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Ketamine—widely known as Special K—never really became a mainstream drug in the 1970s.

Later, with the emergence of the RAVE scene in the late 1980s and early 1990s, ketamine gradually resurfaced as a club drug. Though used much less frequently than ecstasy.
90% of it is used in the US for veterinary purposes and it was also used in the Vietnam War a lot.

John C. Lilly, a doctor who did a lot of work with the drug got addicted to it.

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Used as an anti-depressant. Links to the right go more in depth.

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Sept. 23, 2014 -- Every year, 13 million to 14 million Americans have major depression. Of those who seek treatment, 30% to 40% will not get better or fully recover with standard antidepressants.

That puts them at greater risk of alcohol and drug abuse, hospitalization, and suicide attempts. Now, though, a growing body of research shows there may be new hope: the anesthetic drug ketamine.

Ketamine has a reputation as an illicit party drug due to its hallucinogenic effects. But in a handful of ketamine clinics around the country, people who weren't helped by standard treatments are getting a series of infusions to ease their depression. The drug has also been used in emergency rooms for curbing suicidal thoughts, making it a potential lifesaver.

"The benefits I've seen are pretty impressive, and the data are very strong," says psychiatrist Kyle Lapidus, MD, PhD. He's an assistant professor of psychiatry and neuroscience at Stony Brook University. Lapidus says there have been a large number of positive studies, though the number of participants in those studies has been small.

Ketamine acts quickly -- often within hours or less -- and health care professionals who give it to patients at therapeutic doses say it has mild and brief side effects in most people. But it hasn't been thoroughly studied for long-term safety and effectiveness, and the FDA hasn't approved it to treat depression. "The pace of research can be slow for people who are suffering," Lapidus says.

He says it's not uncommon for doctors to go "off-label" (using a drug for a purpose other than its approved one) when treating patients. And in the case of ketamine, the research, including his own, has convinced him that it can help depressed patients. Lapidus runs a Manhattan clinic called US Ketamine. Soon, he will open a second clinic on Long Island.

'Not a Miracle Drug'

Experts don't know exactly how ketamine works, but they do know it works differently than commonly used antidepressants such as Prozac, Zoloft, and Effexor. That may explain why people who aren't helped by standard treatments respond to ketamine when other medications don't help.

Continued

That's novel and exciting, says psychiatrist Alan Manevitz, MD. He specializes in treatment-resistant depression at Lenox Hill Hospital in New York. What's equally noteworthy is ketamine's ability to go to work right away, unlike most antidepressants, which take weeks, sometimes months, to provide relief.

"Feeling better faster, getting the mood to improve faster -- that's why ketamine is very promising," Manevitz says.

He cautions, though, that no matter how successful ketamine proves to be, you can't count on a single treatment to cure depression. You need to address all aspects of a person's disease, from the biological and the psychological to the social and environmental.

"Ketamine is not a miracle drug at all," Manevitz says. "It may momentarily take them away from that catastrophic place they're in with depression, but you're not addressing the rest of the patient. It's a complex issue to treat psychiatric issues, and you have to treat the whole patient."

For people considering suicide, though, the drug's rapid response could be life-saving. Recent studies have shown that a single dose of ketamine dramatically reduces suicidal thoughts.

How long the drug's effect lasts remains to be answered -- a few days or weeks, it's believed. But that window of relief could prove critical.

"We need suicide treatments so greatly in psychiatry," says researcher Elizabeth Ballard, PhD. "Ketamine could be a bridge for someone who comes in who is suicidal. They are given ketamine, and for the 3 days or so that it's effective, they can be hooked up with outpatient resources, with other medications, with psychotherapy."

Ballard, a researcher at the National Institute of Mental Health, published a study in August that shows ketamine reduces suicidal thoughts independent of its effect on depression or anxiety.

That's an important discovery, Ballard says, because not all suicides can be traced back to depression. Post-traumatic stress disorder, borderline personality disorder, and alcohol or other substance dependence, for examples, also account for some suicides. Further research is needed to explore the study's findings.

Continued

Ketamine Clinics

While researchers continue to study ketamine, practitioners such as Lapidus have already begun to provide it to patients. The Ketamine Advocacy Network lists 17 providers and clinics around the country.

Anesthesiologist Enrique Abreu, DO, runs the Portland Ketamine Clinic in Portland, OR. He works with a mental health specialist -- Marilyn Sears, LCSW and clinic co-founder -- and gives IV ketamine infusions. Most of his patients are self-referrals.

"These people are suffering, and they find us online," says Abreu, who estimates that he has treated 30 people since he opened his clinic 15 months ago.

