Ketamine Addiction: Neurological Effects and How to Get Help

Key Takeaways

• Ketamine is a dissociative anesthetic with therapeutic potential in pain management and depression treatment, but also a risk for addiction.
• Originally developed as a safer alternative to PCP, ketamine has a history of medical use and potential for abuse.
• Recreational use of ketamine can lead to a ‘K-hole’ experience and has seen a rise in urban areas, raising health and safety concerns.
• Ketamine addiction alters the brain’s dopamine system and structure, affecting mood and reward pathways.
• Physical symptoms of ketamine addiction include nausea, increased heart rate and potential organ damage, while psychological symptoms range from relaxation to severe delirium.
• Treatment for ketamine addiction often involves detoxification, therapy and support groups, with a need for personalized care plans.
• Societal consequences of ketamine addiction include healthcare costs, addiction-related crimes and public safety threats.

What is Ketamine?

Ketamine hydrochloride, commonly known as ketamine, is a nonbarbiturate dissociative anesthetic approved by the Food and Drug Administration (FDA) for use as a general anesthetic, either alone or in combination with other medications. It creates a unique dissociative state not aligned with traditional levels of sedation, necessitating its consideration from a different perspective than drugs that follow the classical sedation continuum. 

Ketamine Uses and Mechanism of Action

Ketamine’s efficacy in chronic pain management and as an antidepressant extends beyond its presence in the body, potentially due to increased structural synaptic connectivity in response to a ketamine-induced hyper-glutamatergic state. It is metabolized primarily by the enzymes CYP3A4 and secondarily by CYP2B6 and CYP2C9, undergoing processes like N-dealkylation and hydroxylation. 

While ketamine has shown promising therapeutic potential, particularly in the treatment of depression, current evidence suggests a need for more rigorous studies to fully understand its effects and safety profile.

The Origins of Ketamine

The history of ketamine dates back to 1962 when it was first synthesized by Calvin Stevens at Parke-Davis Laboratories as an offshoot of the molecule phencyclidine (PCP). PCP possessed psychodysleptic, hallucinogenic and dissociative properties, but ketamine was developed to be a safer and more manageable anesthetic alternative. After its initial testing on humans in 1964 at Jackson prison in Michigan, ketamine’s unique properties quickly gained attention in the medical community.

Medical Acceptability

Approved by the FDA in 1970 for medical and veterinary use, ketamine was primarily utilized as a dissociative anesthetic. It was especially favored for its rapid action and was used extensively during the Vietnam War for its analgesic and sedative effects on injured soldiers. Over the years, ketamine’s versatility has been recognized in various medical scenarios, including as an opiate-sparing technique for managing post-operative pain and as a potential rapid-acting antidepressant.

Despite its therapeutic benefits, concerns about its addictive potential and recreational misuse have persisted. Today, ketamine is still used globally as a safe and effective anesthetic, while also being explored for its antidepressant effects in treatment-resistant cases. However, its use in treating mental health disorders is not FDA-approved and its promotion for such unproven uses has been scrutinized.

From Use to Abuse

Ketamine has seen a complex journey from its medical roots to becoming a recreational substance. With the FDA’s approval of esketamine for treatment-resistant depression in 2019, ketamine gained recognition for its potential in mental health treatments. However, this medical promise also paved the way for recreational misuse.

The recreational use of ketamine has been influenced by its dissociative effects, which can induce a trance-like state. Its popularity in the club scene has grown, as users seek the unique ‘K-hole’ experience it can provide. As recreational use grows, so does the potential for addiction and adverse effects, highlighting the need for continued education and regulation to mitigate its misuse.

What Ketamine Does to the Brain

Ketamine addiction is a complex phenomenon with profound effects on the brain’s neurochemistry and structure. Research has revealed that repeated ketamine exposure can lead to significant changes in the brain’s dopamine system, which is crucial for regulating mood and reward pathways.

Another dimension of ketamine’s influence involves its effects on neuronal activity patterns. A Penn Medicine study illustrates how ketamine acts as a ‘switch’ in the brain, reorganizing neuronal activity and potentially flipping the brain’s circuits into an altered state. This profound reorganization of brain function could be a key factor in the development of addiction, as the brain becomes accustomed to and dependent on these altered states.

