After two years of providing intravenous (IV) ketamine therapy for the treatment of pain and mental health conditions—including major depressive disorder, anxiety disorders, and post-traumatic stress disorder—we’ve observed a growing, yet often overlooked demographic among our patients: individuals in the later stages of life confronting their mortality. Many of these patients, burdened by depression and anxiety, turn to us in hopes of enhancing the quality of their remaining years, seeking to confront the challenges of aging or terminal illness with renewed purpose and a sense of dignity.
Interestingly, many of these patients describe their ketamine experiences as deeply profound—offering a bird’s eye view of their life, acceptance of death, and imparting a curiosity for what lies beyond. While this might seem unsettling to some, the overwhelming response is one of peace, deep gratitude and even awe. The experience often leads to a greater appreciation for life and helps them embrace the time they have left with mindfulness and intention. In this discussion, we’ll explore how ketamine therapy can extend beyond treating depression to offer those facing terminal illness or the later stages of life a way to process their mortality with serenity, live meaningfully, and savor each remaining moment.
One of the most interesting effects of IV ketamine therapy is its ability to induce a psychedelic experience, which can profoundly shift a person's frame of thinking. During this altered state, individuals often experience a sense of interconnectedness, expanded consciousness, and a detachment from their usual ego-driven concerns. Patients often report seeing their family linage, or feeling a warm, safe embrace, perhaps akin to being in their mother’s womb. For those approaching the end of life, this shift in perspective can help break the cycles of anxiety, despair, and depression that are commonly associated with terminal diagnoses.
The experience allows individuals to reflect on their lives with greater clarity, understand their past, and experience a sense of closure. Such shifts can be transformative, helping them to live their remaining days with less fear and more focus on the aspects of life that matter most—love, relationships, and appreciating life.
Depression is a common but often under-recognized aspect of end-of-life care. The realization that one’s time is limited can sometimes bring on feelings of hopelessness and deep sadness. Studies have demonstrated that IV ketamine therapy is highly effective for alleviating depressive symptoms in end-of-life and palliative care settings. It shows significant promise by delivering rapid relief, often within hours to days, compared to the weeks or months required for traditional antidepressants to take effect.
What sets ketamine apart is its ability to provide not only symptom relief but also a renewed sense of purpose and hope. By disrupting the default mode network (a brain network involved in self-referential thinking and rumination), ketamine helps patients step outside of their usual patterns of depressive thought. This can open the door to more meaningful therapeutic conversations, where patients can explore and process their fears in a supportive and transformative way and perhaps re-engage with the world around them.
Approximately 50% of cancer patients experience severe pain, whether due to the tumor itself, treatment side effects, or related conditions. For many, this chronic pain is debilitating, with 20% to 40% failing to achieve adequate relief from standard treatments, including opioids, which come with significant side effects and inherent risks. Ketamine is a potent analgesic that has been used for decades in anesthesiology, and more recently, in lower doses to manage chronic pain.
For cancer patients, ketamine can be especially effective in cases of neuropathic pain, which is often resistant to other treatments. It works by modulating pain signals in the brain and spinal cord, providing relief without the side effects associated with long-term opioid use. Additionally, ketamine’s anti-inflammatory properties can also help reduce pain levels, improving patients' overall comfort and quality of life.
In a study of 70 patients with refractory cancer pain treated with IV ketamine in an oncology palliative care unit, 74.3% of patients experienced significant pain relief, either through reduced opioid requirements or decreased pain intensity.
For many, the fear of death is rooted in the unknown. What happens after we die? Will it hurt? How will it affect those we leave behind? These questions can create overwhelming anxiety. The altered states of consciousness facilitated by ketamine can help patients confront these fears from a different perspective.
Many patients describe the experience as transcendent, reporting a sense of connection to something larger than themselves. Whether this is interpreted as spiritual, existential, or purely psychological, it can provide a sense of comfort and reduce the terror often associated with death. Ketamine’s ability to create a feeling of oneness or continuity with the universe can help individuals approach death with a newfound sense of peace.
While the psychedelic experience can be profound, it’s important to approach IV ketamine therapy as part of a comprehensive care plan. The safety profile of ketamine is well-established, especially in a controlled medical setting. When administered by experienced professionals, IV ketamine is both safe and effective, with minimal side effects. It is critical, however, that the treatment is closely monitored, ensuring the right dosage and setting to maximize the benefits.
Equally important is integrating psychotherapy with the ketamine treatments. A trained ketamine-assisted therapist can help patients make sense of their experiences, provide valuable tips for navigating the psychedelic realm and integrate the insights gained into their daily lives. In the context of end-of-life care, this might involve processing grief, finding meaning, or addressing unresolved conflicts. Psychotherapy also provides a space to discuss fears, work through difficult emotions, and plan for a peaceful transition.
IV ketamine therapy offers a unique approach for those grappling with end-of-life issues. By easing depression, shifting perspectives, and reducing the fear of death, ketamine can help individuals face this stage of life with greater peace and dignity. When combined with psychotherapy, the treatment becomes not just a way to alleviate suffering, but a powerful tool for facilitating acceptance, reflection, and emotional healing. In a society where conversations about dying are often avoided, ketamine therapy offers a compassionate and profoundly meaningful approach to end-of-life care, opening doors to deeper healing, discussions and acceptance.
About the Author
Dr. Ray Rivas, a former general and trauma surgeon with over a decade of experience utilizing ketamine, became a ketamine therapy specialist to treat mental health and pain after witnessing its profound impact on his hospital trauma patients and his own mental health. As the founder and medical director of Innerbloom Ketamine Therapy in San Luis Obispo, California, Dr. Rivas applies his extensive medical expertise to provide safe, evidence-based ketamine treatments for mood disorders, including depression, anxiety, PTSD, and chronic pain. His passion lies in helping patients find relief and rediscover hope through personalized, compassionate care.
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