Ketamine: From club drug to depression treatment pioneer

Ketamine was first synthesised by the American chemist Calvin Stevens in 1962 at the University of Michigan. It was initially employed as a new anaesthetic agent. It is an organic chemical compound with the molecular formula C₁₃H₁₆ClNO and a molar mass of 237.73 g/mol. The pharmacological action of ketamine mainly involves NMDA receptor antagonism and is similar to chemical compounds such as dextromethorphan and phencyclidine. However, it stands out for its significantly shorter action and fewer side effects, which is why it has remained popular in medicine for many years.

Ketamine induces a specific type of anaesthesia, referred to in medicine as "dissociative anaesthesia." It selectively inhibits certain structures of the central nervous system, leading to loss of consciousness while simultaneously stimulating others. It causes symptoms such as catalepsy (specific muscle rigidity), eye movements, or hallucinations. The dose of ketamine that induces anaesthesia is 1-2 milligrams per kilogram of body weight.

On both the global and national drug markets, new synthetic drugs, termed modified or designer drugs, continue to appear. These are usually derivatives of "classic" psychoactive substances, including medications. An example of such a substance is methoxetamine, a structural analogue of ketamine. Ketamine itself is also sometimes used as a recreational drug because, when used improperly and uncontrollably, it can induce a sensation of detachment from one's body, which might be accompanied by euphoria and even hallucinations.

Unfortunately, these sensations are only temporary. The subsequent consequences of recreational ketamine use include abdominal pain, nausea and vomiting, seizures, memory and concentration disorders, vision problems, and paranoia. All of these effects negatively impact health, well-being, daily life, and interpersonal relationships. Ultimately, it leads to deterioration and can pose a direct threat to life, similar to many other drugs.

Interestingly, the illegal use and abuse of ketamine began shortly after its introduction to the market, more precisely in 1970. Returning soldiers from Vietnam, who had ketamine used on them as an anaesthetic, described experiencing vivid hallucinations. There were also initial reports of abuse of this medication by healthcare workers. In recent years, ketamine has been termed a club drug because it is frequently used during various types of parties. Repeated administration of ketamine leads to the development of behavioural tolerance, meaning increasingly larger doses are necessary to achieve the desired narcotic effect.

Numerous scientific studies have confirmed that ketamine, when used in moderate, controlled amounts, can have antidepressant effects. This is particularly true for patients with severe forms of depression that do not respond to traditional pharmacotherapy methods. One such study found a significant improvement in depression symptoms in patients taking specific doses of ketamine within a few hours after administering a single dose of the substance. Moreover, a single infusion of ketamine often exerts a rapid antidepressant effect, which can last for several days. During this period, psychotherapy, which is essential for achieving long-term remission of the disorder, can be initiated.

Previously, antidepressant pills were the first-line treatment for patients diagnosed with depression. Often, they prove effective; however, for 40% of patients, the effects are insufficient, and the longer wait time for complete efficacy is a drawback. Therefore, ketamine seems to represent the future in the treatment of depression and certainly requires further, careful scientific study.

References

1. Messer M., Irina H., Ketamine maintenance therapy allows for long-term remission in depression, Psychiatry after Graduation, 3/2010.

2. Pochwat B., Ketamine – a long journey from anaesthetic to prototype antidepressant medication. Review of potential mechanisms of action, Psychiatry Poland 2022; 56(5): 1017–1032.

3. Ross S., Ketamine and Addiction, Psychiatry after Graduation, 2/2009.

This material is presented as part of a collaboration with Patronite.pl. The author is Kamil Radlak - Portal Fizjoterapeuty. You can support the author directly on his Patronite profile https://patronite.pl/fizjoterapeuty