Dopamine’s Role in Ketamine Addiction

Research indicates that chronic exposure to ketamine results in significant alterations in the brain’s dopaminergic pathways. These changes are not uniform across the brain; instead, they vary in different regions, affecting various functions such as mood regulation and basic physiological processes like metabolism and homeostasis. 

For instance, a decrease in dopamine neurons has been observed in regions associated with mood regulation, while an increase occurs in areas governing the body’s fundamental functions. This suggests that ketamine can reshape brain-wide networks in divergent ways, leading to potential consequences for addiction and other mental health disorders.

A study describes ketamine as a rapid-acting antidepressant and highlights its unique impact on the dopamine system. The substance’s ability to induce a general increase in dopamine, particularly in the nucleus accumbens — a key component of the brain’s reward system — suggests a mechanism that could contribute to its addictive potential.

Symptoms and Signs of Ketamine Addiction

Ketamine addiction can manifest through a variety of physical, psychological and behavioral symptoms. Recognizing these signs is crucial for early intervention and treatment. Behavioral signs of ketamine addiction include frequent and compulsive use of the drug, often leading to social and interpersonal issues. 

Changes in social behaviors, neglect of responsibilities and engagement in risky activities to obtain the drug are common among those struggling with addiction. It’s important to note that while ketamine withdrawal symptoms such as shaking, heart palpitations and sweating are less common compared to other substances, they can still occur and signal dependency.

Physical Symptoms

Physical symptoms may include nausea, vomiting, loss of motor function, increased heart rate and blood pressure, as well as potential organ damage, particularly to the kidneys and bladder. Respiratory problems and allergic reactions such as swelling or anaphylaxis are also possible indicators of ketamine misuse. Other symptoms include:

• Slurred speech and loss of coordination, which can impair an individual’s ability to perform routine tasks.
  
• Insomnia and irritability, resulting in altered sleep patterns and mood swings.
  
• Rapid eye movements and antsy behavior, suggesting heightened nervous system activity.
  
• Physical dependence, where the body adapts to the presence of the drug, leading to withdrawal symptoms like depression, excessive sleepiness and drug cravings when ketamine use is reduced or stopped.

Long-term use of ketamine may result in more severe health complications, such as cognitive impairments, memory loss and declines in executive functioning.

Psychological Symptoms

Psychological symptoms can range from feelings of calmness and relaxation to more severe effects. The drug’s dissociative properties might lead to out-of-body experiences or a sense of detachment from reality. Users in a negative state of mind may experience particularly unpleasant psychological effects, including:

• Psychological dependence, marked by a preoccupation with the substance and an inability to stop using despite being aware of negative consequences.
  
• Delirium, amnesia and severe mood swings ranging from euphoria to depression.
  
• Presence of hallucinations and dissociative states, which can lead to a distorted perception of reality and potentially dangerous behaviors.
  
• Insomnia, irritability and antsy behavior, which may disrupt daily functioning and social interactions.
  

Recognizing and addressing these symptoms early can be crucial for recovery and preventing long-term mental health issues.

Long-Term Health Consequences of Ketamine Addiction

Ketamine addiction can have profound consequences for an individual’s health. According to a systematic review, chronic ketamine abuse has been linked to structural brain changes, such as reduced gray matter volume in the prefrontal and orbitofrontal cortex, hippocampus and nucleus accumbens. These changes may underlie the cognitive deficits, memory impairments and executive functioning declines observed in long-term users.

Chronic users may experience symptoms akin to those found in schizophrenia, such as psychosis and a disconnection from reality. The drug’s addictive potential is also a concern, with evidence suggesting that prolonged use can lead to tolerance, physical dependence and a withdrawal syndrome characterized by depression, lethargy and cravings.

Options for Treating Ketamine Addiction

Addressing ketamine addiction requires a multifaceted approach, as with many substance use disorders. Treatment options typically combine medical care, counseling and support groups to help individuals overcome their dependence on ketamine. One of the first steps in treatment is often detoxification, where medical supervision ensures the safe removal of the drug from the body and management of withdrawal symptoms.

