Ketamine Treatment Side Effects to Know Before Starting Therapy

Did you know that ketamine, a medication commonly used as an anesthetic in surgery, is also treating severe depression, anxiety, and chronic pain? In a study conducted by Massachusetts General Brigham, 55% of patients with treatment-resistant depression and major depressive disorder experienced a significant improvement in symptoms after ketamine treatment. 

In my experience working in ketamine therapy centers around North America, I’ve seen the positive impact this therapy can have on those who have struggled to find relief through traditional treatments. However, having a full understanding of potential ketamine treatment side effects is essential when exploring your options. 

What is Ketamine Therapy?

As a family physician working at a ketamine therapy clinic, I often find myself introducing this fascinating medication to patients seeking alternative treatments for treatment resistant depression, anxiety, and chronic pain. 

Overview of Ketamine

When most people think of ketamine, they might picture a powerful medicine used in hospitals. And it’s true, ketamine is an excellent tool for anesthesia, thanks to its ability to quickly and safely render patients unconscious. But that’s just the tip of the iceberg.

Ketamine therapy has shown remarkable promise in treating a variety of health conditions, such as:  

• treatment-resistant depression
• post-traumatic stress disorder (PTSD)
• substance use disorders
• anxiety
• trauma
• addiction
• chronic pain
• eating disorder
• bipolar depression
• obsessive compulsive disorder (OCD)

It can provide rapid relief from symptoms, often within hours or days of treatment, compared to traditional antidepressants like selective serotonin reuptake inhibitors (SSRIs) that need weeks or months to take effect. For patients with suicidal thoughts and who self harm, the rapid effect of ketamine therapy can be life saving.

Mechanism of Action of Ketamine

Ketamine is a unique medication that works differently from most other drugs used to treat mental health conditions. Its primary mechanism of action involves blocking a specific type of receptor in the brain called the N-methyl-D-aspartate (NMDA) receptor.

NMDA receptors are activated by glutamate, one of the most important neurotransmitters in the brain. Glutamate plays a crucial role in regulating mood, learning, memory, and the way we process information. 

When glutamate binds to NMDA receptors, it triggers a complex cascade of events that can lead to the formation of new neural connections, called neurogenesis. In some mental health conditions like depression and PTSD, the normal process of neurogenesis is thought to be dysregulated.

By blocking NMDA receptors, ketamine can temporarily reduce the activity of glutamate and create a sense of dissociation or detachment from one’s surroundings.

Now, I know the dissociative effects might sound a bit scary, but it’s actually a key part of ketamine’s therapeutic effects. It’s like hitting a “reset” button in the brain, giving patients a chance to break free from negative thought patterns and emotional cycles of major depression.

As noted, by blocking NMDA receptors, ketamine induces neurogenesis. This is from increasing the activity of another important neurotransmitter called brain-derived neurotrophic factor (BDNF). BDNF is like a “fertilizer” for the brain, promoting the growth and survival of new neurons and synapses.

This increase in BDNF activity plays a key role in ketamine’s rapid antidepressant effects. By stimulating the growth of new neural connections, ketamine therapy may help “rewire” the brain in a way that promotes resilience and emotional well-being. 

This is why many patients report feeling a sense of clarity, purpose, and renewed energy after ketamine treatment, even if their symptoms have been resistant to other medications.

By blocking NMDA receptors, increasing BDNF activity, and promoting the growth of new neural connections, ketamine can create a profound shift in brain chemistry that can lead to rapid and lasting improvements in mood, anxiety, hard to treat depression and overall well-being. And for patients who have struggled to find relief through other treatments, that can be a truly life-changing experience.

Possible Side Effects of Ketamine Treatment

As a physician who has worked extensively with ketamine treatment, I believe it’s crucial to have an open and honest discussion about the potential side effects of this medication.

Common Ketamine Treatment side effects

Most side effects of ketamine therapy are very mild and short-lived. Here is a table summarizing the common side effects of ketamine treatment and how we manage them at our clinics:

Side Effect	Description	Management
Dizziness	Feeling unsteady or lightheaded- Sense of spinning or vertigo- Usually mild and short-lived	Awareness of potential dizziness- Avoid driving or operating machinery until dizziness subsides (at least until the following day)
Nausea and Vomiting	Related to ketamine’s effects on the brain’s perception of body position and movement- Can trigger a feeling of motion sickness	Anti-nausea medications can help manage symptoms- Nausea usually passes quickly after the infusion
Disorientation and Confusion	Feeling “spacey” or disconnected from surroundings- Difficulty following conversations or remembering events during ketamine infusion- Generally short-lived	Ensured safe, supervised environment during treatment
Fatigue	Feeling tired or exhausted after ketamine  infusion- Normal part of the therapeutic process as the brain integrates new neural connections and changes in brain chemistry	A good night’s sleep after treatment usually leaves patients feeling refreshed and rejuvenated
Temporary Increase in Anxiety or Hallucinations	Can be unsettling but is a direct effect of the medication- Will pass as the drug leaves the system	Close monitoring during infusions to ensure patient safety and comfort- The vast majority of patients do not find these experiences to be unduly distressing

Less Common and Rare Ketamine Treatment Side Effects

Ketamine treatment is generally considered safe and well-tolerated but there may be some less common or rare side effects. However, with the experience, support, and guidance from a specialized ketamine treatment clinic, you can navigate these challenges and continue ketamine treatment with confidence.

