Did you know that up to 30% of patients with major depressive disorder (MDD) don’t respond to traditional antidepressants? But now, there is good news for these individuals. Ketamine, once known primarily as an anesthetic, has rapidly gained recognition for its efficacy in addressing treatment-resistant depression, anxiety, and other hard-to-cure psychiatric conditions.
As a family physician working in mental health, a question I hear often in my practice: “How long do ketamine treatments last?”. And like many aspects of medicine, the answer isn’t always straightforward.
What Is Ketamine?
Ketamine isn’t new to the medical world. It’s been a trusted tool in my field for decades. Many people are surprised to learn this. Originally developed as an anesthetic, it’s now showing incredible promise in mental health treatment. We’re now exploring ketamine in a new light. This isn’t a new drug. It’s a new application of a well-known medication.
Ketamine is a versatile medication with a long history in medicine. It’s primarily known as an anesthetic, but it’s much more than that. At subanesthetic doses, ketamine has shown remarkable efficacy in treating conditions that often resist traditional treatments.
For patients considering ketamine therapy, this history is reassuring. We’re not dealing with an unknown substance. We have decades of data on its safety profile. Of course, its use in mental health is more recent, but evidence has mounted over the last two and a half decades. But we’re building on a solid foundation of medical knowledge.
Many of patients with anxiety and treatment-resistant depression found ketamine therapy extremely helpful. They often remark that ketamine helps quiet the constant chatter of worried thoughts, allowing them to engage more fully with their lives.
Ketamine’s potential in managing chronic pain is particularly promising. I’ve seen patients experience significant relief. For some, it’s provided a level of pain control they haven’t achieved with other treatments.
How Does Ketamine Work in the Brain
Ketamine’s action in the brain is fascinating and complex. It operates differently from traditional antidepressants, which is why it can be effective for treatment-resistant conditions.
The key player in ketamine’s mechanism is the NMDA receptor. NMDA stands for N-methyl-D-aspartate. These receptors are found on brain cells and play a crucial role in neurotransmission, learning, and memory. Ketamine interacts with these receptors, temporarily blocking them.
When ketamine blocks the NMDA receptors, it triggers a cascade of events in the brain. This blockade leads to the release of a neurotransmitter called glutamate in certain areas of the brain. Glutamate then activates another receptor called the AMPA receptor.
The downstream effect of interacting with these neurotransmitters is it leads to the release of molecules that help brain cells communicate better. One of the most important of these molecules is called BDNF (Brain-Derived Neurotrophic Factor). BDNF is often described as a type of fertilizer for the brain because it helps brain cells grow and form new connections.
This process of forming new connections is called synaptogenesis. It’s believed to be one of the main reasons why ketamine can have such rapid and significant effects on mood and cognition. By promoting synaptogenesis, ketamine may help to repair and rebuild brain circuits that have been damaged by stress and depression.
Another important effect of ketamine is its impact on a signaling pathway in the brain called mTOR. The mTOR pathway is involved in cell growth and plasticity. Ketamine’s activation of this pathway is thought to contribute to its antidepressant effects.
Unlike traditional antidepressants that primarily focus on increasing levels of serotonin or norepinephrine, ketamine’s approach is more comprehensive. It doesn’t just alter neurotransmitter levels; it actually helps rewire the brain. Ketamine reduces activity in the “default mode network” of the brain. The default mode network is a set of brain pathways active at rest, thought to be the home of negative automatic patterns of thinking and behaving. Reducing activity in the default mode network, plus enhancement in synaptogenic activity is a powerful tool in the toolkit for mental health patients. This is why ketamine is often described as having a “reset” effect on the brain.
The effects of this process can be rapid and profound. Many patients report improvements in mood and cognition within hours or days of treatment. They often describe feeling as if a heavy weight has been lifted, or experiencing enhanced clarity of thought and a renewed sense of possibility.
This swift action is a significant advantage of ketamine. Traditional antidepressants often take weeks to show effects, while ketamine can produce noticeable changes much more quickly. For patients who have struggled with treatment-resistant depression, this rapid relief can be life-changing.
It’s important to note that while the initial effects of ketamine can be quick, maintaining these benefits may require ongoing treatment. The exact protocols can vary, but many patients receive a series of treatments over time to sustain the positive effects.
Administration Types and Their Impact on Ketamine Treatment Duration
When it comes to ketamine therapy, we have several methods of administration. Each method has its own characteristics. These differences can affect how long the treatment lasts and how well it works.The way we give ketamine is important. It can impact the overall effectiveness of the therapy. Different methods suit different patients and situations. Understanding these options helps us provide the best care possible.
1. Intramuscular (IM) Injection.
At Field Trip Health, one of the ways we administer ketamine is via intramuscular (IM) injections. This method involves injecting the medication into a muscle, usually in your arm or thigh. It’s quick, simple, and takes only a few seconds to administer.
The onset of effects with IM ketamine is relatively rapid – usually within 15-20 minutes. Many of our patients report feeling improvements in their symptoms within hours of their first injection. The acute effects of an IM injection can last for about 45-60 minutes, but the therapeutic benefits often persist for days to weeks.
