Ketamine Therapy: Game Changer or Brain Danger?

In the past two decades, Ketamine therapy as well as other psychedelic treatment has become a more and more viable option for those with depression that has resisted all other forms of treatment. Due to the “War on Drugs” started by the Nixon Administration in the 1970s, many have been raised to believe the falsehoods claimed to be truth by national leaders and their many forms of propaganda against psychedelics. Some of these false claims went so far as to say that these drugs could cause suicide, insanity, or could even alter our DNA. Since these messages were put out so intensely with the intent to spread fear, many households took note and raised children and grandchildren to fear such substances without any true knowledge about what the substances could actually induce or contain, besides the fact that they were illegal. Due to the halt on any progress or research done on these substances after this point, it wasn’t until the early 2000’s that it was seen as an opportunity for therapy. Today we see that the masses are slowly gaining a positive and open minded interest in psychedelics as the fears and uncertainties have begun to fall away. With the help of platforms like Youtube and Netflix, which contain videos and short series showcasing the history of psychedelic drugs as well as peoples’ experiences when using them, the average citizen can see and decide for themselves whether or not these drugs are truly harmful when used responsibly. Now imagine you are someone who has lost hope to find happiness, suffering from constant flashbacks or mood swings so severe you cannot function. Some would give anything to be rid of these symptoms, and with psychedelics growing more popular and more widely discussed, patients have become willing to try these unconventional methods of therapy.

Ketamine itself is a short acting dissociative anesthetic that is known to have hallucinogenic effects. This dissociative effect can be described as a relief or even euphoric for those who may suffer from post traumatic stress and severe depression, as it separates them from emotional pain and traumatic experiences. Ketamine was used for years, dating back to the 1960s, as an anesthetic, but due to its euphoric effects, it became apparent that the drug had a high abuse and addiction risk, so it was classified as a controlled substance in the late 90s. Due to the years of research that have been conducted from its use as an anesthetic, medical professionals have been able to safely administer the drug to patients through an intravenous drip. One patient described the therapy as “not frightening, its pure solitude…I’m able to analyze my thoughts”. Although ketamine is dissociative, it is less intense and more useful at lower doses where patients are still coherent enough to identify their thoughts and identity. Researchers that have studied its dosage for therapy against treatment resistant depression have remained in agreement that the relatively low dose of around .5-1 milligram through an intravenous drip, is most effective. In a 2021 study done by mental health corporation Osmind in San Francisco, California, 537 depression patients were tested after one session of Ketamine Intravenous Treatment. The results of this experiment showed that 52% responded to the treatment, and of those who responded 80% reported remission of symptoms for 4 weeks and 60% for 8 weeks without any infusions during that time. (McInnes) Since this data set is relatively small, researchers and medical professionals are working towards more widespread treatment across the country in order to curate more conclusive data. As a result of this data it can be concluded that the dosage decided upon by researchers should be used moving forward in forthcoming experiments. We can compare this to the standard dosage that people may use who abuse or use ketamine on the street, which is 75 to 125 milligrams. These higher doses can lead to purely euphoric and dissociative effects where one no longer associates with his or her current thoughts and reality anymore. These states of extreme dissociation and loss of senses are called a K-hole. One who enters a K-hole may be subjected to random thoughts or feel as if they are in another place that their physical body is not. Some have described these instances as near-death experiences, where they have visions of deep thoughts and memories which reside in the back of their minds, almost in a dream-like state, sometimes showing them their lives for what they truly are and how they could improve themselves. Although this may seem relatively harmless, patients who are seeking therapy should not be subjected to large enough doses to enter a K-hole, as it increases risk for addiction and subjects them to risk of brain damage. Data shows an approximate 20% decrease in gray matter volume in the brain in those who had used ketamine regularly with the previously mentioned “standard” doses for about 5 years. (Hung) Such decreases in brain volume, specifically the frontal lobe, can cause difficulty and permanent impairment in speech, muscle weakness, behavioral problems, and depression. This shows that although higher doses of ketamine may have some slight benefits for longer lasting remission of depression, the risks are too great for such a small difference. 

It has been found that Ketamine works via the glutamate pathway, unlike other antidepressants which use our serotonin receptors. Glutamate is the neurotransmitter that regulates our central nervous system and can possibly cause depression and other mood disorders when left unmanaged by stress. Those with certain genes which affect these neurotransmitters can experience high levels of depression that cannot be managed by lifestyle changes or other medications. Ketamine inhibits this receptor, allowing the patient to step away from their past trauma or damaging thoughts and make room for permanent healing/changes, rerouting the way their brain interacts with these transmitters - this is called neuroplasticity. 

Many will agree that the biggest risk when it comes to widespread ketamine use, is addiction and abuse. Although controlled treatment centers are popping up around the country, companies like Johnson and Johnson are manufacturing more accessible forms of ketamine with higher addiction risk. In this instance, Johnson and Johnson have developed a nasal spray using a derivative of ketamine called “esketamine” which has been approved by the Food and Drug Administration. Patients must be administered this treatment by a medical professional, but the patient must begin taking antidepressants simultaneous with the start of the treatment. The dosage is also set to be administered at 84 milligrams twice a week for four weeks and beyond. As previously stated the standard dosage for abuse and brain damage is 75-125 milligrams taken regularly. Prescribing this dosage along with other antidepressants with multiple side effects can cause great danger for patients who are prone to addiction as well as those who may be on other medications. This is just one example of a big name company capitalizing on an upcoming treatment, which may have the potential to bring a negative stigma back to psychedelic medicine. 

Conclusive data amongst larger groups could possibly save future treatment resistant patients who would otherwise be stuck in the negative feedback loop of useless treatments that hinder their quality of life. By continuing research in professional settings across the nation, medical professionals and patients can help bring a more positive stigma to psychedelic medicine, allowing for open discussions concerning dosage, administration techniques, and safety methods.