He says he has no mental health background, but he's got 15 years' experience using ketamine as an anesthetic. In fact, many clinic operators are anesthesiologists rather than mental health specialists.

"It's a weird gray area," Abreu says. "Who's going to help these people and do it safely?"

Before Abreu treats someone, he consults with their psychiatrist or primary care doctor. Treatment then consists of six infusions over 12 days. Each infusion lasts about 45 minutes. Side effects, which often include confusion, lucid daydreaming, and fuzzy vision, clear up quickly. Patients are watched closely and must have pre-arranged transport home. They're barred from driving or using heavy machinery for 24 hours.

Abreu says in his experience, the side effects "go away as soon as the infusion is over, and patients don't have hallucinations."

Abreu says about three quarters of his patients aged 15 to 55 benefit from ketamine. Older patients have a lower response rate. The initial six infusions cost $3,800, the beneficial effects of which last anywhere from 3 to 5 weeks for some patients, and up to 12 weeks for others. Patients return as needed for single boosters, which cost $600. Because the FDA has not approved ketamine for this use, insurance doesn't cover it.

Lapidus says his clinic will mainly use a nasal spray form of ketamine, a method that he and his former colleagues at Mount Sinai's Icahn School of Medicine found effective. They published the results of their research in April.

Continued

Manevitz, who has also used ketamine in his practice, says we don't know anything yet about ketamine's potential as a long-term treatment for depression.

"The problem is maintaining the gain, prolonging the effect," he says.

Lapidus agrees: "How to maintain benefits: This is an area that needs a lot more research. Most of the studies published have involved only a single treatment."

Sources

SOURCES:

Kyle Lapidus, MD, psychiatrist, assistant professor of psychiatry and neuroscience, Stony Brook University.

Alan Manevitz, MD, psychiatrist, Lenox Hill Hospital, New York.

Elizabeth Ballard, PhD, research fellow, NIMH.

Enrique Abreu, MD, anesthesiologist, Portland Ketamine Clinic, Portland, OR.

Agency for Healthcare Quality and Research: "Primary Care Depression Guidelines and Treatment Resistant Depression: Variations on an Important but Understudied Theme."

Ketamine Advocacy Network: "Directory of US ketamine doctors."

Larkin, G. Injury Prevention, 2010.

Purves, D. Neuroscience, 2nd edition, 2001.

Ballard, E. Journal of Psychiatric Research, August 2014.

DiazGranados, N. Journal of Clinical Psychiatry, December 2010.

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Ketamine: The Future of Depression Treatment?

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Sept. 23, 2014 -- Every year, 13 million to 14 million Americans have major depression. Of those who seek treatment, 30% to 40% will not get better or fully recover with standard antidepressants. That puts them at greater risk of alcohol and drug abuse, hospitalization, and suicide attempts.

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Heavy use of ketamine intensifies the drug's effects dramatically. The user's judgment becomes extremely impaired, and vision becomes totally distorted. Auditory hallucinations may begin to appear as well. (Ongoing humming or buzzing sounds are the most common.) Some users find it very difficult to move or speak. They may also feel as if time has stopped completely.

Users who have experienced these symptoms run the risk of landing in a "K-Hole." The authors of the NIDA research report titled "Hallucinogens and Dissociative Drugs" describe the "K-Hole" experience as "a terrifying feeling of almost complete sensory detachment that is likened to a near-death experience." The "K-Hole" generates extremely vivid and often frightening hallucinations in users. These individuals may also experience nausea, vomiting, convulsions, DELIRIUM, RESPIRATORY DEPRESSION, and a loss of consciousness. Ketamine users who have eaten or consumed alcohol before taking high doses of

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Ketamine, also called 2-(2-chlorophenyl)-2-(methylamino)-cyclohexanone or CI581, general anesthetic agent related structurally to the hallucinogen phencyclidine ( PCP). Ketamine was first synthesized in 1962 at Parke Davis Laboratories by American scientist Calvin Stevens, who was searching for a new anesthetic to replace PCP, which was not suitable for use in humans because of the severe hallucinogenic effects it produced upon recovery of consciousness. Ketamine was originally patented in Belgium in 1963 and was approved for use in humans by the U.S. Food and Drug Administration in 1970. Soon after, it was put to use to treat American soldiers fighting in the Vietnam War. Today, since ketamine can produce minor hallucinogenic side effects in humans, it is used most often as a veterinary anesthetic. However, the drug does have valuable applications in human medicine, especially as an anesthetic for children and for individuals undergoing minor surgery.

