About Ketamine Therapy


What is ketamine therapy?

Ketamine is a unique medication known as a dissociative anesthetic. Ketamine has some effects that are similar to those of general anesthetics, sedative hypnotic medications, and psychedelics. However, ketamine has a unique mechanism of action its effects on symptoms related to depression, anxiety, PTSD, acute and chronic pain, substance dependence and other related conditions are more powerful and more broadly reaching than that of any of these other agents.

Mechanism of Action

Ketamine acts to block communication between neurons by binding to the NMDA (N- methy-D-aspartate) receptor. The NMDA receptor is the primary receptor in the central nervous system (brain and spinal cord) for the excitatory neurotransmitter, glutamate. In the absence of ketamine, excitatory neurons send glutamate signaling molecules to receiving neurons. When glutamate attaches to the NMDA receptors on receiving neurons, the receiving neurons are “excited” or activated. This turns on or increased the activity of the receiving neurons which then transmit signals to other neurons.

However, when ketamine is present in the brain and spinal cord, it binds to the NMDA receptor in such a way that it blocks the ability of glutamate to activate the receiving neurons. Importantly, a receiving neuron may be one that activates or de-activates other neuronal circuits. That makes things a bit more complicated, but essentially ketamine acts as a master switch to turn entire groups of neurons and their effects either on or off.

Ketamine and Other Anesthetic Agents

General anesthetics and sedative hypnotic agents are thought to turn all neurons in the brain and spinal cord down or off. As a result, general anesthetics and sedative hypnotic agents make a patient completely unconscious, unaware of their surroundings, unresponsive to their environment, and temporarily unable to form new memories. In contrast, ketamine seems to turn down neuronal pathways associated with movement, coordination, and pain while turning up pathways associated with perception of light, touch and sound. This explains the phenomenon of dissociation where patients feel disconnected from their body, feel that their movements are slow or clumsy, and simultaneously feel that lights are brighter, sounds are louder, and touch is more intense.

Ketamine’s overall effect on mood and pain symptoms is less understood. This is because consciousness itself remains a mystery. However, we know that at the doses used in our clinic, ketamine generally results in overwhelmingly positive feelings. One can infer that ketamine turns neuronal pathways that contribute to depression, anxiety, and pain down or off or that it turns neuronal pathways that contribute to positive, calm feelings and control of pain symptoms on or up. It is also possible that ketamine has both effects.

Ketamine’s Effect on Mood and Pain

Regardless of the likely explanations, the fact remains that as many as 70-80% of people who suffer from depression, chronic pain, and other related conditions achieve meaningful improvement in their symptoms after six initial ketamine treatments. This is quite remarkable, especially when one considers the safety and side effect profiles of more traditional treatments for these conditions.

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