Ketamine Therapy: Exploring the Benefits and Potential Side Effects of this Emerging Treatment

Ketamine is a therapeutic medication that has been used since its discovery in Belgium during the 1960s as an anesthetic. It is also a recreational drug with a highly addictive nature and increased potential for abuse.

Recently, however, Ketamine infusion has been used therapeutically for chronic pain and depression that’s proven resistant to other treatments. Interest in it for this purpose has grown in recent years, although it is important to remember that, like most medications, ketamine treatment does have side effects.

Understanding Ketamine Therapy

Ketamine is a synthetic compound derived from phenylcyclohexyl piperidine, more commonly known as PCP, as the severe hallucinations caused by PCP make it undesirable as an anesthetic. For mental health purposes, ketamine therapy has recently been used to treat chronic pain or treatment-resistant depression.

Glutamate is a naturally occurring chemical in the brain that regulates mood and is absorbed by the brain’s NMDA receptors. However, in some people’s brains (particularly those with depression), those receptors either aren’t working as well as they should or in some cases not at all.

With those patients, ketamine therapy can “re-wire” the brain by fixing those receptors that help regulate moods and can help the patient overcome their depression. The treatments do wear off after time but additional doses of ketamine can be administered as needed for maintenance.

It has multiple routes of distribution, including intranasal (through the nose), oral (through the mouth), and intravenous. The intranasal form is, strictly speaking, a related compound called S-ketamine or esketamine. The most common nasal spray brand is called Spravato and, unlike injections for ketamine, is FDA-approved to treat depression and mood disorders.

Common Side Effects of Ketamine Therapy

Therapeutic ketamine users may experience certain physical side effects, such as dizziness, nausea, increased blood pressure, headaches, heart palpitations, bladder pain, and excessive sweating, among others.

It also includes psychological side effects, like aural or visual hallucinations and dissociation. These can be particularly powerful and lead to an experience where the user feels their consciousness separate from their physical body. Recreational users refer to this feeling as “the K-Hole” and for them, it is less of a side effect and more of the intended result, although they generally require much higher doses than the standard therapeutic amount.

These unintended effects can begin during the treatments or shortly after they’ve concluded. They can vary in intensity depending on various factors and may last up to two hours after treatment is administered.

Long-Term Side Effects and Risks

As ketamine has existed for less than 60 years and used therapeutically for an even shorter amount of time, the full extent of its long-term effects is not well-known or understood at present.

However, it is known that long-term use (or abuse) can decrease cognitive function and lead to memory loss, as well as potentially damage the liver or kidneys. As ketamine infusion “reshapes” the brain by reactivating potentially damaged neural pathways, there is always the possibility that it can also eventually change other parts – and not always for the better.

Due to the nature of the drug, there is a heightened risk for dependency and abuse. Users who receive therapeutic low doses may also have the out-of-body experiences that recreational users find appealing and seek out higher doses on the street to have a more intense “trip”.

Managing Side Effects

Some of the mild or moderate side effects experienced during ketamine infusion therapy can be managed or mitigated, especially the physical ones. The good news is that, unlike some treatments or medications that “build up” side effects over time, there is no evidence that ketamine therapy will lead to more severe adverse effects as the number of sessions increases.

Before the first session begins, patients should seek the medical advice of their doctors to make sure that they don’t have any risk factors for certain side effects, list all medications and supplements they’re currently taking, and ask for guidance.

A health care professional may also prescribe medication to preemptively stop side effects before they start. For example, a patient who already suffers from mild bladder pain could end up with significantly higher levels of pain after treatment as bladder pain is a possible side effect. The doctor could then prescribe medication designed to treat bladder pain before the therapy session begins, which would prevent the patient’s pre-existing condition from worsening.

After treatment, the doctor may similarly prescribe additional medication or painkillers in case side effects arise. Some of the psychological side effects, like anxiety or a feeling of emotional emptiness, are less common but are still a possibility. Having a friend, relative, or therapist to speak to may not prevent these feelings from occurring but can help manage them before they spiral into something worse.

