}}'''Ketamine''' is a [[dissociative]] [[anesthetic]]. It is a type of [[drug]] that is commonly administered by [[physicians]] to induce [[anesthesia]] during [[surgery]] or [[medical procedures]]. Ketamine can also be used as a [[painkiller]] and as a [[bronchodilator]], which facilitates easier airflow into the [[lungs]].<ref>{{Cite book |last1=Peck |first1=T. E. |last2=Hill |first2=S. A. |last3=Williams |first3=M. |year=2008 |page=111 |title=Pharmacology for Anaesthesia and Intensive Care (3rd edition) |publisher=Cambridge University Press |location=Cambridge |isbn=978-0-521-70463-2}}</ref>
'''Ketamine''' is a [[dissociative]] [[anesthetic]]. It is a type of drug a doctor might give to put someone to sleep for an operation. Ketamine can also be used as a [[painkiller]] and a bronchodilator (which makes it easier for air to get into your [[lungs]]).<ref>{{Cite book |last1=Peck |first1=T. E. |last2=Hill |first2=S. A. |last3=Williams |first3=M. |year=2008 |page=111 |title=Pharmacology for anaesthesia and intensive care (3rd edition) |publisher=Cambridge University Press |location=Cambridge |isbn=978-0-521-70463-2}}</ref>
Sometimes it can lead to a special type of [[hallucination]] which makes you feel detached from yourself and the things around you<ref>{{Cite journal |last=Bergman |first=S. A. |title=Ketamine: review of its pharmacology and its use in pediatric anesthesia |journal=Anesthesia Progress |volume=46 |issue=1 |pages=10–20 |year=1999 |pmid=10551055 |pmc=2148883}}</ref> which is why some people use it as a recreational drug. As it can have severe side effects, it is usually not available as an over-the-counter drug.
==Medical use==
Occasionally, ketamine use can lead to a specific type of [[hallucination]] that produces feelings of detachment from one's [[body]] and surroundings.<ref>{{Cite journal |last=Bergman |first=S. A. |title=Ketamine: Review of its Pharmacology and Its Use in Pediatric Anesthesia |journal=Anesthesia Progress |volume=46 |issue=1 |pages=10–20 |year=1999 |pmid=10551055 |pmc=2148883}}</ref> This property has made it a popular [[recreational drug]] despite its potentially severe [[side effects]]. For this reason, ketamine is not typically available as an over-the-counter drug.
In medicine, ketamine is normally injected into a [[vein]] or [[muscle]].<ref name="lankenau">{{Cite journal|author=Lankenau SE, Sanders B, Bloom JJ, ''et al.'' |title=First injection of ketamine among young injection drug users (IDUs) in three U.S. cities |journal=Drug and Alcohol Dependence |volume=87 |issue=2–3 |pages=183–93 |date=March 2007 |pmid=16979848 |pmc=1852477 |doi=10.1016/j.drugalcdep.2006.08.015}}</ref>
Ketamine is not the first anaesthetic a doctor would think of using in most situations because of the hallucinations it causes. On the other hand, while most anaesthetics suppress your breathing, resulting in the need for a machine to help you breathe, ketamine does not.<ref name="heshmati">{{Cite journal|author=Heshmati F, Zeinali MB, Noroozinia H, Abbacivash R, Mahoori A |title=Use of ketamine in severe status asthmaticus in intensive care unit |journal=Iranian Journal of Allergy, Asthma, and Immunology |volume=2 |issue=4 |pages=175–80 |date=December 2003 |pmid=17301376 |doi=}}</ref>
== Medical Use ==
This can make it a useful anaesthetic when you don't have any equipment available, for example, in a war zone.{{Citation needed|reason=This claim needs a reliable source|date=December 2013}}
