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Ketamine + Emergency Room = ✨
A New Opportunity for Ketamine
By Stephanie Karzon Abrams, Clin.Pharm.
Mental Health Crises in the Emergency Room and a New Opportunity for Ketamine
Hope For Those in Crisis
Emergency Rooms (ERs) often serve as the frontline for patients, where life-threatening trauma and routine injuries collide in chaos. This includes people experiencing mental health crises when there’s nowhere else to turn.
Imagine this: a patient goes to the ER in distress, suffering from anxiety, severe depression, and suicidal ideation.
The routine approach may include: sedatives, antipsychotics, meeting a psychiatrist, or a rushed referral to social services. These short-term fixes may treat the immediate threat, but they leave the deeper, long-term problem unresolved.
Enter Ketamine.
When administered at lower doses, ketamine can be remarkably effective in treating even the most resistant cases of depression.
This isn’t just a passing trend—when combined with psychotherapy, ketamine is delivering not only immediate relief in crisis situations but also leading to lasting, transformative outcomes.
I want to invite you to consider:
What if doctors in the ER could treat patients experiencing a mental health crisis with ketamine, setting them up for long-term success?
Let’s dive deeper into how ketamine is reshaping emergency care, offering a powerful new approach to addressing mental health crises with both immediate and long-term impact.
An Exploration of Ketamine
Ketamine has been a staple as an anesthetic in emergency medicine for decades.
More recently, researchers are increasingly exploring IV ketamine as an alternative to morphine for pain management, particularly for patients who have a history of opioid use disorder.
Outside of physical pain management, for about 20 years, mental health practitioners have studied ketamine-assisted therapy: a legitimate protocol that provides relief and a chance for true, long-term healing.
Now, looking to the future, there may be an opportunity to combine these practices and offer ketamine as a way to manage mental health crises in the ER.
How Does Ketamine Work?
Ketamine, modulating glutamate in the brain, quickly creates a cascade of neurochemical changes that can rapidly alleviate even the most severe symptoms of depression, anxiety, and suicidal ideation. Its fast-acting mechanism makes it uniquely suited for emergency interventions, offering relief in hours rather than the weeks often required for traditional antidepressants to take effect.
When administered at low doses, ketamine works quickly, often within minutes.
And, rather than just treat symptoms for the moment, it can act as a "mental health bridge," providing relief that can buy time for patients to receive further psychiatric care, while in a new, more receptive state of mind.
Source: Ketamine.net - Ketamine.101
The Opportunity:
Ketamine is an affordable medication, making it a cost-effective intervention.
With some attention to education and preparation for the patient, ketamine could be administered in the ER to stabilize a patient and provide relief.
This would be followed by planning and referrals to mental health professionals for ongoing care, with one of the following:
Psychiatric specialists, psychologists, or social workers within the hospital system for ongoing mental health support.
Ketamine-Assisted Therapy (KAT) practices, where patients can begin a structured protocol integrating therapy with the ketamine experience.
Spravato (intranasal ketamine) clinics, particularly for patients whose insurance covers this FDA-approved treatment for depression.
Ketamine in Medicine
Shifting the Status Quo
ER Physician Dr. Megan Johnson, sees the opportunity ketamine presents for patients and describes her role:
“My role in these cases often starts with ensuring the appropriate lab work is completed and confirming the patient is medically cleared. From there, a social worker or a psychiatrist evaluates whether inpatient care is necessary.
For patients experiencing anxiety attacks, we usually opt for non-benzodiazepine medications and provide discharge instructions to follow up with psychiatry or psychology.
For those struggling with substance use, many hospitals now have substance use counselors who connect with patients, either in person or over the phone, to arrange rehab, outpatient treatment, or medication support."
While Dr. Johnson recognizes the untapped potential ketamine holds for patients, she emphasizes the need for greater education and awareness before its use can be more widely adopted for mental health cases.
Establishing referral pathways to external providers often requires departmental approval, highlighting the vital role ketamine therapy clinic owners and operators play in creating educational initiatives and cultivating trustworthy partnerships.
