Psychiatry Services

Ketamine therapy is a novel treatment approach that uses low doses of ketamine, a dissociative anesthetic medication, to manage various mental health conditions, such as treatment-resistant depression, anxiety disorders, and post-traumatic stress disorder (PTSD). Ketamine is approved for use at high doses as an anesthetic in the operating room. Although not FDA-approved for mental health treatment, lower dose “sub-anesthetic” ketamine injections are used off-label to treat depression, pain, and other mental health/substance use disorders. Click to read third-party ketamine research to understand further why this psychedelic therapy is helping people.

Historically, people struggling with depression, anxiety, and obsessive disorders have had limited treatment options. Many kinds of antidepressants, including SSRIs (selective serotonin reuptake inhibitors), have been helpful in some cases of mild to moderate depressive disorders. When paired with counseling or therapy, symptoms are more likely to become manageable, but for others who have these life-altering symptoms, relief remains elusive. This is where clients and doctors alike can become frustrated at the lack of progress or the return of symptoms. Those who have tried two or more of these medications without adequate symptom relief may be diagnosed with treatment-resistant depression or TRD. Depletion of serotonin, a chemical in the brain that helps to regulate mood, was thought to be a significant issue in the area of mental health. Still, a study by the Journal of Clinical Psychology found that as many as a third of the 9 million people who are treated for depression in the USA have TRD, or depression that does not respond to medications that increase serotonin. This does not have to be the end of the road, and this is where ketamine comes in. Initially approved as a general anesthetic, ketamine hydrochloride was found to be an unusually fast-acting antidepressant. Studies, as stated on the John Hopkins Medicine website, show that it can ease depressive symptoms after a single dose in some patients. It is hypothesized that ketamine may be a suitable medication-based option for treatment-resistant depression.

To understand how ketamine therapy works, a quick crash course in neurobiology is needed to know what is theorized to cause depression, anxiety, and obsessive disorders. Anxiety, depression, and other mental health conditions in this area are linked to a chemical imbalance, specifically serotonin – the chemical that helps to regulate your mood, hence the everyday use of SSRIs when treating depression. Other neurotransmitters, such as GABA (Gamma-Aminobutryric Acid), known as a "calming" neurotransmitter, which helps you to sleep, relax, and calm anxiety, and glutamate, GABA’s opposite, which plays a significant role in how neurons communicate with one another, have been implicated in severe major depressive disorder and treatment-resistant depression. The research is ongoing, but it has been determined that GABA and glutamate have a role in mood regulation. This means that traditional treatment plans for depression, in extreme cases, may not work effectively. It is worth exploring the medications that are used to treat depression and their usage with ketamine for therapy treating depression. If you are taking an SSRI, it is safe to undergo ketamine therapy in parallel. If you are taking another kind of antidepressant, such as an SNRI (serotonin reuptake norepinephrine inhibitor), which boosts a few different brain chemicals, you can also undergo ketamine therapy. The tricyclic antidepressant (TCA) group is generally safe when used with ketamine for mental health. Still, the sedative effects of the two medications together can be problematic. Lastly, monoamine oxidase inhibitors may also be used to treat depression. Still, it is not ideal to use ketamine to treat people who take this medication due to blood pressure issues. One of the benefits of Ketamine treatment is that it acts on the N-methyl-D-aspartate (NMDA) receptor, which is a glutamate receptor, boosting it quickly. Ketamine therapy benefits include better long-term outcomes when the ketamine is used for depression, as it helps in regulating mood, minimizing suicidal thoughts, and helping with overall mental health. Ketamine therapy for depression has also been found to help with neuroplasticity, a process that makes structural and functional changes to the brain. This is important for treating depression, as it allows the brain and the individual to adapt when experiencing new things. Ketamine therapy is helpful in changing pervasive negative thought patterns, helping to treat depression, and alleviating anxiety. The response to Ketamine treatment for depression and anxiety has been found to last for at least a day. Research shows that the positive response to ketamine for depression treatments lasts for one full day in over 70% of patients.

