Ask the Experts

Why Some Doctors Are Turning To Ketamine To Treat Postpartum Depression

Although ketamine is often thought of as a psychedelic party drug, medical studies show it can have a “significant positive effect” on mental health.

If you've struggled with your mental health after welcoming a baby, you're far from alone. Up to 20 percent of new parents experience some form of postpartum depression (PPD) in the weeks and months after giving birth to a new baby, making it one of the most common complications of pregnancy.

As with most mental health conditions, however, PPD is stigmatized, misunderstood, and frequently mistreated, leaving plenty to suffer in silence as their concerns are minimized or diminished by those around them, including their doctors. New parents can feel sad, angry, anxious, lonely, withdrawn, hopeless, and helpless, even if they've never experienced depression in the past. Without proper support, PPD can be downright debilitating, especially during an already vulnerable time in one's life.

For those who seek treatment, talk therapy and/or medication can help. But some patients might need more care, which is why some doctors are recommending novel treatments like ketamine-assisted psychotherapy (KAP) for postpartum patients.

What is ketamine, and how does it help with depression?

You've likely heard of ketamine as a psychedelic party drug ("special K," anyone?), and you're probably wondering how it's legal and/or safe to use medicinally. "Ketamine is a dissociative medication that has been used for anesthesia since the 1960s," explains Dr. Erica Burger, DO, MPH, an integrative psychiatrist at Driftless Integrative Psychiatry. She notes that it was found to have a "significant positive effect on mental health symptoms."

Despite its party drug image, ketamine is "a commonly used general anesthetic," adds Dr. Julie Landry, PsyD, ABPP, a clinical psychologist and founder of the Halcyon Therapy Group. It's also the first and only FDA-approved psychedelic medication, says Landry, used as a nasal spray to help treatment-resistant depression.

"Ketamine provides an attractive alternative to conventional treatments for postpartum conditions because ketamine treatments typically relieve symptoms quickly while traditional medications (including SSRIs and SNRIs) take several weeks to months to work," adds Landry.

Much like traditional antidepressants, it's not exactly clear how ketamine helps those struggling with anxiety and depression, but so far, results seem promising, says Landry. "It seems to work by triggering reactions in the brain that allow brain connections to grow, which is called neuroplasticity," notes Burger. "These new connections make the brain more adaptable, which can be particularly beneficial for people with postpartum depression as it can help them develop more positive thoughts and flexible thinking, as well as improve resiliency. Ketamine can be particularly meditative and allow people to feel safe inside of themselves and explore without the typical psychological defenses in place." (That is, the drug can lower your normal inhibitions safely in a therapy setting, allowing you to open up about your feelings more easily.)

"Ketamine-assisted therapy can help heal past trauma, treat both anxiety and depression, gain perspective, change unhelpful habits, and enhance relationships," says Burger.

Who might benefit from KAP treatments?

Patients with PPD "who have more ruminative and rigid thinking might find particular benefit with ketamine assisted psychotherapy," says Burger, who notes that many of her patients with long-term depression that didn't respond to other treatments found KAP very helpful. "That being said, ketamine-assisted psychotherapy isn't solely for individuals with severe, treatment-resistant symptoms, as people with PPD who are simply looking for other options besides traditional medication and therapy also may benefit," she adds.

Because it's so new, research about its safety and efficacy for breastfeeding patients is ongoing, and it's not confirmed to be safe for pregnant patients. Landry cites a 2021 study in which ketamine was administered to patients during cesarean section proved effective in preventing PPD, adding, "It's important to note this was a single study, and this finding has not been studied in clinical trials."

Like any mental health concern, Landry adds, "Patients should discuss their treatment options with their providers as each person's needs will vary."

What should you expect during KAP treatments?

If this all sounds like what you're looking for, you're probably curious about what KAP actually entails — and yeah, it's definitely not your average therapy session. "In most KAP practices, patients will meet with the provider (a psychiatrist and/or psychotherapist) for a therapy and medical screening intake," says Burger. "After that, patients usually work with the therapist or psychiatrist for a couple of therapy sessions to help prepare for the session. Ketamine medicine sessions are typically three hours in duration, which includes taking the actual ketamine, either by IV, intramuscular, or in lozenge form. Music helps to complement the experience, and an eye mask encourages inward focus. The environment is typically relaxing and peaceful."

After ketamine is given (a process which lasts around an hour), the provider is with the patient throughout the experience, with the intention of maintaining a safe space, facilitating as needed," she adds. "I will often tell patients that it turns conventional Western psychiatry on its head — instead of a doctor telling them what to do, I encourage them to go within and trust their own innate healing capacity to get them through any challenging situations that may arise." She likens it to learning to drive, with the provider sitting beside the patient "with a map in hand and creating a supportive environment for them."

Afterward, the patient can "share what they experienced and how they felt," adds Burger. "Integration is such an important aspect of ketamine-assisted therapy (and all psychedelic therapy). Integration might include ongoing psychotherapy, meditation, dance, journaling, time out in nature, bodywork. There is no blueprint or timeline for it, but it is an essential part of the process that can help the positive shifts that occurred during the ketamine session get integrated into one's daily life."

It might all sound a bit woo-woo, but if you've tried just about everything to feel better, why not explore alternative options?

And when it comes to side effects, Landry notes, "All medications have possible side effects. The side effects will vary depending on what type of ketamine is administered. Ketamine given by infusion may cause an increase in blood pressure, nausea and vomiting, perceptual disturbance, and dissociation."

Adds Burger, "It is, overall, well tolerated. Some people experience a little dizziness and disorientation as they wake up from a session — many people feel like they just woke up from a deep sleep. Unlike other psychedelic medicines, ketamine is compatible with SSRIs and SNRIs — there is no need to stop or taper off of them."

How do you find a KAP provider?

You won't be able to walk into any doctor's office and receive this "highly specialized psychotherapy," says Landry. The Kriya Institute offers a list of certified KAP therapists in the U.S. and Canada, with Burger also recommending Ketamine Psychotherapy Associates (KPA) and psychedelic support. "If you are currently working with a psychiatrist, therapist, or primary care physician, you can ask them if they have any recommendations as well."

Additionally, you'll likely need to pay out of pocket, and treatment can be cost-prohibitive. "Ketamine has been shown to be effective for a number of psychological issues; however, the use of this medicine is still considered 'off label' and is not typically covered by insurance," says Burger. "However, some clinics do offer insurance coverage of the therapy sessions and initial visits." Landry adds that patients "should check with their insurance providers and also ask about out-of-network reimbursement. HSA/FSA accounts may also be helpful in covering the costs."

No matter your concerns, know you're far from alone in whatever you're experiencing, postpartum or otherwise.