In clinical settings, ketamine is most commonly administered via [[injection]] into a [[vein]] ([[intravenous]]) or a [[muscle]] ([[intramuscular]]).<ref name="lankenau">{{Cite journal|author=Lankenau SE, Sanders B, Bloom JJ, ''et al.'' |title=First Injection of Ketamine Among Young Injection Drug Users (IDUs) in Three U.S. Cities |journal=Drug and Alcohol Dependence |volume=87 |issue=2–3 |pages=183–93 |date=March 2007 |pmid=16979848 |pmc=1852477 |doi=10.1016/j.drugalcdep.2006.08.015}}</ref>
==Side effects==
===Short term===
While ketamine is not the preferred [[anesthetic]] in many cases due to its hallucinogenic effects, it offers distinct advantages. Unlike most other anesthetics that suppress [[respiration]] and necessitate the use of mechanical [[ventilation]], ketamine does not significantly inhibit breathing.<ref name="heshmati">{{Cite journal|author=Heshmati F, Zeinali MB, Noroozinia H, Abbacivash R, Mahoori A |title=Use of Ketamine in Severe Status Asthmaticus in the Intensive Care Unit |journal=Iranian Journal of Allergy, Asthma, and Immunology |volume=2 |issue=4 |pages=175–80 |date=December 2003 |pmid=17301376}}</ref>
Short term side effects happen in about 40% of people and include:<ref name ="Quibell">{{Cite journal|author = Quibell R, Prommer EE, Mihalyo M, ''et al.''|title = "Ketamine*"|journal = Journal of Pain and Symptom Management |volume = 41| issue = 3|pages = 640-649|date=March 2011|pmid = 21419322|doi=10.1016/j.jpainsymman.2011.01.001}}</ref>
Ketamine is particularly valuable in situations where advanced medical equipment is unavailable, such as in [[war zones]] or emergency [[field medicine]].{{Citation needed|reason=This claim needs a reliable source|date=December 2013}}
== Side Effects ==
=== Short-Term Side Effects ===
Short-term side effects are experienced by approximately 40% of individuals and include:<ref name="Quibell">{{Cite journal|author = Quibell R, Prommer EE, Mihalyo M, ''et al.''|title = "Ketamine*"|journal = Journal of Pain and Symptom Management |volume = 41| issue = 3|pages = 640–649|date=March 2011|pmid = 21419322|doi=10.1016/j.jpainsymman.2011.01.001}}</ref>
* [[Dizziness]]
* [[Dizziness]]
* [[Double vision]]
* [[Double vision]]
* [[Euphoria]]
* [[Euphoria]]
* [[Blurred vision]]
* [[Blurred vision]]
* Finding it hard to express [[emotions]], not being very emotionally reactive
* Difficulty expressing [[emotions]]
* [[High blood pressure]]
* [[Hypertension|High blood pressure]]
* [[Tachycardia|Fast heart beat]]
* [[Tachycardia]] ([[Fast heart rate]])
* [[Nausea|Feeling sick]] and [[vomiting]]
* [[Nausea]] and [[vomiting]]
* Having trouble understanding or producing [[speech]]
* Speech difficulties
* [[Nightmares]]
* [[Nightmares]]
* [[Illusions]]
* [[Illusions]]
* [[Hallucinations]]
* [[Hallucinations]]
* Changed [[body image]]
* Altered [[body image]]
* [[Impaired memory]] and [[attention]].
* [[Memory]] and [[attention]] impairments.
===Long term===
In the medical setting, ketamine is only given a few times so most long term effects mentioned below are found in recreational ketamine users and animal models.<ref name=morgan11>{{cite journal|last=Morgan|first=Celia J. A.|coauthors=Curran, H. Valerie|title=Ketamine use: a review|journal=Addiction|date=1 January 2012|volume=107|issue=1|pages=27–38|doi=10.1111/j.1360-0443.2011.03576.x|pmid=21777321}}</ref>
====Urinary tract effects====
There are 110 reports of people with problems in their urinary tract due to using ketamine.<ref name=middela>{{cite journal|last=Middela|first=S.|coauthors=Pearce, I.|title=Ketamine-induced vesicopathy: a literature review|journal=International Journal of Clinical Practice|date=1 January 2011|volume=65|issue=1|pages=27–30|doi=10.1111/j.1742-1241.2010.02502.x|pmid=21155941}}</ref>
Symptoms include:
* Urgently needing to urinate.