Unlike inhalation anesthetics or sedative anesthetics (e.g., narcotics and benzodiazepines), ketamine does not depress respiration or other basic functions of the central nervous system. Thus, ketamine has a relatively wide margin of safety. In addition, it is distinct from other anesthetics because it has three major effects: analgesia (pain relief), hypnosis (sedation), and amnesia. The drug is known particularly for its ability to induce a dissociative (cataleptic) state, which is characterized by a lack of pain sensation, unconsciousness, and increased muscle tone. These characteristics are often accompanied by open eyes, jumping eye movements ( nystagmus), and involuntary limb movements.

Ketamine works by altering the activity of neurons in the brain. This is accomplished through the drug's inhibition of neuronal uptake of various neurotransmitters, including serotonin, glutamate, and dopamine. The net effect is a depression of neural communication between the thalamus and the cerebral cortex, resulting in an uncoupling of brain activity associated with memory, motor function, sensory experience, and emotion. Ketamine also stimulates activity in the limbic system, a region of the brain involved in controlling certain autonomic functions and in integrating various brain activities, including those associated with motivation and emotion.

In clinical use ketamine is administered intramuscularly or intravenously. Minor side effects of the drug include tearing (lacrimation) when emerging from the dissociative anesthetic state. Patients can sometimes experience severe and troubling hallucinogenic effects, such as intense dreams and delirium, upon waking; these effects are more common in adults than in children. Hallucinations are directly related to dose. Thus, higher doses produce more pronounced delirium and other symptoms of hallucination than do lower doses.

Ketamine's ability to produce hallucinogenic effects within minutes after administration has led to its abuse as a recreational drug. The dissociative effect of ketamine that is produced by high doses is often described by recreational users as the "K hole"-a separation of the mind and body, or a hallucinatory "out of body" experience. Ketamine is known by various street names, including K, special K, jet, super acid, and cat valium. It may be snorted, injected, or taken orally, and its effects may last from 30 minutes to more than an hour. However, for one or more days after taking the drug, users may display symptoms of amnesia, schizophrenia, impaired judgment, and lack of coordination. In addition, long-term abuse can lead to paranoia, depression, and other evidence of cognitive dysfunction. Many individuals appear to be in a stupor when the drug has been taken in low doses; however, high doses can cause unconsciousness, cardiovascular depression, and death.

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Ketamine, general anesthetic agent related structurally to the hallucinogen phencyclidine (PCP). Ketamine was first synthesized in 1962 by an American scientist who was searching for a new anesthetic to replace PCP, which was not suitable for use in humans because of the severe hallucinogenic effects it produced.

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Ketamine is a medication that is used to induce loss of consciousness, or anesthesia. It can produce relaxation and relieve pain in humans and animals.

It is a class III scheduled drug and is approved for use in hospitals and other medical settings as an anesthetic.

However, it is also a commonly abused "recreational" drug, due to its hallucinogenic, tranquilizing and dissociative effects.

Controversy has arisen about using ketamine "off-label" to treat depression. Off-label uses of drugs are uses that are not approved by the the United States, (U.S.) Food and Drug Administration (FDA).

Ketamine is safe to use in controled, medical practice, but it has abuse potential. Used outside the approved limits, its adverse mental and physical health effects can be hazardous. Prolonged use can lead to tolerance and psychological addiction.

Fast facts on ketamine:

Here are some key points about ketamine. More detail is in the main article.

Ketamine is similar in structure to phencyclidine (PCP), and it causes a trance-like state and a sense of disconnection from the environment.

It is the most widely used anesthetic in veterinary medicine and is used for some surgical procedures in humans.

It is considered a "club drug," like ecstasy, and it has been abused as a date-rape drug.

Ketamine should only be used as prescribed by a doctor.

What is ketamine?

Ketamine can produce feelings of dissociation when used as a drug of abuse.
Ketamine belongs to a class of drugs known as dissociative anesthetics. It is also known as Ketalar, Ketanest, and Ketaset.

Other drugs in this category include the hallucinogen, phencyclidine (PCP), dextromethorphan (DXM), and nitrous oxide, or laughing gas.

These types of drugs can make a person feel detached from sensations and surroundings, as if they are floating outside their body.

Therapeutic uses

Ketamine is most often used in veterinary medicine. In humans, it can induce and maintain general anesthesia before, during, and after surgery.

For medical purposes, ketamine is either injected into a muscle or given through an intravenous (IV) line.

It is considered safe as an anesthetic, because it does not reduce blood pressure or lower the breathing rate.

The fact that it does not need an electricity supply, oxygen, or highly trained staff makes it a suitable option in less wealthy countries and in disaster zones.

