Ketamine infusions are used for acute pain treatment in emergency departments and in the perioperative period for individuals with refractory or intractable pain. In particular, children with cyanotic heart disease and neuromuscular disorders are good candidates for ketamine anesthesia. It is the drug of choice for people in traumatic shock who are at risk of hypotension.
Ketamine is now a controlled substance in Australia, meaning it has a high potential for abuse. The physiological and psychological reasons are the main reason the FDA declared Spravato safe only in a health care facility under supervision.” But it has other physiologic effects on heart rate and blood pressure that can be pronounced.” An ever-increasing number of online “ketamine clinics” have emerged, prescribing off-label generic ketamine for multiple disorders, such as major depressive disorder (MDD), bipolar disorder, anxiety, and post-traumatic stress disorder (PTSD). During the COVID-19 pandemic, the DEA loosened its restrictions, allowing for prescribing of Schedule III substances like ketamine via telemedicine—but not including Spravato. Spravato rules mandate that the drug cannot be taken at home.
What are the Short-Term Ketamine Side Effects?
It’s something that thousands of people are overcoming every day. If you or a loved one is living with an addiction to ketamine, there’s nothing to be ashamed of. Recreational ketamine may be used alone or mixed with other illegal substances.
Despite the risk of emergence reactions, a 2024 meta-analysis by Hung and colleagues178 found that perioperative ketamine significantly improved patient-subjective quality of recovery, pain severity, and psychological symptoms, such as anxiety and depression, without additional adverse events. To date, there has been a lack of evidence supporting the deleterious effects of ketamine in brain injury or increased ICP; more recent studies and reviews have not demonstrated any negative effects or have actually found beneficial effects with regard to ICP and cerebral oxygen consumption (CMRO2).172, 173, 174, 175 Animal studies indicate that ketamine may offer additional antidepressant effects in Alzheimer’s disease.122,125,126
When is ketamine used to treat depression?
Research has found that ketamine can quickly relieve depression in people who do not respond well to other treatment. We also found a three-hertz oscillation in the posteromedial cortex, called the PMC, that another study showed might be related to ketamine’s dissociative effects. In our experiments, we separated the ketamine infusion from the induction of general anesthesia for the surgery, during which a different anesthetic, propofol, was used. The third, the posteromedial cortex, in the back portion of the brain, is a likely site for the dissociative effects.
However, ketamine is only safe when a person takes the drug their doctor has prescribed for a specific purpose. Evidence shows that ketamine is safe for use in people within a wide age range when taken correctly. Research into the use of ketamine for anxiety is scarce, but there is evidence that it has fast-acting, anxiety-relieving effects.
Therapeutic Applications: Ketamine in Clinical Settings
Perry’s case is a tragic example of why it’s not a good idea for doctors to prescribe, or patients to take, ketamine at home—a practice that my colleagues and I have warned against. When friends and family who are depressed ask me if they should seek out ketamine as a potential option, I tell them that it doesn’t make sense unless they have tried oral antidepressants. Beginning in the mid-2010s (see figure 1 in this paper), more doctors started offering ketamine as a treatment for depression. As rates of depression and anxiety have increased dramatically, people have sought therapies outside the standard regimen of oral antidepressants and talk therapy. Even infrequent users—those who used, on average, roughly three times a month—scored higher on a delusional-thought scale than ex–ketamine users, people who took other drugs, and people who didn’t use drugs at all.
- The side effects and risks can be so severe that they cause death.
- In clinical use ketamine is administered intramuscularly or intravenously.
- There’s also the question of how ketamine use might impact personality and behavior over time.
- However, ketamine is only safe when a person takes the drug their doctor has prescribed for a specific purpose.
- In recent years, the medical community has recognized ketamine’s powerful effects on mental health, leading to its use in psychiatry.
- Collectively, these findings shed doubt on the involvement of monoamine reuptake inhibition in the effects of ketamine in humans.
The diverse effects of ketamine, jack-of-all-trades: a narrative review
- In vivo, ketamine rapidly activates the mTOR pathway, promoting synaptogenesis and reversing stress-related synaptic deficits in the prefrontal cortex, which might underlie its fast-acting antidepressant effects in treatment-resistant depression.
- Note that ketamine is remarkable because of its unique mechanism, rapidity of action, antisuicidal effects, and ability to treat depressed patients for whom every other treatment has failed.
- In veterinary anesthesia, ketamine is often used for its anesthetic and analgesic effects on cats, dogs, rabbits, rats, and other small animals.
- Despite these concerns, the potential therapeutic applications of ketamine continue to excite the medical community.
- Unlike traditional antidepressants, which typically take weeks to have an effect, ketamine is quicker.
- Addressing the behavioral aspect of ketamine misuse through professional intervention could be a valuable tool in preventing these dangers from being realized.
- But like many substances with mind-altering properties, ketamine found its way into recreational use.
