Ketamine for Depression

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What is Intramuscular Ketamine Therapy?

Intramuscular (IM) Ketamine Therapy is an outpatient treatment that involves intramuscular injections of ketamine to treat psychiatric conditions such as major depressive disorder (MDD). While the exact mechanisms are not fully understood, ketamine likely functions as a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist.¹ Ketamine was first shown to function similarly to antidepressants in 1975.²

The different types of ketamine treatments are explained below:

• Intramuscular (“IM”): A single injection of ketamine is given into one of your larger muscles, such as the thigh or arm. This procedure is delivered in a hospital or clinical setting and lasts around 40 minutes with 80 minutes of additional observation time. Available at select Athena Care locations.
• Intranasal: Esketamine (Spravato) nasal spray is the only FDA-approved ketamine medication for treatment-resistant depression (TRD). TRD is a type of major depressive disorder that hasn’t responded to at least two medications. Spravato must be taken in a doctor’s office, and for two hours afterward, you must be observed for any side effects. Available at select Athena Care locations.
• Intravenous (“IV”): Intravenous ketamine treatments must be administered at medical facilities or mental health treatment clinics. Sessions typically last about 40 minutes with 80 minutes of additional observation time.
• Troche (also known as a lozenge): Troches are oral medications that can be administered at home or in a clinic environment. They can be recommended as the primary course of treatment or as a preventative precaution between intramuscular, intravenous, or intranasal approaches.

Uses of IM Ketamine Therapy

Several mental health disorders can benefit from ketamine therapy. However, this medication is most frequently used for patients with treatment-resistant depression (TRD). TRD describes people who suffer from depression and have tried two or more antidepressants from different medication classes without experiencing significant symptom relief.

Ketamine may benefit the following conditions:

• Treatment-resistant depression
• Acute suicidality³
• Chronic suicidality
• Post-traumatic stress disorder (PTSD)
• Anxiety disorders (such as treatment-refractory social anxiety disorder and generalized anxiety disorder)
• Depressive episodes in bipolar disorder
• Chronic pain
• Obsessive-compulsive disorder (OCD)
• Addiction
• Eating disorders

How Does IM Ketamine Injection Work?

While the precise mechanism of action of ketamine on treatment-resistant depression is not fully understood, it is believed that ketamine sets off a complex series of events that prompts the brain to form new neural connections. Thanks to these newly formed neural pathways, you can develop more uplifting thoughts and behaviors. This contrasts with conventional antidepressants, which only function while they are present in the body.⁴

If you’d like more information about how ketamine may work to improve depression symptoms, this video from Yale School of Medicine Department of Psychiatry is thorough and engaging.

IM Ketamine Therapy Process

Although every patient’s experience may vary slightly, most intramuscular ketamine treatments are the same. During your initial ketamine therapy session, you’ll meet with a clinician who will assess whether or not you are a good candidate for treatment with ketamine. If it’s determined you are a good candidate, you will discuss ketamine, your treatment plan, and the risks and advantages of intramuscular ketamine therapy.

A doctor or nurse will administer the ketamine injection. During treatment, a medical assistant will monitor your blood pressure, oxygen levels, and pulse.

You may experience pleasant feelings or a sense of disconnection from reality. If you feel queasy, the doctor or nurse may administer an anti-nausea medication. Throughout the course of the ketamine treatment, medical assistants will be on hand to respond to any questions or concerns you may have.

Although every patient reacts differently, the effects of ketamine may still be felt after treatment concludes. Most patients need 30 to 45 minutes to recover from the medication’s effects with an additional 90 minutes of observation. It is unsafe and unlawful to drive after intramuscular ketamine therapy; therefore, you will need to make transportation arrangements.⁵

You will typically receive a series of six injections spread out over three weeks. Each injection session takes 45 to 55 minutes, but you should allow approximately 2 hours for the entire visit. Ketamine treatment typically requires booster doses following the conclusion of your initial six-treatment series, the frequency of which is based on the patient’s treatment plan.

Pros & Cons of IM Ketamine Therapy

Pros

• Rapid symptom relief (for many, but not all, patients)
• High success rates
• Long-term symptom remission for many patients (especially for those who follow the prescribed treatment schedule)

Cons

• Dissociative effects
• Potentially addictive⁶

Side Effects of IM Ketamine Therapy

Although the dosage of ketamine used in intramuscular ketamine therapy is lower than that used in anesthesia, some adverse effects may be similar. Side effects of ketamine frequently disappear by the time the injection session is finished or within a few hours.

