Ketamine

Ketamine

Ketamine is a dissociative anesthetic. It is a type of drug a doctor might give to put someone to sleep for an operation. Ketamine can also be used as a painkiller and a bronchodilator (which makes it easier for air to get into your lungs). Sometimes it can lead to a special type of hallucination which makes you feel detached from yourself and the things around you which is why some people use it as a recreational drug. As it can have severe side effects, it is usually not available as an over-the-counter drug.

Medical use

In medicine, ketamine is normally injected into a vein or muscle. Ketamine is not the first anaesthetic a doctor would think of using in most situations because of the hallucinations it causes. On the other hand, while most anaesthetics suppress your breathing, resulting in the need for a machine to help you breathe, ketamine does not. This can make it a useful anaesthetic when you don't have any equipment available, for example, in a war zone.

Side effects

Short term

Short term side effects happen in about 40% of people and include:

• Dizziness
• Double vision
• Euphoria
• Blurred vision
• Finding it hard to express emotions, not being very emotionally reactive
• High blood pressure
• Fast heart beat
• Feeling sick and vomiting
• Having trouble understanding or producing speech
• Nightmares
• Illusions
• Hallucinations
• Changed body image
• Impaired memory and attention.

Long term

In the medical setting, ketamine is only given a few times so most long term effects mentioned below are found in recreational ketamine users and animal models.

Urinary tract effects

There are 110 reports of people with problems in their urinary tract due to using ketamine.

Symptoms include:

• Urgently needing to urinate.
• Finding it painful to urinate and having blood in your urine.
• Not being able to hold as much urine in your bladder
• These urinary tract problems are most common in people who have abused ketamine daily for a long time.

Neurological effects

People who abuse ketamine a lot (more than 4 times a week) have been found to have impaired memory and increased depression when compared to people who don't abuse ketamine. Those who use ketamine less frequently (1-4 times per week) and those who had stopped taking ketamine showed no difference in the aforementioned parameters. This suggests that these problems with memory and mood do not affect infrequent users and might be reversible once ketamine use is stopped.

One study has recently been done using monkeys as a model to see if ketamine is toxic to the brain. The study found that injecting the monkeys every day for 6 months with ketamine caused more cells to die in the front of their brain and also caused a decrease in activity in the areas of the brain which control movement.

Mechanism of action

Ketamine is an NMDA antagonist in the CNS. By inhibiting NMDA receptors in inhibitory neurons in the brain, it causes increased CNS activity and sympathomimetic effects. As a result, there is not only an anaesthetic effect, but also activation of the CNS unlike other anaesthetics. This is beneficial in surgical settings because it maintains blood pressure, airway reflexes, bronchioles remain dilated, and airways patent. Making this a particularly useful drug in shock and surgery patients because of blood pressure maintained with ketamine use, unlike typical anaesthetics which cause decreased BP and respiratory suppression.

Research

Treating addiction

One study by Evgeny Krupitsky has found that using ketamine along with psychotherapy and group therapy was a lot more effective at treating alcohol addiction than the traditional treatment. The same scientist found that ketamine might also be useful for treating heroin addiction. Patients who had been treated for their addiction with multiple sessions of ketamine fared much better than those who had only had one session of ketamine, with abstinence rates of 50% and 22.2% respectively.

As an antidepressant

Some small studies have been done which found that a single dose of ketamine was able to improve treatment-resistant depression after just a few hours, with the effects lasting for one week. The rapid antidepressant effects of ketamine may prove to be a useful alternative compared to current antidepressants, which can take several weeks to have their effects.

Complex regional pain syndrome

CRPS is a disease that causes severe pain and swelling, getting worse over time. Some researchers have been investigating the use of ketamine to treat this condition. In some cases, low-dose ketamine infusions have shown promising results in reducing pain levels, even in patients who have not responded to other treatments.

Post-traumatic stress disorder (PTSD)

Ketamine has been studied for its potential use in treating post-traumatic stress disorder (PTSD). Some early studies suggest that ketamine may be effective in rapidly reducing the severity of PTSD symptoms, and its effects may last for several weeks following a single treatment. More research is needed to determine the safety and efficacy of ketamine for treating PTSD in the long term.

Recreational use

Ketamine is sometimes used recreationally, typically at sub-anesthetic doses. Users often report feelings of dissociation, hallucinations, and a sense of detachment from their body or reality. This experience is sometimes referred to as entering the "K-hole." However, frequent or high-dose recreational use can lead to a variety of negative health consequences, including bladder damage, cognitive impairment, and addiction.

Risks and side effects

Ketamine can cause various side effects, including nausea, vomiting, dizziness, nystagmus (involuntary eye movements), and increased heart rate and blood pressure. High doses or frequent use of ketamine can lead to more severe side effects, such as bladder damage, cognitive impairment, and addiction.

Long-term use of ketamine can lead to a condition called ketamine cystitis, which is characterized by severe inflammation of the bladder, causing symptoms such as frequent and painful urination, blood in the urine, and incontinence. Additionally, chronic ketamine use has been associated with cognitive deficits, including impairments in memory, attention, and executive function.

Ketamine can also have psychological side effects, such as feelings of anxiety, agitation, and paranoia. These effects may be more pronounced in individuals with a history of mental health disorders. There is also a risk of developing a psychological dependence on ketamine, especially with frequent use.

It is essential to use ketamine under the supervision of a healthcare professional to minimize the risk of side effects and complications. When used medically, ketamine is typically administered in a controlled setting, with appropriate monitoring and management of potential side effects.

References

Ketamine Resources
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