Ketamine Side Effects: Understanding Risks and Safety Measures

Ketamine therapy is a promising treatment option for mood disorders, chronic pain, and other conditions. However, like any medical intervention, it is not without risks. Understanding possible ketamine side effects and ensuring safe administration are critical to achieving the best outcomes. 

At Transcend Health Solutions, with clinics in San Antonio and Austin, Texas, we prioritize patient safety by delivering ketamine therapy under expert supervision. This article delves into common ketamine side effects, the importance of in-person monitoring, and why professional oversight is indispensable for safe and effective treatment.

Ketamine Side Effects: A Comprehensive Overview

Ketamine is a powerful anesthetic and emerging treatment for various mental health conditions, but like any medical intervention, it comes with potential side effects. Understanding these effects is crucial for patients considering ketamine therapy and for healthcare providers administering it. From rare but serious complications like respiratory depression and cardiovascular changes to milder, more common symptoms, this comprehensive overview explores the potential risks associated with ketamine. By addressing these side effects in detail, we aim to equip readers with the knowledge needed to make informed decisions about their treatment journey.

Aspiration and Airway Management

Ketamine, when used in the controlled environment of ketamine-assisted psychotherapy (KAP), induces a dissociative state of consciousness. While airway management is important, it's essential to note that serious complications, such as aspiration, are extremely rare at the therapeutic doses used for mood disorders. Aspiration, which occurs when vomit enters the lungs, can be a life-threatening condition. However, in a clinical setting like Transcend, patients are closely monitored by trained nurses to manage any nausea or vomiting. To minimize the risk, patients are also advised to refrain from eating for at least three hours prior to their ketamine infusion. This careful preparation, along with expert monitoring, ensures that the risk of aspiration is virtually nonexistent at these doses. In contrast, using high-dose ketamine at home without supervision increases the risk of complications, including choking or aspiration pneumonia, which can be fatal.

Respiratory Depression and Laryngospasm

Ketamine is known for its safety profile, especially at the doses commonly used in ketamine-assisted psychotherapy. Respiratory depression, a concern with some medications, is extremely unlikely at the therapeutic doses used for mood disorders. In clinical settings like Transcend, our nurses are highly trained in recognizing any signs of slowed breathing and can take immediate action if necessary. This early intervention helps prevent complications like hypoxia, which could lead to brain damage or more severe outcomes. While rare, laryngospasm—where the vocal cords spasm and obstruct the airway—can occur with rapid, high-dose ketamine administration. However, this is also highly unusual in the controlled, lower-dose environment of ketamine-assisted psychotherapy. In our clinical setting, trained providers can swiftly manage laryngospasm, reducing the risk to the patient. The risk of such an event occurring is significantly higher in home settings where immediate medical intervention might not be available, making supervision crucial.

Cardiovascular Effects: Hypertension and Heart Risk

Ketamine can cause a temporary increase in blood pressure and heart rate. While this is generally manageable in healthy individuals, it poses significant risks for patients with pre-existing cardiovascular conditions. In clinics like Transcend Health Solutions, ketamine side effects, including any rise in blood pressure, can be promptly treated. In the case of negative cardiovascular effects, your Transcend team may support you with intravenous beta blockers, minimizing the risk of severe complications like strokes or heart attacks.

In contrast, unsupervised ketamine use at home lacks real-time monitoring, leaving dangerous cardiovascular changes undetected and untreated. This underscores the importance of professional oversight during ketamine therapy, in case of ketamine side effects.

