Learn which depression treatment option is right for you.

What to do After Ketamine Treatment

Knowing what to do after ketamine therapy can maximize recovery from depression.

The Future of Depression Treatment: How Ketamine Is Reshaping Mental Health Care

Ketamine offers a unique and compelling approach to treating depression due to its rapid onset of action and distinct mechanism of action compared to traditional antidepressants. Unlike selective serotonin reuptake inhibitors (SSRIs) and other conventional medications, which may take weeks or even months to alleviate symptoms, ketamine often produces significant improvement in mood within hours or days. This rapid relief is particularly beneficial for individuals experiencing severe or treatment-resistant depression, providing much-needed respite from the debilitating effects of the illness. Additionally, ketamine works through the glutamate system in the brain, promoting neuroplasticity and the formation of new neural connections – processes believed to underlie its long-lasting antidepressant effects. As this treatment becomes more mainstream, it's important to know what to do after ketamine to maximize its effects.

Understanding How Ketamine Works

Ketamine, originally developed as an anesthetic, has garnered attention in recent years for its rapid and robust antidepressant effects. Unlike traditional antidepressants that primarily target neurotransmitters like serotonin and norepinephrine, ketamine acts on a different neurotransmitter system: glutamate.

Glutamate is the most abundant excitatory neurotransmitter in the brain and plays a crucial role in synaptic plasticity, learning, and memory. Ketamine works by blocking N-methyl-D-aspartate (NMDA) receptors, a subtype of glutamate receptors, leading to increased synaptic glutamate release and activation of downstream signaling pathways.

The rapid antidepressant effects of ketamine are believed to stem from its ability to promote synaptic plasticity and neural regeneration. Ketamine-induced glutamate release triggers a cascade of molecular events that lead to the formation of new synaptic connections and restoration of neural circuits disrupted in depression. Additionally, ketamine increases levels of brain-derived neurotrophic factor (BDNF), a protein that supports neuronal growth, survival, and plasticity.

The 2 Biggest Ketamine Myths of All-Time

Myth: Nasal Esketamine (Spravato) is not as good as IV Ketamine.

Fact: Spravato has been proven in many head-to-head studies to have the same efficacy for treating depression as IV Ketamine. Many ketamine clinics will tout that IV Ketamine is better because it's a cash-pay service, and they don't have to deal with the enormous amounts of paperwork that are required by the DEA to treat Spravato. An observational study from Cambridge, published in The Journal of Clinical Psychiatry, showed that esketamine and ketamine efficacy are virtually identical. What is true is that individuals receiving the drug through IV required far fewer treatments to achieve remission. Additional research out of Yale University also found no significant difference in patient response to intranasal versus intravenous forms of the drug.

If time is more important to you than money, then IV Ketamine may be the better option. But if affordability is a priority, Spravato is the better option. Read our blog about ketamine infusions vs. Spravato for more information.

Myth: Ketamine only works if I'm disassociating.

Fact: While some people enjoy the feeling of being disassociated from reality as it may be the only relief they get from an otherwise chaotic life, disassociation is actually listed as a negative side-effect of ketamine therapy. Assuming that ketamine is only working if you disassociate is akin to thinking that the treatment only works if you're projectile vomiting.