* Finding it painful to urinate and having [[blood]] in your [[urine]].
* Not being able to hold as much urine in your [[bladder]]
* These urinary tract problems are most common in people who have abused ketamine daily for a long time.<ref name =morgan11 />
====Neurological effects====
People who abuse ketamine a lot (more than 4 times a week) have been found to have impaired memory and increased depression when compared to people who don't abuse ketamine. Those who use ketamine less frequently (1-4 times per week) and those who had stopped taking ketamine showed no difference in the aforementioned parameters. This suggests that these problems with memory and mood do not affect infrequent users and might be reversible once ketamine use is stopped.<ref name="Addiction Users Study">{{Cite journal|doi=10.1111/j.1360-0443.2009.02761.x |pmid=19919593 |title=Consequences of chronic ketamine self-administration upon neurocognitive function and psychological wellbeing: a 1-year longitudinal study |year=2009 |last1=Morgan |first1=Celia J. A. |last2=Muetzelfeldt |first2=Leslie |last3=Curran |first3=H. Valerie |journal=Addiction |volume=105 |issue=1 |pages=121–33}}</ref>
One study has recently been done using monkeys as a model to see if ketamine is toxic to the brain.<ref name="Cynomolgus monkey neurotoxiciy">{{cite journal|last=Sun|first=Lin|coauthors=Qi Li, Qing Li, Yuzhe Zhang, Dexiang Liu, Hong Jiang, Fang Pan, David T. Yew|title=Chronic ketamine exposure induces permanent impairment of brain functions in adolescent cynomolgus monkeys|journal=Addiction Biology|date=November 2012|doi=10.1111/adb.12004|pmid=23145560|url=http://onlinelibrary.wiley.com/doi/10.1111/adb.12004/abstract}}</ref>
The study found that injecting the monkeys every day for 6 months with ketamine caused more cells to die in the [[pre-frontal cortex|front]] of their brain and also caused a decrease in activity in the areas of the brain which control movement.
==Mechanism of action==
Ketamine is an NMDA antagonist in the CNS. By inhibiting NMDA receptors in inhibitory neurons in the brain, it causes increased CNS activity and sympathomimetic effects. As a result, there is not only an anaesthetic effect, but also activation of the CNS unlike other anaesthetics. This is beneficial in surgical settings because it maintains blood pressure, airway reflexes, bronchioles remain dilated, and airways patent. Making this a particularly useful drug in shock and surgery patients because of blood pressure maintained with ketamine use, unlike typical anaesthetics which cause decreased BP and respiratory suppression.
==Research==
===Treating addiction===
One study by Evgeny Krupitsky has found that using ketamine along with psychotherapy and group therapy was a lot more effective at treating alcohol addiction than the traditional treatment.<ref>{{cite web|url=http://www.eleusis.us/resource-center/references/acamethod.php|title=The Combination of Psychedelic and Aversive Approaches in Alcoholism Treatment - Eleusis<!-- Bot generated title -->|publisher=}}</ref>
The same scientist found that ketamine might also be useful for treating heroin addiction. Patients who had been treated for their addiction with multiple sessions of ketamine fared much better than those who had only had one session of ketamine, with abstinence rates of 50% and 22.2% respectively.<ref>http://www.eleusis.us/resource-center/references/ketamine-psychotherapy-heroin.pdf</ref>
===As an antidepressant===
=== Long-Term Side Effects ===
