Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, is a type of anesthetic that causes dissociation, meaning it can create a sense of detachment from one’s surroundings or self. Its unique properties make it an excellent choice for emergency anesthesia, conscious sedation, pain relief, and treatment-resistant depression.[1][2]
Recreationally, ketamine is used for its dissociative effects and to alter the sense of self by inducing a state known as 'K-hole.'[3] In addition, it is a popular 'club drug' and is commonly used in low doses to produce euphoric, relaxing, and stimulant-like effects in social settings.[1][3]
However, ketamine is known for its dose-dependent side effects. Common symptoms of ketamine use include dissociation, nausea and vomiting, hypersalivation, increased heart rate, elevated blood pressure, an altered mental state, as well as sedation.[4][5]
- Common side effects include nausea, dizziness, and dissociation, while severe effects like hallucinations, cognitive decline, and bladder issues (ketamine-induced cystitis) may occur, particularly with prolonged or high-dose use.
- Strategies to manage side effects include pre-treatment anti-nausea medications, monitoring vital signs during administration, and providing reassurance. In recreational use settings, harm reduction can help minimize the risks of non-medical ketamine use.
- Treatment of side effects involves antiemetics for nausea, benzodiazepines for agitation, antihypertensives for elevated blood pressure, and stopping ketamine or consulting a specialist for bladder-related complications.
What is ketamine and what is it used for?
Ketamine is a dissociative anesthetic widely utilized in medicine since its development in the 1960s.[5] Initially synthesized as a safer alternative to phencyclidine (PCP), ketamine is recognized for its unique mechanism of action, rapid onset, and versatility in both clinical and research settings.
Ketamine disrupts communication between specific brain regions, inducing a trance-like/dissociative state while providing pain relief, sedation, and amnesia.[5]
Medicinal uses and applications of ketamine
Ketamine serves various medical purposes, including anesthesia for emergency and pediatric procedures, pain management for acute and chronic conditions, and as a rapid-acting treatment for treatment-resistant depression and suicidal ideation. [6][7][8]
It is also used for sedation in critical care settings, managing refractory status epilepticus, and has experimental applications for conditions like substance use disorders, PTSD, and migraines.[6][9][10][11][12]
Recreational use of ketamine and its risks
Due to ketamine’s wide range of effects, especially at different doses and when using different modes of administration (ways to use ketamine, like injecting, snorting, swallowing, etc.), people utilize ketamine’s primary dose-dependent effects in different settings to achieve their recreational drug use goals. Some of these include:[3][10][12][14][15][16][17]
- Dissociative and hallucinogenic effects: K-hole
- Club drug use- as well as use during music festivals
- Sexual settings
- Chemsex or Party and Play (among men who have sex with men)
- Creative exploration
- Use as a stimulant (Low dose and snorted)
- Antistimulant appeal
- Microdosing in social settings
- Association with counterculture movements
- Dissociative effects
- Escapism
- Self-medication
- Psychonautic effects
- For a sense of identity and community
Common and short-term side effects of ketamine
Short-term side effects are temporary and manageable, expected outcomes of recreational ketamine use and ketamine administration in safe, monitored environments.They include:[2][3][18]
Physical effects
- Dissociation: Phenomenological detachment from reality, the self, or surroundings.
- Hypersalivation: Excessive production of saliva.
- Nystagmus: Rapid, involuntary eye movements.
- Nausea and vomiting: Particularly at higher doses or with rapid IV administration.
- Increased heart rate and blood pressure: Temporary cardiovascular response that subsides in around 20 minutes.
- Respiratory depression: At higher doses or in combination with other depressants.
- Muscle rigidity or jerking: Involuntary movements or spasms.
- Sedation and drowsiness: Reduced alertness and impaired motor coordination and functioning.
- Dizziness and unsteadiness: Difficulty maintaining balance.
Cognitive effects
- Impaired working memory: Difficulty processing and retaining information in real time.
- Episodic memory disruption: Trouble recalling specific events or experiences during use.
- Procedural memory impairment: Difficulty performing learned tasks or skills.
- Confusion and disorientation: Cognitive fog and inability to focus.
Sensory and perceptual effects
- Hallucinations: Visual or auditory distortions varying from mild to vivid.
- Altered perception: Changes in time, sound, and spatial awareness.
- Blurry vision: Temporary visual disturbances.
- Heightened sensory input: The perceptions of light, sound, or touch may feel exaggerated or overwhelming.
