(For educational purposes ONLY, this extract has been reproduced with permission by Dr Stephen Hyde from his book, Ketamine for Depression)

Patient Information Brochure
What is ketamine?
Ketamine is a medication that has been widely used as an anaesthetic agent since 1970 both in humans and in animals. In the last 15 years, it has been found helpful for people with pain conditions and, more recently, for people with psychiatric disorders.
How does it work?
Research has not yet determined completely how ketamine acts,but one finding is that there is a rapid regrowth of connections between brain neurons following treatment.
What does a trial of sublingual ketamine involve?
You will come into your doctor’s rooms, and a very small dose ofthe drug will be given to you. The medicine is to be taken sublingually (that is to say, under the tongue). Please try not to swallow but hold the medicine under your tongue for three to four minutes until it is absorbed.We would ask you to remain seated for an hour after the drug has been given as you may feel light-headed when you get up. The drug starts working after about five minutes and will be mostly out of your system after an hour and a half, at which time you will be cleared to leave in the company of a friend or relative who will take you
home.
What happens after the trial dose?
Your doctor will show you how to draw it up properly so that you can give it to yourself safely at home. The timing and dose levels will be explained. Your doctor will arrange follow-up appointments and phone calls to adjust dosage and timing.
Benefits
Unfortunately, we cannot guarantee you will gain benefit from this treatment, but more than 50% of people in clinical trials have reported improvement in psychiatric symptoms.
Alternatives
Your doctor will discuss alternatives with you in your consultation. These would include different medicines, counselling, and physical therapies. Every patient is unique, and therefore, specific alternatives cannot be given on an information leaflet as not all treatments are suitable for everyone.
What are the side effects?
You are advised not to drive or operate machinery for four hours after taking your medicine. Sleepiness may occur for a short period after taking the medicine. If this occurs, future doses can be taken at bedtime.You may also experience a sensation that everything feels ‘unreal’ or ‘far away’. This will only last for a short while and will soon disappear.If you take too much ketamine or are very sensitive to its effects, you
may go to sleep or have unusual dreams and hallucinations. We do not know a great deal about long-term problems that may occur using this medicine. Some studies suggest that there may be difficulties for some with memory loss or thought processing. There are also reports of effects on the liver and the bladder, but these are considered unlikely at the doses being used here. These problems seem to occur in some who take
very high doses for extended periods for non-medical reasons. There are no reports of patients becoming dependent or addicted to ketamine when used as a medical treatment.
Ketamine is not currently licensed for use in psychiatric disorders or chronic pain. There are many drugs that are not licensed for every condition, but they get used anyway because they work. It is quite often the case that a drug company will not apply for a licence for a drug for a particular condition or age group as the studies that they need to do may be too expensive or time consuming to be worth their while. Although patients who take unlicensed drugs do so at their own risk, generally the risk is not great when measured against the possible benefits, and you and your doctor will make a considered judgement as to whether it is reasonable to use this treatment in your particular case.
What are patients normally taught to do?
The preparation of your medicine is not a sterile procedure; the
syringe you are given is reusable. You will be taught how to draw up your medicine and place it under your tongue. Generally speaking, most people need to take it about two to three times a week to begin with, then the dosage and the time between doses are adjusted according to
response. As there is the potential for ketamine to be abused, it should be kept securely out of harm’s way, and it would be wise not to discuss your use of it outside the family.

Ketamine can be obtained through the Calvary Hospital Pharmacy at 5 Frederick Street, Launceston, on presentation of a prescription from your doctor. The current cost of a prescription is about $40. The amount dispensed will last around six weeks at the low starting dose.
Further Information
Any questions arising from this leaflet should be raised with your doctor before signing your consent-for-treatment form.