KETAMINE

TREATMENT

What is Ketamine?

Ketamine is a dissociative anesthetic drug that up until now has been used mainly for induction and maintenance of general anesthesia. It was first synthesized in 1962 as a novel compound derived from PCP in pursuit of a safer anesthetic and is used in medical procedures that do not require skeletal muscle relaxation. Ketamine has been used regularly in veterinary medicine and was used extensively as surgical anesthesia during the Vietnam War. In 2020, a study in Parasites & Vectors found that the fungus Pochonia chlamydosporia is a natural source of ketamine which explains its psychedelic effects, similar to psilocybin. Today, ketamine is also widely recognized as the most promising therapy for the treatment of major depression, PTSD, and suicidal ideation.

What Does Ketamine Do?

Compared to general anesthesia which puts an individual in a sleep-like state, when ketamine is given in subanesthetic doses, it creates a dissociative effect which refers to the feeling of disconnection from thoughts, memories, surroundings, actions, and identity. This dissociative effect is helpful in treating many issues including depression, anxiety, PTSD, and chronic pain. In treatment, ketamine does four main things:

  • Dissociates old neuronal connections

  • Allows for the formation of new, healthy neuronal connections

  • Increases dopamine production

  • Reduces swelling/inflammation in the brain

How Does Ketamine Work?

There is a nucleus in the brain called the lateral habenula, also referred to as the "anti-reward center". It’s called this because after a certain amount of trauma or ongoing disappointments, the lateral habenula will go into "burst mode" which eventually shuts down dopamine production. This leaves an individual feeling tired, unmotivated, and unable to find joy. Ketamine blocks this "burst mode" and turns the dopamine production back on nearly immediately. When burst firing stops, an individual begins to feel relief, joy, and gratitude.

Ketamine also separates neuronal connections in the brain (by NMDA receptor antagonism), which breaks apart old patterns of thinking that are no longer beneficial for an individual. Ketamine then floods the brain with the chemical messenger glutamate (by pyramidal cell disinhibition). This allows neurons to reconnect together, including those which have not communicated with each other for an extended period of time. The reconnection of neurons then allows access to thoughts of joy and gratitude, rather than just the destructive ones.

Lastly, Ketamine stimulates the positive neural networks by increasing brain derived neurotropic factor (BDNF) and activating AMPA and mTOR pathways to increase dendritic spine density (growing new connections in the brain).

In high enough doses, ketamine can create hallucinations, similar to other drugs such as LSD.  In our clinic’s experience, we notice that patients with PTSD tend to have more vivid hallucinatory experiences during their treatment.

Ketamine Therapy Honolulu

Side Effects and Risks of Ketamine

Side Effects

Prescribed doses of ketamine have a variety of side effects, the most common being:

  • Drowsiness

  • Double Vision

  • Confusion

  • Nausea

  • Vomiting

  • Dizziness

  • Feelings of Unease

Side Effects and Risks of Ketamine

If a patient experiences any of these side effects, they will typically return to feeling ‘normal’ within an hour after receiving the treatment.

Risks

Ketamine is generally quite safe when prescribed and given by a medical professional. It is also safe for use for individuals in a wide age range, starting as young as 3 months old. Despite the overall safety, ketamine treatments have the following risks:

  • Hemodynamic Changes - Ketamine is considered to be extremely hemodynamically stable, which is why it is used as an anesthetic for the sickest patients.  Because ketamine is a sympathomimetic, it is not recommended in patients with uncontrolled high blood pressure or unstable angina.

  • Respiratory Depression - This is very uncommon (did you see Thirteen Lives?:) but can occur in very high doses.

  • Emergence Reactions - Includes reactions such as agitation or confusion.

  • Increase in Intracranial Pressure

  • Liver Injury - Long term ketamine use has been shown to cause liver damage.  This is typically a result of consistent recreational use/abuse or from extended use of prescribed ketamine (such as sublinguals or intra-nasal spray).

  • Cognitive Deficits - Some research reports these effects in children.

  • Dependence/Addiction - While ketamine is typically non-addictive, its pain-relieving and mental effects can lead to dependence. This usually occurs as a result of frequent recreational use/abuse or from extended use of prescribed ketamine such as intranasal sprays or sublinguals.

    Ketamine is not recommended for people of any age that have uncontrolled hypertension, acute or chronic unstable angina, or who are currently using stimulants such as cocaine or methamphetamine. In rare cases, concurrent use of ketamine with the afore mentioned conditions could contribute to heart attack or stroke. Ketamine is also not suitable for individuals with schizophrenia or who are pregnant or breastfeeding.