Use of anesthetic in mental health treatment shows promise; must be administered when proper infrastructure and adequate follow-up possible.
Published Jan 01, 2025 | 7:00 AM ⚊ Updated Jan 01, 2025 | 7:00 AM
Mental health awareness has grown significantly in recent years, with more individuals seeking professional help to address the challenges they face.
From therapy sessions to prescribed medication, the focus has shifted to destigmatising mental healthcare so people do not feel reluctant to seek help when they need it.
However, despite these positive strides, many individuals find that traditional treatments fail to provide sufficient relief.
Therapy may not always address the root of their struggle, and even the most commonly prescribed medication may fall short, leaving patients searching for alternative solutions.
In this context, ketamine therapy has emerged as a beacon of hope for those battling treatment-resistant mental health conditions.
Originally developed as an anesthetic, ketamine is now being repurposed as a therapeutic tool for managing severe depression, anxiety, Post-traumatic stress disorder (PTSD), and other chronic mental health issues.
Its unique ability to provide rapid relief — often within hours or days — sets it apart from traditional antidepressants, which can take weeks to show results.
Ketamine therapy centres are gaining popularity across the state as they offer a new lease on life to individuals who have exhausted other options.
These centres provide a structured environment where patients can receive carefully monitored ketamine infusions, nasal sprays, or oral treatments.
The therapy’s ability to enhance neuroplasticity and promote brain recovery has made it particularly effective in alleviating symptoms of depression and anxiety, often with fewer side effects than conventional treatments.
Imagine your brain as a busy traffic signal system, where thoughts and feelings move around like cars on the road.
Sometimes, when someone feels very sad, anxious, or has a lot of pain, it’s like the traffic lights are broken, causing a big jam in the brain.
Traditional medicines for these problems are like repair workers who slowly fix the lights one by one, but it can take weeks before the traffic starts moving smoothly again.
Ketamine is like a special switch that works differently. Instead of slowly fixing the traffic lights, it shuts down the jammed signals for a while, giving the brain a chance to reset and start working properly again.
This can help people feel better really quickly, often within hours.
The medicine is usually given through a small tube in the arm (like filling a car’s gas tank), but it can also come as a nose spray or a pill.
Each person’s brain is unique, so the amount of time the “reset” works can be different, and some people might need a few more treatments to keep things flowing smoothly.
Unlike older medicines that focus on just one type of traffic (like fixing the red cars), ketamine works on the entire road system, helping it grow new pathways and make connections faster.
It’s a special tool for times when the usual methods aren’t enough.
“Ketamine is an anesthetic that has shown efficacy in treating various psychiatric conditions at subanesthetic doses. It is administered typically via intravenous infusion, intranasal spray (like esketamine), intramuscularly or orally,” Senior Interventional Psychiatrist and Ketamine Expert at Manas Institute of Mental Health and Neurosciences, Hubballi Dr Alok Kulkarni told South First.
Ketamine can produce rapid antidepressant effects, often within hours, contrasting with weeks for traditional antidepressants.
“Unlike most antidepressants which primarily target monoaminergic systems, ketamine works on the glutamatergic system, particularly via NMDA receptor antagonism and AMPA receptor activation, promoting neuroplasticity,” said Dr Kulkarni.
Dr Kulkarni emphasises the wide range of situations where ketamine therapy can be applied, showcasing its potential as a versatile treatment option.
In mental health, ketamine therapy is most notably used for treatment-resistant depression (TRD), where conventional antidepressants or psychotherapy have failed to provide relief.
Studies show that ketamine can deliver a rapid reduction in acute suicidal thoughts, often within hours, making it a valuable alternative to electroconvulsive therapy (ECT) in such cases.
While the effects of ketamine are typically transient, lasting from three to 14 days, this contrasts with the more enduring results seen with ECT.
Emerging evidence also suggests ketamine’s promise in treating bipolar depression, though more long-term studies are necessary to confirm these findings.
Preliminary research indicates the potential benefits of ketamine therapy for individuals suffering from post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and anxiety disorders.
