Ketamine

A dissociative anesthetic (not a classic psychedelic), ketamine has long been used as a safe drug in anesthesia and emergency medicine because it maintains stable heart rate and breathing while providing sedation and pain management . Ketamine has been shown to affect the brain in some ways similar to the classic psychedelics, in its effects on brain function and neuroplasiticity. As the more classic psychedelic medications are still waiting for FDA approval, many clinicians have begun to utilize ketamine in psychedelic-assisted therapy.

Background

BACKGROUND

Developed for general anesthesia - as it does not cause respiratory depression, ketamine has been in clinical use since the 1960s for anesthesiology, as well as critical care like acute pain.

Conditions

CONDITIONS

MENTAL HEALTH

Condition	Evidence Level	Type of Evidence
Depression	B	Randomized Controlled Trials (1 or more)
Anxiety	B	Randomized Controlled Trials (1 or more)
PTSD	B	Randomized Controlled Trials (1 or more)
Substance Use Disorders: Alcohol, Cocaine, Heroin	B	Randomized Controlled Trials (1 or more)
Suicidality	A	Systematic reviews and/or meta-analysis or society practice guidelines

ACUTE SETTINGS

Procedures
Burns
Pain (Emergency and post-operative)

CHRONIC SETTINGS

Cancer Pain
CRPS
Phantom limb pain
Fibromyalgia
Ischemic Pain
Migraines

Safety

SAFETY

Broadly safe when appropriately used in a medical setting.

Caution

Avoid cross use of other mood/perception altering substances with ketamine (alcohol, opioids, benzos, cannabis, stimulants) as it can create potential toxicity. Ketamine can elevate blood pressure and this should be monitored in at risk patients.

Acute use - side effects (resolve in about 2 hours after use):

Side effects can include dizziness, nausea, and vomiting
Low dose psychedelic effects include mild dissociation, hallucinations, distortion of time and space
High dose psychedelic effects include significant alterations in perceptions separate from reality

If abused chronically can bring about more pronounced and persistent neuropsychiatric symptoms:

psychosis, schizophrenia-like symptoms
cognitive impairment
poor psychological well-being (1)

Legality

LEGALITY

Ketamine-assisted psychotherapy (KAP) is legal with prescription and has a well-established safety profile.

Psycho-Therapeutic Use

PSYCHO-THERAPEUTIC USE

There are a growing number of ketamine clinics and infusion centers across the United States and elsewhere, treating a variety of conditions.

Protocols include therapy sessions prior to ketamine administration and supportive therapy sessions after.

Routes of administration: Oral, Sublingual (lozenges and troches), Nasal (Spravato), Intramuscular injection (IM), Intravenous infusion (IV)

References

Li, 2016

Gold, 2023