Some small studies have been done which found that a single dose of ketamine was able to improve treatment-resistant depression after just a few hours, with the effects lasting for one week.<ref>[http://www.nih.gov/news/pr/aug2006/nimh-07b.htm NIH. "Experimental Medication Kicks Depression in Hours Instead of Weeks"] ''NIH News'', 7 August 2006</ref><ref>Khamsi, R. [https://www.newscientist.com/channel/health/dn9696.html "Ketamine relieves depression within hours"] ''[[New Scientist]]'', 8 August 2006.</ref> The rapid antidepressant effects of ketamine may prove to be a useful alternative compared to current antidepressants, which can take several weeks to have their effects.<ref name=pmid8788498>{{Cite journal|author=Eison AS, Mullins UL |title=Regulation of central 5-HT<sub>2A</sub> receptors: a review of in vivo studies |journal=Behavioural Brain Research |volume=73 |issue=1–2 |pages=177–81 |year=1996 |pmid=8788498 |doi=10.1016/0166-4328(96)00092-7}}</ref>
Long-term effects of ketamine are mostly observed in [[recreational drug use|recreational users]] or from prolonged exposure in [[animal studies]].<ref name=morgan11>{{cite journal|last=Morgan|first=Celia J. A.|coauthors=Curran, H. Valerie|title=Ketamine Use: A Review |journal=Addiction|date=1 January 2012|volume=107|issue=1|pages=27–38|doi=10.1111/j.1360-0443.2011.03576.x|pmid=21777321}}</ref>
===Complex regional pain syndrome===
==== Urinary Tract Effects ====
CRPS is a disease that causes severe pain and swelling, getting worse over time.<ref>{{cite web|url=https://www.marksandharrison.com/firm-news-announcements/complex-regional-pain-syndrome-crps/|title=Complex Regional Pain Syndrome (CRPS)|publisher=Marks & Harrison}}</ref> Some researchers have been investigating the use of ketamine to treat this condition. In some cases, low-dose ketamine infusions have shown promising results in reducing pain levels, even in patients who have not responded to other treatments.<ref>{{Cite journal|author=Schwartzman RJ, Alexander GM, Grothusen JR, Paylor T, Reichenberger E, Perreault M|title=Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: a double-blind placebo controlled study|journal=Pain|volume=147|issue=1–3|pages=107–15|year=2009|pmid=19836135|doi=10.1016/j.pain.2009.08.015}}</ref>
Chronic ketamine use has been associated with [[urinary tract]] issues, including:
* Increased urgency to urinate
* Pain during urination with [[hematuria]] ([[blood in urine]])
* Reduced [[bladder]] capacity<ref name=middela>{{cite journal|last=Middela|first=S.|coauthors=Pearce, I.|title=Ketamine-Induced Vesicopathy: A Literature Review |journal=International Journal of Clinical Practice|date=1 January 2011|volume=65|issue=1|pages=27–30|doi=10.1111/j.1742-1241.2010.02502.x|pmid=21155941}}</ref>
===Post-traumatic stress disorder (PTSD)===
==== Neurological Effects ====
Ketamine has been studied for its potential use in treating post-traumatic stress disorder (PTSD). Some early studies suggest that ketamine may be effective in rapidly reducing the severity of PTSD symptoms, and its effects may last for several weeks following a single treatment.<ref>{{Cite journal|author=Feder A, Parides MK, Murrough JW, et al.|title=Efficacy of Intravenous Ketamine for Treatment of Chronic Posttraumatic Stress Disorder: A Randomized Clinical Trial|journal=JAMA Psychiatry|volume=71|issue=6|pages=681–688|year=2014|pmid=24740528|doi=10.1001/jamapsychiatry.2014.62}}</ref> More research is needed to determine the safety and efficacy of ketamine for treating PTSD in the long term.
