Generated and edited by Brittany Albright MD, MPH - Sweetgrass Psychiatry

Ketamine Treatment Room with Zero Gravity Massage Chair, Sweetgrass Psychiatry, Isle of Palms, SC

When other traditional treatments for depression are not working, such as psychotherapy, medications (SSRIs, SNRIs), exercise, and healthy eating, there are other great treatment options. At Sweetgrass Psychiatry in Mount Pleasant, SC, we are pleased to provide our patients with treatment resistant depression HOPE. One evidence based, safe treatment option is Intramuscular (IM) ketamine.

We offer IM ketamine in our outpatient office setting as part of a treatment protocol for treatment-resistant depression. Ketamine is not FDA approved for depression but there is abundant scientific literature and research that demonstrates ketamine’s effectiveness in treating depression. Spravato / esketamine is FDA approved for treatment resistant depression.

Here's how a ketamine treatment experience might unfold for some patients in our office setting:

Preparation: Before administration, the psychiatrist or clinician will review the patient’s past medical and mental history. They will ensure that the patient meets criteria for the medication and does not have any health conditions that may make ketamine unsafe (example - unstable heart condition, significantly elevated blood pressure, active addiction, pregnancy, breast feeding, history of stroke or aneurysm). The clinician will provide an explanation of the procedure, potential side effects, risks, and benefits, and what the patient might experience. They'll ensure that the patient is comfortable and understands the process.
What to Bring: We encourage patients to bring what makes them feel comfortable to the session, such as headphones with a relaxing, instrumental playlist, their own pillow and blanket, a sweater if cold, a loved one if desired, a notebook to write ideas and art into.
Administration: The ketamine is administered via an intramuscular injection, typically into a large muscle like the deltoid (upper arm). The does is typically based on 0.5mg of ketamine per kg of the patient. Patients enjoy a private, quiet room during their treatment session.
Immediate Effects: Shortly after injection (within minutes typically), the patient may start to feel some of the effects of the medication, which can include:
- A feeling of dissociation or being "disconnected" from one's body or surroundings.
- Altered perceptions of time and space.
- Visual and auditory distortions.
- A sense of calm or relaxation, though some people might feel uneasy or anxious.
- A floating sensation or feeling of weightlessness.
Monitoring: During the experience, the patient will be monitored for any adverse reactions. Blood pressure, heart rate, and oxygen saturation might be periodically checked. A healthcare provider will be present at all times in the office setting (but not necessarily in the treatment room at all times) to ensure the patient's safety and to answer any questions or address any concerns. We invite patients to bring a loved one to their treatment session for additional emotional support.
Duration: The most intense effects of ketamine typically last between 30 minutes to an hour, although residual effects can linger for a couple of hours. The total time a patient might be in the office could be 2-3 hours, which allows for the administration, the experience, and then a period of recovery and discussion.
Post-Experience: After the effects have worn off, there's often a debriefing or discussion about the experience. Some patients have insights or emotions come up during the ketamine experience, and discussing these with the psychiatrist can be therapeutic. We encourage all patients to meet weekly with their preferred outpatient psychotherapist to process things that come up during their ketamine sessions. Sweetgrass Psychiatry can provide a therapist for the patient upon their request. We encourage patients to journal after each session about insights they learned, how they felt during the session, and ideas to discuss during recommended therapy integration sessions.
Side Effects: Side effects can vary from person to person. Common ones might include nausea, dizziness, increased blood pressure, and increased heart rate. We require that patients don't drive or operate heavy machinery for the rest of the day (until the next morning) after receiving the treatment.

Many patients find IM ketamine to be a beneficial and transformative experience, especially when traditional treatments for depression haven't been effective. However, like any medical procedure, it's essential to be informed, to understand the potential risks and benefits, and to be under the care of trained professionals. If you are interested in learning more about ketamine for treatment resistant depression, contact Sweetgrass Psychiatry in Mount Pleasant, SC for more information today at (843) 800-1303.

What is it Like to Receive Ketamine for Depression?