In human medical practice, it is used in procedures such as:

cardiac catheterization

skin grafts

orthopedic procedures

diagnostic procedures on the eye, ear, nose, and throat

minor surgical interventions, such as dental extractions

It has been used in a hospital setting to control seizures in patients with status epilepticus (SE), a type of epilepsy that can lead to brain damage and death. However, researchers point out that ketamine is normally used for this purpose after 5 to 6 other options have proven ineffective.

It is also an analgesic, and, in lower doses, it can relieve pain.

In 2014, researchers found that a ketamine infusion significantly reduced symptoms of post-traumatic stress disorder (PTSD) in 41 patients who had undergone a range of traumas.

Researchers are looking into other possible medical uses of ketamine, particularly in the areas of treatment-resistant depression, suicide prevention, and substance use disorders. However, this use is controversial.

Treating depression

Researchers for the American Psychological Association (APA) noted in April 2017 that a number of doctors prescribe ketamine "off-label," for people with treatment-resistant depression.

However, they caution:

"While ketamine may be beneficial to some patients with mood disorders, it is important to consider the limitations of the available data and the potential risk associated with the drug when considering the treatment option."

The FDA has not yet approved it for treating depression.

In a study published in BMC Medical Ethics, researchers urge doctors to "minimize the risk to patients" by considering carefully the evidence before prescribing ketamine off-label for patients to treat depression and prevent suicide.

Citing "questionable practice" regarding the prescription of ketamine, they point out that there is not enough evidence to prove that ketamine is safe, and that some studies supporting its use have not been sufficiently rigorous in terms of research ethics.

They call for open debate, more research, and for doctors to try all other options first, before prescribing ketamine.

The National Institutes of Health (NIH) are currently supporting research into whether ketamine may help people with treatment-resistant depression.

Effects

Ketamine use can have a wide variety of adverse effects, including:

drowsiness

changes in perceptions of color or sound

hallucinations, confusion, and delirium

dissociation from body or identity

agitation

difficulty thinking or learning

nausea

dilated pupils and changes in eyesight

inability to control eye movements

involuntary muscle movements and muscle stiffness

slurred speech

numbness

slow heart beat

behavioral changes

increased pressure in the eyes and brain

It can also lead to a loss of appetite, upset stomach, and vomiting.

When used as an anesthetic in humans, doctors combine it with another drug to prevent hallucinations.

Risks

Ketamine is considered relatively safe in medical settings, because it does not affect the protective airway reflexes, and it does not depress the circulatory system, as other anesthetic medications do.

However, some patients have reported disturbing sensations when awakening from ketamine anesthesia.

Ketamine can cause an increase in blood pressure and intracranial pressure, or pressure in the brain.

People with the following conditions cannot receive ketamine for medical purposes:

It is used with caution in those with:

These effects may be stronger in people aged over 65 years.

Some people may have an allergy to the ingredients. Patients with any type of allergy should tell their doctor before using any medication.

Anyone who is using this drug for therapeutic purposes on a regular basis should have regular blood pressure checks.

As a drug of abuse

Ketamine is most often used in the dance club setting as a party drug. It produces an abrupt high that lasts for about an hour. Users report euphoria, along with feelings of floating and other "out of body" sensations. Hallucinations, similar to those experienced with LSD, are common.

In 2014, 1.4 percent of 12th graders reported using ketamine for recreational purposes. This was down from 2002, when 2.6 percent reported using it.

Street names include:

It is taken orally as a pill, snorted, smoked with tobacco or marijuana, or mixed into drinks. Most often, it is cooked into a white powder for snorting. Taken orally, it can cause severe nausea and vomiting.

Regardless of how it is ingested, its effects begin within a few minutes and last for less than an hour.

Higher doses can produce more intense effects known as being in the "K-hole," where users become unable to move or communicate and feel very far away from their body.

Some users seek out this type of transcendental experience, while others find it terrifying and consider it an adverse effect.

Adverse effects

Unwanted effects include:

As the user can become oblivious to their environment, ketamine abuse puts the person at risk of accidental injury to themselves and vulnerable to assault by others.

Problems with co-ordination, judgment, and the physical senses can continue for up to 24 hours. If an individual is using ketamine in a recreational setting, a sober friend should remain with them to ensure their safety.

Long-term effects include bladder and kidney problems, stomach pain, and memory loss.

If addiction and dependence develop, there is also a risk of depression.

Frequent, illegal use of ketamine can lead to serious mental disorders and major physical harm to the bladder, known as ketamine-induced ulcerative cystitis.