The following are the most common potential side effects of intramuscular ketamine therapy:

• Confusion
• Dissociation
• Dizziness
• Double Vision
• Drowsiness
• Fatigue
• Nausea
• Paranoia
• Reduced Appetite

When is IM Ketamine Therapy Right for You?

If traditional depression therapies haven’t helped your symptoms, and you’re in good physical health, ketamine therapy could be a beneficial option for you. Remember that ketamine is not a first-line treatment for depression and is typically only used when other, more established treatments have failed.⁷

Although many people handle ketamine therapy well, it may not be a good choice if any of the following factors are true for you:⁸

• You have schizophrenia
• You have uncontrolled high blood pressure
• You have aneurysmal vascular disease or stroke
• You have cardiac/pulmonary issues
• You have glaucoma
• You’ve recently undergone eye surgery
• You have a history of substance abuse
• You are pregnant or breast-feeding
• You’re an older adult with symptoms of dementia
• You’re a teenager

Cost & Insurance Coverage for IM Ketamine Therapy

Costs for ketamine injections range from $200 to $500 for each injection, depending on the physician, location, dosage, length of injection, the illness being treated, and other services provided. Most facilities administer a course of 6-8 injections over 2 to 4 weeks. For a complete course of IM ketamine treatment for depression, you could pay between $1,200 and $4000, depending on the cost of each injection.

Athena Care charges $350 per ketamine injection.

Ketamine prescribed for Treatment-Resistant Depression is an ‘off-label’ use of the medication, meaning the FDA does not include this use of the medication as an ‘approved indication.’⁹ Medications can be prescribed for ‘off-label’ uses when there is clinical literature supporting the use of the medication for specific indications. Consequently, most insurance companies do not cover ketamine injection therapy for mental health conditions. The FDA has approved esketamine (Spravato) for mental health conditions which can be covered by insurance subject to certain conditions including prior authorization. Coverage specifics will vary, depending on many factors, including your insurance provider and your location.

Athena Care conveniently offers outpatient mental health services throughout Tennessee. We are also in-network with most major insurance plans. Our highly skilled care coordinators will handle the difficulties of contacting your insurance provider for more information about IM ketamine therapy in Tennessee. When you contact us, a care coordinator will review your policy and thoroughly explain your options. You may rest assured that all information discussed and exchanged will be kept private.

Why Choose Athena Care for IM Ketamine Therapy

• Care supervised by psychiatrists and mental health nurse practitioners
• Comfortable, safe environment
• Conveniently located clinics (Nashville, Franklin, Murfreesboro)
• 20+ year record of providing mental health services
• Other mental health services available on site such as psychological assessments, individual therapy, group therapy, and medication management

To book a consultation or contact a specialist for more information,
please call or text 1-866-530-5226 or
email [email protected].

Success Rates, Goals & Outlook of IM Ketamine Therapy

In five placebo-controlled clinical trials over 13 years, 163 patients with major depressive disorder or bipolar disorder and 25 healthy controls provided information on side effects to the NIMH Intramural Research Program (IRP). The NIMH IRP assessment looked at potential side effects, such as headaches, dizziness, fatigue, and dissociative sensations.

Thirty-four of the 120 potential side effects that were examined were shown to be strongly linked with ketamine infusion therapy. Eight of them—feeling unusual, weird, or peculiar; feeling spacey; feeling woozy/loopy; dissociation; floating; visual distortions; difficulty speaking; and numbness—occurred in at least half of the subjects. Fortunately, none lasted longer than four hours. A three-month follow-up revealed no evidence of drug-related major adverse events, urges, an inclination for recreational use, or substantial cognitive or memory losses.¹⁰

Additionally, researchers at the Icahn School of Medicine at Mount Sinai found that repeated ketamine treatment significantly reduces symptom severity in people with chronic PTSD. The recovery was quick and sustained for several weeks.¹¹

Furthermore, while not everyone will respond to IM Ketamine, some studies have shown a rapid reduction in depressive symptoms and suicidal thoughts in patients with TRD. These effects can last for up to one week. Interestingly, intermittent, repeated infusions can extend ketamine’s antidepressant effects and result in stronger therapeutic results than a single infusion.¹²

Overall, the effectiveness of IM ketamine therapy is promising and clinical studies have produced successful results. If IM ketamine therapy is administered one to three times, those who feel some relief from depression will likely continue to benefit from it for several more sessions. Instead of producing a more significant reduction in symptoms, the successive sessions may help sustain the positive effects of ketamine.¹³

Even though some studies have resulted in patients experiencing complete remission in reducing their symptoms, additional research is needed.