Additional Common Myths About Ketamine

  • Myth: Ketamine is only for severe cases of depression and anxiety. Fact: While ketamine can be an effective treatment for severe, treatment-resistant depression, it is also being explored as an option for moderate to severe depression. Research suggests that ketamine may offer rapid relief for individuals who have not responded to traditional antidepressants or psychotherapy.
  • Myth: Ketamine treatment is addictive. Fact: Ketamine has a low potential for addiction when used under medical supervision for therapeutic purposes. Unlike drugs of abuse, such as opioids or stimulants, ketamine is administered in controlled doses and monitored by mental healthcare professionals at clinics like Axis Integrated Mental Health to minimize the risk of misuse or dependence.
  • Myth: Ketamine treatment is a one-time cure for depression. Fact: While ketamine can provide rapid relief from depressive symptoms, its effects are not always long-lasting. Maintenance treatments may be necessary to sustain the antidepressant effects over time. Additionally, integrating ketamine treatment with ongoing therapy and lifestyle modifications can optimize outcomes and promote sustained well-being.
  • Myth: Ketamine treatment is unsafe and has severe side effects. Fact: When administered by trained healthcare professionals in a clinical setting, ketamine treatment is generally safe and well-tolerated. Common side effects may include transient dissociative experiences, dizziness, or nausea, which typically resolve shortly after the infusion. Serious adverse reactions are rare but can occur, highlighting the importance of thorough medical evaluation and monitoring during treatment. What we've seen in our clinic is that ketamine has fewer side effects than daily antidepressants, with no patients reporting sexual dysfunction, weight gain, or tremors, which can sometimes occur with antidepressants.
  • Myth: Ketamine treatment is only effective for depression. Fact: While ketamine is primarily studied for its antidepressant effects, emerging research suggests its potential efficacy in treating other psychiatric conditions, such as anxiety disorders, post-traumatic stress disorder (PTSD), and bipolar depression. Ongoing research aims to elucidate the broader therapeutic applications of ketamine across various mental health disorders. What is true is that the only FDA-approved ketamine therapy, Spravato, is only approved and covered by insurance for depression or suicidal ideation.
  • Myth: Ketamine treatment is only for the rich. Fact: Many people think that effective ketamine treatment can only be paid for out of pocket. While this is true for IV infusions, Spravato (a ketamine-derived nasal spray) is covered by nearly every insurance including Medicaid. Moreover, Janssen Pharmaceuticals has a savings card program that makes treatment only $10 per visit for commercially insured patients. Please read our articles about ketamine infusion costs and Spravato costs for more details.

The Role of Neuroplasticity in Post-Ketamine Care

Unlike antidepressants, which only work while the substance is in your body, ketamine works AFTER it leaves your system. Therefore, knowing what to do after ketamine really matters.

Antidepressants enhance communication by increasing the presence of neurotransmitters in the brain. Consequently, their effectiveness relies on maintaining a specific medication level in your system, which typically takes around 4-6 weeks to achieve.

A brain exposed to ketamine produces new dendritic spines, which create better communication in the brain. However, this isn't instantaneous. According to a study published in Biol Psychiatry, 2021, which was supported by the Yale Center for Psychedelic Science, "Wu et al. showed that the potential for glutamate-evoked spinogenesis rapidly increased 2 hours after ketamine administration. This effect curiously corresponds to the start of behavioral improvement and precedes the rise in dendritic spine density." Considering that the "peak" of disassociation with ketamine therapy happens around 40 minutes into the treatment, it is unlikely that disassociation is related to the increased neuroplasticity that occurs in the brain.

What you do with that neuroplasticity matters as well. It makes no difference to your intelligence if you have a library full of books that are never read. You might as well be functionally illiterate. Understanding what to do after ketamine is essential for optimizing treatment outcomes and promoting long-term recovery.

Boosting Neuroplasticity After Ketamine

Boosting neuroplasticity after ketamine treatment involves engaging in activities and practices that stimulate the brain's capacity for reorganization and adaptation. Incorporating mindfulness meditation, aerobic exercise, and cognitive stimulation can enhance neuroplasticity and promote lasting changes in brain function. Mindfulness meditation encourages present-moment awareness and acceptance, fostering structural changes in key brain regions associated with attention and emotional regulation. Aerobic exercise promotes the release of neurotrophic factors, such as brain-derived neurotrophic factor (BDNF), which support neuronal growth and synaptic plasticity. Additionally, engaging in cognitive activities like puzzles, learning new skills, or engaging in therapeutic interventions can challenge the brain and promote the formation of new neural connections. By embracing these strategies, individuals can optimize the neuroplastic effects of ketamine treatment and support sustained well-being.

Read our blog on how to apply the principles of neuroplasticity to improve mental health for more information.

