Ketamine-Assisted Treatment
David A.N. Siegel, MD
Confidential & Discreet
What Ketamine Is and How It Works
Ketamine is a dissociative anesthetic that acts primarily as an NMDA receptor antagonist, blocking glutamatergic excitatory transmission in the brain. It also has rapid antidepressant and anxiolytic properties, likely involving downstream effects on AMPA receptors, BDNF signaling, and synaptic plasticity. These properties make it a useful clinical tool in certain situations that arise during the treatment of substance dependence.
Why It Has a Role in Addiction Treatment
Withdrawal from alcohol, benzodiazepines, and other substances involves a state of glutamatergic hyperexcitability — the excitatory nervous system, no longer held in check by the substance, becomes profoundly overactive. This is the mechanism behind seizures, severe anxiety, autonomic instability, and the constellation of symptoms that make withdrawal medically dangerous and subjectively unbearable.
Most withdrawal management relies on GABAergic agents — benzodiazepines, primarily — which address the inhibitory side of the equation. But there are clinical situations in which GABAergic agents alone are insufficient, or in which restarting a substitute medication in the same class is not advisable. Ketamine, by acting directly on the NMDA receptor, addresses the excitatory side. It can reduce the glutamatergic surge that drives refractory withdrawal symptoms, providing relief that other agents cannot.
Beyond acute withdrawal, ketamine’s antidepressant and anxiolytic effects can be valuable for symptoms that emerge during treatment and prove resistant to conventional approaches — severe depression, treatment-resistant anxiety, or the profound dysphoria that can accompany protracted withdrawal from multiple substance classes. In these situations, carefully administered ketamine can stabilize a person’s clinical picture enough to allow the broader therapeutic work to continue.
How I Use It
I use ketamine selectively, as one tool among several, in situations where the clinical picture calls for it. It is not a standard part of every treatment plan. The decision to use it is made individually, based on the specific withdrawal syndrome, what has and hasn’t responded to other approaches, and the person’s overall clinical situation.
When ketamine is indicated, it is administered under close medical supervision, at carefully controlled sub-dissociative doses, and integrated into the broader treatment. It is not a standalone intervention. It is a way of managing a specific clinical problem — refractory withdrawal, treatment-emergent mood instability, symptoms that are blocking progress — so that the real work of understanding and recovery can proceed.
A Note on Ketamine Dependence
Ketamine itself has potential for dependence, particularly when used recreationally or outside of careful medical supervision. This is rare in a supervised clinical context and is something I monitor for. The doses and patterns of use involved in clinical treatment are fundamentally different from those associated with recreational dependence.
Getting in Touch
The first conversation is free and completely confidential. There is no obligation of any kind.