Side Effect	Description
Hallucinations and Perceptual Disturbances	Some patients might experience hallucinations or perceptual disturbances during treatment. It’s like suddenly finding yourself in a vivid, dreamlike landscape. While this can be startling, remember that it’s a direct effect of the medication and will pass as it leaves your system.
Increased blood pressure	Some patients may have an increase in blood pressure, usually mild at most 10mmhg systolic. We monitor blood pressure before and after treatment and screen patients for conditions that a small change in blood pressure may worsen. The increase in blood pressure goes away as the effects of the medicine wears off in about an hour
Visual Disturbances	Double vision can occur, making the world look like a 3D movie without the glasses. It’s temporary, but we always ensure you’re in a safe environment until it passes.
Changes in Appetite and Salivation	Loss of appetite or excessive salivation can happen. Your body might decide it’s not dinner time, or suddenly think it’s preparing for a feast. These effects typically resolve quickly after treatment.
Eye Tearing	Your eyes might decide to throw a little water party. It’s usually nothing to worry about, but we’re always here to ensure your comfort.
Emotional Responses	In rare cases, patients might experience severe anxiety or panic attacks. It’s like your emotions suddenly turning up the volume. Our team is trained to help you through these intense moments with care and expertise.
Allergic Reactions	Although rare, allergic reactions can occur. It’s like your immune system getting a bit too enthusiastic about the treatment. We’re always prepared to handle these situations if they arise.
Bruising	Sometimes patients experience bruising at the injection site. This is only associated with approved IV ketamine. Ketamine clinic healthcare providers can offer FDA approved nasal spray ketamine called esketamine or other approved compounded ketamine products that do not bruise like IV ketamine.

Potential Long-Term Ketamine Treatment Side Effects

As a family physician deeply involved in ketamine-assisted psychotherapy I regularly explain potential long-term ketamine side effects to patients. It’s important to note that these serious side effects are associated with club drug ketamine and NOT with low dose ketamine infusion or ketamine-assisted psychotherapy provided in a professional ketamine clinic.

Cognitive Impairment: Memory and Concentration Issues

I know cognitive impairment sounds a bit scary – like your brain deciding to take an extended vacation without your permission. But let’s break it down a bit.

Some patients have reported changes in memory and concentration with long-term high dose ketamine use in non clinical settings. 

However, it’s important to note that these effects are typically associated with frequent use and larger doses, which  is NOT how we approach ketamine treatment at Field Trip Health clinics. We’re more like gentle gardeners, carefully tending to your mental health, not overzealous landscapers trying to reshape everything at once.

Urinary Tract and Bladder Problems

With frequent, long-term ketamine use, some individuals have experienced urinary tract and bladder issues.

Symptoms can include increased frequency of urination, pain while urinating, or in severe cases, damage to the bladder lining. But don’t panic! These issues are primarily associated with recreational use or very high doses over extended periods. In our controlled medical setting, we keep a close eye on things to ensure your bladder stays happy and calm. Ketamine cystitis has not been reported in clinical trials of ketamine for mental health conditions.

Psychological Dependence or Addiction

Now, let’s talk about a topic that often comes up when discussing any medication: dependence. The word ‘addiction’ can sound like a big, scary monster under the bed, but in the context of ketamine therapy, it’s more like a very rare, very shy creature that we almost never see.

Psychological dependence or addiction to ketamine is extremely uncommon in controlled medical settings like ours. We’re providing carefully monitored, therapeutic doses. It’s like the difference between enjoying a slice of cake at a birthday party and trying to live on nothing but cake. One’s a treat, the other’s a recipe for disaster.

Tolerance, requiring higher doses to achieve the same effect

Last but not least, let’s chat about tolerance. In medical terms, tolerance means needing higher doses of a medication to achieve the same effect over time.

Some patients may develop a tolerance to ketamine with long-term use. It’s as if your body is saying, “Oh, this again? I’m used to it now, you’ll have to do better than that.” This could potentially lead to needing higher ketamine doses to maintain the therapeutic effects.

But don’t worry – this isn’t a runaway train. At the Field Trip Health clinics, we closely monitor each patient’s response to ketamine treatment. If we notice signs of tolerance developing, we can adjust our approach. Sometimes, this might mean taking a little break from ketamine treatment.

Remember, while these potential long-term ketamine side effects are important to be aware of, they’re not inevitable. Many of our patients undergo ketamine treatment without experiencing these issues. Our job is to work with you, monitor your progress, and adjust your treatment plan as needed to maximize benefits while minimizing risks.

Precautions and Interactions

When it comes to ketamine treatment, an ounce of precaution is worth a pound of cure. Just like you wouldn’t set off on a hike without checking the weather forecast and packing appropriate gear, you shouldn’t embark on ketamine treatment without first having a thorough discussion with your healthcare team.

Before Undergoing Ketamine Treatment

Think of this pre-treatment conversation like a trail planning meeting but in a certified health care provider’s office. Just as you’d map out your route and make note of any potential hazards before a hike, health care providers need to review your medical history, current medications, and any allergies or sensitivities before starting ketamine treatment.

This is especially important if you have any pre-existing health conditions that could interact with ketamine like high blood pressure.

Other mental health conditions like bipolar disorder or a history of substance abuse are also considered before receiving ketamine. It’s important to be honest with your doctor to avoid serious ketamine side effects.

Your current medication list is like your packing list for the journey. Just as you wouldn’t want to pack items that don’t serve you or that could weigh you down, you’ll want to review your medications with your doctor to avoid unwanted effects.

Some medications, especially other central nervous system (CNS) depressants like opioids or benzodiazepines, can interact with ketamine and cause adverse events.

In a Field Trip Health clinic we provide the medical supervision of a hospital setting without the added stress. Our team monitors vital signs and stays alert for any adverse reactions like trouble breathing, dizziness, nausea, confusion, changes in blood pressure or increased heart rate.

So before you set off on this treatment journey, take the time to plan, prepare, and communicate with our medical professionals at Field Trip Health. With the right precautions and support, you can navigate the trail of ketamine treatment with confidence, moving towards better health and well-being, one step at a time.

FAQ

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.