One of the common questions we get is what to expect during a treatment session. Ketamine can be administered in three ways. The first is an infusion therapy, the second is a nasal spray, and the third is via an oral route. Ketamine infusion therapy is the most popular. Before treatment with ketamine infusion therapy, there can be no use of alcohol or benzodiazepines for at least 24 hours, as this may dull the benefits of ketamine and can hinder how it treats depression. Your vital signs will be taken prior to treatment to ensure safety, and your weight will be confirmed so the medication can be properly dosed. An IV line will be placed after the appropriate safety checks and comfort measures have been taken. Ketamine infusions for mental health treatment will typically last 40 minutes. , Ketamine for mental health issues like anxiety and depression may have different dosages, which will be determined on an individual basis based on client experience and response During the infusion, a Daydream MD staff member will be in the room with you at all times. Once the infusion is complete, you may feel dizzy or drowsy. Because of this, it is unsafe to drive following a treatment session. Please arrange safe transportation before your scheduled treatment time.

Ketamine was synthesized in 1962 and found to be an extremely safe and effective short-acting dissociative anesthetic and analgesic (pain reliever). It is FDA-approved for many indications, including its use as anesthesia for children in operating and emergency rooms. For Daydream MD’s ketamine treatments, sub-anesthetic doses of ketamine are given—only a fraction of what would be administered during a surgical procedure. When administered at these doses, ketamine allows individuals to experience different planes of consciousness, similar to other classic psychedelic medicines. Often, it induces a state of “ego dissolution,” which is viewed by many psychiatrists and other mental health practitioners as a doorway to healing.

Ketamine treatments at specific doses will have dissociative and psychedelic effects. For someone living with depression, the felt experience of dissociation in this context can provide a respite or the ‘breathing room’ to reflect, rest, and begin retaking control. Ketamine treatments can also give rise to psychedelic experiences that provide our members with a potential avenue for new connections, insights, and experiences.

Ketamine treatments offer many neurochemical effects that help treat the underlying neurobiology associated with depressive symptoms. These neurobiological effects allow members greater emotional regulation and experience and often provide new responses to triggers and a deeper understanding of themselves and their connection to the world around us. There are still many studies being conducted that are deepening our understanding of the neurobiology of psychedelics further. Here is what we know thus far:

Ketamine is a unique treatment because ketamine has an entirely novel mechanism; it can work where other drugs have failed. It offers a rapid onset of effect, creating a relief of depression and anxiety within 24-72 hours, and those who respond see approximately 70% effectiveness. Ketamine’s robust efficacy in many participants challenged with suicidal thoughts, a reduction of symptoms can be noticed immediately after the administration of a single ketamine treatment. Ketamine also increases synaptic plasticity stimulating the regrowth of synapses (connections between neurons), effectively rewiring the brain.

Dr. Arsalan Azam is a board-certified Emergency Medicine physician, medical director, and founder, of the treatments provided at Daydream MD. He attended medical school as a Deans Scholar at Case Western Medical School. He completed clinical rotations at the world-famous Cleveland Clinic. His residency in Emergency Medicine was completed at Metropolitan/Harlem Emergency Medicine Residency. He has practiced as an emergency medical practitioner around the US, working as a relief physician to help understaffed hospitals. This emergency work led him to oversee many psychiatric emergencies, giving him the idea to start Daydream MD.

Interested in learning more about ketamine therapy? Click to read sourced third-party ketamine research; listed below are a couple of our favorite sources: National Library of Medicine: How Ketamine Relieves Depression Symptoms Yale University: How ketamine drug helps with depression Forbes: The truth about ketamine therapy Oxford University: First UK study of ketamine for people with severe depression The Washington Post: Ketamine depression treatment research Harvard: Ketamine for treatment-resistant depression