What Is Ketamine Therapy (& Can It Help Treat Anxiety and Depression)?

When it comes to treating mental health conditions like depression and post-traumatic stress disorder, there are a number of routes to take, from talk therapy to psychiatric medications like SSRIs and MAOIs. You may have also heard of ketamine therapy, which uses ketamine, a drug that was originally used as an animal anesthetic, administered in a clinical setting to improve mental health symptoms. I checked in with Dr. Marcel Green, a double board-certified psychiatrist, to learn more about the benefits, risks and more.

Dr. Marcel Green, MD, is a double board-certified psychiatrist at Hudson Mind. He is a graduate of Columbia University’s medical school, and obtained psychiatry residency training within the Icahn School of Medicine at Mount Sinai and child-adolescent psychiatry fellowship training within the Zucker School of Medicine at Hofstra/Northwell. He specializes in Interventional Psychiatry, with dual expertise in contemporary treatment models from the field’s frontier, along with the integration of psychiatric and psychological treatment models with interventions across the wellness spectrum.

Per WebMD, ketamine was first used in Belgium in the 1960s as an anesthesia medicine for animals, and the FDA approved it as an anesthetic for humans in 1970. Dr. Green says, “Ketamine is a dissociative anesthetic that acts widely across the brain, used for decades for general anesthesia and pain with contemporary research showing effectiveness for a wider array of conditions.”

It sure is. Dr. Green tells me, “Its effectiveness for treatment-resistant depression has been established, and one form has been FDA-cleared for this condition.” He explains that at low doses, its psychedelic properties can be used to treat mental health conditions such as post-traumatic stress disorder and general mental health optimization. He adds that ketamine has been shown to hold potential to improve depressive symptoms faster than antidepressant medications. “The psychedelic properties temporarily lowers the rigidity of a person’s thought patterns, allowing one to renegotiate their relationships to themselves, their past, others and the life circumstances,” he tells me. “As such, it can significantly enhance therapy.”

Before starting ketamine treatment, it’s necessary to have a full evaluation by a mental health professional to identify any medical conditions that can be impacted by treatment. Dr. Green says that ketamine treatment can cause temporary nausea, so nausea medication is typically given with treatment. Ketamine can also temporarily increase blood pressure, which he says is typically only of concern for people who have medical conditions that make them sensitive to blood pressure changes (like certain heart and kidney diseases). Still, “People who have hypertension effectively treated with medication can still undergo ketamine treatment,” he says.

It's also crucial that ketamine therapy is given within a medically supervised setting, since ketamine’s psychedelic properties cause temporary sensory alteration. Dr. Green adds, “People who have histories of bipolar disorder, psychosis or substance use disorders require evaluation by an experienced ketamine clinician to ensure they can proceed safely with treatment.”

Ketamine therapy is administered in a supervised clinical setting through intravenous, intramuscular, intranasal or sublingual routes. Dr. Green explains that the duration of a single session depends on the dose and can range from 45 minutes to 90 minutes, and the number of sessions recommended varies based on the goals of the treatment.

This also varies depending on the route. “One form of ketamine, an intranasal form, is covered by insurance if specific criteria are met, namely evidence of treatment resistant major depressive disorder,” Dr. Green says, adding that the other forms are not covered by insurance. “Intravenous and intramuscular ketamine treatments can range from $500 to $1,500 per treatment. Sublingual ketamine are typically prescribed for those who meet clinical criteria for treatment and can commit to a highly supervised structure of use, with prescriptions being $50 per prescription.”

If you’re interested in exploring ketamine therapy, Dr. Green advises consulting with a ketamine clinician to ensure that they:

• Are experienced with ketamine treatment protocols
• Can thoroughly explain potential benefits and risks of treatment
• Can clearly explain the rationales for ketamine treatment with respect to other mental health treatments
• Can explain how a treatment course can be used to augment a patient’s mental health efforts