The duration of effects can vary, but it’s generally similar to what you might experience with other methods. Many patients report sustained improvement in symptoms for 2-4 weeks following a single treatment. A series of treatments over a few weeks has been shown to have cumulative benefits. Some patients may require maintenance treatments every 2-6 weeks to sustain the benefits.
One of the advantages of IM ketamine is the intensity of the experience. This intensity can be particularly beneficial for psychological breakthroughs in therapy, potentially extending the duration of positive effects through lasting cognitive and emotional shifts.
2. Sublingual Tablets or Troches.
For patients who may not be comfortable with injections, we offer sublingual ketamine as an alternative at Field Trip Health. This method involves placing a tablet or troche under your tongue and letting it dissolve.
Sublingual ketamine is like the slow and steady tortoise of our administration methods. It has a slower onset and generally lower peak blood levels of ketamine compared to IM administration. The acute effects typically last about 30-45 minutes, but the absorption process is more gradual. This can lead to a gentler experience with effects that may persist for several hours after the tablet has dissolved.
While the effects might not be as dramatic as with IM injections, it has the advantage of being more convenient. Sublingual ketamine can be particularly effective for maintaining treatment benefits over time when used regularly. Some patients use sublingual ketamine as a maintenance method between more intensive in-clinic treatments, which can help prolong the overall duration of treatment efficacy.
3. Intravenous (IV) Infusion.
IV infusion is another method of ketamine administration, though not offered at our clinic. It involves direct delivery into the bloodstream. The effects are often felt quickly due to direct entry into the bloodstream. While we don’t use this method, it’s a common approach in some ketamine therapy settings.
IV ketamine infusions offer precise dosing control and rapid onset of effects. A typical infusion lasts about 40 minutes to an hour, with acute effects often persisting for a few hours after the infusion ends. The rapidity and intensity of IV administration can lead to quick symptom relief, with many patients reporting improvements within hours of their first infusion.
The duration of therapeutic effects from IV ketamine can range from days to weeks. Many of my patients report feeling improvements in their symptoms within hours of their first infusion. However, to maintain these benefits, a series of infusions is usually recommended. A common initial protocol might involve six infusions over two to three weeks, which can extend the duration of benefits for some patients to several months.
After this initial series, the duration of effects can vary. Some patients maintain their improvements for weeks or even months. Others might need maintenance infusions every 2-6 weeks to sustain long-term benefits.
4. Intranasal (IN) Spray.
Intranasal ketamine, specifically esketamine (a form of ketamine approved by Health Canada for treatment-resistant depression), is another administration method for ketamine therapy.
Esketamine is administered as a nasal spray in a clinical setting. The onset of action is fairly rapid, with main effects typically felt within 15 minutes and lasting 40 minutes to an hour. The acute effects of intranasal administration can last for a few hours, but the therapeutic benefits may persist for days to weeks.
The treatment protocol for intranasal esketamine or intranasal ketamine is designed to extend the duration of effects through regular administrations. It typically involves twice-weekly treatments for the first month, then spacing into a maintenance protocol as needed for the patient. A transition to maintenance may include once weekly for the second month, followed by every other week thereafter. This structured approach aims to maintain the therapeutic benefits over an extended period, providing sustained symptom relief with regular use.
Factors Influencing Ketamine Treatment Duration
When it comes to ketamine therapy, one of the most common questions I hear is, “How long will the effects last?” It’s a bit like asking how long a candle will burn – it depends on a variety of factors. Let’s shed some light on what can influence the duration of ketamine’s effects.
The Presence of Other Illnesses
Our minds and bodies don’t operate in isolation. The presence of other illnesses, particularly chronic conditions, can impact how long ketamine’s effects last.
For instance, patients with chronic pain conditions might find that their pain levels influence how long they experience relief from depressive symptoms. Similarly, those with anxiety disorders might need more frequent treatments to maintain the calming effects of ketamine.
It’s not all bad news, though. In some cases, ketamine can help manage symptoms of multiple conditions simultaneously. I’ve had patients report improvements in both their mood and chronic pain levels, creating a positive feedback loop that extends the benefits of treatment. Evidence supports that patients with depression may have even more benefit from ketamine for chronic pain management.
Severity of Symptoms
The severity of your initial symptoms can influence how long ketamine’s effects last. Patients with milder symptoms may experience longer-lasting benefits from each treatment. Those with more severe symptoms might need more frequent sessions.
Treatment response varies among individuals. Some patients maintain improvements for extended periods after a session. Others may require more regular treatments to sustain the benefits. At Field Trip Health, we tailor the treatment schedule to each patient’s unique needs.
Patients with more severe depression or anxiety might initially need more frequent treatments to achieve and maintain relief. However, as symptoms improve over time, we often find that we can space out treatments without losing benefits.
