Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist originally FDA-approved for anesthesia, is increasingly being used off-label for the treatment of pain and various mood and mental health disorders, including major depressive disorder, anxiety disorders, post-traumatic stress disorder (PTSD), postpartum depression, obsessive-compulsive disorder (OCD), and more.
While opioids, benzodiazepines, and anti-psychotics remain the most commonly prescribed medications for acute pain, anxiety, and agitation, they have limitations, including delayed onset and significant risks such as respiratory depression, hypotension, and cardiac arrhythmias, all of which can lead to hemodynamic instability and even death.
In the acute care setting, ketamine is an attractive treatment option due to its rapid onset, safety profile, and high efficacy. Administered intravenously, ketamine begins to take effect within minutes, with a duration of approximately 30-40 minutes, and rarely causes respiratory issues or significant blood pressure or heart rate flucuations.
At Innerbloom Ketamine Therapy, we believe that being well-informed is a crucial first step in starting ketamine therapy. This includes understanding not only the benefits but also potential side effects, safety considerations, and contraindications. Join us as we guide you through our treatment protocols and emphasize that your safety remains our top priority.
For a deeper exploration of ketamine's potential side effects, risks, and addiction concerns, be sure to read our article: Ketamine: Navigating Risks, Mitigating Misuse, and Confronting Potential Addiction.
Some patients may experience nausea at higher doses of ketamine, especially when combined with movement or intense visual stimuli. Nausea can be easily treated with either oral or intravenous medications. At Innerbloom Ketamine Therapy, we typically use Zofran, which can be administered intravenously for rapid anti-nausea relief. For patients with a known predisposition to nausea or those who have experienced it during previous infusions, we can prescribe or premedicate with sublingual oral Zofran. Zofran is a safe, highly effective, and widely used medication for treating nausea. While some ketamine clinics incorporate movement or visual stimulation, such as videos, our protocol at Innerbloom is for clients to wear eyeshades and remain still in a comfortable infusion chair.
The therapy session is often described as a pleasurable experience, though some sessions can be emotionally challenging. Ketamine may bring to the surface memories or internal issues that you may have consciously or subconsciously suppressed. This is where the healing begins, and it’s normal to experience some level of anxiety during the process. As a medication with psychedelic properties, ketamine can induce altered states of consciousness that may feel unusual or entirely new, especially for those who have never encountered such experiences before. Some individuals report having spiritual or mystical encounters, while others describe ketamine therapy as one of the most meaningful and profound experiences of their lives.
“But along with the feeling of ineffability, the conviction that some profound objective truth has been disclosed to you is a hallmark of the mystical experience, regardless of whether it has been occasioned by a drug, meditation, fasting, flagellation, or sensory deprivation. William James gave a name to this conviction: the noetic quality. People feel they have been let in on a deep secret of the universe, and they cannot be shaken from that conviction.” ― Michael Pollan, How to Change Your Mind
At Innerbloom Ketamine Therapy, our primary approach to managing anxiety or strong emotional responses is through compassionate guidance and support. You can take comfort in knowing that a dedicated professional is always present during your infusion, focused on your well-being and needs. One of the key advantages of the intravenous route is the ability to quickly adjust or stop the infusion if you’re experiencing discomfort, as well as the option to promptly administer IV medications if needed to address any symptoms.
Patients may experience a slight increase in heart rate and blood pressure, which is a normal response and usually does not require treatment. The ketamine experience can also be emotionally intense, and some psychological response is expected to varying degrees. We monitor your heart rate, blood pressure, and oxygen levels and have intravenous medications available to manage any issues warranting treatment.
One of the key advantages of ketamine is that it is rarely associated with respiratory depression or breathing issues. This stands in contrast to opioids like morphine or benzodiazepines like Xanax, which can cause slowed or shallow breathing and significant drops in oxygen levels. We monitor your oxygen saturation and keep an oxygen tank and mask readily available in case supplemental oxygen is needed. Hypoxia may be more likely in individuals with underlying pulmonary conditions, sleep apnea, a history of smoking, or those who are morbidly obese.
Laryngospasm is a rare occurrence where the vocal cords suddenly close during inhalation, temporarily blocking airflow into the lungs. This condition can be resolved by performing a jaw-thrust maneuver, which involves applying firm pressure inward toward the base of the skull, typically breaking the spasm within 1-2 breaths. While extremely uncommon during ketamine infusions, laryngospasm is more likely with high doses administered too quickly. To minimize this risk, our protocol uses a controlled IV infusion over 40 minutes rather than rapid administration. An intramuscular route may be offered at lower doses, primarily for patients with significant prior experience with ketamine.
Frequent (multiple doses per day) and high doses of ketamine—often 10 to 100 times higher than those used in a clinical setting and typically associated with recreational abuse—can lead to a condition known as ketamine-associated cystitis or interstitial cystitis. This condition is characterized by lower urinary tract symptoms such as lower abdominal pain, painful urination (dysuria), frequent urination, urgency, difficulty urinating, or blood in the urine (hematuria). Complications can include impaired kidney function, bladder hardening with reduced capacity, and in severe cases, the need for surgical intervention.
The proposed mechanism for interstitial cystitis involves the direct toxic effect of ketamine metabolites on bladder cells, leading to fibrosis and structural damage that affects bladder function. Treatment typically begins with stopping ketamine use, which may be sufficient for restoring normal bladder function. In severe cases, procedures or surgeries may be necessary, such as stenting or the placement of drainage tubes to manage urinary flow. In extreme cases, cystoplasty—a reconstructive surgery to increase bladder capacity—may be required.
It is important to note that interstitial cystitis is very unlikely to occur with IV ketamine administered for therapeutic use. Unlike recreational use, where doses are high and frequent, IV ketamine in clinical settings is administered at much lower doses. At Innerbloom Ketamine Therapy, infusions are spaced over a course of 3-6 weeks, significantly reducing the risk of interstitial cystitis. Given the controlled, low-dose treatment protocol and infrequent sessions, the likelihood of developing this condition is extremely rare and not expected in our practice.
At Innerbloom Ketamine Therapy, we thoroughly review your medical history and carefully screen for contraindications—conditions or factors that may make ketamine therapy unsuitable for certain patients. These contraindications include:
Ketamine is a highly effective, fast-acting, and safe treatment option for mood disorders and other mental health conditions. Severe side effects or long-term complications are rare in a therapeutic setting, such as infusion therapy. The more common side effects, such as anxiety and nausea, are typically mild and easily managed. Our staff brings extensive experience from years in acute care settings, including emergency rooms and trauma surgery, so we are well-equipped to handle even the most challenging situations. At Innerbloom Ketamine Therapy, we are fully prepared to address any potential side effects and are committed to ensuring your safety throughout your entire experience.
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