Ketamine Patient Information

What is Ketamine?

Ketamine is a medication that has been widely used as an an anesthetic since 1970 in humans and animals. In addition to its properties as an anesthetic, ketamine has shown effectiveness in treating people with pain conditions and more recently psychiatric conditions, particularly depression, Anxiety and Post Traumatic Stress Disorder (PTSD).

We reserve the right to refuse treatment to anyone we deem not appropriate for Ketamine Assisted Therapy due to medical or mental health reasons.

How does Ketamine work?

We do not fully understand ketamine’s mechanisms of action, and, in fact, there are likely many different mechanisms of action. What we do know is that Ketamine is an NMDA antagonist. It blocks the NMDA receptor from being activated by glutamate in the brain. Ketamine appears by various mechanisms to initiate rapid growth of connections between neurons (brain cells)-or “neurogenesis”; however, another mechanism seems to be related to shift in state of consciousness (aka non-ordinary states of consciousness) that can occur in a dose-dependent fashion.

These shifts in consciousness can range from very mild to profound and can be very therapeutic. The benefits of these changes are very likely accentuated by the addition of psychotherapy and lifestyle changes. Non-ordinary states of consciousness may also be used to augment the process of psychotherapy, i.e., Ketamine Assisted Psychotherapy.

What does a trial of Ketamine involve?

The dose of ketamine will be self-administered in one of the treatment rooms in the clinic, at which point instruction for how to take it either under the tongue, via a lozenge, or intra-nasal spray-will be given. You will be placed in a recliner with a pillow and blanket, along with an eye mask and noise cancelling headphones playing a curated play list. We ask that you remain seated for at least an hour after use, as light-headedness may occur. You will be under the monitoring of a clinic “guide/sitter” who is there to monitor you for adverse reactions and/or provide support if the experience is challenging. 

The medicine will start working after approximately 10 minutes, and the effect will mostly wear off within about 60 minutes, after which time you will be cleared by the “guide/sitter” and given a snack. You will then attend a psychotherapy appointment immediately after the experiential portion or 24 to 48 hours later. You will be able to leave with the support of a family member or support person. You will not be able to operate a motor vehicle or navigating public transportation after any of the ketamine treatment sessions, so please have a ride arranged.

What happens after the trial dose?

Once the treatment team reviews your experience of the trial dose, with your input, we will recommend a course of treatment and psychotherapy sessions to help with the process of integration. Due to the highly individualized nature of this type of treatment, each course of treatment will be created, monitored, and adjusted to reflect each client’s needs. We are a collaborative, multidisciplinary program so this decision involves your input as well as the recommendation of everyone on the team.

What benefits can I expect?

No treatment can be guaranteed to be of benefit or free of side-effects, however, Ketamine therapy at judicious doses in well selected people seems to be very well-tolerated, and exceptionally effective for treatment refractory mental health conditions such as depression.

Around 70% of people in clinical trials have reported significant improvement in psychiatric symptoms, and in many cases, ketamine can effectively lead to resolution of symptoms, or what is known as remission. The duration of beneficial effects is an important issue, as the effects of ketamine itself can be transitory-typically from a few days to weeks, which may lead to ongoing treatment with the medicine. However, the thinking is that if the ketamine is used in conjunction with psychotherapeutic work and lifestyle interventions, transitory improvement can be turned into enduring change.

It is important to understand that the benefits of ketamine assisted psychotherapy (or any psychedelics) not be attributed to the molecule, as a “magic pill” but it is understood that the gains made relate to the effort clients put into integrating their journeys and build positive habits to move forward in their healing.

What are the side effects?

Patients may experience a sensation of being “unreal”, or “far away”, which may be pleasant or occasionally unpleasant, and which should last only a short while before fading away. However, to be on the safe side patients are advised to abstain from driving or any potentially hazardous activities until after a night’s rest. Sleepiness may occur after treatment, and patients eventually may take Ketamine near bedtime.
If you have a large dose of Ketamine, or are unusually sensitive to its effects, you may have intense feelings, anxiety, and a visually intense experience. These can be thought of as a “psychedelic” experience, and there is typically some value and meaning behind these experiences. It is one of the ways things are processed and it’s to the clients benefit to understand these experiences holistically; physically, cognitively, spiritually. You may also have some intense dreams after your session.
It is important to understand that these medicines are thought to connect us with our inner healers, and we don’t need to be “in charge”, think our way through or be in control to make healing happen. Often the best way to approach this type of treatment is to surrender to the medicine, and to your inner healer. This is also why we stress the importance of a good integration plan which is holistic and ongoing; this will be co-created with your multidisciplinary treatment team.
Though we do not know everything about the long-term effects of taking Ketamine, data is accumulating rapidly. Some studies suggest that there may be difficulties with memory or thought processing. There are also possible effects on liver or bladder, but these are considered very unlikely at low doses for psychiatric purposes. Such adverse effects seem to occur to people who take high doses of ketamine for long periods of time for non-medical purposes (ketamine abuse). Reports of such side effects, or of addiction or dependence to ketamine in people using it for medical purposes seem to be very rare.
Nausea is a relatively uncommon side effect, and if it occurs may be treated simply with an anti-nauseate medication. Ketamine is associated with modest and transient increase in blood pressure with could be dangerous in those prone to cardiac issues or neurological issues associated with increased intracranial pressure.
Though we have found ketamine to be physically safe and well tolerated, it is a powerful medicine and can open the patient up emotionally or even lead to a sense of feeling overwhelmed. Therefore, developing a secure and open alliance with the treatment team is crucial for working through any powerful emotions or experiences that might arise. It is therefore important that patients not hesitate to reach out with questions or concerns as they arise.

Off-Label status

Generic (racemic) ketamine has not been licensed by Health Canada for psychiatric use, though a specific form of ketamine (s-ketamine, or “Spravato”) has been licensed for use in Canada and the USA for depression. Generic ketamine, which may be equally safe and effective, as well as more affordable and versatile, is, therefore, considered an “off-label” application of the medicine.

Many drugs are not formally approved for use in specific conditions but are used none the less where they appear to be safe and effective for a particular condition. It is very common that a pharmaceutical company will not apply for a license for a specific drug for a specific indication because the studies needed to support such applications are too time- consuming or expensive, as is  the case for generic drugs such as ketamine. Although in the case of unlicensed drugs the patient must take the drug at their own risk after informed consent, generally the risk may not be great when compared to the benefit that is expected to be associated with the drug, or compared with alternative treatment, or even no treatment at all. In the case of generic ketamine, this risk-benefit analysis should be assessed carefully with your physician after thoughtful discussion of risks and benefits.

You should never feel pressured into the decision to take any mediation. It’s important that you not proceed with ketamine or any other off-label intervention until you are satisfied that you appreciate the associated risks and benefits and you have had all your questions and concerns satisfactorily answered by your physicians.

We invite you to speak with the members of our team if you have concerns at any time during your treatment. We are here to support you through the program.

Have additional questions?

Any further questions you may have should be answered to your satisfaction before you decide to have a trial of ketamine. Please remember that the treatment team are there to answer any questions which will allow you to make an informed decision about this novel treatment for your condition.