Exploring the Different Types of Ketamine Use in Psychiatry

Ketamine, originally developed as an anesthetic, has gained prominence in psychiatry over recent years for its rapid antidepressant effects, particularly in patients with treatment-resistant depression. This post explores the various types of ketamine use in psychiatry, their mechanisms, benefits, and considerations.

1. Intravenous (IV) Ketamine

Overview

IV ketamine is administered in a clinical setting, typically through an infusion. This method allows for precise control over dosage and ensures rapid onset of action, often within hours.

Benefits

• Rapid Relief: Patients often experience significant improvements in mood within hours of administration, which is particularly unique as medications for depression often takes weeks if not months to improve mood (if they work at all).

• Controlled Environment: Administered under medical supervision, minimizing complications and side effects.

Considerations

• Cost: IV treatments can be expensive and are often not covered by insurance.

• Accessibility: Limited availability in some regions due to the need for medical supervision.

2. Intranasal Ketamine (Spravato)

Overview

Spravato, the intranasal formulation of ketamine, was approved by the FDA in 2019 for treatment resistant depression. It offers a convenient alternative to IV administration and can be self-administered under medical supervision.

Benefits

• Ease of Use: Patients can receive treatment in a less intrusive manner, which can enhance comfort and compliance.

• Quick Onset: Similar to IV ketamine, effects can be felt rapidly.

Considerations

• Side Effects: Can include dissociation, dizziness, and nausea- only within the first few hours

• Monitoring: Patients must be observed for at least two hours after administration due to potential side effects. Patients also can not drive following their appointment and must have rides set up.

3. Intramuscular (IM) Ketamine

Overview

IM ketamine involves injection directly into a muscle, providing a balance between the rapid effect of IV ketamine and the ease of administration found in other methods.

Benefits

• Rapid Onset: Like IV ketamine, IM administration can lead to quick relief of depressive symptoms.

• Less Invasive: IM injections can be less threatening for patients who may be anxious about IV infusions.

Considerations

• Administration Challenges: Requires trained personnel for injections, which may limit access.

Pain at Injection Site: Some patients may experience discomfort or pain at the injection site.

4. Oral Ketamine

Overview

Oral ketamine involves taking the drug in pill form (lozenge, troche). While it is less commonly used, it is gaining attention for its accessibility and ease of administration- especially in a therapeutic setting. 

Benefits

• Convenience: Patients can take it at home or in a therapy office, reducing the need for frequent clinical visits.

• Cost-Effective: Generally more affordable than IV or intranasal treatments.

Considerations

• Bioavailability Issues: Oral administration may have variable absorption rates, leading to inconsistent effects.

• Delayed Onset: Takes longer to feel effects compared to IV or intranasal forms, but onset is still within 15-30 minutes.

5. Off-Label Use

Overview

Many clinics offering ketamine therapy use off-label doses and formulations. These settings often provide a range of ketamine-based treatments tailored to individual patient needs. This is a unique and patient centered option that minimizes the need for clinic settings. This is what we currently offer at Lakeside Integrative NPs in Psychiatry. During this therapeutic journey, patients relax with their provider present and attentive every step of the way. Eye covers and relaxing music is used to promote a gentle internal journey.

Benefits

• Customized Treatment: Providers can tailor treatments to patient needs based on their specific conditions and responses.

• Broader Accessibility: Many clinics have emerged, offering services to a wider patient population.

Considerations

• Lack of Regulation: Off-label use can lead to variability in treatment protocols and quality. However, off-label does not mean ineffective- it just means that the FDA hasn’t approved it for a specific treatment modality yet.

• Potential Risks: As with any unregulated treatment, there may be risks involved, including lack of comprehensive follow-up care. This is why at Lakeside Integrative NPs in Psychiatry, we provide frequent check-ins and thorough monitoring of our patients throughout the ketamine assisted sessions. 

• Longer therapy sessions: Therapy sessions with ketamine are typically about 3 hours long and patients do need to have a ride home arranged as they will be unable to drive. For best outcomes, 3-5 therapy sessions are recommended, about two weeks apart with telehealth integration sessions in between. 

6. Combination Therapies

Overview

Some practitioners combine ketamine with other treatments, such as psychotherapy, antidepressants, or mindfulness practices, to enhance efficacy. At Lakeside Integrative NPs in Psychiatry, we do this with consideration of patient values and goals. 

Benefits

• Holistic Approach: Combining therapies can address underlying issues while providing rapid relief from severe symptoms.

• Potential for Improved Outcomes: The synergistic effects may lead to more sustainable mental health benefits.

Considerations

• Complexity of Treatment: Managing multiple therapies can be challenging for patients and practitioners alike.

• Monitoring and Adjustments: Close monitoring is essential to adjust therapies as needed based on patient response. Communication with your provider will be paramount.

Conclusion

Ketamine has emerged as a transformative tool in the field of psychiatry, offering hope to many suffering from debilitating mental health conditions. As research continues to evolve, understanding the various types of ketamine use will be crucial for practitioners and patients alike. While the promise of rapid relief is exciting, careful consideration of the benefits and risks associated with each method is essential for effective and safe treatment outcomes.

Whether through IV infusion, intranasal delivery, IM injections, oral forms, or in combination with other therapeutic approaches, the future of ketamine in psychiatry holds considerable potential. As more individuals seek alternatives to traditional therapies, exploring the nuances of ketamine treatment options will remain paramount.