What is Low Dose Ketamine Treatment and How Does it Work?

Struggling with depression, anxiety, or post-traumatic stress disorder (PTSD) can have a devastating effect on the quality of your life. Negative thought patterns challenge your ability to maintain healthy relationships, function well at work and can adversely affect your physical health. Although certain medications and treatment approaches can help, they are not always enough. Low-dose ketamine - by itself or in conjunction with your current medications - may be the answer.

In 1970, the Food and Drug Administration (FDA) approved ketamine for use in humans and animals, primarily as an anesthetic. Ketamine has an excellent safety record without the potential respiratory dangers presented by some other anesthetics.

Although higher doses of ketamine can trigger hallucinogenic effects in humans, scientists have found very low amounts of ketamine do not cause a psychedelic effect. Multiple studies and anecdotal evidence finds that low-dose ketamine can effectively treat symptoms of depression, anxiety, and PTSD by reducing negative thought patterns, improving the management of negative emotions, and decreasing physical and psychological pain for many individuals.

What is Very Low-Dose Ketamine?

A very low amount (microdose) of a substance that can deliver psychedelic effects at high doses but does not significantly alter consciousness at low doses is known as a “psycholytic" dose. When a person ingests a psycholytic dose of ketamine, they can still function effectively in their daily lives, but the experience also opens their mind. Many users of very low-dose ketamine report enhanced clarity and ability to focus on their work, improved productivity, an elevated mood, and lessened anxiety.

Neuroscientist John Lilly discovered the benefits of low-dose ketamine in the 1970s as he experimented with various self-administered doses over ten years. Contemporary researchers agree with his findings.

According to John Lilly, the following doses deliver vastly different effects.

• Very low doses of 25-50 mg deliver pain relief, engender feelings of love, compassion, and forgiveness, and a state of relaxation without a hallucinogenic effect.
• A 75-100 mg dose delivers a more profound experience that may include out-of-body sensations. It may help the user work through unresolved problems and process past trauma.
• A high dose of 150-200 is an intense experience and can be dangerous for someone with depression or anxiety. The DEA warns when people use ketamine at this dose; it can trigger hallucinations, distort perceptions of sight and sound and make the user feel disconnected from reality.

People using medium to high doses of ketamine may experience an intense, psychedelic experience and should remain under the supervision of a mental health professional. A psychedelic experience can be frightening, while very low-dose ketamine is typically gentle and calming. Micro doses of ketamine often awaken feelings of self-compassion and reduce self-judgment in the user.

How Does Low-Dose Ketamine Facilitate Healing?

Ketamine can be a surprisingly effective partner in the therapeutic process. Because many users experience deep, personal insights, less physical and mental pain, and continued lucidity while under the effects of low-dose ketamine, they are better equipped to achieve personal growth and healing through psychotherapy, meditation, or other practices.

Psycholytic therapy offers the unique ability for patients to enjoy a relaxed, reflective state while working on self-healing through mind-body practices or working with a mental health practitioner. When working with a mental health professional, very low dose ketamine allows the patient to maintain an awareness of their thoughts and emotions as their therapist guides them into a deeper understanding of the root causes of their mood disorder and finds a path to healing.

People who take prescribed antidepressants like SSRIs may opt to use ketamine in place of or in conjunction with that medication. Many Joyous patients report having experienced unpleasant side effects from SSRIs, including insomnia, muscle pain, nausea, blurred vision, drowsiness, low-libido, and more. Many of our patients remain on their SSRIs while on Joyous treatment, while some choose to wean off those medications with the approval and monitoring of their psychiatric providers. This choice is entirely up to our patients and their providers.

How Does Low-Dose Ketamine Work?

While most people experience the blues now and then, major depressive disorder is severe and long-lasting. The National Institute of Mental Health (NIMH) estimates that 21 million Americans over 18, equating to 8.4 percent of adults in the United States, had at least one episode of major depression in 2020. Adults between 18-25 and multi-racial adults experience the highest percentage of major depression.

Untreated major depressive disorder may damage communication pathways between the brain and the nervous system, as well as physical parts of the brain. Symptoms of untreated depression can be severe and may include chronic pain, fatigue, dysfunctional mood regulation, lack of motivation, impaired cognition, emotional bias, disinterest in the surrounding world, and increase the person’s risk of suicidal thoughts and actions.

When left untreated, severe mood disorders damage the person's enjoyment of life and can be life-threatening. Although a small percentage of people with depression or other severe mood disorders commit suicide, they are at greater risk than the general population.

About 60 percent of people who commit suicide have had a mood disorder, which may include major depression, bipolar disorder, or dysthymia (persistent depressive disorder). Government statistics report that many young people who commit suicide have a substance use disorder, a depressive disorder, or both. Anecdotal evidence and limited studies suggest low-dose ketamine may reduce suicidal ideation – suicidal thoughts or actions – for many people at risk.

When people experience chronic stress, depression, and other negative emotions, neural connections in the brain weaken over time. Studies suggest ketamine may stimulate and strengthen certain neural connections and even enable the brain to form new connections. This ability of brain synapses to adapt and change is called neuroplasticity.