What to Do After Ketamine Therapy

Do's

  • Schedule a therapy session: Sharing experiences with ketamine treatment during therapy sessions facilitates integration and processing of insights gained. Therapists can assist individuals in making meaning of their experiences and translating them into actionable steps for growth. Scheduling time with a therapist a day or two after treatment can help you build better emotional processing skills, and counteract maladaptive patterns from the past. Knowing what to do after ketamine includes integrating therapy into your post-treatment plan to foster resilience and facilitate lasting change.
  • Prioritize Self-Care: Knowing what to do after ketamine includes making lifestyle changes that support mental health and overall well-being.After completing ketamine treatment, individuals should prioritize self-care activities that support mental and emotional well-being. This includes adequate rest, hydration, and engagement in activities promoting relaxation.
  • Consider TMS: Patients should consider transcranial magnetic stimulation (TMS) after ketamine treatment to sustain and enhance the therapeutic benefits achieved. While ketamine can provide rapid relief from depressive symptoms, its effects may not always be long-lasting. TMS offers a non-invasive and well-tolerated option for individuals seeking sustained improvement in mood and functioning. Integrating TMS into post-ketamine care can optimize treatment outcomes and support individuals in their journey towards long-term recovery and well-being.
  • Meditate: Meditation is shown to increase synaptic growth, and combined with the effects of ketamine, you can boost your ability to shape new synapses into more positive thought patterns that can help you recover faster.
  • Embrace Mindfulness: Incorporating mindfulness practices into daily routines can aid in processing emotions and reducing stress levels. Practicing mindfulness fosters present-moment awareness, facilitating resilience in the post-ketamine period.
  • Maintain Physical Activity: Knowing what to do after ketamine includes making lifestyle changes that support mental health and overall well-being. Engaging in regular physical activity complements the effects of ketamine treatment by releasing endorphins and enhancing mood. Individuals are encouraged to incorporate exercise routines suited to their preferences and abilities.
  • Seek Social Support: Building a strong support network is crucial after ketamine treatment. Connecting with supportive friends, family, or peers can provide emotional validation and encouragement throughout the recovery process. Ask your provider if they have a social prescribing program.
  • Schedule Follow-Up Care With Your Provider: After completing ketamine treatment, individuals may require follow-up care to monitor progress and adjust treatment plans as needed. We recommend seeing your psychiatric provider at least once a month while in ketamine treatment. Understanding what to do after ketamine includes staying engaged with healthcare providers and attending follow-up appointments. This ongoing support ensures that individuals receive comprehensive care and continue to experience the benefits of ketamine treatment over time.

DON'T

  • DO NOT DRIVE: No matter how confident you are in your faculties after ketamine treatment, do not take the risk of driving yourself home. Not only can you cause harm to others, but you may also get discharged from your provider if caught driving after treatment.
  • Eat a heavy meal: To avoid nausea and vomiting, patients are instructed not to eat 2 hours prior to treatment. After treatment, you may be hungry, and we recommend avoiding heavy meals as your stomach may still need some time to adjust.
  • Watch the news: Ketamine treatment often induces a state of heightened sensitivity and vulnerability, making individuals more susceptible to negative stimuli. The constant barrage of distressing news stories, sensationalized headlines, and negative imagery prevalent in the media can exacerbate feelings of anxiety, sadness, or despair, undermining the therapeutic effects of ketamine.
  • Consider avoiding social media: Social media platforms are saturated with curated content, comparison triggers, and sensationalized news, which can exacerbate feelings of anxiety, self-doubt, and discontent. Moreover, the constant stream of information and social interactions can overwhelm the senses and disrupt the delicate balance achieved during ketamine therapy. By limiting exposure to social media, patients can create a conducive environment for healing, reduce stress, and foster a sense of inner peace and stability. Prioritizing real-world connections, engaging in mindfulness practices, and pursuing activities that promote relaxation and self-care are recommended alternatives to mitigate the potential negative impact of social media on post-ketamine recovery.

Knowing What to Do After Ketamine Maximizes Recovery from Depression

In conclusion, knowing what to do after ketamine treatment is essential for maximizing its benefits and promoting long-term recovery from depression. To get the most out of your ketamine treatment, it's important to understand how it works and be proactive in shaping your thought patterns. By embracing therapy, leveraging neuroplasticity, dispelling myths, incorporating lifestyle changes, and navigating follow-up care, individuals can foster resilience and maintain their progress on the path to wellness.

As individuals embark on their post-ketamine journey, it is imperative to understand the significance of proactive self-care. This guide underscores what to do after ketamine, emphasizing the principles of neuroplasticity and the pivotal role of therapy in fostering sustained well-being.

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