Dr. Geeta Arora, a Cold Spring resident, is a physician who combines ketamine doses with therapy to treat mental health problems such as post-traumatic stress disorder (PTSD), depression and anxiety.
What is ketamine’s history?
Ketamine is a synthetic anesthetic invented in the 1960s. It is derived from PCP [phencyclidine] and has proven to be remarkably safe. During the Vietnam War, it was known as a “buddy drug” because injecting ketamine into wounded soldiers reduced their pain, slowed heart rates and improved success rates for subsequent procedures in field hospitals. Some studies show that ketamine helps alleviate symptoms of PTSD. In fact, there are currently more than 3,600 studies supporting its use for mental health care.
What inspired you to treat people with ketamine?
I began treating patients with ketamine in 2014. While working in the hospital setting, I administered ketamine to individuals dealing with end-of-life anxiety and pain. However, it was the profound impact of the pandemic that led me to make a significant life change. After witnessing the devastating loss of 93 percent of my patients, and five of my colleagues, from COVID-19 within just a few weeks, I decided to leave hospital medicine. I wanted to collaborate with therapists and help people reduce their mental suffering by utilizing precise ketamine dosing alongside psychotherapy.
How does ketamine work?
Ketamine’s mechanism of action sets it apart from traditional antidepressants like Prozac or Cymbalta. While those medications primarily target serotonin, norepinephrine and dopamine — which make up a small percentage of the brain’s neurotransmitters — ketamine works on glutamate, a neurotransmitter present in more than 90 percent of neurons. Excitingly, new antidepressants are being developed to target the same neurotransmitter. I use intramuscular injections, allowing 93 percent of the dose to reach the brain. Other methods, such as lozenges or intranasal delivery, vary in effectiveness from 17 to 60 percent absorption. Intravenous injection provides 100 percent absorption but requires a clinical setting.
How does your approach differ from others?
While many practitioners use ketamine as a standalone treatment, my approach is more nuanced. I don’t typically work with medically complex or acutely suicidal patients, where intravenous ketamine can be very beneficial. Instead, I focus on individuals who have tried various treatments — such as antidepressants and therapy — for years without success. By combining precise dosing with therapy, we create a supportive “safety container” for the patient’s healing journey. This holistic approach can offer the structure for profound inner healing.
What can patients expect during treatment?
Patients undergo preparatory sessions and maintain a close relationship with their therapists throughout the treatment. Dosing sessions typically last up to three and a half hours. Patients share that their experiences vary from beautiful and mystical to scary. They often describe a deep sense of self-understanding, observing their lives from a third-party perspective and recognizing patterns that were holding them back. Some experience a profound sense of peace. I’ve had patients who started working with me because of suicidal thoughts and after a few dosing sessions have renewed hope and excitement for life.
