What to Know About Ketamine Use

Ketamine is a dissociative anesthetic developed in the early 1960s and used in human and veterinary medicine. The drug is primarily used for anesthesia. It has also been used off-label in treating depression and PTSD and has been FDA-approved for treatment-resistant depression.

In the 1950s, phencyclidine (PCP) was developed as an intravenous general anesthetic, but because of its severe side effects, ketamine was designed to replace it. MXE (methoxetamine) is also a similar drug made from arylcyclohexylamines.

This article discusses the possible therapeutic uses of ketamine as well as the potential for addiction. It also covers treatment options that can help people recover from ketamine addiction.

Overview of Ketamine

Ketamine is a Schedule III drug, which means it is approved for use as an anesthetic in hospital and other medical settings. It is safe and effective when used in a controlled medical setting, but it also has the potential for misuse and addiction.

Drug Class: Ketamine is an NMDA receptor antagonist. It has anesthetic, dissociative, and hallucinogenic effects.

Common Side Effects: Ketamine can have side effects, including elevated blood pressure, tremors, hallucinations, confusion, and agitation.

What Does Ketamine Do?

In medical settings, ketamine is given intravenously to induce and maintain anesthesia. The drug produces dissociative effects that are short in duration. It can also produce hallucinogenic-like effects, lasting a short period of time, from one to two hours.

It creates a state of total dissociation called a "k-hole." This occurs when large amounts of ketamine are used to the point that it impairs a person's bodily and environmental awareness.

Ketamine's exact mechanisms of action are not fully understood, but researchers believe that it works by affecting glutamate receptors in the brain. Glutamate is a neurotransmitter that has been implicated as a contributor to depression. Because ketamine blocks glutamate receptors, it is sometimes used as a treatment for depression. 

Psychiatric Uses

Ketamine has been shown to have antidepressant effects in patients with mood disorders. For this reason, it has been sometimes used intravenously off-label to help treat major depressive disorder and bipolar disorder.

In 2019 the U.S. Food and Drug Administration (FDA) approved an intranasal form of ketamine for use in treatment-resistant depression. Some research has also found that ketamine can reduce symptoms of post-traumatic stress disorder (PTSD).

Studies suggest that ketamine can be fast-acting as an antidepressant, often relieving symptoms in as little as 24 hours. However, using ketamine as a treatment for depression requires a valid prescription and should only be done under the supervision of a medical professional.

Common Side Effects

Some of the common short-term side effects that people experience include:

• Visual disturbances
• Confusion and disorientation
• Drowsiness
• Increased heart rate
• Elevated blood pressure
• Nausea and vomiting
• Euphoria
• Sedation

Depending on the dosage, some can experience these more severe side effects of ketamine:

• Severe allergic reaction
• Hypotension and heart rhythm abnormalities
• Difficulty talking
• Abnormal movements
• Slowed or depressed breathing

Ketamine Addiction and Withdrawal

Ketamine has the potential for misuse and addiction. Some of the signs that someone might be using ketamine include:

• Changes in sleep habits
• Irritability
• Mood changes
• Hallucinations
• Difficulty speaking
• Memory problems
• Disorientation
• Presence of drug paraphernalia

The use of ketamine can result in tolerance, dependence, and symptoms of withdrawal. When tolerance occurs, people require larger or more frequent doses of the drug to achieve the same effects they felt initially. Dependence occurs when a person needs to continue taking a drug in order to avoid the negative effects of withdrawal. 

Overdose

Taking too much ketamine can also lead to a drug overdose. Typically, the outward symptoms of ketamine overdose are the psychotropic effects, including dreams, illusions, and hallucinations—similar to LSD and PCP use.

Benzodiazepines might be given to reduce agitation. This requires caution, however, as in cases of ketamine overdose, ketamine was typically not the only drug ingested. Over-sedation and drug interactions are a concern.

If you believe that someone has overdosed on ketamine or another substance, contact emergency services immediately.

Addiction

The National Institute on Drug Abuse reported in 2019 that a bit less than 0.1% of people in 12th grade had used ketamine in the past year.

Addiction to ketamine can cause chemical changes in the brain's reward system that make it very difficult to stop taking the drug. Because ketamine creates feelings of detachment, people often experience major disruptions in multiple life areas once they have developed an addiction.

Signs of addiction can include neglecting work and family responsibilities and spending large amounts of money on the drug. The high from ketamine is short-lived and tolerance tends to build quite quickly, meaning people who use it need to increase the amount they use in order to get the same results.

Withdrawal

Once people have become tolerant, dependent, or addicted to ketamine, they are likely to experience symptoms of withdrawal when they stop taking it. These symptoms can range in severity from mild to more serious. 

Symptoms of withdrawal can include:

• Depression
• Anxiety
• Rapid heartbeat
• Fatigue
• Lack of appetite
• Insomnia
• Nightmares
• Restlessness
• Tremors
• Chills or sweats
• Anger

Because ketamine withdrawal symptoms can sometimes be serious, it can be helpful to go through the detox and withdrawal process under the supervision of trained addictions recovery professionals.

How to Get Help

While ketamine use and addiction is serious, there are effective treatment options available. Treatment options may include cognitive-behavioral therapy (CBT), individual therapy, group therapy, family therapy, motivational enhancement therapy, or other approaches.

While there are no specific medications approved for the treatment of addiction to ketamine, interventions may include the use of medications to treat co-occurring psychiatric conditions.