Understanding Ketamine’s Use in Physical and Mental Health

Ketamine is a short-acting general anesthetic that has been in clinical use since the 1970s. It was initially administered in the United States for sedation and pain control during the Vietnam War. Today, it continues to serve a variety of important medical purposes.

Beyond its approved clinical applications, the medication is also known for recreational misuse due to its dissociative properties. According to the Drug Enforcement Administration (DEA), illicit forms of ketamine are often referred to as Special K, KitKat, Vitamin K, and other street names.

In recent years, ketamine has attracted significant research attention for its potential benefits in managing certain mental health disorders. Even so, researchers are still working to better understand exactly how ketamine functions in the body, how dosing should be optimized, and what long-term effects it may produce.

This article provides a comprehensive overview of ketamine’s medical uses, possible side effects, and what current evidence says about its safety and effectiveness.

What is ketamine and how does it affect the body?

Ketamine is classified as a dissociative anesthetic. Research from 2018 indicates that ketamine works primarily by binding to the N-methyl-D-aspartate (NMDA) receptor in the brain, where it blocks glutamate activity.

Glutamate is a key neurotransmitter involved in normal brain signaling and cognitive function. By influencing glutamate pathways, ketamine can interrupt pain signals and alter perception, which explains its role in anesthesia, pain management, and depression treatment.

Ketamine also partially interacts with other brain receptors, including those associated with:

• opioids
• serotonin
• gamma aminobutyric acid (GABA)
• sigma
• dopamine

Researchers continue to explore how these interactions contribute to ketamine’s clinical effects. Some research from 2014 suggests that its activity at these receptors may support its pain-relieving, anti-inflammatory, and antidepressant properties. If you’re wondering about its relationship to narcotics, you may also find it helpful to read Is ketamine an opioid for clarification on how it differs from traditional opioid medications.

Other effects associated with ketamine use may include:

• sedation
• dizziness
• euphoria
• hallucinations
• vivid dreams
• disorientation
• feeling incapacitated
• delusions
• amnesia

These dissociative sensations are one reason ketamine is misused recreationally as a “club drug.”

Ketamine is available in multiple formulations and dosage strengths. The intensity and duration of its effects vary depending on the dose, route of administration, and whether it is used legally under medical supervision or obtained illegally.

Medical use dosage forms

Ketamine is a rapid-acting general anesthetic. In medical settings, it is administered as an intravenous injection directly into a vein for sedation. It may also be delivered via intramuscular injection into a muscle.

Esketamine (Spravato) is a related formulation available as a nasal spray. It is prescribed in combination with an antidepressant for adults with treatment-resistant depression.

According to a 2014 review, ketamine for therapeutic purposes is only given under the supervision of a qualified healthcare professional. Physicians do not prescribe ketamine for unsupervised, at-home use.

Recreational use dosage forms

• powder
• liquid

The DEA warns that higher doses of non-medical ketamine can trigger severe adverse reactions. In the United States, ketamine is categorized as a Schedule III non-narcotic substance and is illegal to possess without a prescription.

What is ketamine used for medically?

When asking, What is ketamine used for in medical practice, the primary answer is anesthesia. According to reviews from 2020 and 2021, ketamine is approved by the Food and Drug Administration (FDA) as a short-term injectable anesthetic for both humans and animals. When administered intravenously, it typically takes effect within 10 to 30 seconds. It may be used alone or alongside other medications.

In addition to anesthesia, ketamine is sometimes used off label for other medical conditions. According to 2016 research, it has been utilized in pain management for:

• burns
• cancer pain
• chronic neuropathic pain
• migraine
• other types of chronic pain

Off-label prescribing means a healthcare provider uses a medication for a purpose other than its FDA-approved indication. While early findings are promising, additional studies are necessary to confirm long-term safety and effectiveness, especially for chronic pain conditions.

A 2018 review also indicates that ketamine may help in the treatment of substance use disorders, including alcohol, cocaine, or opioid use disorder. However, further investigation is required to establish appropriate dosing strategies and long-term outcomes.