Neuroplasticity means the brain can change and reorganize its structure, functions, or connections in reaction to experiences, injuries, or other stimuli. Many scientific researchers believe chronic depression or anxiety is a stimulus that causes changes in the brain, including atrophy in areas of the cortical and limbic brain, which are brain regions that control mood and emotions. Ketamine works to repair atrophied brain deficiencies, especially those related to glutamate receptors.

Glutamate is a chemical messenger in the brain that regulates mood, memory, and learning. Glutamate is made in the central nervous system and is essential in producing gamma-aminobutyric acid (GABA), commonly referred to as the “calming neurotransmitter.” GABA blocks specific brain signals to slow activity in the central nervous system, which may lessen emotions like fear and anxiety.

Ketamine blocks receptors on GABA and glutamate neurons, increasing activity in the brain's prefrontal cortex. Increased activity in this brain region helps improve cognitive function, impulse control, and a person's ability to manage emotional reactions better.

Science Supports the Benefits of Low-Dose Ketamine

With one exception, the FDA has not explicitly approved ketamine to treat depression, anxiety, and PTSD. The exception is Spravato®, a nasal spray for treatment-resistant depression that is only available at a certified doctor’s office or clinic. However, as mentioned above, ketamine has passed rigorous FDA testing and is approved by the agency as safe for human use. Doctors may legally prescribe ketamine "off-label" to treat mood and trauma-related disorders. Off-label prescribing is an accepted practice, with many physicians prescribing medications for purposes other than those initially approved by the FDA.

A study published in the Journal of Palliative Medicine on the effects of daily oral ketamine on depression and anxiety in hospice patients found that all participants who completed the trial improved significantly in symptoms of anxiety and depression.

Researchers have identified ketamine as especially effective for those with treatment-resistant depression, meaning standard treatment approaches have not improved symptoms or kept them from returning. A study published in the journal Current Neuropharmacology found ketamine to be "rapidly effective," delivering "a significant clinical improvement in depressive symptoms within hours after administration." The study also found ketamine effectively reduced suicidality in TRD [treatment-resistant depression] samples.

Ground-breaking findings by researchers at the Yale School of Medicine herald ketamine as “the biggest breakthrough in depression research in a half-century.” Encouraged by the widely reported benefits for those with depression, additional extensive studies of low-dose ketamine are underway.

Ketamine is also proven effective for anxiety disorders. A recently published meta-analysis of randomized controlled trials of ketamine in treating refractory anxiety spectrum disorders suggests ketamine “may be broadly effective across treatment-resistant anxiety spectrum disorders.”

Ketamine properties appear to be unique. Researchers have been unable to produce a pharmaceutical drug that successfully replicates the beneficial, fast-acting effects of ketamine.

Is Low-Dose Ketamine Addictive?

When used at low doses and as recommended, ketamine presents little to no risk for dependence or addiction. However, because the drug delivers a euphoric or hallucinogenic effect at high doses, it has the potential for abuse. Valued by some as a “club drug,” high doses of ketamine are particularly popular with high school students. The University of Michigan's Monitoring the Future Survey reports about three percent of high school seniors in the U.S. used higher dose ketamine one or more times in the year surveyed.

As with any substance that has the potential for mind-altering effects, whether it is a drug or alcohol, overuse or abuse can cause dependence or addiction. If you use low-dose ketamine as recommended by your medical practitioner to treat a mental health condition, the use of the drug is safe and legal.

What Can You Expect From the Joyous Low-Dose Ketamine Treatment?

The Joyous protocol of low-dose ketamine to heal unhealthy thought patterns is unlike any other. Combining decades of scientific data from renowned researchers into a personalized treatment plan is helping thousands of people just like you improve their mental health.

After completing a short questionnaire and a lengthy medical intake,  you will talk with one of our medical professionals via a telehealth visit to determine if ketamine is right for you. If it is, our compounding pharmacy will produce a custom lozenge at the appropriate starting dose and ship a one-month supply directly to your home. The lozenges deliver ketamine directly into the bloodstream when placed in the cheek. The starting dose is usually relatively low, but we will make continual adjustments as you progress through your treatment plan.

Your Joyous Care Navigator will guide you throughout the process, ensuring you are supported and have all your questions answered. Over the first three to five days, you will get a good idea of how ketamine affects you. Some people begin to feel better almost immediately. For others, it may take a little longer. Because the Joyous team is in constant communication with you, we can easily make dose adjustments as needed.

After you have been on the Joyous treatment protocol for 21 days, you will have another telehealth consultation to discuss with your health practitioner if a refill is advisable. If yes, we will send a new 30-day supply of medication to your home.

Depression, anxiety, and other negative emotions can adversely impact every aspect of your life. While antidepressants and similar medications have their place and help many, they simply aren't enough or don't work for others. Low-dose ketamine is proven effective, quick acting, and typically produces few, if any, adverse side effects.

Contact us today to learn whether low-dose ketamine is right for you.