Patient Selection and Contraindications

Suitable candidates for ketamine therapy include those with chronic pain or major depression that hasn’t responded to anti-depressants or other medications. Many ketamine clinics require that the patient not only take antidepressants before therapy begins but that they continue taking the medication afterward.

However, it is contradicted in some situations and may not be advisable for patients with heart problems, specific angina, substance use disorders, or those who have previously experienced psychosis, as ketamine can exacerbate these conditions.

Prospective ketamine therapy patients must undergo a thorough medical evaluation before their treatment begins. This can help prevent complications or more severe side effects by identifying patients more susceptible to them.

Comparative Analysis with Traditional Treatments

The side effects of traditional antidepressant medications or medical treatments generally include increased suicidal thoughts, erectile dysfunction or other sexual issues, nausea, weight gain, trouble sleeping, tremors, and others.

By comparison, ketamine therapy’s side effects are relatively mild or moderate in most cases, although both treatments can have life-threatening or life-altering side effects under certain circumstances.

Patients and their health care providers should consider a risk-benefit analysis before choosing ketamine therapy. If potential side effects could pose a serious risk, if treatment may not be effective for a patient’s particular situation, or if other short-term issues are present, it’s important to identify them before treatment begins.

Patient Experiences and Perspectives

Ketamine therapy has famously been used by celebrities like Chrissy Teigen, Lamar Odom, and Elon Musk, among others. Sharon Osbourne told The Times of London that she used it to treat her depression and, as a result, she was finally able to “relax” despite her depression and personal issues. Many others have echoed these claims and stated that they believe ketamine therapy should be more common.

A clinical trial conducted at Yale University in 2018 revealed no long-term effects suffered by the sample group. However, the study does note that those effects may simply not have presented within the timeframe and there’s always the possibility that long-term effects may eventually appear in ketamine therapy patients.

Legal and Ethical Considerations

Legally speaking, ketamine is considered a Schedule III drug on the federal level and is only to be administered by a qualified physician. It is legal for therapy purposes in all 50 states and is an approved drug by the FDA, although it is not specifically approved to treat depression, making any use of this sort “off-label”.

For this reason, many insurance companies won’t cover the use of ketamine therapy for depression or chronic pain, which can lead some people who suffer from these conditions to seek it out illegally. However, medications containing the derivative S-ketamine like Spravato are FDA-approved and are billable through insurance. These prescriptions can also be more difficult to obtain, as they require a specific treatment and risk-management plan before the drug can be administered.

However, regardless of its legal status, there are certain ethical considerations to be taken into account as well. Because of its high potential for abuse, patients with a history of substance use disorders may become addicted more easily and begin using it recreationally, which can present a major problem that physicians must weigh before any treatment begins.

Conclusion

Ketamine therapy is a relatively new style of treatment for chronic pain and treatment-resistant depression, among other conditions. However, it can be dangerous for some patients due to its high potential for abuse.

It should only be taken with proper medical supervision and with the full informed consent of the patient. If they understand the risks, are medically cleared to begin receiving therapy, and make an informed decision about beginning treatment, it can provide fantastic results where other medications fail.

However, it can also become quite addictive and result in the patient being in a worse spot than they were before treatment began.

If you or someone you know has used ketamine therapeutically or as a street drug and you think you may have become addicted, Long Island Interventions may be able to help. Their experts can help you choose the right course of action to help you overcome this problem. Call or visit their website to set up an appointment today.

References:

• https://pubmed.ncbi.nlm.nih.gov/30063304/
• https://www.webmd.com/depression/features/what-does-ketamine-do-your-brain
• https://www.webmd.com/depression/side-effects-antidepressants
• https://www.healthline.com/health/k-hole
• https://pubmed.ncbi.nlm.nih.gov/34363603/
• https://www.spravato.com/#important-safety-information
• https://www.natlawreview.com/article/key-legal-considerations-relating-to-ketamine-behavioral-health-platforms
• https://pagesix.com/2022/04/25/sharon-osbourne-underwent-ketamine-therapy-after-the-talk-exit/
• https://mcpress.mayoclinic.org/living-well/ketamine-for-treatment-resistant-depression-what-you-need-to-know/

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Published on: 2024-01-30
Updated on: 2024-10-14