Ketamine and alcohol

Ketamine toxicity alone is unlikely to lead to death, according to the WHO. However, combining it with other substances, such as alcohol, can increase the sedative effects, possibly leading to a fatal overdose.

In the U.S., 1,550 emergency department (ED) visits were due to illegal ketamine use, and 71.5 percent of these also involved alcohol.

Overdose

The risk of overdose is high, because, for a recreational user, there is only a slight difference in dosage between obtaining the drug's desired effects and an overdose.

Addiction

Ketamine is a Class III controlled substance. Prolonged use can cause dependence, tolerance, and withdrawal symptoms. Quitting can lead to depression, anxiety, insomnia, and flashbacks.

Chronic users have been known to "binge" their ketamine use in an attempt to experience again the dissociative, euphoric effects of their early first use.

The complications of long-term use can be fatal.

A final word

Ketamine is an anesthetic drug, used in human and veterinary medicine. It is important to distinguish the valid medical uses from the non-medical, recreational use of the drug.

When properly administered by a trained medical professional, ketamine is a safe and valuable medication.

Used in recreational settings, however, ketamine abuse can produce unpredictable physical and mental health results. In the long term, it can lead to psychological damage and, in some cases, death.

Any drug use should be prescribed by a doctor who knows the patient's full medical history.

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Ketamine: Uses, effects, risks, and warnings

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Ketamine is an anesthetic, used to induce a loss of consciousness and relieve pain. It is commonly abused for its hallucinogenic and dissociative effects and, controversially, it may be prescribed to treat depression. Learn more about the recommended uses and adverse mental and physical effects of misuse here.

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Generic Name: Ketamine (KEET a meen)
Brand Name: Ketalar

Uses of Ketamine:

It is used to cause sleep during care.

It is used to put you to sleep for surgery.

It may be given to you for other reasons. Talk with the doctor.

What do I need to tell my doctor BEFORE I take Ketamine?

If you have an allergy to ketamine or any other part of ketamine.

If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.

If you have any of these health problems: Aneurysm, chest pain, high blood pressure, raised pressure in the brain, mental illness, overactive thyroid gland, or weak heart.

This is not a list of all drugs or health problems that interact with this medicine.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take ketamine with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

What are some things I need to know or do while I take Ketamine?

Tell all of your health care providers that you take this medicine. This includes your doctors, nurses, pharmacists, and dentists.

Avoid driving and doing other tasks or actions that call for you to be alert for 1 full day after getting ketamine and until the effects of this medicine have worn off.

Talk with your doctor before you drink alcohol or use other drugs and natural products that slow your actions.

Have your blood pressure checked often. Talk with your doctor.

You will need to have heart function tests while taking ketamine. Talk with the doctor.

Mental problems have happened with this medicine as ketamine wears off. These problems may range from pleasant, dream-like states to hallucinations, change in how you act, or not thinking clearly or with logic. Most of the time, these problems last up to 2 hours but may last up to 24 hours after using this medicine. Be sure to have an adult you can trust watch and help you for up to 24 hours after you get ketamine. Talk with your doctor.

If you are 65 or older, use this medicine with care. You could have more side effects.

Studies in young animals and children have shown that frequent or long-term use of anesthesia drugs or drugs used for sleep in children younger than 3 years of age may lead to long-term brain problems. This may also happen in unborn babies if the mother uses ketamine during the third trimester of pregnancy. Talk with the doctor.

Use with care in children. Talk with the doctor.

Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using this medicine while you are pregnant.

Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby.

How is this medicine (Ketamine) best taken?

Use ketamine as ordered by your doctor. Read all information given to you. Follow all instructions closely.

It is given as a shot into a muscle or vein.

It is given as an infusion into a vein over a period of time.

What do I do if I miss a dose?

This medicine is given on an as needed basis.

See also: Dosage Information (in more detail)

What are some side effects that I need to call my doctor about right away?

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Signs of high or low blood pressure like very bad headache or dizziness, passing out, change in eyesight.

Trouble breathing, slow breathing, or shallow breathing.

Slow heartbeat.

A heartbeat that does not feel normal.

Feeling confused.

Hallucinations (seeing or hearing things that are not there).

Change in how you act.

Muscle stiffness.

Change in eyesight.

Not able to control eye movements.

What are some other side effects of Ketamine?

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.

You may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects at http://www.fda.gov/medwatch.

See also: Side effects (in more detail)

If OVERDOSE is suspected:

If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

How do I store and/or throw out Ketamine?

If you need to store this medicine at home, talk with your doctor, nurse, or pharmacist about how to store it.

Consumer Information Use and Disclaimer

If your symptoms or health problems do not get better or if they become worse, call your doctor.