Milder Side Effects of Ketamine-Assisted Psychotherapy

While severe side effects are rare, patients should also be aware of milder, more common side effects associated with ketamine-assisted psychotherapy (KAP). These include:

• Dizziness: Many patients report feeling lightheaded during or after a session. This is typically short-lived and resolves within a few hours.
• Nausea: Although steps are taken to minimize nausea, such as fasting before treatment, some patients may still experience mild queasiness. Anti-nausea medications can help alleviate this discomfort.
• Confusion or Disorientation: The dissociative effects of ketamine can lead to temporary confusion or a sense of detachment from reality. This is normal and usually subsides shortly after the session ends.
• Fatigue: It is common to feel tired or drained following a session, as the body and mind process the treatment experience. Rest and hydration are recommended.
• Blurred Vision: Some patients experience slight visual disturbances, such as blurred vision or sensitivity to light. These effects are temporary and typically resolve on their own.
• Changes in Perception: During the session, patients may notice altered perceptions of time, space, or sound. While this can be unsettling for some, it is an expected part of the therapeutic process and not harmful.

Understanding these milder side effects can help patients prepare for their sessions and manage expectations. At Transcend Health Solutions, our team provides comprehensive pre-treatment education and post-session support to ensure patient comfort and safety.

Risks of Chronic Ketamine Use

While ketamine can provide significant benefits for certain mental health and pain conditions, long-term or chronic use carries distinct risks. Regular misuse or recreational use of ketamine can lead to physical, cognitive, and psychological complications. Understanding these risks is essential for individuals who may rely on ketamine therapy or are concerned about its long-term effects.

Bladder Damage and Chronic Use

Another concern associated with ketamine is its potential to cause bladder damage. Chronic or recreational ketamine use can lead to ketamine-induced cystitis, characterized by bladder inflammation and other urinary tract issues.

However, in KAP settings, this risk is minimal. Treatments are typically scheduled once or twice weekly, significantly reducing the likelihood of bladder damage compared to chronic, high-dose usage. At Transcend Health Solutions, we adhere to evidence-based protocols, ensuring patients receive the lowest effective dose. Research indicates that administering ketamine more than twice a week offers no additional benefit, and higher frequency protocols—often promoted by some telehealth providers—increase unnecessary risks.

Brain Changes

Chronic ketamine use has been associated with changes in brain structure and function, particularly when used at high doses or over extended periods. Some studies suggest that prolonged ketamine use can lead to cognitive deficits, including memory loss, difficulty concentrating, and impaired executive function. These effects may be reversible with cessation of use, but prolonged exposure increases the risk of long-term neurological damage.‍

Why In-Person Medical Supervision is Critical

The risks associated with ketamine—from aspiration to cardiovascular events—highlight the importance of professional, in-person supervision. At Transcend Health Solutions, we prioritize patient safety through:

• Continuous Monitoring: Nurses and providers remain bedside to monitor vital signs and manage any side effects in real time.
• Evidence-Based Protocols: We follow scientifically validated dosing schedules and avoid unnecessary risks associated with high-frequency or high-dose treatments.
• Emergency Preparedness: Our trained staff is equipped to handle rare but serious side effects, such as laryngospasm or severe hypertension, ensuring patient safety at all times.

Ketamine Side Effects in Home Settings

Administering ketamine outside of a clinical environment significantly increases risks. Patients who take high-dose ketamine at home may lack the ability to recognize or manage serious side effects. For instance:

• Aspiration: Without medical supervision, a vomiting episode can quickly escalate into a life-threatening situation.
• Respiratory Depression: Slow or obstructed breathing may go unnoticed, leading to severe complications.
• Cardiovascular Events: Elevated blood pressure or heart rate could result in strokes or heart attacks without timely intervention.

Telehealth providers who promote unsupervised ketamine use often ignore these risks, prioritizing convenience over safety. This approach jeopardizes patient well-being and undermines the therapeutic potential of ketamine.‍

Worried about Ketamine Side Effects? How to Discuss Ketamine Therapy with Your Primary Care Physician

Ketamine-assisted psychotherapy (KAP) has been shown to be an effective and fast-acting treatment for depression, bipolar disorder, suicidal ideation, post-traumatic stress, substance use disorder, and other disorders that may be resistant to more traditional treatments. 

