Addiction Medicine Made Easy | Fighting back against addiction

How Ketamine Treats Depression, Anxiety, And PTSD

Jan 26, 2026

Dr. Mark Reimach, an addiction psychiatrist and ketamine clinic clinician, explains where ketamine helps most. He covers its use for depression, anxiety, PTSD and acute suicidality. He contrasts IV vs nasal approaches, outlines induction and maintenance protocols, and discusses safety, addiction risk, and how ketamine pairs with psychotherapy and medication management.

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INSIGHT

Unique Anti-Suicidal Properties

Ketamine is one of few psychiatric medicines shown to reduce acute suicidal thinking.
This rapid anti-suicidal effect separates it from most traditional oral antidepressants.

ANECDOTE

Ketamine Addiction Is Rare In Clinical Practice

Mark Reimach notes ketamine addiction is rare in his 20-year addiction psychiatry practice.
He recalls roughly ten primary ketamine-addiction cases over two decades, far fewer than alcohol or opioid cases.

ADVICE

Keep Existing Meds During Ketamine Initiation

Keep proven psychiatric medications in place when starting ketamine and only taper slowly after sustained stability.
Prioritize maintaining stability and adjust PRN meds first if needed.

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Join us for this episode which is a fast, honest tour through what ketamine can actually do for mental health—without the hype. We sit down with addiction psychiatrist Dr. Mark Hrymoc to unpack where the evidence is strongest, who qualifies, and why IV ketamine often produces quicker relief than nasal esketamine when depression won’t budge. From treatment-resistant depression and acute suicidality to anxiety and PTSD, we dig into the protocols that matter: six-session inductions, customized maintenance, and practical strategies for measuring progress with tools like the PHQ-9.

We pull back the curtain on how ketamine works at the receptor level—NMDA antagonism, downstream dopamine effects, and BDNF-driven neuroplasticity—and explain why dissociation may help some patients but isn’t required for benefit. You’ll hear how we screen candidates, manage blood pressure, reduce nausea, and set up sessions with eye masks, ambient music, and a nurse at the bedside so the experience is safe, focused, and grounded. We also get real about addiction risk, clarifying the difference between recreational use and a carefully monitored medical protocol, and how stable recovery timelines factor into clinical decision-making.

For PTSD and anxiety, we explore pairing ketamine with psychotherapy and post-session integration to turn insights into change. We compare IV ketamine’s dosing flexibility with Spravato’s structured pathway, talk costs and coverage, and outline how to taper other meds only after sustained stability. Looking ahead, we spotlight promising research directions—from extending response with adjuncts to early signals for substance use disorders—and why interventional psychiatry is opening a much-needed chapter beyond traditional antidepressants. If you’ve wondered whether ketamine is a bridge or a destination, this conversation gives you a clear, practical map. Subscribe, share with a clinician friend, and leave a review to help others find evidence-based mental health care.

To contact Dr. Grover - ammadeasy@fastmail.com