As an anesthesiologist who has used ketamine in the operating room for years, I’ve watched with great interest—and no small amount of hope—as this powerful medication finds new footing in the world of mental health care. What started as a staple in surgical and emergency settings is now showing real promise as a treatment for depression, PTSD, chronic pain and more, especially in patients for whom traditional approaches just haven’t worked.

Most people are familiar with Propofol, thanks to its unfortunate role in Michael Jackson’s death. But long before Propofol came on the scene, ketamine was being used as a true anesthetic—offering not just sedation and pain control, but the rare ability to do so without compromising a patient’s breathing. That unique profile made it a go-to in high-stakes settings. And early on, many of us began noticing something intriguing: some patients reported mood improvements after receiving ketamine. It wasn’t subtle—and it wasn’t just once.

That anecdotal evidence sparked years of research, and the results have been eye-opening.

How ketamine works and why it’s different. Most antidepressants work by increasing serotonin levels and can take weeks to show any benefit. Ketamine works differently. It targets a different set of receptors (primarily NMDA receptors) and acts within hours—sometimes minutes—especially when administered intravenously or intramuscularly. It’s thought to help the brain form new connections, essentially “rewiring” areas involved in mood regulation. For many patients, this represents a radical shift in what’s possible in treating mental illness.

It’s important to note, however, that many online and telemedicine practices have popped up which are prescribing ketamine with little to no oversight. One should keep in mind that ketamine is still a very powerful drug with significant potential side effects (including death) that should be prescribed and administered in a carefully monitored environment by qualified mental health clinicians.

Depression and suicidal ideation. One of ketamine’s most groundbreaking uses is in treating major depression that hasn’t responded to other treatments. In those at high risk for suicide, ketamine can buy precious time—delivering rapid symptom relief when every hour counts. That’s not just promising; it’s lifesaving.

PTSD and anxiety disorders. Some studies point to a promising role in ketamine therapy for PTSD and severe anxiety. These are often individuals stuck in cycles of fear and hypervigilance, and ketamine has been shown to ease the intensity of traumatic memories and interrupt the looping thoughts that come with anxiety. It doesn’t erase trauma, but it can help people breathe again. Of course, more studies are needed to validate these observations.

Chronic pain. Beyond mental health, ketamine is increasingly used to treat chronic pain syndromes like complex regional pain syndrome (CRPS) and fibromyalgia. By modulating how the brain and spinal cord process pain, it can provide significant relief and improve daily function. It’s not a cure, but for many, it’s a breakthrough. Several studies are currently investigating the safety and efficacy of ketamine in the treatment of these disorders.

Routes of administration and safety. Now, let’s be clear: ketamine is powerful. It’s classified as a dissociative anesthetic, meaning it can alter perception and even cause hallucinations. It’s chemically related to phencyclidine (PCP) —yes, that PCP—which is why it must be administered in a controlled medical setting by clinicians trained in its effects and safety protocols.

It can be delivered in several ways: IV, IM, nasal spray and even orally. IV remains the most studied and precise, but intranasal options like esketamine (Spravato) are opening doors for outpatient treatment. Side effects like dissociation, elevated blood pressure and confusion can occur, but with proper screening and monitoring, they are manageable and usually short-lived.

Looking ahead. While this article seems to paint a fairly positive image of ketamine, it’s important to note that many of these treatments are regarded as “off-label.” This means that there is not enough evidence for the FDA to endorse the use of this drug for these disorders. However many drugs are successfully used off-label for a variety of disorders, thus consultation with your health care professional is critical when evaluating the risk and benefits. Further, most insurance carriers will not reimburse for off-label medication use, resulting in out-of-pocket pay.

The integration of ketamine into mental health and pain management isn’t a trend—it’s a paradigm shift. It’s giving hope to patients who’ve run out of options. This isn’t about replacing traditional therapies; it’s about adding a powerful new tool to the kit. As research continues to evolve, I believe ketamine will become a cornerstone of modern psychiatric and pain care.

Dr. Elisha is an anesthesiologist and founder of Desert Cities Anesthesia Professionals. His podcast, I’ll Ask the Questions Around Here!, delivers captivating conversations and unique perspectives from fascinating guests. For more visit www.JosephElishaMD.com.

Sources: 1) Jelen LA, McShane R, Young AH. Guidelines for ketamine use in clinical psychiatry practice. BJPsych Open. 2024;10(3):e107. doi:10.1192/bjo.2024.62; 2) https://publichealth.jhu.edu/2024/what-to-know-about-ketamine