Adverse ketamine side effects
Adverse effects refer to harmful and potentially serious reactions that occur unpredictably during medical administration or due to misuse, differing from expected short-term effects by their severity or need for intervention. These are not necessarily tied to chronic use but may arise in specific situations:[2][3][18]
Adverse physical effects
- Respiratory depression
- Bladder issues (ketamine cystitis)
- Cardiovascular complications
- Severe nausea or vomiting leading to dehydration
Neurological effects
- Severe confusion or delirium
- Panic or severe anxiety
- Psychotic episodes
Psychological and behavioral effects
- Repeated recreational use can lead to a compulsive cycle of seeking ketamine for its dissociative effects.
- Impaired decision-making and decreased inhibition during dissociation increase vulnerability to accidents, harm, or risky sexual behavior.
Long-term effects of ketamine use
Chronic ketamine use poses significant physical, cognitive, psychological, and neurological risks: [3][10][19][20][21][22][23]
- Physical Effects: Includes painful urination, bladder damage (ketamine-induced cystitis), kidney issues, liver enzyme elevation, and abdominal pain ("K-cramps").
- Cognitive Effects: Impaired memory, reduced decision-making abilities, and structural brain changes are common.
- Psychological Effects: Persistent cravings and addiction often disrupt relationships and responsibilities.
- Neurological Risks: Long-term use may result in ongoing dissociative symptoms and sensory issues.
Early intervention and harm reduction strategies are crucial to mitigate these risks.
Ketamine overdose
Taking a large amount of ketamine alone could cause an overdose. The risk of death from ketamine use alone is rare due to its ability to cause unconsciousness with minimal impact on airway reflexes or blood circulation.[3] However, there is still a possibility, and overdose is more prevalent when ketamine is mixed with other drugs.[3][10][22] People are also at a higher risk of physical harm/accidents while under the influence of ketamine.
Call 911 immediately if you, or someone else, has any of the following symptoms:[3]
- Trouble breathing
- Blurred vision
- Symptoms of high blood pressure
- Fast heartbeat
- Convulsions/seizures
- Delirium or psychosis
- Unconsciousness
First aid responders don’t need to involve the police.
Ketamine interactions and contraindications
Ketamine use and administration require careful consideration of potential drug interactions and contraindications. One must understand these interactions and contraindications to ensure the safe and effective administration of ketamine.
Interactions
- Central nervous system depressants: Alcohol, benzodiazepines (e.g., diazepam) and opioids (e.g., morphine)
- Sympathomimetic agents: Epinephrine (adrenaline), norepinephrine and amphetamines
- Bronchodilators: Theophylline and aminophylline
- Monoamine oxidase inhibitors: Phenelzine and tranylcypromine, for example
Contraindications
- Known hypersensitivity or a previous adverse reaction to ketamine (allergic)
- Raised intracranial pressure or raised pressure in the brain due to conditions like brain tumors, head trauma, or hydrocephalus
- A history of severe cardiovascular disease, such as uncontrolled high blood pressure, recent heart attack or cardiac event, or severe heart failure
- Schizophrenia and psychosis
- A history of substance use disorder
- Pregnancy and lactation/breastfeeding.
- Elevated intraocular (eye) pressure, such as in conditions like glaucoma
- Overactive thyroid gland
- Chronic obstructive pulmonary disease
- Epilepsy [3][5][24]
Additional factors to consider before administering ketamine are in pediatric patients, elderly patients, and patients with impaired liver function, as the liver metabolizes ketamine.
Managing side effects and treatment for ketamine abuse
Ketamine, used in a medical setting for depression and pain management, can have significant side effects. Managing these side effects in therapeutic/clinical contexts involves:[23][25]
- Close monitoring: Medical professionals monitor heart rate, blood pressure, and mental status during treatment to address acute side effects.
- Adjunct medications: Anti-nausea medications (e.g., ondansetron) and anxiolytics may manage specific side effects.
- History taking: Identifying contraindications before administration minimizes risks.
- Controlled dosing: Administered in clinical settings, therapeutic ketamine is given at optimal doses and allows for dose adjustments if needed.
Non-medical ketamine use involves higher, unregulated doses, leading to more severe side effects. Managing these issues typically requires:[26][27]
- Detoxification under medical supervision for possible withdrawal symptoms.
- Inpatient rehabilitation using therapeutic measures like cognitive behavioral therapy, motivational interviewing, and mindfulness practices.
- Building a support system through peer groups like Narcotics Anonymous (NA) provides a long-term solution to prevent relapse and sustain recovery.
Problematic ketamine has distinct challenges. Therapeutic side effects can many times be predicted and managed under professional care, whereas recreational use leads to unpredictable, severe consequences requiring harm reduction insights and notably comprehensive addiction treatment.
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