Frequent recreational use (more than 4 times a week) has been linked to impaired [[cognitive functions]], including [[memory]] deficits and increased [[depression]].<ref name="Addiction Users Study">{{Cite journal|doi=10.1111/j.1360-0443.2009.02761.x |pmid=19919593 |title=Consequences of Chronic Ketamine Self-Administration Upon Neurocognitive Function and Psychological Wellbeing: A 1-Year Longitudinal Study |year=2009 |last1=Morgan |first1=Celia J. A. |last2=Muetzelfeldt |first2=Leslie |last3=Curran |first3=H. Valerie |journal=Addiction |volume=105 |issue=1 |pages=121–33}}</ref>
==Recreational use==
== Mechanism of Action ==
Ketamine is sometimes used recreationally, typically at sub-anesthetic doses. Users often report feelings of dissociation, hallucinations, and a sense of detachment from their body or reality. This experience is sometimes referred to as entering the "K-hole."<ref>{{cite web|url=https://www.vice.com/en/article/59zj5z/what-is-a-k-hole-ketamine|title=What Is a K-Hole and What Does It Feel Like?|publisher=VICE|author=Max Daly}}</ref> However, frequent or high-dose recreational use can lead to a variety of negative health consequences, including bladder damage, cognitive impairment, and addiction.<ref>{{Cite journal|author=Morgan CJ, Curran HV |title=Acute and chronic effects of ketamine upon human memory: a review |journal=Psychopharmacology |volume=188 |issue=4 |pages=408–24 |year=2006 |pmid=17019667 |doi=10.1007/s00213-006-0572-3}}</ref>
Ketamine functions as an [[NMDA receptor]] antagonist in the [[central nervous system]] ([[CNS]]). By inhibiting these receptors, ketamine prevents excessive [[excitatory neurotransmission]], resulting in an [[anesthetic]] effect. Additionally, it produces [[sympathomimetic]] effects that help maintain [[blood pressure]] and [[airway reflexes]]. These properties make it a critical option for patients with [[shock]] or requiring [[emergency surgery]].
==Risks and side effects==
== Research ==
Ketamine can cause various side effects, including nausea, vomiting, dizziness, nystagmus (involuntary eye movements), and increased heart rate and blood pressure. High doses or frequent use of ketamine can lead to more severe side effects, such as bladder damage, cognitive impairment, and addiction.<ref>{{Cite journal|author=Morgan CJ, Curran HV |title=Acute and chronic effects of ketamine upon human memory: a review |journal=Psychopharmacology |volume=188 |issue=4 |pages=408–24 |year=2006 |pmid=17019667 |doi=10.1007/s00213-006-0572-3}}</ref>
=== Treating Addiction ===
Studies have explored ketamine's role in managing [[alcohol addiction]] and [[opioid use disorder]].<ref>{{cite web|url=http://www.eleusis.us/resource-center/references/acamethod.php|title=The Combination of Psychedelic and Aversive Approaches in Alcoholism Treatment - Eleusis|publisher=Eleusis}}</ref>
Long-term use of ketamine can lead to a condition called [[ketamine cystitis]], which is characterized by severe inflammation of the bladder, causing symptoms such as frequent and painful urination, blood in the urine, and incontinence.<ref>{{Cite journal|author=Chu PS, Ma WK, Wong SC, et al.|title=The destruction of the lower urinary tract by ketamine abuse: a new syndrome?|journal=BJU International|volume=102|issue=11|pages=1616-1622|year=2008|pmid=19021601|doi=10.1111/j.1464-410X.2008.07917.x}}</ref> Additionally, chronic ketamine use has been associated with cognitive deficits, including impairments in memory, attention, and executive function.<ref>{{Cite journal|author=Morgan CJ, Curran HV |title=Acute and chronic effects of ketamine upon human memory: a review |journal=Psychopharmacology |volume=188 |issue=4 |pages=408–24 |year=2006 |pmid=17019667 |doi=10.1007/s00213-006-0572-3}}</ref>
=== Antidepressant Effects ===
Preliminary studies suggest that a single dose of ketamine can significantly alleviate symptoms of [[treatment-resistant depression]] within hours, with effects lasting up to a week.<ref>[http://www.nih.gov/news/pr/aug2006/nimh-07b.htm NIH: "Experimental Medication Kicks Depression in Hours Instead of Weeks"]</ref>
