Ketamine
Ketamine is a medication originally synthesized in 1962 as an anesthetic, primarily intended for short-term surgeries. It gained notoriety in the 1990s for its recreational use among young people, leading to its classification as a Schedule III controlled substance in the United States in 1999. Despite its controversial history, ketamine has garnered attention in the medical community for its potential antidepressant effects, particularly for patients who do not respond to conventional treatments. In 2019, the FDA approved a derivative known as esketamine for depression, highlighting ongoing research into its therapeutic applications for conditions such as PTSD and other mental health disorders.
While ketamine can produce rapid relief from depression, it is also associated with significant side effects, including increased heart rate, impaired motor function, and potential hallucinations. In unmonitored environments, users may experience severe reactions, sometimes referred to as "K holes," where they feel disconnected from reality. The drug has also been misused in situations involving sexual assault due to its dissociative properties. Medical professionals caution that, while ketamine shows promise, it can lead to serious complications with chronic use or when mixed with other substances. Overall, ketamine represents a complex intersection of therapeutic potential and risk, making it a topic of ongoing study and debate.
Ketamine
Category: Substances
Also known as: K; special K; vitamin K
Definition: Ketamine hydrochloride is a short-acting anesthetic. It has pain-killing and hallucinogenic properties.
Status: Legal in the United States for use as an anesthetic in medical settings; nonmedical use is illegal
Classification: Schedule III controlled substance
Source: Synthetic drug with no natural sources; supplies are diverted from legal sources for illegal use
Transmission routes: Intravenous, intramuscular, ingestion, inhalation
History of Use
Ketamine was first synthesized in 1962 in the laboratories of the Parke-Davis pharmaceutical company. It was developed as an alternative to phencyclidine (PCP) for use as an anesthetic. Clinical use in short-term surgery in humans was initiated in 1975. Many patients began reporting hallucinations while under the drug’s influence. Its use became limited in humans, but it had more widespread applications in veterinary medicine. The drug was soon diverted from hospitals, medical offices, and medical supply houses.
By the 1990s ketamine had become a popular drug for recreational use among teenagers and young adults in the club scene. The United States Drug Enforcement Administration (DEA) added ketamine to its list of emerging drugs of abuse in the mid-1990s. It was classified as a schedule III controlled substance in 1999.
Meanwhile, as ketamine faced increasing scrutiny from the US government during the 1990s and early 2000s, various institutions began conducting studies to determine whether ketamine could safely be used as an antidepressant and mood stabilizer. With one of the first small studies conducted at the US National Institutes of Health (NIH), other larger studies began at Yale University and Mount Sinai Hospital. Based on the potential for ketamine to relieve depression within hours, researchers continued to test the drug's effect on depression on patients for whom other medications have not worked. Yale eventually emerged as a leading center for this type of study.
During the late 2010s and early 2020s, ketamine attracted increased attention from researchers, medical professionals, and individuals interested in alternative therapies for depression, post-traumatic stress disorder (PTSD), and other mental health conditions. In 2019 the US Food and Drug Administration (FDA) approved a new medication for depression, Spravato, which included esketamine, a substance derived from ketamine. Throughout the early 2020s ketamine clinics, where patients could receive doses of ketamine under medical supervision, saw a surge in popularity. However, medical professionals noted that despite the potential benefits of ketamine for some patients, they cautioned that the drug could still trigger adverse side affects, including psychosis, in others.
Effects and Potential Risks
Primary side effects of ketamine observed in medical settings include increased heart rate and blood pressure, impaired motor function and memory, numbness, nausea, and vomiting. While sedated, patients are unable to move or feel pain. Once the drug wears off, patients have no memory of what occurred while they were sedated. Researchers studying the potential therapeutic effects of ketamine noted the drug's ability to trigger the production of glutamine, which encourages the brain to produce new neural pathways and can make it easier for people with depression and other mental health challenges to develop more positive thinking and other behaviors.
In unmonitored situations, ketamine produces a dose-related progression of serious adverse effects from a state of dreamy intoxication to hallucinations and delirium. A “trip” on ketamine has been described as being cut off from reality—“going down into a K hole”—and as an out-of-body or near-death experience. Users may be unable to interact with others around them or even see or hear them. Ketamine has been used as a date rape agent because the victim often has no memory of what occurred.
Because abusers feel no pain, they may injure themselves without realizing they are doing so. Chronic use can lead to panic attacks, rage, and paranoia. High doses or prolonged dosing can lead to respiratory depression or arrest and even death. Ketamine is often mixed with heroin, cocaine, or ecstasy. Any of these combinations can be lethal.
Bibliography
Chen, Jennifer. “How Ketamine Drug Helps with Depression.” Yale Medicine, 9 Mar. 2022, www.yalemedicine.org/news/ketamine-depression. Accessed 27 Mar. 2023.
Dillon, Paul, Jan Copeland, and Karl L. R. Jansen. “Patterns of Use and Harms Associated with Non-Medical Ketamine Use.” Alcohol and Drug Dependence, vol. 69, 2003, pp. 23–8.
“Ketamine.” United States Drug Enforcement Administration, April 2020, www.dea.gov/sites/default/files/2020-06/Ketamine-2020.pdf. Accessed 27 Mar. 2023.
Smith, Dana G. “Psychedelics Are a Promising Therapy, but They Can Be Dangerous for Some.” The New York Times, 20 Feb. 2023, www.nytimes.com/2023/02/10/well/mind/psychedelics-therapy-ketamine-mushrooms-risks.html?searchResultPosition=3. Accessed 27 Mar. 2023.
Winter, Caroline. "Is Ketamine the Best Hope for Curing Major Depression?" Bloomberg Businessweek. Bloomberg, 19 Aug. 2015. Web. 30 Nov. 2015.