Among the recreational drugs currently entering the psychiatric mainstream (MDMA, LSD, etc.), ketamine is something excessive. Most people have a rough idea of what “acid” or “molly” should do, even if they have never tried it. Ketamine, meanwhile, remains outside a dedicated sect—An enigma. It’s not a lot popular relaxant. There is no standard Hollywood version of the ketamine outing. You hear talk of k-holes, and occasionally an allusion to its use as a horse sedative, but little about its real effects, and less about what it is like to use it in a clinical setting. take, which has more and more patients with depression and mood. deviations will do soon. To set the record for this week Giz asks we reached out to a number of people who have done clinical ketamine trials.
Mikael Tiger
Researcher, Clinical Neuroscience, Karolinska Institutet
In one of my studies, we treated thirty depressed patients with ketamine.
During treatment, most patients reported an intense dissociation. They were disconnected from reality in different ways and saw things differently. One patient felt that the radio was playing in 3D, which she said was intensely absorbing. After returning to the same program, she realized that it was actually dull.
About 20% of the patients had hallucinations, and the majority found the experience interesting; some compared it to drunkenness. (Ketamine is addictive for this reason.) Two out of thirty considered it a horrible experience, although they were willing to do it again as they responded to the treatment. In general, it was considered very intense.
The drug was administered in a hospital, and nurses were present during the experience. These were nurses who worked extensively with severely depressed patients and helped with the administration of ECT, which as a treatment (in a sense) is closer to ketamine therapy than LSD or psilocybin therapy. With ECT, as with ketamine, the goal is to get the patient into what we call remission – to return him to his life before the onset of major depression. This is different from, for example, psilocybin therapy, where the psychotherapy component is very important. With ketamine, people do not gain insights that they can integrate into their daily lives, as with psychedelic therapy. They had a strange experience, but no insights.
After treatment, the antidepressants developed. This is very new: most normal antidepressants take weeks before an effect is seen. 70% of the patients in our trial woke up the next morning and felt much better.
Michael Grunebaum
Associate Professor, Psychiatry, University of Columbia
The vast majority of patients with mood disorders treated with ketamine infusions feel strange and / or spacious. Some feel like they are floating. Some people notice that their arms or legs somehow feel different – bigger than usual, numb or harder to move. Some get a kind of numbness around their face or mouth. Sometimes people feel cold. A rare couple experience mild hallucinations – shapes or colors on the walls or ceiling.
A small percentage of people feel anxious when they get ketamine, possibly because the sensations are not known; some people may find it more difficult to find the right words, which can cause anxiety. A small minority may also feel sad, tearful or in a hurry. Conversely, a small percentage of patients experience some form of euphoria. But more often, what most experience is that strangeness / space. Usually all these effects disappear after about 15-30 minutes after treatment.
The drug is usually administered intravenously, in a slow drop of more than forty minutes, but a nasal spray version has recently been approved. People can get two or three treatments a week for a few weeks and then take regular breaks. There is still a lot of research on what the right frequency for maintenance treatment is, as well as how long treatment should last, how safe it is, and so on. Studies of ketamine addiction show serious risks for long-term use of ketamine, although therapeutic doses are much lower, perhaps a tenth as large as typical street doses.
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Adam Kaplin
Clinical Director of the Psychiatric Esketamine Clinic and Assistant Professor of Psychiatry and Behavioral Sciences at Johns Hopkins University
One patient of ours would turn off the lights every time and go into a dreamlike state, during which she would fly over New York City, where she had worked before. She is looking forward to it – her little trips to the city. Another woman swore we were hiding lemons in the room. We had a patient for whom colors would vibrate outside the window – he described a green like no green he had seen before. Another heard voices and saw spiders crawling on the door.
That is, it has a wide range and mostly depends on the patient. Virtually no one who taught us, however, said they did not want to continue. When ketamine works, it works dramatically – in the first or two doses, people get dramatically better; some even feel that they are back to their old selves. Having this reaction in people with treatment-resistant depression is unbelievable after a few doses.
The people who were the worst about it were people who had never experimented with drugs before. One person we treated, a musician, treated his body like a temple – no drugs or alcohol for the rest of his life. So for him, ketamine was a terrifying experience: he just did not know what was going to happen. But usually people who have taken drugs in the past are a gifted experience.
One thing that helped with side effects – and I swear I get no money for this – was Enya. Always, Enya calmed our patients, even patients who were hard stones. It was Enya who really did it for them.
Rebecca Price
Associate Professor, Psychiatry and Psychology, University of Pittsburgh
During and immediately after a ketamine infusion, most patients feel numb, a little “high” or euphoric, and some feel distant or detached from what is going on around them. Some people feel dizzy, nauseous or have headaches. Researchers usually think there is nothing too special about the acute experience of receiving ketamine. When ketamine treatment is successful, the ‘special’ things come downstream in the form of a collective feeling of relief from depression and other negative emotional symptoms, which peaks about 24 hours after the infusion, linked to neuroplasticity changes that follow later. takes place. times. We usually consider the things that happen during the infusion and right around the infusion, mostly as troublesome side effects, rather than anything that is particularly therapeutic. This makes ketamine very different from other drugs that are now being investigated as psychiatric treatments, such as psilocybin.
Joshua Berman
Assistant Professor of Psychiatry and Clinical Guidance of the Ketamine Program at Columbia University
Patients report a variety of experiences while receiving ketamine treatment for depression, but overall, psychiatric dose ketamine is a ‘tamer’ experience than many people would think. Most patients describe that they feel “spacious”, from 5-15 minutes after the initial treatment, and the feeling draws in between 30-90 minutes. Some describe it as high, and a small number of patients become slightly dizzy. Some patients almost describe hallucinations as seeing patterns around them. Although almost all describe a feeling of dissociation, very few people really feel outside their bodies, and fewer feel that they have lost touch with reality even for a short time. These feelings may increase if higher doses are used, and there is no general agreement among ketamine physicians or a high degree of dissociation is required to achieve the desired antidepressant effect.
Ketamine is administered via IV or via an intranasal inhaler in a medically controlled environment where vital signs and the patient’s response can be monitored. Treatment sessions usually last two hours, after which the patient can go home.
The acute effects (feeling spacey, dissociated or high) disappear within one to two hours after administration, but any reduction in depressive symptoms can last for hours to days. It can take different treatments to consolidate an antidepressant and last longer. Once fully established, the antidepressant effect can continue with maintenance treatments that can be 2-4 weeks apart. For some patients a long period of maintenance treatment is required, while other patients have maintenance remission after only a few months.
Many patients report rapid improvement in mood, anxiety, and hedonic function, which initially attracted the psychiatric profession to use ketamine. This is the first treatment for depression that can work within minutes to hours. But for many, the first one or two (or even four) treatments give a much more subtle feel, with variable improvement in overall mood – it varies at first, but then consolidates. About one-third of patients have no response or no sustained response.
For most patients, the experience is very pleasant or neutral, but sometimes patients may briefly feel sad or tearful.
Ketamine treatment differs from the psychedelic guided therapies designed to provide therapeutic insights into the altered conditions achieved. The prevailing model for ketamine therapy is more like a physical treatment designed to improve synaptic connections using mechanisms that work faster than those used by conventional antidepressants. That said, some patients describe having insights or a shift in perspective during ketamine treatments in a way that may contribute to their recovery from depression, and some therapists are investigating whether it can be used as an “ego-resolving” therapy enhancer, as better established with MDMA and psilocybin.
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