Disclaimer

Ketamine is not a cure, nor a first-line drug to treat mood and chronic pain conditions. Instead, it is a treatment alternative that may work when other therapies have failed. Ketamine is not meant to replace other past, present, or future therapies services, such as other medications, electroconvulsive therapy (ECT), transcutaneous magnetic stimulation (TMS), or counseling from a qualified mental health professional. It is not a treatment of choice in mental health or pain emergencies. And although the drug may help decrease suicidal ideation, patients actively contemplating suicide should first seek help from emergency mental health services. If we feel you are at imminent risk for hurting yourself or others, we are duty bound to seek help from the appropriate  outside agencies, for both your safety and that of others.

The most common short-term side effects include nausea, headache, elevated blood pressure, elevated heart rate, dizziness, and a feeling of dissociation from reality. The dissociation can cause extreme anxiety to a minority of people, sometimes requiring termination of therapy and use of sedative drugs. However, most people find of these problems mild, transient, treatable, and well-tolerated. 

The long-term side effects of ketamine are less certain due to insufficient data. Potential complications of chronic use include liver inflammation and dysfunction, gall bladder disease, urinary bladder dysfunction, memory impairment, trouble thinking, ketamine craving and dependency, and signs of schizophrenia. Such problems have usually been reported in people taking large doses (eg, with repeated surgery or recreational use). Whether such problems will appear in patients given ketamine in the doses used for mood and chronic pain disorders remains to be seen. 

The long-term safety of ketamine is seen a recent survey of 6,630 patients receiving IV ketamine for depression in 36 different treatment centers. Only 0.1% of patients developed bladder problems, 0.03% thinking problems, and 0.03% schizophrenia-like symptoms. 0.7% developed had to discontinue their treatment due to complications, the most common cause of for which was anxiety. No cases of addiction from IV ketamine were reported. 

Unlike intranasal ketamine, intravenous (IV) ketamine used to treat mood and chronic pain disorders has not yet received approval from the Food and Drug Administration (FDA). Technically, its use for these conditions is "off label."  But off label use of a drug does not necessarily mean it is more dangerous or less effective. For example, a third of drugs used in the intensive care unit and three-fourths of drugs used to treat headache are off label. In fact, the existing data suggests that IV ketamine is more effective than intranasal ketamine, justifying its use in our clinic.