An Introduction to the Successful Ketamine Infusion Therapy

Ketamine infusion therapy is very well-known and adopted for practical use in the medical world. Despite this, many of us lack basic significant knowledge regarding this therapy. Let us try to know about this in detail.

To begin with, firstly, it is very important to have a basic knowledge of ketamine to understand ketamine infusion therapy.¹

What is Ketamine?

Ketamine drug was explored and approved for the first time in 1970 by the United States Food and Drug Administration (FDA) for surgical anesthesia² during the Vietnam War. At present days, ketamine is one of the World Health Organization’s Lists of Essential Medicines.

Ketamine is a derivative of arylcyclohexylamine³, which is a chiral compound. It is very similar to psychedelics, a hallucinogenic drug. Ketamine, a dissociative hallucinogenic drug⁴ like psychedelics, is different because of its neurobiological activity in the brain. It possesses psychedelic and psychotic properties.

Following the administration of a prescription, symptoms such as hallucinations and paranoia are normal. Ketamine has been found to trigger psychotic episodes in some people, including positive symptoms presentation for a patient with schizophrenia.

More specifically, ketamine is a medication prescribed for the initiation and maintenance of anesthesia that provides the patient with relief from pain and behaves like a sedative. It is an NMDA receptor antagonist that is the reason for most of its action other than the anti-depressive effect. Ketamine anesthesia differs from anesthesia because breathing is preserved and the airway is reflexed; an incline in the total blood pressure can be witnessed.

However, these benefits of ketamine administration fade away with time, and repeated use of it is not yet studied thoroughly. When administered in lower doses, ketamine is very beneficial to provide relief from pain as well as helps in the treatment without developing depression.

Ketamine infusion therapy also consists of side effects like blood pressure, nausea, liver toxicity, and urine toxicity when consumed in higher doses. The reason behind the anti-depressive effects of ketamine infusion therapy is yet to be studied.

Ketamine is a fast-working antidepressant, and research supports the idea that it could prevent suicide. According to the research, it is depicted that a patient responding positively to ketamine rapidly decreases suicidal thoughts in the patient and relieves the patient from serious depression.

Ketamine Infusion Therapy:

Depression is one of the emerging disabilities in younger and older generations around the world. Many drugs have been developed, are in process, and are available to combat depression and ketamine is one of the finest.

The well-known ketamine infusion therapy includes administering single or series of infusions for managing psychiatric disorders⁵ like post-traumatic stress disorder, depression, and suicidality.

Due to the availability of ketamine infusion therapy clinics in healthcare facilities, psychiatric-mental health advanced practice nurses (APRNs), and psychiatric-mental health RNs are collaborating with certified registered nurse anesthetists (CRNAs) to make ketamine infusion therapy available to the patient with chronic and medicine-resistant mental health conditions.

There are two types of ketamine therapy beneficial in treating depression, namely Ketamine IV infusion and nasal spray. Among these, Ketamine IV therapy is the most effective type of ketamine infusion therapy.

Most of the research conducted has been on ketamine IV infusion therapy. Another method is the nasal spray infusion method which is not much in practice.

Ketamine IV Infusion Therapy:

In ketamine IV infusion therapy,  the ketamine, more specifically known as racemic ketamine, is administered intravenously and enters directly into the recipient’s bloodstream.

The R and S ketamine, mirror-image molecules of ketamine, are the major components of ketamine infusion therapy⁶. Administered in the arm, ketamine immediately starts responding, and its effect can last from days to weeks.

Ketamine infusion therapy is a series of six infusions as a part of the induction phase. Following that, one infusion is administered every 2 to 6 weeks in the maintenance period.

Years ago, FDA approved it as an anesthetic. However, it is not prescribed as a first-line treatment for depression, but it is considered after the failure of antidepressant medications.⁷

How Does Ketamine Infusion Therapy Work?

The exact structural metabolism of ketamine is not yet known. However, it can be said that it functions as an antidepressant that assists patients in managing depression though the functioning of ketamine is entirely different than that of other antidepressant drugs.

Due to ketamine body undergoes several processes which in one way or another help in combating depression.

• Ketamine minimizes the intensity of signals responsible for triggering inflammation. Thus, it indirectly prevents mood disorders in a patient and helps communication within the brain region. This functional property of ketamine adds to its efficiency.
• It helps in the process of synaptogenesis, where the ketamine binds to NMDA receptors. Eventually, this leads to an increase in the secretion of glutamate neurotransmitters in the synaptic cleft and activated AMPA receptors.
• NMDA and AMPA together release molecules to assist neuronal communication. This overall process impacts mood, cognition, and thoughts.

 Patient’s Response To Ketamine Infusion Therapy:

Most patients are supposed to respond within six infusions of the therapy. If a patient fails to do so, then they can’t respond to further infusions. In such cases, they have been prescribed an alternative drug for depression.

Apart from this, if a patient responds to the infusions are guided to continue the treatment further. According to a survey, 8 infusion therapy are administered generally during the acute phase. After this, it depends on the doctor, the patient, and the patient’s condition for continuing or pausing the therapy.

Side effects:

Every drug has some side effects, which can range from minor to severe. When pursuing extreme depression, the possible benefits outweigh the costs, particularly if the patient already has suicidal thoughts. Patients are also warned of the risks of ketamine IV infusion treatment, which include the following:

• Drowsiness and/or a dream-like experience. Some patients characterize their experience as a night of twilight sleep, in which they are drowsy but alert during the procedure.
• The vision that is doubled or distorted
• Confusion
• Jerky muscles
• Nausea and vomiting
• loss of appetite
• Insomnia or sleeping problems
• Hypertension

In the past few years, ketamine has proved very beneficial for the treatment of depression. However, information regarding its functioning and metabolism is yet to be discovered.

1. Maher, Dermot P., Lucy Chen, and Jianren Mao. “Intravenous ketamine infusions for neuropathic pain management: a promising therapy in need of optimization.” Anesthesia & Analgesia 124.2 (2017): 661-674. ↩︎
2. Robinson, Daniel H., and Alexander H. Toledo. “Historical development of modern anesthesia.” Journal of Investigative Surgery 25.3 (2012): 141-149. ↩︎
3. Pelletier, Romain, et al. “Arylcyclohexylamine derivatives: pharmacokinetic, pharmacodynamic, clinical and forensic aspects.” International Journal of Molecular Sciences 23.24 (2022): 15574. ↩︎
4. Petersen, Mark, Uttam Garg, and Hemamalini Ketha. “Hallucinogens—psychedelics and dissociative drugs.” Toxicology Cases for the Clinical and Forensic Laboratory. Academic Press, 2020. 295-303. ↩︎
5. Henderson, Max, et al. “Work and common psychiatric disorders.” Journal of the Royal Society of Medicine 104.5 (2011): 198-207. ↩︎
6. Maher, Dermot P., Lucy Chen, and Jianren Mao. “Intravenous ketamine infusions for neuropathic pain management: a promising therapy in need of optimization.” Anesthesia & Analgesia 124.2 (2017): 661-674. ↩︎
7. Bosman, Renske C., et al. “Failure to respond after reinstatement of antidepressant medication: a systematic review.” Psychotherapy and psychosomatics 87.5 (2018): 268-275. ↩︎

Last Updated on April 29, 2024 by ayeshayusuf