Ketamine therapy has received a great deal of interest and press lately, particularly in the wake of the Netflix mini-series based on the Michael Pollan book, How to Change Your Mind, which ushered in a great deal of interest regarding psychedelics. While technically a dissociative anesthetic and not a psychedelic, ketamine has attracted a great deal of interest in the past few years, as it is the only treatment with psychedelic properties that is currently legal. However, in the light of high profile deaths, like that of Matthew Perry, who died with ketamine in his system, there is increasing concern about whether or not it is truly safe to use.

What is Ketamine?

Ketamine is a dissociative anesthetic that was first developed in the 1960s. It is commonly used in medical settings as an anesthetic and pain reliever, particularly in emergency situations. Ketamine is believed to work by blocking certain receptors in the brain, leading to a rapid increase in neurotransmitters that can improve mood and reduce symptoms of depression and anxiety.

How is Ketamine Administered?

Ketamine can be administered in several ways, including intravenously, intramuscularly, and orally. In medical settings, it is typically given intravenously or intramuscularly.

Currently, there is only one FDA-approved form of ketamine treatment for mental health conditions, esketamine, a nasal spray that must be administered in a supervised setting.

While there is evidence to suggest that ketamine may be effective in crisis situations for actively suicidal individuals, evidence for its long-term efficacy remains limited. Currently, intravenous ketamine infusions are not FDA approved to treat any mental health conditions. While practitioners may use it off-label to treat depression, there is not enough data to suggest that this should be the case.

Potential Side Effects of Ketamine Treatment

While ketamine therapy has shown promising results for some individuals, it is not without its risks. Some of the potential side effects of ketamine treatment include:

Nausea and Vomiting

Nausea and vomiting are common side effects of ketamine treatment. This is particularly true when ketamine is administered intravenously or intramuscularly. These side effects can be managed with anti-nausea medication, but they can still be uncomfortable for some individuals.

Dizziness and Disorientation

Because ketamine is a dissociative anesthetic, it can cause feelings of detachment from reality. This can lead to dizziness, disorientation, and a sense of being disconnected from one's surroundings. These effects can be particularly concerning for individuals with a history of anxiety or panic attacks.

Increased Heart Rate and Blood Pressure

Ketamine can also cause an increase in heart rate and blood pressure. This is a common side effect of many anesthetics and can be managed with medication or by adjusting the dosage of ketamine.

Hallucinations and Delusions

One of the most concerning side effects of ketamine treatment is the potential for hallucinations and delusions. These can be particularly distressing for individuals with a history of mental health conditions such as schizophrenia or bipolar disorder.

Potential for Addiction and Abuse

Ketamine has a high potential for abuse and addiction. It is classified as a Schedule III controlled substance in the United States, meaning it has a moderate to low potential for physical and psychological dependence. Accordingly, individuals with a history of substance abuse may be at a higher risk for developing an addiction to ketamine.

Safety Concerns of Ketamine Treatment

In addition to the potential side effects, there are also safety concerns associated with ketamine treatment. These include:

Lack of Long-Term Research

While ketamine has been used in medical settings for decades, its use in treating mental health conditions is relatively new. While there is evidence to suggest that ketamine may be effective in crisis situations for actively suicidal individuals, evidence for its long-term efficacy remains limited.

Lack of Regulation and Oversight

Ketamine therapy for mental health conditions is not currently regulated by the FDA. This means that there is no standardized dosage or treatment protocol, and the quality of ketamine used may vary from clinic to clinic. This lack of oversight can increase the risk of adverse effects and complications.

Because most clinics providing ketamine infusion services are private, for-profit enterprises, there are some potential ethical dilemmas and issues associated with these treatments. In the interest of making money, these centers may be less likely to rigorously screen individuals who express interest in ketamine treatments and may be less likely to turn away someone who might not be the ideal fit. This is potentially extremely dangerous, as some individuals have come to expect great results from ketamine, which in some circles, is spoken of as a panacea. When individuals don’t experience life changing results, it can even result in suicide.

Potential for Misuse and Overuse

As mentioned earlier, ketamine is addictive, something that anyone who has ever been to a rave or stopped by a nightclub in the 1990s or early 2000s could tell you. The fact that ketamine may have medical uses does not take away from the fact that it is a substance that has resulted in dependency and misuse for many people. Additionally, frequent use or abuse of ketamine is associated with bladder damage. While most individuals do not report this side effect, it is nevertheless a potential problem that can emerge from excessive ketamine use.

Dangers of Ketamine Therapy

While ketamine therapy may offer relief for some individuals with mental health conditions, it is not without its dangers. Some of the potential dangers of ketamine therapy include:

Masking Underlying Issues

Ketamine therapy may provide temporary relief from symptoms of depression, anxiety, or PTSD. However, it does not address the underlying issues that may be causing these conditions. This can lead to a false sense of improvement and may delay proper treatment for the root cause of the mental health condition.

Interactions with Other Medications

Ketamine can interact with other medications, particularly those that affect the central nervous system. This can lead to dangerous side effects and should be carefully monitored by a healthcare professional.

Risk of Overdose

Ketamine is a powerful anesthetic and can be dangerous if not administered correctly. There is a risk of overdose, particularly when used in high doses or in combination with other substances.

Conclusion

As with any new treatment or experimental drug, it is important for enough research and data to be gathered before any definitive conclusions about effectiveness can be made. Because there is limited information regarding the potential of ketamine to put depression into remission in the long-term, expensive ketamine infusion treatments may not be worth the cost. Because ketamine is a short-acting drug, any relief from depression symptoms from ketamine treatment is likely to be short-lived.

The Risks of Ketamine Treatment