While these results are promising, further research is required to establish its efficacy for these conditions.
Beyond mental health, ketamine is also gaining traction in managing chronic pain conditions, including complex regional pain syndrome (CRPS), neuropathic pain, and other persistent pain disorders.
In cases where traditional treatments have failed, ketamine infusions offer relief by altering the brain’s pain-processing pathways.
Dr Kulkarni advises psychiatrists to carefully evaluate several factors before considering ketamine therapy.
He suggests that one of the primary determinants is the patient’s treatment history.
Ketamine therapy is generally recommended for individuals who have not responded to multiple traditional treatments, such as antidepressant medications or psychotherapy.
This makes it particularly suited for cases of treatment-resistant depression.
The severity of symptoms also plays a crucial role. Ketamine is often considered when a patient experiences acute suicidality or severe depressive episodes that require rapid intervention to prevent harm or stabilise the condition.
Comorbidities must be assessed, as certain medical conditions can make ketamine therapy unsuitable.
For instance, patients with severe cardiovascular issues, a history of substance misuse involving dissociatives or psychedelics, or uncontrolled hypertension are generally not ideal candidates for this treatment due to potential risks.
Also, infrastructure and support systems are key to ensuring the therapy’s success.
The availability of follow-up care, integration of psychotherapy, and rigorous monitoring for both safety and efficacy are essential components of a comprehensive treatment plan.
These factors ensure that ketamine therapy is applied responsibly and effectively, with a focus on patient well-being.
Balancing the use of ketamine therapy with long-term management strategies is essential for achieving sustained mental health benefits.
Dr Kulkarni emphasises the importance of integrating ketamine treatment into a broader, comprehensive care plan.
One key approach is pairing ketamine therapy with psychotherapy, such as Cognitive Behavioral Therapy (CBT). This combination can extend the therapeutic benefits of ketamine while addressing deeper, underlying psychological issues.
For long-term effectiveness, some treatment protocols include maintenance dosing, involving periodic booster infusions to prevent relapse and maintain symptom relief.
“Regular monitoring is also critical. Continuous assessment of the patient’s response allows for necessary adjustments to traditional medication regimens and ensures early detection of tolerance or dependency,” said Dr Kulkarni.
In addition to medical strategies, lifestyle modifications play a vital role.
Encouraging patients to adopt practices that support overall mental health, such as regular exercise, balanced nutrition, and good sleep hygiene, can enhance the therapy’s outcomes.
“Finally, education is fundamental. Patients should be informed about how ketamine works, its effects, and the importance of combining it with a comprehensive treatment plan,” said Dr Kulkarni.
The safety and potential side effects of ketamine therapy are critical considerations in its application, as highlighted by Dr Kulkarni.
Ensuring patient awareness and clinical oversight is paramount to a safe and effective treatment process.
“Patient education is a cornerstone of this approach. Patients must be thoroughly informed about potential side effects, such as dissociation — a sensation of detachment from reality — which, while typically transient, can be unsettling for some individuals,” said Dr Kulkarni.
Ketamine therapy must be administered in a controlled clinical environment.
This ensures the availability of infrastructure and trained professionals to address any adverse reactions promptly and safely.
“Psychological support is equally vital, both during and after treatment sessions. For patients who might find the dissociative effects of ketamine distressing, access to mental health professionals can provide reassurance and aid in processing their experience,” said Dr Kulkarni.
Dose management is another critical aspect. Starting with lower doses allows healthcare providers to evaluate each patient’s unique reaction and adjust the dosage gradually to achieve therapeutic efficacy without unnecessary risks.
Given ketamine’s potential for misuse, it is essential to monitor for abuse and set clear boundaries.
This includes tracking the frequency of use and implementing safeguards to prevent diversion or dependency.
“Also, a thorough risk-benefit analysis should be conducted with every patient. This involves a candid discussion about the potential benefits of ketamine therapy — such as rapid mood improvement — and the possible risks, including side effects and the chance of developing dependence,” said Dr Kulkarni.
(Edited by Rosamma Thomas.)
