What is Ketamine?

The recent overdose of actor Matthew Perry has thrust ketamine back into the limelight, a substance recognized by the medical community for its potent ability to relieve treatment-resistant depression and chronic pain, and also feared for its dangers when used recreationally. As scientists continue to research the potential of psychedelics like MDMA and psilocybin as mental health treatments, ketamine, an approved anesthetic, has quickly grown in popularity and is currently estimated to be a $900 million dollar industry as ketamine clinics sprout up across the country.

Nevertheless, it's crucial to note that ketamine lacks approval from the Federal Drug Administration (FDA) for the treatment of depression, although it can be legally used off-label. This means with a patient’s informed consent a drug can be legally administered for a purpose it hasn't been officially approved to address. Spravato, a prescription version of ketamine as a nasal spray, was approved in 2019 by the FDA for treatment-resistant depression. It can only be used in a clinic or doctor’s office under the supervision of a medical professional. 

Before emerging as a depression treatment, ketamine was a popular recreational drug used for its dissociative properties, that include sedative, stimulating, and psychedelic effects. Despite its quick adoption in mental health practices, the black market continues to thrive with the amount of illicit ketamine seized from 2017 through 2022 rising 1,100%, according to researchers at New York University and the University of Florida. 

The surge in recreational ketamine use underscores the need for more awareness of its associated risks. Simultaneously, it calls for a deeper exploration of ketamine's promising therapeutic potential. Instances such as Perry's unfortunate incident tend to influence public perception, creating a need to balance awareness of risks with a nuanced understanding of the substance's positive therapeutic aspects, thereby preventing unwarranted hindrances to progress.

Ketamine’s Therapeutic Potential

Ketamine, originally developed as an anesthetic, has found a new lease on life in the field of mental health. Recent research has shown that controlled and monitored administration of ketamine can have profound effects on conditions like depression, anxiety, and PTSD. Unlike traditional antidepressants that may take weeks to show results, ketamine's impact is often rapid, providing relief to those who may have otherwise struggled with treatment-resistant mental health disorders.

According to a Los Angeles Times article, conventional antidepressants work by increasing levels of the brain chemicals serotonin, dopamine and norepinephrine to improve mood, while ketamine seems to mostly generate the neurotransmitter glutamate, which helps stimulate communication among brain cells. Ketamine works quickly to create new neural connections and improve neuroplasticity which is believed to contribute to the alleviation of symptoms in various mental health conditions. In addition to the inhaled-version, Spravato, ketamine is administered through injections or infusions closely monitored during treatment. Upon discharge, they are instructed not to drive because of grogginess and impaired judgment. 

“Reconfiguring the brain’s narrative is akin to re-routing a deeply carved riverbed; and when trauma and cognitive dissonance are strongly present in reinforcing the shape of that riverbed, it may be a better strategy to knock out those components first via ketamine therapy,” said Wellcore advisor, Caleb Greer, Nurse Practitioner in a recent interview. “I’ve at least seen this approach help a good number of my clients. After 2-3 administrations of the treatment, they were able to more confidently and clearly rewrite a narrative and take actionable steps toward becoming the better version of themselves.”

Clinics offering ketamine-assisted therapy have emerged as a beacon of hope for individuals seeking alternative treatments, especially those such as veterans suffering from PTSD. Psychotherapy often accompanies treatment and patients undergoing such therapies report not only a reduction in symptoms but also a transformative shift in their overall perspective on life. The controlled setting, along with the guidance of trained professionals, ensures that the therapeutic potential of ketamine is harnessed without exposing individuals to unnecessary risks.

Recreational Risks

Despite the regular ketamine infusions noted in Perry's autopsy report for mental health treatment, his ketamine levels at the time of his death were in the range of someone undergoing general anesthesia - an indication that he was self-medicating. His overdose highlights the dark side of ketamine when used without medical supervision. 

Recreational users may find themselves in situations where they unintentionally consume higher doses, leading to severe consequences such as dangerous psychiatric reactions, respiratory distress, cardiac issues, and even death. The unregulated nature of the illicit ketamine market further exacerbates these risks, as purity and dosage levels can vary significantly.

The potential for addiction and dependence adds another layer of concern, as individuals may find themselves trapped in a cycle of use that becomes increasingly difficult to break.

Is It Right For Me?

For those considering ketamine therapy, seeking professional guidance from a mental health specialist is paramount. Clinics offering ketamine-assisted treatments prioritize safety and provide a controlled environment for individuals to explore the therapeutic potential of the drug under medical supervision. However, as with all other medical treatments, take the time to vet providers and ensure they adhere to established ethical standards and safety protocols. A thorough evaluation of a provider's qualifications, reputation, and adherence to legal guidelines will contribute to a safer and more effective ketamine therapy experience. Remember, the collaboration between patients and reputable professionals is key to unlocking the full benefits of ketamine-assisted treatments while minimizing potential risks.

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