Learn About Ketamine

What medical conditions do ketamine help with?
Ketamine, originally known for its use as an anesthetic, is increasingly being used to treat a variety of medical conditions, particularly in the realm of mental health. Some of the key conditions it is used for include:
  1. Treatment-Resistant Depression: Ketamine has shown promise in rapidly alleviating symptoms of depression, especially in individuals who have not responded to traditional antidepressants.
  2. Chronic Pain: It can be effective in managing chronic pain, particularly neuropathic pain, which is pain caused by nerve damage.
  3. Post-Traumatic Stress Disorder (PTSD): There is growing evidence that ketamine may help alleviate symptoms of PTSD.
  4. Anxiety Disorders: Some studies suggest ketamine can help reduce symptoms of anxiety, particularly in those with treatment-resistant anxiety.
  5. Obsessive-Compulsive Disorder (OCD): Ketamine might offer relief for OCD symptoms in certain cases, especially where traditional treatments have not been effective.
How does ketamine work?
Ketamine’s mechanism of action in treating mental health disorders, particularly depression, is complex and distinct from traditional antidepressants. Here’s an overview of how ketamine works in this context:
  1. NMDA Receptor Antagonism: Ketamine is primarily known as an NMDA (N-methyl-D-aspartate) receptor antagonist. By blocking these receptors, which are part of the glutamate pathway, ketamine affects neurotransmitter activity in the brain. Glutamate is the most abundant excitatory neurotransmitter in the brain, and its regulation is crucial for mood and thought patterns.
  2. Synaptic Connectivity: Research suggests that ketamine rapidly stimulates the growth of new synapses, the connections between neurons, in the brain. This effect is thought to be a crucial part of its rapid antidepressant action. Depression and chronic stress are believed to decrease synaptic connectivity, and ketamine appears to counteract this.
  3. Glutamate Surge: The blocking of NMDA receptors leads to an increased release of glutamate in certain areas of the brain. This surge in glutamate can then activate AMPA receptors (another type of glutamate receptor), leading to further downstream effects that contribute to neuroplasticity and mood regulation.
  4. Neurotrophic Factors: Ketamine has been shown to increase the levels of certain neurotrophic factors, such as brain-derived neurotrophic factor (BDNF). These factors are vital for neuron health, growth, and survival, and their increased presence is associated with improved mood and cognitive functions.
  5. Anti-inflammatory Effects: Some research indicates that ketamine may have anti-inflammatory properties, which could be relevant since inflammation is thought to play a role in some mental health disorders.
  6. Psychological Effects: The psychoactive effects of ketamine, such as a sense of disconnection from one’s immediate environment or altered perception, might also contribute to its therapeutic benefits in some patients, potentially providing new perspectives or insights.

The rapid action of ketamine in relieving symptoms, particularly in treatment-resistant cases, is one of its most notable aspects, as traditional antidepressants typically take weeks to become effective. Ketamine is still being studied and oral ketamine use at home is not FDA approved for any circumstance.

How long does the effect of oral ketamine last?
The duration of the effects of oral ketamine, especially when used for treating mental health conditions like depression, can vary significantly between individuals. Here are some general points to consider:
  1. Immediate Effects: The psychoactive effects of ketamine, which can include changes in perception, mood, and cognition, typically occur shortly after administration. These effects usually last for the duration of the drug’s active presence in the system, often a few hours.
  2. Therapeutic Effects on Mood Disorders: When used for depression or other mood disorders, the therapeutic effects of ketamine may last much longer than its immediate psychoactive effects. Some patients report relief from symptoms for days or even weeks after a single dose. However, this can vary widely among individuals.
  3. Duration and Frequency of Treatment: For sustained therapeutic benefit, repeated doses are often necessary. The frequency and total number of doses can depend on the individual’s response and the specific treatment protocol. Usually doses are taken several times a week for the first few weeks as a loading protocol. Doses are often then spaced out less frequently as a maintenance protocol. The providers at Flow Wellness will customize a dosage plan for your unique health needs.
  4. Individual Variability: The response to ketamine can be highly individualized, with factors like metabolism, body weight, and overall mental health status influencing how long its effects last.
  5. Formulation and Dosage: The formulation (e.g., lozenge, liquid, capsule) and dosage of oral ketamine also play a role in how long its effects last. Oral ketamine typically has lower bioavailability compared to other forms of administration, like intravenous (IV) or intramuscular (IM) injections, which means a larger dose may be required to achieve the same effect.
