What is Ketamine? A Look at Its Medical Benefits and Uses

Ketamine is a psychoactive substance that has garnered a unique reputation, having been used both recreationally and in medical contexts. Recent discoveries highlight its significant potential in treating mental health conditions such as depression. This article covers the essential aspects of ketamine, its medical benefits, and its innovative applications.

What is Ketamine?

Ketamine, originally an anesthetic, is a drug known for its hypnotic, analgesic, and amnestic properties. These attributes make it a valuable tool in various medical specialties, particularly for pain management. Ketamine's unique properties allow it to provide relief where other medications might fail, proving useful for a range of applications.¹

How Does Ketamine Work?

Ketamine consists of two enantiomers: S-ketamine and R-ketamine. Enantiomers are molecules that are mirror images of each other and can have different effects in the body. S-ketamine, in particular, is noteworthy for its mechanism as an NMDA receptor antagonist. It works by blocking the neurotransmitter glutamate, which plays a crucial role in neural activation and synaptic plasticity.²

This distinctive mechanism of action sets ketamine apart from traditional antidepressants, which usually target neurotransmitters such as serotonin and norepinephrine. By engaging a different pathway, ketamine offers new hope for individuals with treatment-resistant depression—those who have not found relief with standard antidepressant therapies.²

Ketamine for Depression and Beyond

In recent years, ketamine has emerged as a breakthrough treatment for depression, especially treatment-resistant depression. The use of ketamine for depression (aside from esketamine/S-ketamine) is an off-label, but not uncommon practice. Ketamine has similar properties to esketamine and has shown similar anti-depressant effects. With ketamine/esketamine some individuals experience a more rapid improvement in symptoms as compared to the typical response time for SSRI/SNRI antidepressants. The nasal spray form of esketamine, approved by the FDA in March 2019, has been a promising development.³

Moreover, in August 2020, the FDA extended its approval to include the use of esketamine for treating suicidal ideation or behavior. This new indication enhances its value, offering a rapid-action treatment option for patients experiencing acute suicidal thoughts, giving hope to those with severe depression.³

Ketamine’s Broader Medical Uses

Beyond its psychiatric applications, ketamine is a versatile drug utilized in various medical fields for its pain-relieving properties. It is often used in emergency and surgical settings as an anesthetic and for pain control. By providing effective pain relief without the risks associated with opioids, ketamine serves as a crucial alternative in the arsenal of pain management strategies.¹

Potential Risks

There are some short and long-term health risks associated with ketamine. The risks vary based on the dosage of ketamine, if it is combined with other substances and the frequency and duration of use. Short-term symptoms include headache, drowsiness, confusion, difficulty speaking, numbness, blurred vision, and nausea. It may also elevate blood pressure and heart rate. Long-term symptoms include issues with memory, depression, anxiety, and gastrointestinal problems. Ketamine should always be used with proper medical supervision to prevent significant health risks. Patients are encouraged to discuss both risks and benefits of ketamine treatment with their medical provider. Combining ketamine with other controlled substances and drugs, such as opioids, can be life-threatening.⁴

Conclusion

Ketamine’s journey from a once-controversial recreational substance to a groundbreaking medical treatment underscores its complex and multifaceted nature. From effectively managing severe depression to providing rapid relief for suicidal ideation, ketamine represents a pivotal advancement in mental health care.³ As research continues, it may reveal even broader applications, underscoring its importance in modern medicine.

Understanding ketamine's properties and applications arms individuals and healthcare providers with knowledge of this powerful tool, paving the way for more informed decisions in mental health and pain management treatments.

Sources:

1. United States Drug Enforcement Administration (DEA). (2020, April). Ketamine. Drug Fact Sheet: Ketamine. https://www.dea.gov/factsheets/ketamine
2. Rosenbaum SB, Gupta V, Patel P, et al. Ketamine. [Updated 2024 Jan 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470357/
3. Kritzer, M. D., Mischel, N. A., Young, J. R., Lai, C. S., Masand, P. S., Szabo, S. T., & Mathew, S. J. (2022). Ketamine for treatment of mood disorders and suicidality: A narrative review of recent progress. Annals of clinical psychiatry: official journal of the American Academy of Clinical Psychiatrists, 34(1), 33–43. https://doi.org/10.12788/acp.0048
4. NIDA. 2024, April 9. Ketamine. Retrieved from https://nida.nih.gov/research-topics/ketamine on 2024, August 14