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Ketamine treatment service

Find out about our paid-for ketamine treatment service for depression

Potential side effects

Ketamine is known to produce some side-effects. It is not a licensed treatment for depression and the effects of taking it long term are unknown. There may also be unusual side-effects which occur acutely which are unreported.

Ketamine commonly causes brief side effects. These are more common at higher doses, but the relationship between dose and side-effects is variable, even within the same patient.

Brief side effects

Side-effects which occur during or shortly after treatment include:

Feeling dissociated (mind and body feel separate). Occasionally, this extends to the point of an ‘out of body’ experience.

Dizziness.

Feeling ‘a bit drunk’.

A floating sensation.

Lightheadedness.

Patients commonly feel tired for the rest of the day after treatment.

Altered perception– things “look peculiar” or sound different.

Nausea or vomiting – this can be treated with antinausea agents. Do not have a big meal before treatment.

Anxiety – this can extend to the point of panic. It may be associated with a ‘near death’ experience. This can occur ‘out of blue’ even in people who have had many treatments. The anxiety diminishes rapidly as the drug is broken down in the body, so the infusion can be turned off if necessary. In this case, the anxiety settles within 5-10 minutes.

Headache – responds to paracetamol.

Temporary bruising. The treatment involves a needle being put into the vein on the back of your hand and a low dose of ketamine infused over 40 minutes.

An increase in blood pressure or a fast heart rate. This will be monitored during you first infusion and before and after subsequent infusions During the infusion, if you find the side effects too unpleasant then please tell a member of the team that you would like to stop.

Less-common side effects

Vivid dreams.

Hallucinations (feeling, seeing or hearing something that is not actually there).

Dysphoria (feeling unwell or unhappy) Occasionally people have felt a worsening in their depressive symptoms and suicidality whilst taking ketamine. If this happens, you should notify the ketamine clinic and your local team.

Mania (unusually elevated mood which causes problems). Ketamine should be stopped immediately if you suspect this is happening. The ketamine team and your local team need to be informed promptly.

Rare physical side-effects

Liver damage. If you are receiving ongoing ketamine treatment, you will need a monitoring blood test every 6-8 months. This should be done by your GP. Alternatively, we can do this when you attend to pickup medication or for an appointment, but you will be charged for this at a rate of £100 per occasion, so we strongly encourage you to have this test done by your GP.

Long term theoretical risks

Dependence

Ketamine is sometimes taken illegally in large, frequent doses. Drug abusers can become addicted to it. Sometimes people find that if they stop ketamine their depression relapses. This is not the same as addiction. This is reliance.

Sometimes patients taking it for depression find that their depression is no longer controlled despite continuing to have treatment with ketamine. There can be several possible reasons, one of which is that they have developed tolerance to ketamine. This may mean that a treatment break is needed or that it is no longer an effective treatment and therefore will be stopped. Sometimes, the dose can be safely increased. However, it is best to reduce the dose or extend the interval between doses to help maintain the effect.

Sometimes, people find that they think a lot about ketamine and crave it. It is important to notice that this is happening and to be open and honest with the clinical team about this.

We are not aware of reports of anyone who has taken ketamine as prescribed for the treatment of depression and who has become addicted. However, when people use ketamine illegally it is not uncommon for the dose and frequency to escalate.

For comparison, ketamine is much less addictive and dangerous than strong opiates (eg fentanyl, methadone), is probably less addictive and dangerous than tobacco, and has equivalent risks to alcohol and benzodiazepines.

Bladder damage

Bladder damage. This is common in people who take illegal ketamine recreationally at doses of over 1g ketamine daily. This dose is substantially higher than the maximum we use.

Drinking plenty and avoiding alcohol reduces the concentration and damage potential of ketamine metabolites in the bladder. The main symptoms of ketamine-induced bladder damage are pain passing water, and needing to pass urine more often. If you start to experience these symptoms please contact your GP and the ketamine clinic.

Cognitive impairment. This has not been observed over 1 year treatment with esketamine, but has been seen in addicts taken high doses daily. It is associated with evidence of brain shrinking and other brain lesions.

Personality change

Apathy has been reported in addicts.

Precautions after treatment

If accompanied home by a responsible adult, you will stay on the unit for an hour after treatment.

If it is not possible for you to be accompanied, you will stay on the unit for at least two hours after the end of the infusion.

After ketamine treatment you must not:

  • drive a vehicle
  • drink alcohol
  • sign any legal documents
  • be responsible for looking after dependents

until the following morning.

Potential benefits

Ketamine is a novel treatment for depression which has not responded to other treatments. A rapid antidepressant effect has been demonstrated in several clinical trials of single intravenous infusions over the last 15 years in patients with depression with has not responded to at least 2 or 3 antidepressants.

The response lasts a day for about 70% of patients and up to three days for 30% of patients. In some cases this benefit is longer: up to four months, following three infusions over three weeks. The majority of patients relapse within two weeks after treatment.

The best evidences comes from a trial in which patients were randomly allocated to a dummy treatment which was thought would probably not work for depression (midazolam) or to ketamine. After seven days, four out of 25 (16%) patients who had been given midazolam infusion were responders compared with 21 out of 47 (47%) who had received the ketamine infusion.

It is important to recognise that ketamine is not licensed as an antidepressant. It has not been evaluated in large, or long term, clinical trials. There is much that is not known about how, or for whom, it works.

Large trials of the closely related drug esketamine, which is a component of ketamine, have shown broadly similar effects. A safety study of over 800 patients who took intranasal esketamine and a newly initiated antidepressant showed a 43% remission rate at 12 months.

Download information leaflet

PDF file. Requires pdf reader

Referrals

Your psychiatrist or GP should send a send a referral letter, preferably by email to:

KetamineClinic@oxfordhealth.nhs.uk

or by post to:

Referrals
Ketamine Clinic
Warneford Hospital
Headington
Oxford
OX3 7JX

Version: Web 15 November 2018

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