Ketamine: A Breakthrough in Depression Treatment or Dangerous Street Drug?

Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Chemical Collective or any associated parties.

Introduction

Antidepressants have become one of the most prescribed categories of drugs in the western world with an estimated 7.3 million people (or 17% of the UK population) now taking them. The worrying thing is, their efficacy is not proportional to their endemic distribution. That’s not to say that no one feels the benefit of drugs like prozac – a type of drug called an SSRI (selective serotonin reuptake inhibitor) – but when you look at the data behind these medications, there is an argument that they barely outperform placebos in properly conducted studies.

For years the debate around the effectiveness of these medicines has been ongoing in the scientific community and a paper published in 2018, based on a massive study of the efficacy of 21 antidepressant medications, appeared to put the argument to bed when it concluded that these medicines produced better outcomes for patients versus placebos. However, a subsequent review of that study has now been published, and it challenges this outcome, positing that the conditions applied in the study drifted from the established, ‘gold standard’ protocols and because of this, the results were skewed towards positive findings for antidepressants.

So what are we to make of this and where do we go from here? In my mind, this is a question that demands answers. Surprisingly, a street drug which has been consumed in clubs and parties for decades is showing amazing potential for the treatment of the most severe forms of depression – that drug is Ketamine.

Horse Tranquiliser?

We’ve all heard ketamine being referred to as horse tranquilliser – in fact, it’s an enduring joke on the drug scene that almost every user has heard. Where I’m from, the drug is even referred to as ‘Horse’ for that very reason, and the truth is, ketamine has in fact been used as an anaesthetic for large animals for decades, horses included. What’s less commonly known though, is that doctors have been using it as a human anaesthetic for a long time as well, and it is a useful tool in circumstances where more traditional options are not suitable. The FDA approved it for this purpose way back in 1970.

Effects of Ketamine

As an anaesthetic it is effective because it essentially separates mind and body, so that patients are in a state where respiratory function remains normal but the body no longer responds to sensory input. This dissociative effect is very different from that achieved by other methods of anaesthesia and has its place in clinical settings for this reason.

Dissociation can be fun, though, as ket users will attest. On the street, the drug usually comes as a salt-like powder, or if you’re getting the purer forms, glassy shards that are then crushed and – most commonly – snorted. Unlike speed, ecstasy or cocaine, ketamine is not a powerful stimulant, it’s actually mildly sedative at low to medium doses. This sedation is much more pronounced at high doses, but even one recreational hit can bring on a calming effect, combined with a ‘waveyness’ that in my experience is unique amongst commonly available street drugs.

Subsequent doses can bring about the onset of that previously mentioned dissociation, where you can lose motor control, often feeling like you’re dropping in and out of your current surroundings and experiencing a degradation of awareness of what’s going on in your immediate environment. 

The further you go, the more intense this all gets. Speech becomes affected and users’ verbalisations often make less and less sense to others. Strange hallucinations begin, very different to traditional psychedelics. Then the famous ‘K Hole’ can take hold. In this state you’ll most likely become incomprehensible and need to lie down as your mind separates from your body and your consciousness feels like it is ‘elsewhere’.

Into the Void

Some of the weirdest experiences I’ve ever had were on high doses of ketamine – and I’m a veteran user of potent psychedelics as detailed in my previous 3 part article about my own journey with narcotics. The ket hole experience is even harder to describe than a DMT breakthrough. You find yourself folded out of normal reality, wobbling and effervescing into strange mindscapes were almost nothing makes any sense. At times, a partial memory will drift into your awareness, but it quickly dissipates into another unrecognisable vista. It really is bizarre, but usually far from unpleasant – if you know what you’re getting yourself into. This experience can actually be quite scary, especially for first time users.

A Fine Line

I’ve always found that there is a fine line (pun intended) between staying compos-mentis and becoming a rubber mess. So much so that we jokingly refer to the drug as ‘regretamine’. Like most psychoactive substances, set and setting are vitally important.  Real ketamine wears off fairly quickly, but it really depends on the dose and method of consumption. Most of the effects of a moderate dose will have worn off after an hour; but returning close to baseline after a k-hole can easily take 2-3 hours. A decade ago when there was a crackdown on street ketamine due to its increasing popularity, analogues of the compound started surfacing, touted with names like ‘rhino ket’ (methoxetamine).

These drugs were similar in action to ketamine but some lasted for hours and my experience with these was much less pleasant. Emerging from high doses took much longer, and you could find yourself caught somewhere between reality and ‘the hole’, at which point, stimuli from your current surroundings could leak into your already weird hallucinations. Some examples would be: Hearing people laughing, catching sight of a common object and feeling the texture of the carpet all reverberated through my skewed awareness on different occasions, sometimes in a difficult-to-articulate but unmistakable negative sense. This can also happen with genuine ketamine but to a much lesser extent and duration, at least in my experience.

After the main effects of ketamine wear off, lots of people report an afterglow – a lasting feeling of tranquillity and contentment, and this is a clue to what scientists are interested in beyond ketamine’s anaesthetic qualities.

Potential of Ketamine

People with treatment resistant depression are now, in rare cases, being prescribed ketamine to relieve their chronic suffering, and with astounding results. When you tell people this, they imagine doctors racking up lines of ket in their office but of course this is not the case. A nasal spray has been developed called esketamine and is administered to patients twice a week for 1 to 4 weeks. They are given a small dose and have to attend a clinic to receive it, where they are then monitored for another 2 hours.

