Side Effects of Ketamine: Safety and Risks

Ketamine is a powerful therapeutic option for many conditions, including treatment-resistant depression, anxiety, PTSD, and chronic pain, including fibromyalgia and migraines. It is increasingly being studied for long COVID and even cognitive benefits. Like all medical treatments, there are risks and benefits with Ketamine that all patients should be aware of.

Different Forms of Ketamine Have Different Risks

Ketamine can be administered in many forms, including:

• IV: the safest and fastest-acting form with direct doctor supervision
• Intramuscular (IM): fast-acting
• Intranasal: slower-acting
• Oral: slowest-acting, lowest bioavailability, often mailed directly to patients

Each form has different risks. IV Ketamine is the safest and most effective form of Ketamine delivery when used with direct physician supervision. IV Ketamine is also the fastest-acting form because the medication is delivered directly to your central nervous system where the healing occurs. Here are the other important considerations for IV Ketamine:

• Highest dosing-precision: IV Ketamine allows for exact dosing, making effects most predictable.
• Highest bioavailability: IV Ketamine is the only form with 100% bioavailability, making it the most consistent experience.
• Fastest dose-adjustments: dosing of IV Ketamine can be changed instantaneously. This allows for customizing the experience to be safe for patients with heart, lung, liver, and kidney conditions. This is very different than taking pills or receiving shots, where the dose cannot be adjusted after administration.
• Direct physician supervision: ensures immediate treatment of short-term side effects.
• Fewest number of doses: IV Ketamine is so effective that it typically allows for the fewest number of Ketamine doses. The fewer the doses, the lower the chance of side effects.

Because IV Ketamine is typically used for 6 doses over 2-3 weeks, the risks of side effects are greatly reduced. This contrasts from other forms of administration, like oral lozenges, which patients may take weekly for years.

Short-Term Ketamine Side Effects

In most forms of administration, Ketamine can cause alterations to our consciousness. These effects are transient and typically resolve as soon as the Ketamine wears off, usually within 1 hour:

• Confusion
• Dizziness
• Perceptual disturbances
• Dissociative experience
• Euphoria
• Increased blood pressure

Patients with a history of psychosis may be more susceptible to the dissociative effects of Ketamine. Ketamine should be pursued only with a collaborative team in such cases.

In our experience, a small subset of patients will experience fatigue lasting up to 48 hours. These cases are rare and are dose-dependent, meaning that the higher the dose of Ketamine, the more likely the prolonged fatigue.

Can Ketamine Cause Memory Problems?

Memory impairment or confusion associated with Ketamine use is typically transient. To the contrary, many studies are investigating the potential of Ketamine to improve cognitive function.

Long-Term Ketamine Side Effects

IV Ketamine is not intended for long-term use. The fewest number of doses should be used for the greatest therapeutic effect. Other forms of Ketamine are sometimes used for longer term. Any time Ketamine is used for extended periods of time, the risks of long-term side effects increases:

• Bladder inflammation: called "Ketamine Cystitis." This is observed in recreational users where doses/durations of abuse are unknown (but likely very high). The first report of Ketamine cystitis in a medical setting was reported in 2024 after nearly 1 year of oral ketamine use multiple times a week. Fortunately, the bladder injury appears reversable in roughly 95% of cases. This demonstrates the importance of using the fewest number of infusions for the greatest benefit.
• Dependence: Ketamine is an abusable substance. When used in a medical setting, however, the risk of developing a "liking" appears quite low. However, caution should always be used in any substance with abuse potential, further emphasizing the importance of judicious use with direct medical supervision.

Ketamine: Risks and Benefits

In making the decision to pursue Ketamine therapy, patients must always weigh the risks and benefits of Ketamine treatment:

• Risks of untreated depression, anxiety, or PTSD: risk of heart disease, stroke, cognitive dysfunction, dementia, and other diseases.
• Risks of oral medications: extensive, possibly worse with prolonged use over decades.
• Risks of Ketamine: typically low with IV administration under physician supervision.

Learn if IV Ketamine is Right For You

You deserve to find healing from depression, anxiety, and PTSD. Left untreated, these conditions can have serious risks. It is important to speak with your doctor about the benefits and risks of IV Ketamine therapy. Schedule a free consultation with Clarus Health to learn if IV Ketamine Therapy may be effective in uncovering your healing capacity.