatergic transmission. Glutamate is involved in communication between brain cells; when those pathways function more effectively, the brain may form new connections that can be relevant to mood.
- Ketamine may also influence brain plasticity, including processes that involve proteins such as brain-derived neurotrophic factor (BDNF).
Conditions considered for ketamine treatment
The evidence, regulatory status and suitability of ketamine differ by condition.
Principal clinical focus
- Major depressive disorder
- Treatment-resistant depression
- Bipolar depression
Considered individually
- Post-traumatic stress disorder
- Anxiety disorders
- Obsessive-compulsive disorder
- Selected pain conditions
Careful selection and monitored treatment
Careful patient selection
Suitability is assessed individually before treatment is recommended. A psychiatrist reviews your diagnosis, previous treatments, medical history and relevant safety considerations, then determines whether ketamine may be appropriate.
- diagnosis and previous treatment
- relevant medical and cardiovascular factors
- current medications
- substance-use considerations
- pregnancy considerations where relevant
- previous adverse reactions
- ability to participate safely in treatment and follow-up
Monitored treatment
Treatment occurs in a controlled clinical setting. Response and tolerability are monitored. Temporary psychological and physical effects can occur, and the treatment plan may be adjusted according to clinical response.
Is ketamine treatment appropriate for you?
Ketamine is not appropriate for everyone. A psychiatric assessment considers your symptoms, treatment history, medical factors and individual goals before treatment is recommended.
Frequently asked questions
Answers to common questions about ketamine treatment, including onset, safety, administration and how it compares with TMS.
How effective is ketamine treatment?
About two-thirds of patients with treatment-resistant depression and chronic PTSD would respond to ketamine treatment, which is a reduction in half of the symptoms. It's imperative to emphasize that while ketamine boasts a rapid effect, the influence of a single-dose treatment is fleeting. To unlock an amplified and prolonged impact, multiple treatments are essential.
How soon can I expect to see results with ketamine treatment?
Using a twice-weekly dosing schedule, some patients would respond within a week. However, the effect tends to be short-lasting with fewer treatments. A 4-week treatment program is recommended.
How is ketamine administered?
While ketamine can be administered in multiple routes, our centre uses intramuscular and subcutaneous injections, as they have demonstrated effectiveness. During the induction phase, ketamine is administered twice weekly over 3 weeks.
Is ketamine treatment safe?
Ketamine is highly accepted by most patients. In most studies, 95-100% of patients can complete the whole treatment course. However, like all medical treatments, ketamine can be associated with some side effects. Neurological: headaches and dizziness; less commonly sedation, faintness, poor coordination, or tremors; typically short-term. Psychotomimetic: dissociation, perceptual disturbances, and feelings of unreality; no long-term psychotomimetic effects have been reported in studies. Acute psychiatric: anxiety, agitation, or mood elevation; less frequently detachment, emotional blunting, or psychosis. Cognitive: memory loss, poor concentration, or confusion, typically short-lived. The clinic also remains vigilant regarding less common risks like long-term cognitive impairments, urinary tract symptoms and the development of tolerance.
Is maintenance treatment necessary?
A maintenance treatment plan spanning six months is recommended. Nevertheless, given that many patients undergoing ketamine treatment have shown resistance to medications, experiencing mild relapse upon discontinuation of treatment is not uncommon. In such instances, resuming ketamine treatment often proves effective in alleviating symptoms.
What factors affect the treatment outcome?
Positive predictors of ketamine treatment outcome include: a shorter duration of depression; taking a concomitant antidepressant; being less treatment-resistant. Negative outcome predictors include: a higher number of treatment failures; more severe depressive illness.
Who cannot receive ketamine treatment?
Ketamine administration is contraindicated in patients with a heightened cardiovascular risk, including those with unstable angina and poorly controlled hypertension. Individuals with elevated intracranial and intraocular pressure should also refrain from ketamine treatment. Furthermore, patients with uncontrolled hyperthyroidism, severe liver disease, or a history of psychosis are advised to avoid ketamine therapy. Additionally, due to potential interactions with other substances, the use of substances and alcohol is discouraged during ketamine treatment. Pregnant patients are cautioned against undergoing ketamine therapy due to uncertainties regarding fetal risks.
What is a ketamine bad trip?
Within this transformative experience, encountering a “bad trip” entails confronting intense emotions, anxiety, and a perceived loss of control. While these experiences can be uncomfortable and challenging, they are temporary and often indicative of deep-seated emotional or psychological issues that are surfacing. Another aspect is the sense of time distortion. A bad trip is one in which the person experiences sensory overload, vivid hallucinations, and deep thoughts that are challenging to deal with in the moment. In our nurturing environment, your well-being is our top priority. We provide unwavering support and guidance throughout your journey.
Is ketamine treatment FDA-approved?
At present, the FDA has approved only one type of ketamine called esketamine for treating major depressive disorder. It's a specific part of ketamine called the S-enantiomer. However, research indicates that esketamine might not work as well as the full mixture of ketamine. That is why many ketamine clinics use ketamine “off-label” for treating psychiatric disorders, even though it's not officially approved for those uses.
How should I choose among ketamine and TMS treatments?
Both treatments demonstrate efficacy in addressing several mental illnesses, albeit through distinct mechanisms. To summarize, their efficacy is similar. Ketamine offers a rapid onset of action, whereas TMS is associated with a lower incidence of side effects. Ketamine has more short-term side effects. TMS onset 4-6 weeks; ketamine within 2 weeks, sometimes hours or days. Effectiveness similar, about 2/3 of patients would significantly improve. TMS is more durable. After TMS patients can return to work; after ketamine recovery time may be up to a few hours and driving is not recommended on the treatment day. TMS sessions usually 20-30 (4-6 weeks); ketamine about 4-6 sessions (2-3 weeks). Individuals who do not respond to one treatment may find success with the other. The decision is made collaboratively with the patient and healthcare provider.