It later gained prominence for its rapid antidepressant effects discovered in 2000, marking a major breakthrough in depression treatment. At the Interventional Psychiatry Service at Yale, where I work, we often find that a pattern of one treatment every 3-4 weeks is sufficient for helping patients maintain the treatment’s antidepressant effects. If patients take ketamine several times a week at high doses for an extended period, this can result in irreversible problems with memory and thinking, and increase their risk of delusions. In circumstances where insurance pays for treatment (more common with esketamine than ketamine), patients are often required to have tried at least two oral antidepressants before starting treatment with ketamine/esketmaine.
The hydroxylation of the cyclohexan-1-one ring of norketamine to the three positional isomers of hydroxynorketamine occurs by CYP2B6 and CYP2A6. Initially, both isomers are metabolized to their major active metabolite, norketamine, by CYP2B6, CYP3A4 and CYP2C9 isoforms. These searches produced 5,268 non-duplicate citations; 185 articles (case reports, case series, pharmacokinetic studies, animal studies pertinent to pharmacology, and reviews) were considered relevant.
Last year, Musk told CNN’s Don Lemon that he has a ketamine prescription and uses the drug roughly every other week to help with depression symptoms. Medication, outpatient, and inpatient treatment are generally available to address the health effects of addiction including ketamine misuse. Doctors can use activated charcoal in a supervised medical setting to help with gastrointestinal detox in a ketamine overdose, if this is deemed necessary.2 Medications can be used in an emergency room to mitigate some of the psychiatric and medical ketamine overdose symptoms.2
Pathological changes and symptoms appear to decrease in a time-dependent fashion with abstinence from ketamine. In the early 2000s, reports began to emerge of persistent urological symptoms in chronic recreational ketamine users. Co-administration of ketamine with other anaesthetic and sedative agents such as clonidine, propofol, or benzodiazepines may attenuate the deleterious cardiovascular effects in at-risk populations.181,182
More recently, interest has grown around the anti-inflammatory properties of ketamine in the context of depression. Dale and colleagues146 found that perioperative intravenous ketamine for patients undergoing cardiopulmonary bypass surgery, abdominal and thoracic surgeries, and cataract surgeries significantly inhibited IL-6-mediated inflammation in the postoperative period. Clinical studies of the anti-inflammatory properties of ketamine are limited; however, in 2012, a meta-analysis was conducted. For example, cocaine induces a systemic surge in anti-inflammatory effects through cortisol production, and ketamine co-administered with cocaine attenuates this anti-inflammatory process rather than enhancing it.145 Animal studies simulating septic shock found that ketamine reduced pro-inflammatory mediators TNF-alpha and IL-6 whilst improving haemodynamics, arterial oxygenation, and metabolic acidosis.
In clinical use ketamine is administered intramuscularly or intravenously. This is accomplished through the drug’s inhibition of neuronal uptake of various neurotransmitters, including serotonin, glutamate, and blood in urine hematuria symptoms and causes dopamine. Ketamine, general anesthetic agent related structurally to the hallucinogen phencyclidine (PCP).
Immediate Psychological and Physical Sensations
It is so unique it may generate other treatments as good or better, such as new molecular variants without psychedelic effects. How many patients with a past history of a substance use disorder (SUD), or someone currently being treated for an SUD, may develop a ketamine addiction like Matthew Perry? But it is also reasonable to curb our enthusiasm for all forms of ketamine except Spravato until studies show that ketamine is better than Spravato, as well as safe and efficacious. In Australia, 300,000 people said they used ketamine in the previous 12 months, compared to 70,000 in 2016. These unsafe and often contaminated drugs can contain MDMA or ketamine-like analogs that are created and distributed illegally.
Ketamine’s Psychological Effects: From Depression Treatment to Potential Risks
This widespread alteration in brain function contributes to the complex psychological experiences, including changes in perception, mood, and thought processes. The initial disruption is thought to trigger a surge in the release of glutamate, which then activates other types of receptors. It functions as an antagonist of the N-methyl-D-aspartate (NMDA) receptor, a component in neural communication. Another formulation is esketamine, a molecule derived from ketamine, which is available as a nasal spray. It induces a state of immobility and amnesia, ensuring the patient has no memory of the procedure while feeling detached from any pain.
But there is still much to learn about how ketamine works, which dosages are effective, and how safe it is. Traditional antidepressants can take weeks to start working. A 2018 review has shown ketamine may also be effective for treating substance use disorders, such as alcohol, cocaine, or opioid use disorder. It works rapidly (within 10 to 30 seconds) when given intravenously for anesthesia. Your doctor will not prescribe any form of ketamine for you to use on your own. Esketamine (Spravato) is a Alprazolam injection form of ketamine available as a nasal spray.
While traditional antidepressants can take weeks or even months to kick in, ketamine has shown the ability to lift severe depression in a matter of hours or days. In the 1970s and 80s, it gained notoriety as a “club drug,” known for its dissociative effects. Imagine, if you will, a drug that can lift the veil of depression in mere alcohol and acutane hours, when traditional antidepressants often take weeks to show effect. At lower doses, it has psychoactive properties and has gained popularity as a recreational drug. Thus, higher doses produce more pronounced delirium and other symptoms of hallucination than do lower doses.