Ketamine can also have psychological side effects, such as feelings of anxiety, agitation, and paranoia. These effects may be more pronounced in individuals with a history of mental health disorders. There is also a risk of developing a psychological dependence on ketamine, especially with frequent use.<ref>{{Cite journal|author=Muetzelfeldt L, Kamboj SK, Rees H, Taylor J, Morgan CJ, Curran HV |title=Journey through the K-hole: phenomenological aspects of ketamine use|journal=Drug and Alcohol Dependence |volume=95 |issue=1-2 |pages=219–29 |year=2008 |pmid=18355990 |doi=10.1016/j.drugalcdep.2008.01.024}}</ref>
== Recreational Use ==
Recreational users typically consume ketamine at [[sub-anesthetic doses]]. The dissociative effects, often referred to as a "K-hole," include [[hallucinations]] and a profound sense of detachment.<ref>{{cite web|url=https://www.vice.com/en/article/59zj5z/what-is-a-k-hole-ketamine|title=What Is a K-Hole?|publisher=VICE}}</ref> Chronic use, however, may lead to serious consequences such as [[bladder damage]], [[cognitive decline]], and [[psychological dependence]].<ref>{{Cite journal|author=Morgan CJ, Curran HV |title=Acute and Chronic Effects of Ketamine Upon Human Memory: A Review |journal=Psychopharmacology |volume=188 |issue=4 |pages=408–24|year=2006}}</ref>
It is essential to use ketamine under the supervision of a healthcare professional to minimize the risk of side effects and complications. When used medically, ketamine is typically administered in a controlled setting, with appropriate monitoring and management of potential side effects.
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Occasionally, ketamine use can lead to a specific type of hallucination that produces feelings of detachment from one's body and surroundings.<ref>Bergman, S. A.,
Ketamine: Review of its Pharmacology and Its Use in Pediatric Anesthesia,
Anesthesia Progress,
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PMC: 2148883,</ref> This property has made it a popular recreational drug despite its potentially severe side effects. For this reason, ketamine is not typically available as an over-the-counter drug.
Medical Use
In clinical settings, ketamine is most commonly administered via injection into a vein (intravenous) or a muscle (intramuscular).<ref name="lankenau">Lankenau SE, Sanders B, Bloom JJ, et al.,
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While ketamine is not the preferred anesthetic in many cases due to its hallucinogenic effects, it offers distinct advantages. Unlike most other anesthetics that suppress respiration and necessitate the use of mechanical ventilation, ketamine does not significantly inhibit breathing.<ref name="heshmati">Heshmati F, Zeinali MB, Noroozinia H, Abbacivash R, Mahoori A,
Use of Ketamine in Severe Status Asthmaticus in the Intensive Care Unit,
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Vol. 2(Issue: 4),
pp. 175–80,
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Ketamine is particularly valuable in situations where advanced medical equipment is unavailable, such as in war zones or emergency field medicine.
citation needed(December 2013)
Side Effects
Short-Term Side Effects
Short-term side effects are experienced by approximately 40% of individuals and include:<ref name="Quibell">Quibell R, Prommer EE, Mihalyo M, et al.,
Long-term effects of ketamine are mostly observed in recreational users or from prolonged exposure in animal studies.<ref name=morgan11>Morgan, Celia J. A.,
Ketamine-Induced Vesicopathy: A Literature Review,
International Journal of Clinical Practice,
Vol. 65(Issue: 1),
pp. 27–30,
DOI: 10.1111/j.1742-1241.2010.02502.x,
PMID: 21155941,</ref>
Neurological Effects
Frequent recreational use (more than 4 times a week) has been linked to impaired cognitive functions, including memory deficits and increased depression.<ref name="Addiction Users Study">,
Consequences of Chronic Ketamine Self-Administration Upon Neurocognitive Function and Psychological Wellbeing: A 1-Year Longitudinal Study,
Addiction,
2009,
Vol. 105(Issue: 1),
pp. 121–33,
DOI: 10.1111/j.1360-0443.2009.02761.x,
PMID: 19919593,</ref>
Recreational users typically consume ketamine at sub-anesthetic doses. The dissociative effects, often referred to as a "K-hole," include hallucinations and a profound sense of detachment.<ref>
-Ketamine-Structural_Formulae_V2.svg)
