For decades, ketamine was best known as an anesthetic used in surgery and emergency medicine. Now, it’s being offered in clinics across the US as a therapy for depression, anxiety, and post-traumatic stress disorder. Its rise in psychiatric care has sparked both excitement and controversy.
Doctors are increasingly recommending ketamine treatment, especially for patients who don’t respond to conventional medications. In this article, we’ll cover what ketamine therapy involves, why it’s gaining traction in psychiatry, and the debates surrounding its use. Let’s get started.
What ketamine treatment is and why doctors recommend it
Ketamine treatment typically involves intravenous infusions delivered over several weeks, sometimes followed by maintenance sessions based on individual response. More recently, the FDA approved esketamine, a nasal spray derived from ketamine, for treatment-resistant depression.
What makes this therapy stand out is its speed. Traditional antidepressants can take weeks to have an effect, but ketamine often reduces symptoms within hours or days. For people living with severe depression or suicidal thoughts, that rapid relief can be life-changing.
Doctors are also recommending it for conditions beyond depression. Clinical use has expanded to post-traumatic stress disorder (PTSD), certain anxiety disorders, and even chronic pain. The American Society of Anesthesiologists and several psychiatric associations have issued guidance supporting its use in carefully monitored medical settings.
For patients who feel stuck after trying multiple medications, ketamine offers a different mechanism of action. Instead of targeting serotonin, it affects the brain’s glutamate system, which plays a role in mood regulation and neuroplasticity. That difference may explain why it works for people who haven’t found relief elsewhere.
The debates and risks around ketamine therapy
While the benefits are promising, ketamine therapy comes with ongoing debates. Experts warn that its long-term effects are still not fully understood. Here are some of the main concerns:
- Potential for abuse: Ketamine has long been known as a club drug, and its dissociative effects raise concerns about dependency if not carefully controlled.
- Side effects: Patients may experience high blood pressure, nausea, or perceptual changes during infusions. Respiratory issues are also possible if it’s not administered properly.
- Lack of long-term data: Research supports short-term benefits, but there’s limited evidence on how safe and effective ketamine remains after years of use.
- Accessibility and cost: Ketamine infusions are often not covered by insurance, making them expensive and out of reach for many people who might benefit.
- Ethical concerns: Some question whether expanding ketamine use too quickly risks exposing vulnerable patients to treatments that aren’t fully studied.
Despite these issues, updated guidelines from groups like the Royal Australian and New Zealand College of Psychiatrists now advise psychiatrists on when and how to integrate ketamine into psychiatric care. Experts stress that it should only be administered in medical settings with proper monitoring.
Ketamine therapy is not a cure-all, but its ability to bring fast relief where other treatments fail explains why more doctors are recommending it. The challenge ahead is balancing that potential with careful use, strong safeguards, and ongoing research to answer the questions that remain.