If you're considering ketamine-assisted psychotherapy (KAP), it's essential to involve your primary care physician (PCP) in the decision-making process before beginning treatment. Your PCP can provide valuable insights into how ketamine therapy may interact with your current medications, medical history, and overall health status. Open communication ensures your broader care plan is cohesive, reduces the risk of potential complications, and supports the safe integration of ketamine therapy. Here are some tips for discussing KAP with your PCP:

Talking about Ketamine with Your Doctor

How can you bring up the subject of KAP and ketamine side effects with your PCP? Here are some tips:

1. Do Your Research: Familiarize yourself with the benefits and risks of ketamine therapy, particularly as it relates to your specific condition. Bring reputable sources or printed materials to share with your physician.
2. Be Honest About Your Symptoms: Explain why you're considering KAP, whether it's for treatment-resistant depression, anxiety, or chronic pain. Discuss how other treatments have failed or been insufficient.
3. Share Information About Your Provider: Provide details about Transcend Health Solutions, including our commitment to safety, evidence-based protocols, and in-person medical supervision. This reassures your PCP that you're pursuing care in a reputable setting.
4. Discuss Medical History: Be prepared to review your medical history, including any cardiovascular conditions, respiratory issues, or other health concerns that could influence your eligibility for ketamine therapy.
5. Ask for Their Input: Your PCP may have valuable insights or concerns about how ketamine therapy fits into your treatment plan. Encourage them to collaborate with the team at Transcend Health Solutions to ensure seamless care coordination.
6. Request a Referral if Needed: Some insurance providers may require a referral from your PCP for ketamine therapy. Ask your physician to provide one if they feel it's appropriate.

By involving your PCP, you create a partnership that prioritizes your health and ensures ketamine therapy is a safe and effective part of your journey toward wellness. At Transcend Health Solutions, we are happy to communicate directly with your physician to address any questions or concerns they may have.

Ketamine Side Effects: Debunking Common Myths and Misconceptions

As ketamine-assisted psychotherapy (KAP) gains popularity, misconceptions about ketamine side effects have also become widespread. Addressing these myths helps patients make informed decisions and reduces unnecessary fears about this transformative therapy.

Myth 1: Ketamine Causes Addiction in Medical Settings

While ketamine has potential for abuse in recreational settings, the controlled, clinical use of ketamine in KAP is not associated with addiction. At Transcend Health Solutions, we administer ketamine at low, therapeutic doses under strict medical supervision, minimizing any risk ketamine side effects, including dependency.

Myth 2: Ketamine Leads to Long-Term Brain Damage

Some people worry that ketamine use can cause irreversible brain damage. However, research shows that when administered responsibly and in appropriate doses, ketamine does not harm the brain. In fact, ketamine promotes neuroplasticity, helping the brain form new, healthier connections—an essential mechanism for treating mood disorders.

Myth 3: Ketamine Side Effects Are Always Severe

Many individuals assume ketamine therapy is fraught with severe side effects. In reality, most patients experience only mild, temporary ketamine side effects like dizziness or nausea. Severe complications are rare, especially in clinical settings where trained professionals monitor patients closely.

Myth 4: Ketamine Therapy Works Immediately for Everyone

While ketamine often produces rapid improvements in symptoms, it is not a one-size-fits-all solution. Some patients may need multiple sessions to experience significant benefits, and therapy outcomes can vary based on individual factors. Managing expectations is a critical part of the therapeutic process.

By confronting these myths, Transcend Health Solutions empowers patients to approach KAP and possible ketamine side effects with confidence, knowing they are in safe and capable hands.‍

Ketamine Side Effects: Prioritizing Safety

Ketamine therapy offers hope for individuals struggling with treatment-resistant depression, anxiety, and chronic pain. However, its benefits can only be realized when administered safely and responsibly. Understanding ketamine side effects and the importance of professional oversight is essential for achieving optimal outcomes.

At Transcend Health Solutions, we are committed to providing safe, effective, and evidence-based ketamine therapy. Our clinics in San Antonio and Austin, Texas, are staffed with experienced professionals dedicated to patient care. Whether you’re considering ketamine-assisted psychotherapy or exploring options for mood disorder treatment, trust Transcend to prioritize your safety every step of the way.

