Considering the fact that we are in the middle of reading ”Ketamine,” I wanted to write this blog post on current research about the potential for ketamine to help patients suffering with major depressive disorder (MDD). MDD is a serious psychiatric illness that causes functional impairment in more than 15 million adults every year. Historically, monoaminergic antidepressants have been used to treat MDD, but their track record is far from perfect. Antidepressants could have a delayed onset of symptoms — as well as the fact that many patients remain treatment resistant. An interesting study from Shin et. al (2020) details the mechanisms of ketamine and how it can function as an antidepressant at sub-anesthetic doses. Furthermore, the study above states that ”Ketamine treatment protocols for MDD will eventually be established as a treatment option for clinical practice” (Shin et. al, 2020). Personally, this led to more research and many questions about how ketamine interacts with other drugs. I mean long term safety and abuse potential have to be taken into consideration when thinking about this drug as a viable substitute for antidepressants to help those diagnosed with MDD.
A study by Lankenau et. al (2005) shed some light on polydrug use, the topic that originally fascinated me, within ketamine injectors in New York City. Obviously, polydrug use is an epidemic in today’s society and has been linked with significant adverse health outcomes. The above study details how drug overdoses, increased risk to pathogens such as HIV, and drug dependence are all more common when mixing ketamine with other drugs — the specific aspect I found interesting, though, is when Dr. Lankenau and his team brought up the the topic of combining depressants. Like heroin and ketamine, for example. Mixing the two above drugs is an uncommon and risky situation since both drugs depress the central nervous system, (CNS) which controls the respiratory and circulatory systems (Jansen, 2001). Although there is little to no data on overdose numbers, I would hypothesize that the combination of ketamine and heroin is one of the leading causes of death within polydrug users.
The other two drug combinations I found most interesting were ketamine injected alongside ecstasy and ketamine injected with marijuana. I conjectured that taking ketamine along with marijuana / ecstasy would enhance the experience of ”getting high” – but I was mistaken. In the above study from Lankenau et. al (2005), more than 30% of frequent drug users admitted that ketamine was their drug of choice. What’s intriguing is that repeatedly using ketamine revealed that polydrug use – either co-use or simultaneous drug use – often detracted (detracts) from the ketamine experience. I would have predicted the exact opposite, especially with drugs like cocaine, ecstasy, marijuana, etc.
It is clear that ketamine has the potential to help with MDD and may act as a ’safe’ alternative to antidepressants. Despite this, the research community must continue testing the effects of ketamine on patients — and especially those who will use ketamine in combination with other drugs. This will increase the safety of long term ketamine users as well as help protect against potential abuse of the drug.
Shin, C., & Kim, Y. K. (2020). Ketamine in Major Depressive Disorder: Mechanisms and Future Perspectives. Psychiatry investigation, 17(3), 181–192. https://doi.org/10.30773/pi.2019.023
Lankenau, S. E., & Clatts, M. C. (2005). Patterns of polydrug use among ketamine injectors in New York City. Substance use & misuse, 40(9-10), 1381–1397. https://doi.org/10.1081/JA-20006693
Jansen K. Ketamine: Dreams and Realities. Sarasota, Florida: Multidisciplinary Association for Psychedelic Studies; 2001. [Google Scholar]
Clatts MC, Welle DL, Goldsamt LA, Lankenau SE. An ethno-epidemiological model for the study of trends in illicit drug use: Reflections on the ‘emergence’ of crack injection. International Journal of Drug Policy. 2002;13:285–295. [Google Scholar]
Veraart, J., Smith-Apeldoorn, S. Y., Bakker, I. M., Visser, B., Kamphuis, J., Schoevers, R. A., & Touw, D. J. (2021). Pharmacodynamic Interactions Between Ketamine and Psychiatric Medications Used in the Treatment of Depression: A Systematic Review. The international journal of neuropsychopharmacology, 24(10), 808–831.