Medicine
What is Ketamine?
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Ketamine is a dissociative anesthetic that has been used since the 1970’s in many different ways. Due to its excellent safety profile and the fact that it does not suppress breathing, Ketamine was used in war times as an anesthetic to help with trauma on the battlefield. It is used extensively in emergency rooms and it also has a role in veterinary medicine. Ketamine is most often used in hospital settings by anesthesiologists during major and minor surgical procedures as an anesthetic. Recently, lower dose (subanesthetic) ketamine has shown great promise in the treatment of mental health conditions, most notably depression and suicidality.
Ketamine is one of the safest and most widely used anesthetics in the world according to the World Health Organization. Researchers at Yale have been studying low-dose ketamine since 2000 in controlled clinical settings for patients with severe depression who are unresponsive to other antidepressants. In several studies, more than half show a significant decrease in depression symptoms in 24 hours and approximately 4 out of 5 went on to find significant improvement.
Ketamine is now used extensively for many chronic mental health conditions such as depression, suicidality, anxiety, anxious bipolar depression (without mania), post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), existential distress, and more. Many clinicians, including us at Skylight Psychedelics, classify ketamine as a psychedelic, which means mind manifesting, however, it is not a classic hallucinogen like psilocybin, the compound found in psychedelic mushrooms, which also has many promising mental health benefits.
At Skylight we believe the main way ketamine works is by allowing clients to connect with their inner healing intelligence.
Note: It remains unclear if the effect ketamine has on the opioid receptors plays a role in its antidepressant effects. Ketamine’s effect on these receptors demonstrates how this medicine also functions as an analgesic (pain medicine) for those with chronic pain.
How Does Ketamine Work For Mental Health Conditions?
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The exact mechanism by which ketamine functions as an antidepressant remains largely unknown. So far the medical community has learned that ketamine has an affinity for multiple receptors and it likely affects several different types of receptors in the brain, including: N-methyl-D-aspartate (NMDA) receptor, which binds glutamate, the primary excitatory neurotransmitter in the brain as well as Alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptor, which is also involved in glutamate neurotransmission. Ketamine’s antidepressant effects may be due to activation of the AMPA receptor by the ketamine metabolite.
It has been demonstrated that people who suffer from chronic depression and anxiety experience atrophy of neuronal connections in the frontal part of the brain. Ketamine enhances neuroplasticity, the brain cell’s ability to form new connections with one another via expression of brain-derived neurotrophic factor. Not only has ketamine demonstrated the ability to repair neurons that were atrophied from chronic depression, but it also promotes the growth of new neuronal connections!
Furthermore, animal studies have suggested that neuronal vascular endothelial growth factor signaling in the prefrontal cortex region of the brain mediates the rapid antidepressant actions of ketamine. It is also referred to as a “psychoplastogen” which refers to small molecule neurotherapeutics that induce swift changes in plasticity following a single administration. These changes are thought to promote lasting changes in behavior patterns. Ketamine also activates at the level of the anterior cingulate cortex and by increasing connectivity between the insula and default mode network.
Which Mental Health Conditions Can Benefit form Ketamine
Ketamine is used to treat various conditions.
Notably the following:
- Depression
- Suicidality
- PTSD
- Anxiety
- OCD
- Substance abuse co-occurring with a primary psychiatric disorder
- Relationship and existential issues such as existential distress.
- Bipolar I and II depressive phases (not mania)
- Psychological reactions to physical illness and life threatening illnesses
- Chronic pain often requires higher doses of ketamine in a medically supervised settings such as a clinics or hospital
Note:
There are other indications for ketamine that are not included on this list.