It is unclear from these studies if there is a dose-response relationship between ketamine and the incidence or intensity of psychiatric adverse effects, although adverse effects for most medications that act in the CNS are dose related. It is noteworthy that the treatment of choice to prevent or abort ketamine-induced hallucinations or dissociative effects is low-dose benzodiazepines (such as IV lorazepam or midazolam) or α2 agonists (clonidine), and not antipsychotics. As such, individuals with a history of serious psychomimetic effects and relative contraindications to rescue medications such as benzodiazepines (eg, use of some human immunodeficiency virus retroviral drugs, poorly controlled myasthenia gravis, history of adverse reaction) may not be good candidates for ketamine treatment. A history of psychosis as a contraindication is based on reports that the administration of subanesthetic IV ketamine to schizophrenics has caused reactivation of hallucinations and/or delusions.213 It is also possible that patients with delirium can experience an exacerbation of symptoms with ketamine infusion. Similar to multiple guidelines for epidural steroid injections,262 a consecutive “series” of infusions should not be administered by rote, but rather tailored to patient response. Considering the risks of long-term ketamine treatment, limiting these to no more than 6 to 12 treatments per year is reasonable, although deviations may be made in exceptional circumstances (grade C recommendation, low to moderate level of certainty).

Two Aurora Fire Rescue Paramedics called to the scene then administered a large dose of ketamine — at least 500 milligrams — to McClain. Specific diagnostic categories that have been studied in RCTs include neuropathic pain of mixed diagnoses, traumatic spinal cord injury, PHN, and PLP. Conditions with features of neuropathic pain have also been studied including CRPS, fibromyalgia, and chronic ischemic pain. Your commitment to the recommended treatment schedule, combined with proper lifestyle changes and therapeutic support, creates the foundation for lasting positive outcomes. Regular exercise, quality sleep, and proper nutrition strengthen these benefits, making your progress more sustainable. For optimal safety, all doses should be administered under medical supervision rather than through at-home self-administration.

Higher Response Rates with IV Ketamine

Availability of personnel and equipment for resuscitation at all times is also mandatory irrespective of the level of infusion (grade A recommendation, low level of certainty). Maintaining the positive effects of ketamine therapy requires a structured approach to follow-up care. After completing initial treatments, patients typically need maintenance sessions every four to six weeks, sometimes more frequently. Clinical studies show that weekly maintenance infusions effectively sustain antidepressant benefits.

While we cannot definitively state that these same benefits would apply to ketamine treatment, these findings suggest psychotherapy could potentially play an important role in enhancing and extending ketamine’s antidepressant effects. – Both intravenous and intranasal ketamine formulations show strong short-term effectiveness in reducing symptoms of treatment-resistant depression, while oral ketamine demonstrates a more gradual but still meaningful benefit. – All included studies reported significant improvements in depressive symptoms following oral ketamine treatment.

• This has led to a chorus of calls from various sources for the development of consensus guidelines.
• Also, if you’re dealing with a mental health condition, you might not be eligible to receive this kind of therapy.
• One trial found that 44% of patients reached remission when ketamine was paired with cognitive behavioral therapy—an encouraging signal, even if based on small sample sizes (British Journal of Psychiatry, 2023).
• Finally, in addition to preventing the chronification of acute pain, another top National Institutes of Health chronic pain research priority is the establishment of registries.
• The meta-analyses noted that therapy might help extend ketamine’s effects, but the data were too limited to explain why—or to say which therapeutic approach works best, or when to deliver it (Journal of Clinical Psychiatry, 2023).

Although pain relief in most patients “did not reach clinically meaningful thresholds,” up to 46% reported improvements in their pain, daily functioning, sleep, anxiety, depression, fatigue and quality of life. The improvements were sustained over 3 and 6-month follow up periods, with 80% of patients returning for additional infusions, a telling sign the treatment has benefits. Tankha and his colleagues focused on outpatients who received low dose ketamine infusions – 0.5 mg/kg over 40 minutes for five consecutive days. Their findings, recently published in the journal Regional Anesthesia & Pain Medicine, show that over 90% of patients completed all five treatment days, demonstrating the feasibility of outpatient infusions. Based on specific requests, we tried to provide recommended dosing ranges whenever possible. Therefore, one could reasonably extrapolate ketamine dosing schemes for a condition that has been adequately investigated to another condition that has not been well researched, as is typically done for other analgesic medications.

Over the past 2 decades, the use of intravenous ketamine infusions as a treatment for chronic pain has increased dramatically, with wide variation in patient selection, dosing, and monitoring. This has led to a chorus of calls from various sources for the development of consensus guidelines. Researchers say their findings demonstrate that ketamine infusions can be part of a pain management program, when combined with behavioral therapies and patient education. The findings also give hope to millions of pain sufferers with complex conditions that have not responded to conventional treatment. A study published last year showed that the drug given to patients who play computer games designed to boost self-esteem after a ketamine infusion appeared to prolong the benefits of the anesthetic for up to three months after the therapy.

Clinical Implications

” The overall incidence of adverse effects was approximately 1 in 3 volunteers, and frank emergence delirium was minimal. Most of the subjects described strange experiences such as a feeling of floating in outer space and having no feeling in their arms or ketamine infusion therapy effectiveness legs. Encouraged by its anesthetic effect, Parke-Davis filed for FDA approval of the drug and carried out further clinical studies.

