Ketamine, otherwise known as a “horse tranquiliser”, is a powerful hallucinogenic dissociative drug that is known more commonly as a street drug, however, it has a very important medical basis too.
It was first developed in 1962 as a human anaesthetic and is different to other anaesthetics because it does not stop spontaneous breathing, so you don’t need to be on a ventilator, and it works to produce both amnesia and analgesia (pain relief). This means it is commonly used in war zones, or remote places such as the mountains, where medical equipment is scarce. Interestingly, another common place for Ketamine is paediatrics, for when young children in hospitals require a minor surgery, such as stitching up a deep cut; this allows children to technically stay conscious (less risky) but be completely zoned out and not feel pain.
In more recent years, Ketamine has been being trialled for treatment-resistant depression. To put it in very basic terms, it works by flash-mobbing the NMDA receptor in your brain (a very important receptor in psychiatric illnesses). Compared to other medications, ketamine’s fast-acting, long-lasting antidepressant effect is what has put it on the map; response to the drug takes place within a few minutes and has been found to last from 7 to 10 days. This means for those patients who are suicidal, this is being considered to be a new first-line treatment.
For many years now, it has not been very accessible as it is only available at certain clinics and only by some doctors. It is administered at low doses intravenously (0.15-0.5mg/kg, usually over 30-60 minutes). Unsurprisingly, if you administer too much ketamine too quickly, it can produce unpleasant side effects such as hallucinations and nausea. However, in March this year the FDA approved a nasal spray of a ketamine alternative, called Esketamine. Ketamine is a mixture consisting of 2 molecular forms, R- and S-ketamine. Esketamine, which has the S- form of ketamine, is proposed to have the same antidepressant effects of ketamine. It will be interesting to see how this is taken up by medics and received by patients alike. There are concerns about abusing the drug, however, it is a drug of “unique taste”, and many participants do not like the feeling of the drug.
What are the next steps?
One of the next steps is ketamine-assisted psychotherapy; the concept being that ketamine
increases neuroplasticity in the brain, which would mean you’re in a better position to consider alternative perspectives. Some participants have described it as being stuck in a deep hole, to which the ketamine helps you out of, but you need the psychotherapy to move away from the hole and avoid falling back in.
There are also various clinical trials currently on using ketamine to treat chronic pain, alcoholism and bipolar disorder. The results are promising, but unfortunately once again, access is limited.
It is a general feeling in the field of mental health that we are stuck in a rut, desperate for new more creative treatments. Perhaps this is a step in the right direction? Fingers crossed.