Individual Biology
We talked about ketamine’s effects on synaptogenesis. One thought is that for some people, perhaps with more primarily biologically based depression or mental health issues like Bipolar Type II, or post concussion syndrome, their brains may prune these new synapses over time back to their prior setpoint. Therefore for some patients to maintain the benefits of ketamine, the may need a booster treatment every 2-6 weeks.
At our clinic, we recognize this variability. We start with a personalized approach for each patient. We carefully monitor how you respond to the treatment. Based on your individual reaction, we adjust the treatment plan as needed. This personalized care helps us optimize the benefits of ketamine therapy for each patient.
Life Circumstances and Stress Levels
Life doesn’t pause when you’re undergoing treatment. Stressful life events, changes in work or relationships, or other significant life circumstances can all impact how long ketamine’s effects last.
This is where the importance of holistic care comes in. We often recommend complementary strategies like stress management techniques, regular exercise, and maintaining a support network to help prolong the benefits of ketamine therapy.
Integration’s Impact on Ketamine Therapy Duration and Effectiveness
Integration is a critical part of ketamine therapy. It plays a key role in the long-term effectiveness of the treatment. Ketamine therapy often opens up new possibilities in the mind. However, to make lasting changes, we need to actively work with these new perspectives.
The treatment itself is just the beginning. After each session, it’s important to reflect on your experiences. We encourage patients to explore new thought patterns and behaviors. This active engagement helps solidify the positive changes initiated by ketamine. It’s an ongoing process that can significantly enhance the overall benefits of the therapy.
Psychotherapy and Counselling
At our clinics we believe that combining ketamine treatments with regular psychotherapy or counseling sessions can help extend and deepen the benefits of ketamine. These sessions provide a space to process the insights and emotional shifts that often occur during ketamine therapy.
It’s like having a guide to help you navigate a newly discovered landscape. Your therapist can help you make sense of your experiences and translate them into practical changes in your daily life.
We find that if patients have psychological content as part of their mental health condition that kettamine-assisted psychotherapy allows them to process more deeply and meaningfully, they tend not to require maintenance treatment as often, if at all.
If you are ready to maximize the benefits of your ketamine therapy, you may consider exploring ketamine-assisted psychotherapy. This powerful combination of ketamine treatment and specialized therapy can help you:
- Process and integrate your ketamine experiences more effectively
- Develop new coping strategies and thought patterns
- Address underlying issues contributing to your symptoms
- Create a personalized plan for sustained mental health improvement
At our clinic, we offer integrated ketamine-assisted psychotherapy programs tailored to your unique needs. Our experienced therapists work closely with our medical team to ensure you receive comprehensive, coordinated care that supports long-lasting positive change.
FAQ
You should not stop your other medications without consulting your doctor. Ketamine is often used for treatment-resistant depression and anxiety, it may interact with other drugs. Always discuss potential interactions and safety with your healthcare provider to ensure optimal treatment outcomes and avoid relapse.
The duration of ketamine treatment varies, typically involving 6 sessions over 3 weeks, with maintenance sessions as needed. Research indicates that ketamine’s antidepressant effects can be sustained with repeated dosing. Patients should consult healthcare providers for personalized treatment plans.
Not necessarily. For some patients, ketamine therapy serves as a ‘bridge’, providing relief while other treatments or life changes take effect. Others find long-term, periodic treatments beneficial. It’s less about being ‘on ketamine’ indefinitely and more about finding a sustainable rhythm of care.
Missing a scheduled ketamine treatment, can impact the efficacy. Patients may experience a relapse or worsening of symptoms due to disrupted dosing and administration. It’s crucial to consult with your healthcare provider to ensure safety and maintain the therapeutic effects of the treatment.
Ketamine treatment for depression typically involves an initial series of six infusions over 3 weeks, with dosing twice a week. This rapid-acting therapy is particularly effective for treatment-resistant depression. Maintenance infusions may be needed every two to four weeks to sustain effects and prevent relapse.
The antidepressant effects of ketamine typically last about one or two weeks after a single infusion, up to one month in some cases. For sustained improvement, repeated infusions are often necessary, extending the duration of effects to several months. This rapid efficacy is particularly beneficial for treatment-resistant depression and anxiety.
After a ketamine infusion, patients should be monitored for at least 1 to 2 hours to ensure safety and assess for any adverse effects. This monitoring period is crucial to observe the immediate effects of the treatment and manage any potential side effects like dissociation or changes in vital signs.
About the Author
Dr. Mario Nucci MD CCFP is a licensed Family Physician with a passion for mental health and the development of new therapies. He is actively engaged in research with a faculty associate professorship at Northern Ontario School of Medicine, and research collaborations with the University of Ottawa, University of Calgary, Lakehead University, Concordia University and Vancouver Island University.
Dr. Nucci is the founder of Bay and Algoma Health Centre in 2019, a walk-in and addiction medicine clinic. He founded the Canadian Centre for Psychedelic Healing in 2019, now operating as Field Trip Health, providing cutting edge mental health care in Toronto, Montreal, Vancouver, Ottawa, Hamilton, Kitchener-Waterloo, Thunder Bay, Sault Ste. Marie, and at-home.
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