Ketamine is a medicine that was approved by the FDA in 1970 for use as an anesthetic. It creates a state of “dissociation” in the person receiving it. The mind becomes less aware of the body, making it useful in a variety of situations. In the emergency room, ketamine is used for procedural sedation, such as when a broken bone needs to be reset or a complex laceration repaired. Ketamine has a unique property among anesthetics in that it does not suppress breathing or cause a drop in blood pressure. It has been used extensively and safely for over 5 decades in trauma settings, battlefield medicine, and the operating room.

Around the year 2000, it was discovered that ketamine had an unexpected property: some people receiving it noted rapid relief of symptoms of depression. Some people even had their depression lift after they had been through many other failed treatments.

Since then, doctors and therapists have been using ketamine “off-label” (meaning a valid use, but not a use that the FDA originally approved) for treatment-resistant depression, as well as a variety of other mental health conditions.

Ketamine is unlike any other antidepressant medication. The majority of antidepressants work at the serotonin receptors in the brain, but ketamine works by binding to receptors associated with the neurotransmitter glutamate. There are a number of ideas as to how ketamine produces its rapid antidepressant effect, but we still don’t know for certain which of these is correct.

Ketamine can be given in a number of different ways. At Innate, we mainly give ketamine by IV infusion, although we sometimes use tablets that dissolve and are held in the mouth, or intramuscular injection (“shots”).

When we give IV ketamine, a tiny plastic catheter is placed in a vein and medicine is infused over 40 minutes or so, although some infusions may be longer. While the medicine is infusing, you wear eye shades, and listen to music through headphones. As the medicine works, your mind will feel very different from your normal, everyday consciousness.

Under the effects of ketamine you may experience visions, which are different for each person, and from session to session. You may be unaware of your body. Many people find the sessions enjoyable, although not all do. Our staff will prepare you and keep you safe during your ketamine experiences. You will come back to your normal mind after the infusion wears off, usually within 45 minutes after it finishes. Some people feel slightly dizzy or nauseated after the treatment, and this wears off after a couple of hours. We encourage people to take it easy for the rest of the day after a ketamine experience.

Ketamine has a low addiction potential. Unlike many medicines that are prescribed for mental health conditions, such as benzodiazepines (Valium, Ativan, Xanax, etc.), there is no physical dependence with ketamine, and no withdrawal when it is stopped. Some people abuse ketamine recreationally, but this is a very different context than our carefully monitored therapeutic setting.

Yes and no. Ketamine has a following as a “club drug,” and people do use it in those settings. But it is also a legitimate pharmaceutical medicine that is used extensively in both mental health and anesthesia contexts.

Not all potential clients need referrals, although most are referred by a psychiatrist, therapist, or primary care doctor. At Innate, when we have a referral, we know that a trained professional has evaluated you and believes that ketamine may be of benefit to you. If you self-refer, there may be additional screening to determine whether ketamine therapy may be appropriate for you.

We don’t know if ketamine will work for any one person. Ketamine’s effectiveness is dependent on many variables such as individual biology, genetics, psychological makeup, and the nature of the condition ketamine is being used for. At Innate, our initial screening will help us begin to assess whether we believe ketamine is likely to be effective for you. If we think ketamine is not likely to be effective, we may refer you for other mental health services instead.

Ketamine has been shown to be effective for treatment resistant depression in about ⅔ to ¾ of clients*. If you enter treatment with us, we will monitor your response using a series of self-reported symptom scores. Usually, it takes at least three or four treatments before we can begin to tell if ketamine is effective–although some people feel a positive effect almost immediately!

If you are seeing a therapist or psychiatrist before coming to Innate (and we recommend most people do), you will continue to see them during and after your treatment. With your consent, we will make contact with your mental health providers before treatment, and keep them informed of your progress periodically. Continuity of care is very important to us because it helps us provide you the most effective treatment.

Treating people with ketamine requires special skills, and special settings where care can be delivered and clients monitored. At Innate, our staff are trained in working with people in non-ordinary states of consciousness, and in providing safe, compassionate care.

Under the effects of ketamine you may experience visions, which are different for each person, and from session to session. You may be unaware of your body. Many people find the sessions enjoyable, although not all do. Our staff will prepare you and keep you safe during your ketamine experiences. You will come back to your normal mind after the infusion wears off, usually within 45 minutes after it finishes.

Many people find the ketamine experience to be relaxing and interesting. Occasionally, however, clients may find the experience to be disorienting or frightening. In general, we manage this by coaching you beforehand about what you may expect, and by supporting you during the experience. That support may be a spoken reassurance, or gentle touch such as holding your hand. Rarely, we may administer medicine to help you relax through the experience.