Do I need to see a therapist?
Yes, it’s highly advisable to see a therapist while undergoing ketamine treatments for several reasons:
  1. Integrated Care: Combining ketamine treatment with psychotherapy can provide a more comprehensive approach to mental health care. Ketamine can create windows of improved neuroplasticity and reduced symptoms, which can be particularly beneficial during therapy sessions.
  2. Processing Experiences: Ketamine can induce profound psychological experiences and altered states of consciousness. A therapist can help you process these experiences, integrate insights, and apply them constructively to your life and mental health challenges.
  3. Monitoring Mental Health: A therapist can monitor your mental health status throughout the course of ketamine treatments. They can provide valuable feedback on your progress and help adjust treatment plans as needed.
  4. Support and Guidance: Undergoing treatment for mental health conditions can be emotionally challenging. A therapist can offer support, coping strategies, and guidance through difficult periods.
  5. Safety and Well-being: A therapist plays a crucial role in ensuring your overall safety and well-being during treatment, particularly if you have a history of mental health disorders or are at risk of adverse reactions.
  6. Continuity of Care: After the completion of ketamine treatments, ongoing therapy can help maintain and build upon the improvements in mental health, providing long-term support and strategies to manage symptoms.
It’s important to coordinate care between the healthcare provider administering the ketamine treatments and your therapist to ensure the best possible outcome. Ketamine is most effective when combined with therapy and traditional treatments for depression and anxiety.
Will ketamine fix my depression?
Ketamine treatments will make you feel more resilient.  The stressors don’t change… what changes is your ability to cope & your willingness to engage in other treatments, both for mental health & physical health.
  1. Treatment-Resistant Depression: Ketamine has shown promising results in treating treatment-resistant depression, where individuals have not responded to other antidepressant medications.
  2. Rapid Symptom Relief: One of the notable aspects of ketamine therapy is its potential to provide rapid relief from depressive symptoms, often within hours or days, which is much faster than most traditional antidepressants.
  3. Not a Cure-All: While ketamine can be effective for some, it is not a guaranteed cure for depression and does not work for everyone. Its effects can be temporary, and ongoing treatment may be necessary.
  4. Combination with Other Treatments: Ketamine is often most effective when used in combination with other treatments, such as psychotherapy, lifestyle changes, and other medications.
  5. Variability in Response: Individual responses to ketamine can vary widely. Some people may experience significant improvements in their symptoms, while others may see more modest or short-lived benefits.
  6. Maintenance Therapy: After the initial treatment phase, maintenance or “booster” doses of ketamine may be required to sustain its antidepressant effects.
Why does someone else have to be present while taking ketamine?
Having someone to monitor you during a ketamine treatment is crucial for several reasons, primarily related to safety and the management of potential side effects:
  1. Psychoactive Effects: Ketamine can induce profound psychoactive effects, including altered perception, disorientation, and dissociation. These effects can impair your ability to respond to your environment safely and appropriately.
  2. Emotional Support: The experience of undergoing ketamine treatment can be intense and sometimes emotionally challenging. Having a healthcare professional or a trusted family member/friend present can provide emotional support and reassurance.
  3. Emergency Response: In the rare event of a medical emergency, having someone present ensures that immediate action can be taken, such as calling for emergency services.
  4. Guidance Through the Experience: Especially for those new to ketamine treatments, having a guide or supervisor can help in navigating the experience, providing instructions, or helping with relaxation techniques if needed.
  5. Post-Treatment Care: After the treatment, you might still be under the influence of ketamine’s effects and may not be able to drive or operate machinery. A responsible adult can ensure you get home safely and continue to monitor you as the effects wear off.
Flow Wellness offers guided ketamine treatments at our relaxing downtown clinic for an additional fee.
What are potential long term side effects of ketamine?
While ketamine has emerged as a promising treatment for certain mental health conditions, particularly treatment-resistant depression, it’s important to be aware of the potential long-term side effects associated with its use, especially when used frequently or in higher doses. These include:
  1. Cognitive Impairment: Long-term use of ketamine can potentially lead to cognitive deficits, including problems with memory, attention, and executive functioning.
  2. Urinary Tract Issues: Frequent ketamine use has been linked to urinary tract and bladder problems, such as ketamine cystitis. This condition can cause painful urination, increased urinary frequency, and in severe cases, bladder damage.
