Ketamine has been shown to have rapid and effective antidepressant effects for individuals with treatment-resistant depression and has also shown promise in reducing symptoms of anxiety and post-traumatic stress disorder (PTSD). However, ketamine does have some addictive potential which can lead to diversion and misuse. It is important to understand what behaviors lead to more or less misuse as ketamine becomes a more popular mental health treatment.

The addictive potential of ketamine

Ketamine, a synthetic derivative of phencyclidine, is a sometimes misused party drug that is restricted (i.e. a controlled substance) because of its addictive potential. Ketamine is also used as an anaesthetic in human and veterinary medicine [1]. Let’s explore this further, looking at the evidence.

First, it is important to understand what addiction is. Addiction is a ****state of psychological or physical dependence (or both) on the use of alcohol or other drugs. The term is often used as an equivalent term for substance dependence and sometimes applied to behavioral disorders, such as sex, internet, and gambling addictions [2]. Addiction is a chronic, relapsing brain disease characterized by compulsive drug-seeking and use despite harmful consequences. Addiction changes the brain in fundamental ways, and these changes can last long after the drug use has stopped.

Ketamine, like many other drugs, can be addictive. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), addiction to ketamine is diagnosed when someone meets two or more of the following criteria in a 12-month period:

1. Taking ketamine in larger amounts or for longer than intended.
2. Wanting to cut down or stop using ketamine but not managing to.
3. Spending a lot of time getting, using, or recovering from the effects of ketamine.
4. Having cravings and urges to use ketamine.
5. Continuing to use ketamine despite knowing it is causing physical or psychological problems.
6. Giving up important social, occupational, or recreational activities because of ketamine use.
7. Using ketamine in situations where it is physically dangerous.
8. Continuing to use ketamine despite ongoing problems with relationships, work, or finances [3].

While ketamine does not have the same level of physical addiction as some other drugs, it can be psychologically addictive. Some people may develop a tolerance to ketamine, which means they need to take more and more of it to achieve the desired effect. This can lead to dependence, where the body adapts to the presence of the drug and experiences withdrawal symptoms when it is stopped.

Withdrawal symptoms from ketamine can include anxiety, depression, irritability, and insomnia. However, these symptoms are generally less severe than those associated with other drugs such as opioids or alcohol.

Therapeutic ketamine treatment

It is worth noting that ketamine has been used in clinical settings to treat depression and other mental health conditions. These treatments are typically done under medical supervision and at much lower doses than recreational use. While ketamine has shown promise as a treatment for some conditions, it is not a cure-all and should only be used under the guidance of a healthcare professional.

In conclusion, while ketamine does not have the same level of physical addiction as some other drugs, it can be psychologically addictive and lead to dependence. Anyone who is concerned about their ketamine use should speak to a healthcare professional. If you or someone you know is struggling with addiction, there is help available. Contact a local addiction treatment center or support group for more information.

_ _ _

References

1. Ho RCM, Zhang MW. Ketamine as a rapid antidepressant: the debate and implications. BJPsych Advances. 2016;22(4):222-233. doi:https://doi.org/10.1192/apt.bp.114.014274
2. Substance use, abuse, and addiction. https://www.apa.org. Published 2022. Accessed March 9, 2023. https://www.apa.org/topics/substance-use-abuse-addiction#:~:text=Addiction is a state of psychological or physical, gambling addictions. Adapted from APA Dictionary of Psychology
3. Ketamine Abuse: Addiction, Effects, and Treatment. American Addiction Centers. Published December 2022. Accessed March 16, 2023. https://americanaddictioncenters.org/ketamine-abuse‌

Cover photo by Randy Jacob on Unsplash