Do not share your drugs with others and do not take anyone else's drugs.

Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.

Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.

Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.

Check with your pharmacist about how to throw out unused drugs.

Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about ketamine, please talk with your doctor, nurse, pharmacist, or other health care provider.

If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about ketamine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using ketamine.

Review Date: December 6, 2017

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Ketamine: Indications, Side Effects, Warnings - Drugs.com

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Generic Name: Ketamine (KEET a meen) Brand Name: Ketalar It is used to cause sleep during care. It is used to put you to sleep for surgery. It may be given to you for other reasons. Talk with the doctor. If you have an allergy to ketamine or any other part of ketamine.

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Ketamine is snorted, smoked, or dissolved in water. The liquid form is swallowed or injected directly into a vein or muscle. When used by physicians or veterinarians as an anesthetic, ketamine comes in liquid form and is packaged in small glass vials. This liquid can be returned to a dry form by heating or "cooking" it. The "baked" drug is then crushed into a powder. Powdered ketamine is snorted through the nose in "bumps" (similar to "lines" of cocaine). It is also sprinkled on marijuana or tobacco and rolled into a homemade cigarette. In the United States, a 20-milligram unit of ketamine typically sells for about $25.

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A typical ketamine trip begins with a feeling of numbness all over the body. At low doses, users generally become somewhat disoriented, lose their sense of balance, and find it difficult to walk. Users then experience altered vision, muffled hearing, and a floating sensation as they enter a dreamy state known as "K-Land." In Designer Drugs, M. Foster Olive noted that "the perception of colors and music is enhanced" in the "K-Land" phase, and users may see "walls and carpets glowing different colors [and] ceilings turning to liquid." Some ketamine users claim that while in this relaxed state, they gain insights into their own personalities, the people they know, and the workings of the universe.

At higher doses, ketamine increases the sense of disconnection between the mind and the body. Users feel as if they are looking down at themselves from some higher place. These so-called "out-of-body experiences" are sometimes religious in nature. Some users claim they have seen visions of angels after taking ketamine

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Like other club drugs such as GHB and Rohypnol, ketamine has been used as a "date-rape" drug. Liquid ketamine is "odorless and tasteless," warns the Partnership for a Drug-Free America, "so it can be added to beverages without being detected." In addition, it causes memory loss. Victims of ketamine-related sexual assaults may find it impossible to identify their attackers.

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2-(2-chlorophenyl)-2-(methylamino)-cyclohexanone or CI581

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K, ket, quick, Lady K, special K, vitamin K, Kit-Kat, green, blind squid, jet, super acid, honey oil, cat valium, super C, k-hole

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A form of ketamine, the drug given to the boys trapped in a Thai cave, has recently been approved by the FDA for use as an antidepressant.

In the past, ketamine was used as a club drug, commonly known as "Special K."

Ketamine is what scientists call a "dirty drug," meaning it doesn't just target one system in your brain, but dozens.

Watch the video above to learn how this multi-purpose drug works.

Following is a transcript of the video.
Tape: Breaking news. The 10-day ordeal, 12 young boys and their soccer coach found alive in a flooded cave in Thailand.

Narrator: Remember when that happened? It was one of the most difficult rescue missions of all time, involving as many as 10,000 people, and now we know that rescuers gave the boys a drug which helped the mission succeed. That drug was ketamine.

Ketamine was first synthesized in the 1960s as an anesthetic, a sedative. That's why it was so useful in the rescue mission. But ketamine actually has a lot of different uses. In the '80s, it became a popular club drug, gaining nicknames like Special K and Cat Valium, and more recently, in early 2019, a form of ketamine was approved by the FDA as an antidepressant.

So how does a drug that's so multipurpose actually work? Ketamine is what scientists call a dirty drug. That means it doesn't just target one system in your brain, but dozens. It has a weak effect on opiate receptors in the dopamine system, which drugs like heroin and cocaine target. But most importantly, ketamine manipulates a neurotransmitter called glutamate, earning it the attention of psychiatrists nationwide. Glutamate is what many of the neurons in your brain use to communicate with each other, and without it, well, your brain would essentially shut down like a city grid without power.

Now, at high doses, ketamine seems to block glutamate. That's why it's such an effective anesthetic. But in low doses, like what you might find at a club or in a spray of the FDA-approved drug esketamine, it actually ramps up glutamate production, and that comes with all kinds of side effects. It can make you hallucinate or feel as though you're losing touch with reality. And it might also help build new connections or synapses between neurons, electrifying new parts of that city grid.

