What Dr. Leeds Does and Does Not Do With Ketamine in Benzodiazepine Tapering

Does Dr. Leeds run a ketamine clinic?

No. Dr. Leeds does not run a ketamine infusion clinic, does not give infusions, and does not offer “ketamine therapy” as a service. He does not use it to treat depression, pain, or any other condition.

What he does is much narrower. In selected benzodiazepine tapering cases, he has prescribed compounded ketamine, a preparation that dissolves under the tongue or a nasal spray, made to order by a compounding pharmacy. Each decision was made in a consultation, one patient at a time.

So, why would ketamine come up during a taper at all?

What is ketamine, and why does it come up during a taper?

Ketamine is a dissociative anesthetic, not a psychedelic. It is a Schedule III controlled substance, approved by the FDA only as an injection for anesthesia and not for any psychiatric disorder. Spravato, an approved esketamine nasal spray, is a separate product that is given only under observation in certified medical settings.

Compounded ketamine is neither of those. The FDA has not evaluated a compounded product’s safety, effectiveness, or quality, and it has not established a safe or effective dose of ketamine for any psychiatric use. In fact, the FDA’s October 2023 alert on compounded ketamine says it is not aware of evidence that it is safer, more effective, or faster than medications approved for psychiatric disorders.

Patients ask about it anyway. In selected cases Dr. Leeds has used it as an adjunct, meaning an addition to a taper already in place, and whether it would help any particular person is not something anyone can promise.

Ketamine is never a substitute for a gradual taper.

The taper is the treatment. A benzodiazepine taper works by lowering the dose slowly enough that the brain can adjust at each step, and nothing taken alongside it changes that. When Dr. Leeds has used ketamine, it was added to a slow, patient-directed taper, never as a reason to cut faster or to stop.

One warning stands above the rest: never stop a benzodiazepine suddenly, and never let a taper turn into an abrupt stop. Sudden discontinuation can trigger seizures and can be life-threatening. Whatever shape a taper takes, it must be gradual and medically supervised.

Physical dependence on a prescribed benzodiazepine is not addiction. It is a medical condition caused by the medication, and the way out is on the practice’s benzodiazepine tapering program page.

What are the risks, and who should not take it?

Risks come first. Of course, ketamine commonly causes dissociation, a feeling of being disconnected from your body or the room you are in, along with sedation, nausea, and a rise in blood pressure and heart rate. The ketamine label describes hallucinations, vivid dreams, and confusion in the hours after a dose, and it tells patients not to drive for 24 hours.

Unfortunately, the risks do not end when the dose wears off. The label warns of slowed breathing when too much is taken, of liver injury with repeated use, of bladder and urinary tract damage with long-term use or misuse, and of psychiatric effects that can persist for days or weeks. Ketamine can be misused, and people who have misused drugs before, or who have been dependent on them, may be at greater risk of misusing it.

The FDA’s 2023 alert adds that taking a compounded product at home, with no one trained to watch for sedation, dissociation, and changes in blood pressure and heart rate, may put a patient at risk of a serious adverse event. That warning weighs in every decision, and it is one reason the answer may be no.

Who should not take it? Anyone for whom a rise in blood pressure would be dangerous, and anyone with no one nearby who knows what to watch for. Yet, benzodiazepines are themselves sedating, so a second sedating drug on top of a taper is never a casual addition. It is not for everyone.

If you are in crisis right now, do not wait for a consultation.

If you are thinking about suicide or feel unable to stay safe, call or text 988, the 988 Suicide and Crisis Lifeline, at any hour. Call 911 if someone has stopped a benzodiazepine and is having a seizure, or if a person who has taken ketamine is hard to wake, is breathing slowly, or is severely confused or agitated. Emergency care is never the wrong call.

How is the decision made, and how do you ask?

In a consultation, and nowhere else. Dr. Leeds lays out the risks, the alternatives, including no ketamine at all, and the patient’s right to say no, or to stop later, without it changing their care.

While Dr. Leeds is willing to use adjunct treatments that some deprescribers avoid, willingness is not a recommendation. A patient who asks and hears no has lost nothing, because the taper was always the treatment.

The way to ask is the contact form. Dr. Leeds provides concierge telemedicine care for patients in Florida, with an office in Fort Lauderdale. This page is not an offer of ketamine, and asking about it does not mean it will be prescribed.

This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.