• One small study might suggest a treatment works wonders, but if ten larger studies show it barely helps, a meta-analysis will reveal the truth.
• – Esketamine produced a modest antidepressant effect, with effect sizes ranging from 0.15 to 0.23 on a scale where 0 indicates no effect and 1 indicates a very strong effect.
• Regular exercise, quality sleep, and proper nutrition strengthen these benefits, making your progress more sustainable.
• Wyatt Technology’s DynaPro Plate Reader 4 integrates advanced light scattering techniques, optimizing workflows in biotherapeutic and nanoparticle research.
• However, in the only RCT evaluating IV ketamine for cancer-related pain, a low-dose, 24-hour infusion of 1 mg/kg found no benefit in individuals who were receiving concomitant opioid therapy.164 In RCTs evaluating higher dosages administered as either serial outpatient infusions123 or an inpatient infusion161 for CRPS, significant improvement compared with placebo persisted for over 2 months.

Preclinical Evidence and Challenges in Translation: Can Ketamine Reverse or Halt Central Sensitization?

One large meta-analysis reported that patients receiving ketamine were 10 times more likely to show improvement in suicidal ideation by Day 1 compared to placebo (Translational Psychiatry, 2024). Repeated infusions further extended this benefit, helping keep suicidal thoughts lower for days or even weeks in some cases (Translational Psychiatry, 2024). In clinical trials of IV ketamine, response rates (meaning a ≥50% reduction in symptoms) were seen in 45% to 65% of patients within 24 hours—compared to just 5%–20% for placebo (Therapeutic Advances in Psychopharmacology, 2023; Brain Sciences, 2023). Remission (few or no symptoms) occurred in up to 30% of patients after one infusion, and repeated infusions increased the odds to 40% or more (Brain Sciences, 2023; Current Neuropharmacology, 2014).

Clinical Trials vs. Systematic Reviews

Ketamine infusion therapy is delivered at a dosage that is less than you would get if you were receiving ketamine for anesthesia, but some of the side effects might seem similar. The good news is that they typically go away either by the time the infusion is over or within a few hours. In one study, 88% of the participants given a ketamine infusion in the emergency room had their suicidal ideation go away in just 90 minutes. Ketamine infusion therapy helps with a number of psychiatric conditions, but it is most commonly used in those with treatment-resistant depression, a form of major depressive disorder. You are likely to be diagnosed with treatment-resistant depression if you have tried more than two antidepressant treatments and have not responded adequately. The 23-year-old was brought to the ground by three officers and was given two carotid holds.

Ketamine’s unique approach to mental health treatment begins with its distinctive interaction with brain chemistry. Primarily targeting N-methyl-D-aspartate (NMDA) receptors, ketamine blocks these receptors in the brain’s prefrontal cortex and hippocampus. This blockage triggers a cascade of events that increases glutamate levels and creates new neural pathways, essentially rewiring areas affected by depression. – Oral ketamine did not produce immediate effects; statistically significant improvements in depression symptoms typically appeared after 2 to 6 weeks of treatment. But in the only randomized trial focused on depression, combining psychotherapy with ketamine showed no significant benefit over ketamine alone (Journal of Affective Disorders, 2022). The meta-analyses noted that therapy might help extend ketamine’s effects, but the data were too limited to explain why—or to say which therapeutic approach works best, or when to deliver it (Journal of Clinical Psychiatry, 2023).

This page is intended to provide an accessible summary of the best available research I could obtain, but it is not a substitute for a comprehensive literature review conducted by a research institution. – This delayed onset mirrors the timeline of traditional antidepressants, contrasting sharply with the rapid effects of IV ketamine. Once the infusion is over, you will likely still feel a little out of it as the ketamine wears off. Have a ride (whether a loved one or a ride-share) home, because you will not be able to drive. Because ketamine is a dissociative anesthetic, you might experience more extreme effects, like an out-of-body experience or feeling as though your mind is no longer connected to your body. The new neural pathways—think of them as new roads in your brain—allow you to create more positive thoughts and, therefore, behaviors.

Someone who is suicidal does not have the luxury of waiting several weeks for a medicine to kick in. Ketamine infusions have been shown to be the kind of ketamine treatment that your body absorbs the best,but they are not the only kinds of ketamine treatment out there. Which one you go with may depend on your preferred setting (clinic vs. home) and, of course, the price. This website is for informational purposes only and should not be considered as medical advice, diagnosis or treatment.

Find Ketamine Infusion Therapy Near Me in Bethesda, MD: A Lifeline for Depression and Anxiety

See exactly what the evidence says — 33 systematic reviews and meta-analyses, with outbound links to every source. It is thought that ketamine infusions work by inducing the production of glutamate, a neurotransmitter in the brain. The glutamate leads the brain to form new connections and repair damaged ones, increasing its adaptability. Pain News Network is a 501 (c) (3) non-profit online news service for information and commentary about chronic pain and pain management.

Instead of getting lost in the noise of conflicting results, you get a big-picture view of what the best research actually says. – This level of improvement is roughly equivalent to the benefit seen when adding an antipsychotic to an antidepressant for treatment-resistant depression. No other approved antidepressant—including SSRIs or esketamine nasal spray—matches the rapid onset consistently observed with IV ketamine.