For some, medication-assisted treatment (MAT) may be appropriate. MAT can involve using medications to manage withdrawal symptoms or treat co-occurring mental health disorders that often accompany substance use disorders. It’s important for treatment plans to be personalized, taking into account the individual’s health history, the severity of the addiction and any co-occurring mental health conditions.

Rehabilitation programs offer structured treatment environments that can be beneficial for recovery. These programs may include inpatient or outpatient settings, providing different levels of care depending on the individual’s needs. Psychotherapy is another cornerstone of ketamine addiction treatment, addressing the psychological aspects of addiction.

Rehabilitation Programs

Following detox, individuals may participate in various forms of therapy, including cognitive-behavioral therapy (CBT), which helps modify the patient’s drug-use expectations and behaviors and improve coping strategies.

• Psychotherapy: Central to many rehab programs, psychotherapies like Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) help patients understand the root causes of their addiction and develop coping strategies.
  
• Group Therapy: Groups like Narcotics Anonymous offer peer support and the opportunity to share experiences and strategies for recovery.
  
• Family Therapy: Involves family members in the treatment process to repair relationships and build a supportive home environment post-rehabilitation.
  

Rehabilitation centers often provide tailored treatment plans that consider the individual’s age, gender and specific circumstances of their addiction. The goal is to achieve full recovery and equip individuals with the tools they need for long-term sobriety.

Psychotherapy

Ketamine-assisted psychotherapy (KAP) is an innovative treatment approach that combines the administration of ketamine with psychotherapeutic techniques to address substance use disorders, including ketamine addiction. The primary goal of KAP is to leverage the psychotropic effects of ketamine, which include its ability to facilitate neuroplasticity and promote new neural connections, to enhance the therapeutic process and foster deeper insights and emotional breakthroughs during therapy sessions.

It is important to note that KAP is still a relatively new treatment and requires further longitudinal research to fully understand its efficacy and safety profile. The integration of KAP into addiction treatment represents a promising area of mental health research, with institutions like the National Institute of Mental Health (NIMH) involved in ongoing studies to refine and understand the potential of ketamine as a therapeutic tool.

How to Prevent Ketamine Addiction

Preventing ketamine addiction involves a multifaceted approach that includes education, regulation and early intervention. Educating the public, especially young people, about the risks of ketamine misuse is crucial. This includes highlighting the drug’s potential for dependency and its adverse effects on mental and physical health. Regulation plays a key role in preventing addiction by controlling the availability of ketamine and ensuring it is used only for legitimate medical purposes.

Early intervention is essential for individuals who show signs of ketamine misuse. This could include counseling or therapy sessions that address the reasons behind drug use and provide coping strategies. Additionally, support groups and rehabilitation programs can offer the necessary support for those struggling with ketamine misuse.

Societal Consequences of Ketamine Addiction

Ketamine addiction not only affects individuals but also has far-reaching consequences for society. The misuse of ketamine has led to a variety of societal challenges. The increase in ketamine seizures in the US by 349% from 2017 through 2022 and a 81% rise in poisonings reported to national poison control between early 2019 and late 2021, highlight the growing concern over its recreational use and the strain it places on law enforcement and healthcare systems.

Communities are affected through increased healthcare costs and the burden of addiction-related crimes. Families suffer as addiction can lead to financial instability, emotional distress and strained relationships. Additionally, ketamine’s potential use in facilitating sexual assaults due to its amnesia-like effects poses a significant threat to public safety. The diversion of pharmaceutical ketamine from legitimate medical facilities to the streets disrupts medical supply chains and undermines trust in healthcare providers.

How to Get Help for Ketamine Addiction

For those seeking alcohol addiction treatment, The Recovery Village Indianapolis Drug and Alcohol Rehab stands as a beacon of hope. Located within the heart of Indy, we offer a comprehensive array of treatment options, including medical detox, inpatient care, partial hospitalization and intensive outpatient services. 

When you or a loved one are ready to embark on the path to recovery, our Recovery Advocates are here, ready to assist. Reach out to learn more about our tailored treatment programs, designed to cater to your specific needs and situation.