Some people feel great almost immediately after the infusion! Others may feel a little spacy, or tired. Other people feel energized. However you may feel, we encourage you to take it easy for the rest of the day after a ketamine experience.

As the medicine wears off, some people feel slightly dizzy or queasy. This side-effect typically wears off after a couple of hours. If you have significant nausea, we may give you some medicine to treat it.

Ketamine commonly causes your blood pressure and pulse rate to rise for about 45 minutes during and after a treatment. Most people don’t notice this. For some people with conditions like high blood pressure, heart disease, or other vascular disease, this requires extra monitoring by our staff. Sometimes, we will give you medicine to control your blood pressure.

Occasionally, people will develop bladder irritation after ketamine treatment. If you notice any symptoms such as burning with urination, bladder discomfort, or blood in your urine, report it to Innate’s staff immediately.

We offer different types of appointments depending on your treatment.

Infusion-only appointments last two hours. Some people need additional time to recover after the infusion and we have a lounge where you can do this while enjoying a snack and a beverage.

Infusion/therapy appointments last 170 minutes, just under 3 hours. These appointments consist of a two-hour infusion session, followed by a 50-minute “emergence psychotherapy” session with one of our therapists. Most often, you will meet with the therapist by telemedicine over an iPad in your room.

Traditional Ketamine-assisted Psychotherapy (KAP) appointments last 3 hours. In these sessions, you will have psychotherapy before and after receiving the medicine. A therapist will remain in the room with you for the entire 3-hour session.

Innate staff will meet with you at your intake to determine what types of treatments are appropriate for you. This may depend on a number of factors including your preferences, your treatment budget, whether you are currently in therapy, etc.

People who experience a remission in their symptoms as a result of ketamine therapy often feel well for some period of time. In most, symptoms creep back after a while. That may be a few weeks, and it may be a few months. Some people have a durable response that doesn’t require any ongoing treatment, but those are the exception more than the rule.

After the initial series of ketamine treatments (called “induction”), many people come back for periodic booster sessions. The frequency with which these are needed varies a lot from person-to-person but typically range from once monthly to once every 6 months or so.

A typical induction series is 6 treatments over a 3 week period. We recommend at least 3 - 4 treatments before assessing the effectiveness of treatment. In some people the effect is fairly rapidly felt, in others it takes a bit more time, and in some cases ketamine is not effective.

Ketamine has been shown to be effective in some individuals with major depression (including treatment resistant depression), suicidal thoughts, anxiety disorders, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). These are complex and highly individual diagnoses, and for many people ketamine becomes part of a treatment plan that may include psychotherapy, conventional psychopharmacology, lifestyle interventions, and other modalities such as eye movement desensitization and reprocessing (EMDR), transcranial magnetic stimulation (TMS), etc.

Psychedelic therapies with LSD, psilocybin (“magic mushrooms”), and the like, are undergoing a resurgence of interest and clinical research after being made illegal in 1971 with the passage of the Controlled Substances Act. MDMA-assisted therapy was made illegal in 1986. Prior to being banned, there was tremendous academic and professional interest in using these therapies in mental health. Current clinical trials are focusing on MDMA-assisted therapy for PTSD, and psilocybin-assisted psychotherapy for major depression. Both of these medicines are wending their way through the laborious FDA approval process. As of now, these therapies are still illegal, and therefore unavailable outside of clinical trials.

Many people consider ketamine therapy to be a form of psychedelic-assisted therapy. Ketamine is currently the only legal psychedelic medicine available in the US.

Because of its anesthetic properties, we recommend you do not eat or drink for a minimum of 4 hours prior to your ketamine session. For sessions scheduled first thing in the morning, you should not eat after midnight the night before.

Comfortable, loose-fitting clothing is best. Bring an extra pair of socks to keep your feet warm. You are welcome to bring a favorite blanket or pillow to keep you cozy.

While you may drive to your ketamine appointment, you will not be allowed to drive home! We recommend having a close friend or family member pick you up to drive you home after your session. You should not drive, or engage in mentally taxing activities for the remainder of your treatment day.

You will likely still be in a very open and spacious frame of mind after your session. We encourage you to allow yourself to remain in that mindset for as long as possible.

There are a few mental health conditions that make ketamine therapy contraindicated. One of these may be bipolar disorder, if you are not taking mood-stabilizing medication. Another may be psychotic disorders such as schizophrenia. Substance use such as alcohol, benzodiazepines (Valium, Ativan, Xanax, etc.), or opiates, may also diminish the effectiveness of treatment. Additionally, the mood-stabilizer lamotrigine has been reported to blunt the effect of ketamine. If you take this medicine, you may require higher doses of ketamine than people who do not.