Chadi Abdallah: When people are stressed for a long time or when they suffer from depression for a while, they start losing these connections, and when we give them ketamine 24 hours, they reverse. Now they look like more a normal brain. So we believe that perhaps ketamine is working by regenerating these connections that are needed for normal brain functioning.

Narrator: And that could make ketamine one of the best drugs out there for treating depression. This isn't how other antidepressants work. Medications like Prozac and Zoloft take weeks if not months to kick in, and they regulate serotonin, another chemical in the brain, which scientists have long tied to depression.

These more traditional drugs may work for some people, but not for everyone. In fact, as many as 4 million American adults have treatment-resistant depression. And for them, well, ketamine might be the only drug out there that can provide relief. That's according to Doctor Andre Atoian. He's the founder of Ketamine Specialists, a clinic where he administers ketamine to patients with mood disorders, pain, and addiction.

Andre Atoian: Ketamine is the agent that works when most others have failed. It is something that really allows us to give patients a sort of new hope 'cause a lot of people that I treat have basically already tried everything, and they're in this situation where nothing's really working, and they're suffering, they're miserable.

Narrator: So it's hard to deny that ketamine's effect on depression sounds promising, and, clearly, it's a useful sedative. But here's the thing...

Nolan Williams: As far as effect, it's, you know, there's still a lot we don't know.

Narrator: That's Doctor Nolan Williams, an assistant professor of psychiatry at the Stanford University Medical Center. He says that because ketamine manipulates so many different receptors in the brain, it's been hard to nail down all of them. So it's still unclear how it might affect different patients both short- and long-term, and researchers still haven't figured out how to preserve its benefits as an antidepressant.

Abdallah: The challenge is how to maintain these new connections. Is it to give ketamine repeatedly? We know that we cannot give it every day, that's like substance of abuse, because then it will harm the brain.

Narrator: So while FDA approval is considered a victory for the millions of people with treatment-resistant depression, doctors still caution that ketamine should only be used as a last resort.

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Ketamine, once known for its club-enhancing effects, is now an FDA-approved antidepressant. Here's what it does to your brain.

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A form of ketamine, the drug given to the boys trapped in a Thai cave, has recently been approved by the FDA for use as an antidepressant. In the past, ketamine was used as a club drug, commonly known as "Special K."

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schedule III hallucinogen, dissociative anestetic, similar to PCP(phencyclidine)

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Sept. 23, 2014 -- Every year, 13 million to 14 million Americans have major depression. Of those who seek treatment, 30% to 40% will not get better or fully recover with standard antidepressants.

That puts them at greater risk of alcohol and drug abuse, hospitalization, and suicide attempts. Now, though, a growing body of research shows there may be new hope: the anesthetic drug ketamine.

Ketamine has a reputation as an illicit party drug due to its hallucinogenic effects. But in a handful of ketamine clinics around the country, people who weren't helped by standard treatments are getting a series of infusions to ease their depression. The drug has also been used in emergency rooms for curbing suicidal thoughts, making it a potential lifesaver.

"The benefits I've seen are pretty impressive, and the data are very strong," says psychiatrist Kyle Lapidus, MD, PhD. He's an assistant professor of psychiatry and neuroscience at Stony Brook University. Lapidus says there have been a large number of positive studies, though the number of participants in those studies has been small.

Ketamine acts quickly -- often within hours or less -- and health care professionals who give it to patients at therapeutic doses say it has mild and brief side effects in most people. But it hasn't been thoroughly studied for long-term safety and effectiveness, and the FDA hasn't approved it to treat depression. "The pace of research can be slow for people who are suffering," Lapidus says.

He says it's not uncommon for doctors to go "off-label" (using a drug for a purpose other than its approved one) when treating patients. And in the case of ketamine, the research, including his own, has convinced him that it can help depressed patients. Lapidus runs a Manhattan clinic called US Ketamine. Soon, he will open a second clinic on Long Island.

'Not a Miracle Drug'

Experts don't know exactly how ketamine works, but they do know it works differently than commonly used antidepressants such as Prozac, Zoloft, and Effexor. That may explain why people who aren't helped by standard treatments respond to ketamine when other medications don't help.

Continued

That's novel and exciting, says psychiatrist Alan Manevitz, MD. He specializes in treatment-resistant depression at Lenox Hill Hospital in New York. What's equally noteworthy is ketamine's ability to go to work right away, unlike most antidepressants, which take weeks, sometimes months, to provide relief.

"Feeling better faster, getting the mood to improve faster -- that's why ketamine is very promising," Manevitz says.

He cautions, though, that no matter how successful ketamine proves to be, you can't count on a single treatment to cure depression. You need to address all aspects of a person's disease, from the biological and the psychological to the social and environmental.