What is ketamine used for in mental health care?

Another important aspect of understanding What is ketamine used for involves its growing role in mental health treatment. Reviews from 2018 and 2020 highlight ketamine’s effectiveness in addressing conditions such as major depressive disorder and suicidal ideation, often in combination with psychotherapy.

One notable advantage of ketamine compared to traditional antidepressants is its rapid onset. A 2020 review suggests it may begin working within 2 hours, whereas many conventional antidepressants require several weeks to produce noticeable improvement.

Research from 2018 and 2021 suggests ketamine may provide benefits for:

• treatment-resistant depression
• post-traumatic stress disorder (PTSD)
• anhedonia
• anxiety

Despite encouraging findings, researchers emphasize that more data is needed to determine optimal dosing, duration of therapy, and long-term safety.

In 2019, the FDA approved esketamine nasal spray under the brand name Spravato for treatment-resistant depression. Administration must occur under medical supervision in a certified setting.

Another formulation, R-ketamine, is currently being studied as a potential therapy for treatment-resistant depression.

Are there side effects of ketamine therapy?

Side effects of ketamine can vary depending on multiple factors.

These factors include:

• the type of drug (medical or recreational)
• how it’s administered
• dosage
• your age
• existing health conditions, such as high blood pressure or heart disease
• other medications you are taking

Adverse effects may differ from person to person but can include:

• nausea or vomiting
• dizziness
• muscle spasms or stiffness
• urinary problems, including painful, difficult, or frequent urination and loss of bladder control
• confusion
• heart-related problems, such as arrhythmia, slow heart rate, high blood pressure, heart failure, or cardiac arrest
• seizures
• eye problems
• anxiety
• hallucinations
• insomnia
• addiction
• trouble breathing
• allergic reaction, including rash, trouble breathing, and swelling of the tongue, lips, or face

A 2022 review found that prolonged, high-dose recreational use may be associated with changes in brain function, mood disorders, and psychotic symptoms.

Because recreational ketamine is sometimes combined with other substances, it is difficult to determine whether observed cognitive and behavioral effects are caused solely by ketamine or by additional factors.

Ongoing research suggests that potential long-term effects may involve difficulties with:

• memory
• executive function
• attention
• self-control

Getting help

If you or someone you care about is struggling with ketamine addiction, support is available. Many individuals successfully recover each year, and professional guidance can make a significant difference. Seeking help is a proactive step toward improved health and well-being.

You may consider these resources:

• Addiction Center with resources about ketamine treatment and rehab
• Partnership to End Addiction
• Narcotics Anonymous
• SMART Recovery
• Substance Abuse and Mental Health Services Administration

Is ketamine therapy covered by insurance or Medicare?

Coverage depends on several factors. When used for anesthesia, ketamine is typically covered by insurance. However, injectable ketamine prescribed for depression or other mental health conditions is not currently FDA-approved for those indications and may not be covered, as it is considered off-label use.

That said, developments are ongoing, and future approvals could expand insurance coverage for additional conditions, including treatment-resistant depression.

Insurance providers evaluate several criteria when determining benefits, such as:

• the condition being treated — non-FDA-approved uses are less likely to be covered
• the specifics of the individual plan
• the formulation (esketamine is covered by many plans)

If your healthcare provider recommends ketamine therapy, discuss potential insurance coverage with them and contact your insurer directly for clarification.

Takeaway

Extensive research continues to explore the diverse clinical applications of ketamine, particularly for mental health conditions such as treatment-resistant depression, PTSD, and suicidal ideation.

Individuals with certain medical conditions — including high blood pressure, heart disease, or specific psychiatric disorders such as schizophrenia — may not be suitable candidates for ketamine therapy. A healthcare professional can review the latest evidence and help weigh the potential benefits and risks.

Ketamine can cause serious side effects and should never be used without medical supervision. Using ketamine without a prescription is illegal, and illicit products may be contaminated with other substances that heighten the risk of severe complications.

If you are considering ketamine treatment, speak with your doctor to learn more about its approved uses, safety profile, and whether it may be appropriate for your situation.