ENGLEWOOD, Colo. — For decades, ketamine has been used as an anesthetic. More recently, there has been a growing interest in how the drug can be used to treat depression or post-traumatic stress disorder (PTSD).
According to Johns Hopkins, the anesthetic is used off-label "for everything from psychiatric illnesses to autoimmune disorders." Ketamine has not been approved by the FDA for treating mental health disorders, but in 2019, esketamine was approved by the FDAfor adults with treatment-resistant depression. Esketamine is a "variant of the ketamine molecule" that was approved by the FDA as a nasal spray, according to UCHealth.
UCHealth also reports that, when used in "safe, supervised settings with a medical expert," ketamine seems to help with treatment-resistant depression. Still, UCHealth said, "Ongoing research is vital."
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Dr. Beth Ballen became the first prescriber to provide ketamine treatment for depression and mood in the Denver area in 2012. Ballen said ketamine has been used off-label for more than a decade to treat depression.
"We have people that will say, 'Isn't that the horse tranquilizer or the party drug?' And I explain to people that ketamine was developed decades ago for use for general anesthesia, and it is one of the safest anesthetics. That's why it's used in pediatrics a lot," Ballen said. "Yes, it's used in veterinary medicine. It's used in the emergency room, and it's used in pediatrics because it doesn't cause the same respiratory depression that other anesthetic agents can. They use it in the military because it also treats pain. So, if you're a soldier and you get an injury in the field, the medic can just give you an injection of ketamine and not worry about checking your vital signs."
Ballen said there is a huge difference between using ketamine in a medical setting and using it recreationally. At her practice, she said the goal is to individualize the treatment, ensuring the dosage is unique to each patient.
"We start at the same dose for everyone based on weight, but after that first infusion, it's based on how you respond and what we're trying to get out of it," Ballen explained. "My nurses are really educated and experienced with deciding, do we need to increase the dose? Do we need to increase the length of the infusion? Add more fluid to the bags? Change the music?"
Setting the appropriate mood for a ketamine infusion is critical, according to Ballen.
"If you come in and you've been stuck in traffic and you're stressed out and irritated, we need a few minutes to decompress before," Ballen used as an example. "That's also why the music can be very helpful, and it has to be the right music. We provide an eye mask, which helps people go inward instead of getting distracted. We have noise-canceling headphones just, again, so people can hear the music and kind of tune out everything else."
At Ballen's practice, there is an emphasis on combining ketamine infusions with traditional therapy.
"The next day is the prime time to do therapy because you still have the benefits [of the infusion] but can also participate and you're sharp," said Ballen. "I think that's why we have such a high success rate, which is much higher than in the studies because we are looking at the whole person. And if you don't have a therapist, we're likely going to suggest that you get one... You can't just give ketamine in a bubble."
One of Ballen's patients is Miranda Spencer, who first sought ketamine therapy after her father passed away shortly after she first moved to Colorado in 2022.
"I was struggling with some PTSD symptoms," Spencer said. "I was having very intrusive suicidal thoughts. And so, I Googled 'How to stop suicidal thoughts,' and I saw an ad for ketamine therapy."
First, Spencer tried a different clinic. She said the injections gave her some instant relief and allowed her to sleep, but the treatment was not having the long-lasting effects she wanted.
"Then a friend of mine referred me to Beth and just went on about how great her clinic was, and so I reached out. I got an appointment with Dr. Ballen, and then immediately started to get ketamine infusions. Before I was getting injections, which is like a needle in your arm, and then here I was getting an actual IV of the ketamine," Spencer explained. "That's when I really started to see or feel the relief from some of my PTSD symptoms from my dad's death."
The holistic mental health care that Spencer receives at Ballen's clinic is another reason she believes the ketamine therapy is now having a greater impact than it did at the first clinic.
"You can't just give me an injection and fix me... One of the reasons, I believe, that where I was going to get the injections wasn't really doing much was because there was not — I didn't see a therapist there. There was no psychiatrist there," Spencer said. "I did not feel the safest at the first clinic, but here, all of my infusions have been literally so relieving for me. Every time I come out of them with this insane sense of just hope."
Spencer was already seeing Ballen for ketamine infusions when she was sexually assaulted in November 2023. Medical records provided to Denver7 show she suffered fentanyl poisoning in addition to injuries from a sexual assault.
"When you lose a parent, it kind of feels like a part of you or losing a part of yourself," Spencer said. "When you're sexually assaulted, it feels like your whole you kind of dies. It's like you are just a completely different person."
Ballen said she wanted to see Spencer as quickly as possible after the assault.
"What I think is great, especially with the ketamine, is if we can intervene right after an assault — when people are thinking, 'I'm not in any shape to go see a doctor right now,' like 'I'll go next week or next month,' — but that's when we can break out the neurobiological issue of that imprinting on the brain and kind of mix that up so that it doesn't imprint. And we can prevent long-term PTSD from forming because of the way ketamine works by increasing growth factor to grow new neurons, new connections," Ballen said. "It helps later on, too, but it's an especially unique opportunity when we're lucky enough to meet people as soon as possible after the assault."
For Spencer, the sessions with Ballen alongside the ketamine infusions have changed her life.
"It's allowed me to be able to live through it," Spencer said. "It saved my life so many times... I always feel it's about reminding me that I can do this and I can keep pushing and I'm going to be able to survive this."
The ketamine infusions have shown Spencer she is capable of saving herself — something Ballen said is at the heart of psychiatric progress with patients.
"People don't give themselves credit for how hard they've worked, and it's kind of like, I didn't save your life. You did by seeking help and doing the work and showing up," Ballen said while smiling at Spencer. "That's why therapy is so helpful. But you have to be really brave to seek treatment and advocate for yourself."
Research appears limited on ketamine therapy specifically in Colorado. Prehospital use of the drug was the subject of a state health department review after paramedics administered ketamine during an encounter with Elijah McClain that turned deadly. That study determined ketamine can be used safely in the field by paramedics but requires more training and monitoring. It did not examine ketamine therapy.
Ketamine can be addictive, particularly for those who may be addicted to other substances, according to UCHealth.
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