By prioritizing collaboration and shared understanding, these efforts ensure patients receive seamless, informed care, effectively bridging the gap between emergency interventions and long-term mental health support.
Off Label Benefits
A physician I spoke to recently who chose to remain unnamed, told me about a recent experience:
He uses ketamine primarily for orthopedic cases, but takes the time to provide a brief explanation to patients before administering it to his patients. Preparing them for the unique feeling ketamine can provide and informing them that there may be some additional benefits pertaining to their mental health.
He has observed remarkable effects, including one patient who later returned to the ED weeks after their visit - not just to express gratitude, but to share that they hadn’t had any problematic substance use since their experience with the doctor.
TL;DR Summary
🚑 ERs are often the first stop for mental health crises, but traditional treatments like sedatives don’t address the root problem.
💉 Ketamine is now being explored as a rapid mental health intervention, delivering immediate relief for severe depression, anxiety, and suicidal ideation.
🧘🏽 Combining ketamine’s mental health applications with ER practices could transform how we handle mental health emergencies.
🌉 Ketamine offers a “bridge” by stabilizing patients in crisis, giving them time to access further psychiatric care while in a more receptive state.
🧠 Ketamine quickly modulates brain chemistry, providing relief far faster than traditional antidepressants.
💲Ketamine is a cost-effective medication, making it an accessible option.
❤️🩹 Building partnerships between ERs and ketamine therapy providers could ensure patients receive seamless care from crisis to recovery.
🌱 Ketamine has the potential to shift mental health care in ERs, providing hope for those in their most vulnerable moments.
As we reimagine how we approach mental health crises in emergency rooms, ketamine emerges not just as a treatment but as a lifeline - a way to offer immediate relief and open the door to lasting healing. Its dual role as a trusted anesthetic and a groundbreaking mental health intervention bridges the gap between acute care and long-term support.
The opportunity is here: to educate, to collaborate, and to redefine what’s possible for patients in their darkest moments. By embracing ketamine’s potential and fostering partnerships between emergency departments and mental health providers, we can create a more compassionate, effective system of care.
Curious about how ketamine could transform mental health treatment in the ER and beyond?
Let’s continue the conversation.
By Stephanie Karzon Abrams, Clin.Pharm.
Citations & References
📖 Anxiety and Panic Attacks:
Case Report: A patient presented to the ED with acute chest pain and shortness of breath, initially suspected of having a cardiac event. Further evaluation revealed the symptoms were due to a severe panic attack, highlighting the challenge of differentiating between cardiac and anxiety-related presentations in emergency settings
Maloy, Katherine (ed.), 'Anxiety, Trauma, and Hoarding', in Katherine Maloy (ed.), A Case-Based Approach to Emergency Psychiatry (New York, 2016; online edn, Oxford Academic, 1 July 2016), https://doi.org/10.1093/med/9780190250843.003.0002, accessed 14 Dec. 2024.
📖 PTSD-Related Episodes:
Case Example: A patient experienced a dissociative episode triggered by PTSD, leading to disorientation and distress. The ED environment exacerbated these symptoms, complicating diagnosis and management. This case emphasizes the need for trauma-informed care in emergency settings
Maloy, Katherine (ed.), 'Anxiety, Trauma, and Hoarding', in Katherine Maloy (ed.), A Case-Based Approach to Emergency Psychiatry (New York, 2016; online edn, Oxford Academic, 1 July 2016), https://doi.org/10.1093/med/9780190250843.003.0002, accessed 14 Dec. 2024.
📖 Suicidal Ideation:
Patients frequently present to emergency departments (EDs) with suicidal ideation, seeking immediate intervention. A notable case involves a 25-year-old female who was transported by ambulance to the ED after expressing suicidal thoughts at a mental health clinic. Upon arrival, she appeared calm and denied current suicidal ideation. However, during her stay, she eloped from the ED, highlighting challenges in managing such patients and the critical need for continuous monitoring and appropriate safety measures
Bourgeois JA, Xiong G, Barnes DK, et al. The One That Got Away—Elopement of a Suicidal Patient in the Emergency Department.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2023.
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