John Krystal, MD, chief of psychiatry at Yale-New Haven Hospital and Yale School of Medicine in Connecticut, who is leading the way in investigating the amazing antidepressant effects of ketamine, has commented “Ketamine can produce feelings of unreality; visual and sensory distortions; a distorted feeling about one’s body; temporary unusual thoughts and beliefs; and a euphoria or a buzz,” The treatment is not by any means commonplace, and is not given to just anyone who is suffering from low mood. Doctor Krystal puts it like this:

We’re reaching out in a new way to patients who have not responded to other kinds of treatments and providing, for some of them, the first time that they’ve gotten better from their depression.

One of the most impactful aspects of this treatment is for patients with suicidal tendencies. Some believe that the realisation of its effectiveness came from the fact that when someone who has gone beyond suicidal ideation and needs to actually be talked down from the ledge of a tall building or the precipice of a bridge, they are often given IV ketamine by emergency responders to calm them down in the ambulance. Doctors then started noticing that in their follow-up assessments 9 months later, their patients often stated that they hadn’t felt suicidal since. Savvy clinicians soon made the connection and began looking into this potential life-saving use of ketamine.

Saving Lives

A groundbreaking study into this application of the drug has produced impressive results. Early on, it was established that IV administration was more effective for the purpose of the study, and that’s how the experiment proceeded. Participants were carefully screened to ensure the results would be as relevant and definitive as possible. It was extremely comprehensive and the principle findings stated:

This study confirmed, in a large randomised controlled trial, that ketamine is a fast acting, efficient treatment of suicidal ideation. This effect was rapid, with 43.8% remission only two hours after the first infusion versus 7.3% in the placebo group.

No other traditional treatment has displayed such high efficacy for people with severe suicidal ideation, and when we consider the intention of the study, we can get a sense of how important this kind of research is:

Around 700 000 people worldwide die from suicide annually, and 10 to 20 times this number attempt suicide.

These numbers are staggering and highlight the shocking statistics behind a truth that has now reached mainstream acceptance – mental health is not a fringe issue. People are dying, and the traditional methods we currently use to address this simply aren’t sufficient. There is a sickness permeating through modern society and with adolescents emerging as the most at-risk demographic, we can’t ignore this problem any longer.

It's Getting Worse

Social media has been heavily linked to decreasing mental health in young people, and with apps like TikTok having almost exponential growth in their user base – specifically in the adolescent demographics – we’re most likely only seeing the beginning of what is becoming an epidemic of immense proportions, and this is not just about depression and anxiety, but suicidal ideation; among children. Never in the history of humanity have we had to worry about kids committing suicide. There is a terrifying psychological illness fermenting in the roots of our society and the old adage has never been more apt; ‘desperate times call for desperate measures.’

Ketamine, along with other street drugs like MDMA and magic mushrooms have been demonised in mainstream media for decades, and this has – in no small part – restricted the visibility of their medicinal properties. With the mental health of humanity at large decreasing, scientists and policy-makers are coming to terms with the fact that we can no longer ignore every substance that has abuse potential. Of course, risk assessment is still vital.

Risks of Ketamine

Ketamine use is not without its own risks. In the short term, official sources list the following as potential adverse side effects – although some of them sound like the very effects that users are looking for;

• Disorientation, confusion, or loss of motor coordination.
• Dizziness, nausea, or vomiting.
• Increased blood pressure, heart rate, breathing, or body temperature.
• Changes in sensory perceptions, including visual or auditory hallucinations.
• Feeling detached from yourself, your surroundings, or your environment

We cannot say the same about the long term abuse of street ketamine – it has a scary list of potential dangers that I’m sure we can all agree, no one is seeking to experience, including;

• LUTS (Lower Urinary Tract Symptoms)
• Heart attacks and strokes
• Seizures
• Kidney failure
• Hydroureteronephrosis (a condition where one or both kidneys become stretched and swollen as the result of a build-up of urine inside them)
• Severe pelvic pain

While few ketamine users will ever experience these life threatening risks, we cannot forget that they exist. The fact is, the long term risks of drugs like cocaine, opiates and even cannabis are well known among users and well publicised in mainstream media, the same cannot be said for ketamine. Harm reduction is so important and should always be a part of these conversations.

Conclusion

Ketamine is saving lives and easing the suffering of people who have been enduring mental pain for decades. 

Pharmaceutical companies undoubtedly would prefer to maintain the current model where we keep filling our prescriptions, taking our daily antidepressant and hoping things improve, but it’s time to acknowledge that it’s better to cure ailments than to indefinitely treat their symptoms – regardless of whether or not it’s less profitable for the manufacturers of said traditional treatments. This has now become a life or death issue and profit has to take a back seat. If drug laws are holding back treatments that are potentially orders of magnitude more effective than what we are currently using, in my opinion, those laws need to change. If ketamine holds the key to this insidious problem, we can’t let the fact that it can be abused hold it back from helping humanity.

When it comes to drugs like ketamine, it’s time for a paradigm shift. That means shaking off the negative connotations that global governments and mainstream journalism have happily reinforced for decades – seemingly without an accurate sense of the reality of the situation. Thankfully, change has begun, and I’m proud to play my part in keeping the momentum going, however small that part might be. Every voice counts.

Dev | Community Blogger at Chemical Collective

Dev is one of our community bloggers here at Chemical Collective. If you’re interested in joining our blogging team and getting paid to write about subjects you’re passionate about, please reach out to David via email at blog@chemical-collective.com