  3. Gastrointestinal Distress: Some individuals may experience gastrointestinal issues, such as abdominal pain and nausea, with long-term ketamine use.
  4. Psychological Dependence: There is a risk of developing psychological dependence on ketamine, particularly in individuals with a history of substance misuse.
  5. Tolerance: Over time, individuals might develop tolerance to ketamine, meaning higher doses are required to achieve the same therapeutic effect, which can increase the risk of side effects.
  6. Mood Changes: While ketamine is used to treat mood disorders, long-term use can sometimes lead to mood swings, irritability, or depression.
  7. Liver Function: Chronic use of ketamine may have an impact on liver function, though this is more commonly associated with high doses or abuse of the drug.
  8. Cardiovascular Effects: Ketamine can increase blood pressure and heart rate, which might have implications for long-term cardiovascular health, particularly in individuals with pre-existing heart conditions.
Could ketamine make me feel worse?
Yes, it is possible for medical ketamine treatment to have adverse effects or not work as intended for some individuals, potentially worsening symptoms or leading to new issues. Here are some potential risks and considerations:
  1. Exacerbation of Symptoms: In some cases, ketamine may not alleviate depression or other targeted symptoms and could potentially exacerbate them. This can vary greatly from person to person.
  2. Psychological Effects: Ketamine can induce dissociation and altered states of consciousness, which some individuals may find distressing or disorienting. For some, these experiences can be unsettling or lead to increased anxiety or other psychological symptoms.
  3. Potential for Abuse: Ketamine has a potential for misuse and addiction. Even when used medically, there is a risk of developing a psychological dependence on the drug, particularly in individuals with a history of substance abuse.
  4. Side Effects: Like all medications, ketamine can have side effects, including nausea, dizziness, increased heart rate, elevated blood pressure, and cognitive impairment. These side effects can be uncomfortable and may outweigh the benefits for some individuals.
  5. Interactions with Other Conditions: Ketamine may not be suitable for individuals with certain medical conditions, such as uncontrolled high blood pressure, heart disease, or a history of psychosis.
  6. Uncertainty in Long-term Effects: The long-term effects of ketamine treatment, especially for mental health, are still being researched. There is some uncertainty about the risks associated with prolonged or repeated use.
Who shouldn't use ketamine?
Medical ketamine treatment may not be suitable for everyone, and certain individuals should be cautious or avoid it altogether due to potential risks or contraindications. Here are some groups who should generally not undergo medical ketamine treatments:
  1. Individuals with a History of Substance Abuse: Given ketamine’s potential for misuse and psychological dependence, individuals with a history of substance abuse or addiction should be cautious. Ketamine treatment may pose a higher risk for relapse or developing a new substance use disorder.
  2. Those with Certain Psychiatric Conditions: People with a history of psychosis or psychotic disorders, such as schizophrenia, should generally avoid ketamine, as it can potentially exacerbate these conditions.
  3. People with Uncontrolled High Blood Pressure or Heart Disease: Ketamine can increase blood pressure and heart rate, which may pose risks for individuals with uncontrolled hypertension or pre-existing heart conditions.
  4. Pregnant or Breastfeeding Women: The effects of ketamine on pregnancy and breastfeeding are not well-studied, so it is typically avoided in these situations.
  5. Individuals with Severe Liver Disease: Since ketamine is metabolized in the liver, those with severe liver impairment may have difficulty processing the drug, leading to increased risk of toxicity.
  6. People with a History of Severe Urinary Tract Issues: Due to ketamine’s association with urinary tract and bladder problems, individuals with a history of these issues should be cautious.
  7. Those with Certain Allergies or Sensitivities: If an individual has a known allergy or sensitivity to ketamine or related compounds, they should avoid its use.
What if I have heard bad things about ketamine?
If you don’t think ketamine will work, then it won’t work. You must tell yourself that the ketamine is making changes in your body, it’s healing your synapses that have become damaged through stress over time. Sometimes the changes are subtle & you may not pick up on those small clues that things are improving. 
The improvements have been described by some as “sliding a dimmer switch” rather than “flipping a switch”… things may brighten slowly!
Do you take insurance?
Oral ketamine use is not FDA approved and typically not covered by insurance. Flow Wellness does not process insurance. We do take FSA/HSA payments and can provide a superbill to give to your insurance company.


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