If you have questions about ketamine side effects or want to learn more about our services, contact Transcend Health Solutions today. Let us help you on your journey to better mental health.

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References

Ansari, M., Pittman, B., Tylee, D. S., Ostroff, R., Wilkinson, S. T., & Nikayin, S. (2024). Blood pressure changes during ketamine infusion for the treatment of depression. General hospital psychiatry, 90, 62–67. https://doi.org/10.1016/j.genhosppsych.2024.07.001‍

Feder A, Costi S, Rutter SB, Collins AB, Govindarajulu U, Jha MK, Horn SR, Kautz M, Corniquel M, Collins KA, Bevilacqua L, Glasgow AM, Brallier J, Pietrzak RH, Murrough JW, Charney DS. (2021), A randomized controlled trial of repeated ketamine administration for chronic posttraumatic stress disorder. American Journal of psychiatry. 178(2):193-202. https://doi.org/10.1176/appi.ajp.2020.20050596‍

Green, S. M., Roback, M. G., Krauss, B., & Emergency Department Ketamine Meta-Analysis Study Group (2010). Laryngospasm during emergency department ketamine sedation: a case-control study. Pediatric emergency care, 26(11), 798–802. https://doi.org/10.1097/PEC.0b013e3181fa8737‍

Horváthy, D.B., Szántó, P., Marschall, B. et al. (2020). Ketamine decreases cell viability of bone explants and impairs bone healing in rats. Journal of Orthopedic Surgery and Research 15(46). https://doi.org/10.1186/s13018-020-1579-x‍

Ko, S. (n.d.). Are ketamine infusions addictive? The American Society of Ketamine Physicians, Psychotherapists, and Practitioners. https://www.askp.org/are-ketamine-infusions-addictive/‍

National Institutes of Health. (2019, November 15). Side effects mild, brief with single antidepressant dose of intravenous ketamine. [News release]. https://www.nih.gov/news-events/news-releases/side-effects-mild-brief-single-antidepressant-dose-intravenous-ketamine‍

Sepulveda Ramos, C., Thornburg, M., Long, K., Sharma, K., Roth, J., Lacatusu, D., Whitaker, R., Pacciulli, D., Moredo Loo, S., Manzoor, M., Tsang, Y. Y., Molenaar, S., Sundar, K., & Jacobs, R. J. (2022). The therapeutic effects of ketamine in mental health disorders: A Narrative review. Cureus, 14(3), e23647. https://doi.org/10.7759/cureus.23647‍

Srirangam, S., & Mercer, J. (2012). Ketamine bladder syndrome: an important differential diagnosis when assessing a patient with persistent lower urinary tract symptoms. BMJ case reports, 2012, bcr2012006447. https://doi.org/10.1136/bcr-2012-006447‍

Strous, J. F. M., Weeland, C. J., van der Draai, F. A., Daams, J. G., Denys, D., Lok, A., Schoevers, R. A., & Figee, M. (2022). Brain changes associated with long-term ketamine abuse, a systematic review. Frontiers in neuroanatomy, 16, 795231. https://doi.org/10.3389/fnana.2022.795231‍

Wells, A. (2024, April 25). Ketamine: A rising star in mental health treatment. Anxiety & Depression Association of America. https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer-professional/ketamine-rising-star-mental-health‍

Wilkowska, A., Szałach, Ł., & Cubała, W. J. (2020). Ketamine in bipolar disorder: A Review. Neuropsychiatric disease and treatment, 16, 2707–2717. https://doi.org/10.2147/NDT.S282208‍

Wu, H., Savalia, N. K., & Kwan, A. C. (2021). Ketamine for a boost of neural plasticity: How, but also when? Biological Psychiatry, 89(11), 1030-1032. https://doi.org/10.1016/j.biopsych.2021.03.014‍