"Ketamine is not a miracle drug at all," Manevitz says. "It may momentarily take them away from that catastrophic place they're in with depression, but you're not addressing the rest of the patient. It's a complex issue to treat psychiatric issues, and you have to treat the whole patient."

For people considering suicide, though, the drug's rapid response could be life-saving. Recent studies have shown that a single dose of ketamine dramatically reduces suicidal thoughts.

How long the drug's effect lasts remains to be answered -- a few days or weeks, it's believed. But that window of relief could prove critical.

"We need suicide treatments so greatly in psychiatry," says researcher Elizabeth Ballard, PhD. "Ketamine could be a bridge for someone who comes in who is suicidal. They are given ketamine, and for the 3 days or so that it's effective, they can be hooked up with outpatient resources, with other medications, with psychotherapy."

Ballard, a researcher at the National Institute of Mental Health, published a study in August that shows ketamine reduces suicidal thoughts independent of its effect on depression or anxiety.

That's an important discovery, Ballard says, because not all suicides can be traced back to depression. Post-traumatic stress disorder, borderline personality disorder, and alcohol or other substance dependence, for examples, also account for some suicides. Further research is needed to explore the study's findings.

Continued

Ketamine Clinics

While researchers continue to study ketamine, practitioners such as Lapidus have already begun to provide it to patients. The Ketamine Advocacy Network lists 17 providers and clinics around the country.

Anesthesiologist Enrique Abreu, DO, runs the Portland Ketamine Clinic in Portland, OR. He works with a mental health specialist -- Marilyn Sears, LCSW and clinic co-founder -- and gives IV ketamine infusions. Most of his patients are self-referrals.

"These people are suffering, and they find us online," says Abreu, who estimates that he has treated 30 people since he opened his clinic 15 months ago.

He says he has no mental health background, but he's got 15 years' experience using ketamine as an anesthetic. In fact, many clinic operators are anesthesiologists rather than mental health specialists.

"It's a weird gray area," Abreu says. "Who's going to help these people and do it safely?"

Before Abreu treats someone, he consults with their psychiatrist or primary care doctor. Treatment then consists of six infusions over 12 days. Each infusion lasts about 45 minutes. Side effects, which often include confusion, lucid daydreaming, and fuzzy vision, clear up quickly. Patients are watched closely and must have pre-arranged transport home. They're barred from driving or using heavy machinery for 24 hours.

Abreu says in his experience, the side effects "go away as soon as the infusion is over, and patients don't have hallucinations."

Abreu says about three quarters of his patients aged 15 to 55 benefit from ketamine. Older patients have a lower response rate. The initial six infusions cost $3,800, the beneficial effects of which last anywhere from 3 to 5 weeks for some patients, and up to 12 weeks for others. Patients return as needed for single boosters, which cost $600. Because the FDA has not approved ketamine for this use, insurance doesn't cover it.

Lapidus says his clinic will mainly use a nasal spray form of ketamine, a method that he and his former colleagues at Mount Sinai's Icahn School of Medicine found effective. They published the results of their research in April.

Continued

Manevitz, who has also used ketamine in his practice, says we don't know anything yet about ketamine's potential as a long-term treatment for depression.

"The problem is maintaining the gain, prolonging the effect," he says.

Lapidus agrees: "How to maintain benefits: This is an area that needs a lot more research. Most of the studies published have involved only a single treatment."

Sources

SOURCES:

Kyle Lapidus, MD, psychiatrist, assistant professor of psychiatry and neuroscience, Stony Brook University.

Alan Manevitz, MD, psychiatrist, Lenox Hill Hospital, New York.

Elizabeth Ballard, PhD, research fellow, NIMH.

Enrique Abreu, MD, anesthesiologist, Portland Ketamine Clinic, Portland, OR.

Agency for Healthcare Quality and Research: "Primary Care Depression Guidelines and Treatment Resistant Depression: Variations on an Important but Understudied Theme."

Ketamine Advocacy Network: "Directory of US ketamine doctors."

Larkin, G. Injury Prevention, 2010.

Purves, D. Neuroscience, 2nd edition, 2001.

Ballard, E. Journal of Psychiatric Research, August 2014.

DiazGranados, N. Journal of Clinical Psychiatry, December 2010.

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Ketamine: The Future of Depression Treatment?

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Sept. 23, 2014 -- Every year, 13 million to 14 million Americans have major depression. Of those who seek treatment, 30% to 40% will not get better or fully recover with standard antidepressants. That puts them at greater risk of alcohol and drug abuse, hospitalization, and suicide attempts.