The spray has a “black box” warning about the risk of sedation and trouble with attention, judgment, and thinking, as well as risk for abuse or misuse of the drug and suicidal thoughts and behaviors.
Other forms of ketamine not approved by the FDA for mental health
conditions include IV infusion, a shot in the arm, or lozenges. Most research looks at ketamine given by IV. You can only get it by IV or shot in a doctor’s office. Some doctors will prescribe lozenges for at-home use -- often to keep depression at bay between infusions.
At his clinic, Stewart only sees patients who have referrals from a doctor that diagnosed them with treatment-resistant depression. Stewart doesn’t make these diagnoses. He starts patients with a research-based six infusions spaced over 3 weeks.
“That’s how people get started,” Krystal says. “Two infusions a week, and then they go down to one infusion a week, and then most people go down to eventually one infusion every 2 to 4 weeks.”
Most research stops the initial treatment at 6 weeks. There’s no research to suggest that more than 6 weeks in a row brings more benefits, though people do go back for boosters if symptoms return.
The IV infusion lasts about 40 minutes. The dissociative experience starts quickly and takes about 15 to 20 minutes to wear off after the drip ends. A doctor is always on site during the whole process. The doctor isn’t necessarily in the room with the person being treated but is available if they need anything or become anxious or confused.
While the patient is on the drip, Stewart says, they look asleep. Most don’t move or talk. Though some, he says, may talk or make a comment about the music playing on their headphones or some part of their experience or perhaps ask where they are. Unless they need something, Stewart says, no one interferes.
Christa Coulter-Scott, a pediatric nurse from Athens, GA, got treatment in a similar setting in Gainesville, GA. She says she didn’t want to wake up. “It was like a spiritual journey. I felt warm, safe, and confident. As the treatment went on, all the weight of stress was taken off of me in layers. I felt like I had the power of the universe at my fingertips.”
It's a bold statement from a 51-year-old who had felt powerless to depression and anxiety
since childhood. As an adult, she’s also been diagnosed with PTSD
and chronic pain
. Coulter-Scott has tried 10 different antidepressants over the years. But the dark cloud of depression never budged.
Christa Coulter-Scott says ketamine treatment eased the depression she's had for most of her life.
Yet, after ketamine therapy, she says, “My head feels lighter, and I don’t have that gloomy, dark, heavy feeling in my mind. And everything around me looks brighter -- the sun, the lights in my office.”
When she returned to work the next day after an infusion, she asked a co-worker whether the lighting had been changed. It hadn’t. “I don’t know if it’s a side effect of ketamine or a side effect of being less depressed.”
Winograd describes it similarly. He talks about feeling like he was floating in a color. “It was the first time I understood the expression ‘happy place.’ It was this space where everything that had to do with my real life disappeared, and I didn't have any of that weight that I carry with me everywhere I go.”
The antidepressant effects of ketamine wear off in hours, days, or a couple weeks in people who only get a single infusion. The series of infusions has longer-lasting effects.
Coming Back to Real Life
At Stewart’s clinic, after the mind-altering part of the ketamine experience is over, a health provider sits and talks with the patient in a process called integration. Other clinics may recommend that patients continue their talk therapy
“It’s my sense that this is important,” Stewart says. “When people come out of this really profound experience, they have a lot to say, and these are people who have a lot of baggage and a lot of experiential pain. A lot of times, ketamine leads to an unpacking of that baggage.”
Krystal, who provides IV and intranasal ketamine for treatment-resistant mood disorders
at the VA Connecticut Health System and Yale-New Haven Hospital, encourages patients to continue with their psychotherapy
after ketamine treatment.
Doctors who administer IV ketamine tend to recommend patients continue with their regular antidepressant regimen, too. As for the nasal spray, it’s only approved for use along with an oral antidepressant.