Understanding Ketamine: What Is It?
How Does Ketamine Work in the Brain?
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Medical and Psychiatric Applications
- Treatment-Resistant Depression (TRD): Ketamine is a breakthrough treatment for patients with major depressive disorder who have not responded to traditional selective serotonin reuptake inhibitors (SSRIs).
- Rapid Pain Management: Due to its potent analgesic properties, sub-anesthetic doses of ketamine are used in emergency rooms and specialized clinics to treat severe acute and chronic pain conditions, including neuropathic pain and fibromyalgia.
- Suicidal Ideation: Clinical studies indicate that ketamine infusions can rapidly reduce acute suicidal ideation, often within hours of administration, providing a critical window for ongoing psychiatric care.
- Procedural Sedation: Because it preserves respiratory drive and blood pressure better than many other sedatives, it remains a preferred medication for short procedures and rapid sequence intubation in emergency and pediatric care.
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- Intravenous (IV) Infusion: The most common method in specialized clinics, IV infusions deliver the medication directly into the bloodstream under medical supervision. This allows for precise control of the dose and immediate cessation if needed.
- Intramuscular (IM) Injection: This involves injecting the medication into a large muscle, resulting in rapid systemic absorption.
- Intranasal Spray: A specific formulation (esketamine) is approved by health authorities for use alongside oral antidepressants in adults with treatment-resistant depression.
- Oral Forms: Compounded sublingual or oral ketamine lozenges are sometimes used in at-home or clinic-based maintenance therapy, although their bioavailability and safety profiles are different from IV administration.
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Side Effects and Risks
- Dissociation, feeling detached from one’s body or reality
- Mild increases in heart rate and blood pressure
- Dizziness, nausea, or vomiting
- Blurred vision and involuntary rapid eye movement
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