Student Submission by: Nicholas Ward
Ketamine is an anesthetic that can cause dissociation. It has been sold many years as a street drug to allow users to dissociate for several hours at a time, causing feelings of euphoria or spiritual awakening due to its dissociative properties. Spravato (eskatamine), which is a nasal-spray form of ketamine, was marketed starting 2019 for treatment of depression although it is not FDA approved.
Ketamine has a wide range of effects because it binds to many receptors in the brain and body including, opioid, nicotinic, muscarinic, GABA and glutamate receptors. The actions of the Glutamate receptors, specifically the NMDA type for those that know what that means, are responsible for the various psychedelic effects. The glutamate receptors effects some of the famous neurotransmitters like dopamine, serotonin, and acetylcholine downstream in the event chain of your brain.
The benefit to this drug is that is uses a completely different combination of pathways compared to typical SSRIs or SNRIs used for depression and it can take effect quickly. For many individuals with suicidality, this may remove the feelings of suicide after just one session. It can also be used for treatment-resistant depression where there was no success before.
The dangers include side effects such as problems with heart rate or breathing, confusion, seizures, or urinary problems. It is important that the use of the drug be monitored and carefully dosed to ensure it is done at a safe level. Because is puts someone in a dissociative state if Ketamine is not done in the proper environment it can lead to what is known as a “bad trip” where you have nightmarish levels of fear, paranoia, and confusion.
Some clinics are now administering Ketamine combined with a session to prepare for the medication with a controlled atmosphere followed with a session afterwards to help the individual reorient to reality. Most treatment clinics integrate psychotherapy intro the treatment plan to make best use of the effects.
Sprovato may be covered by insurance. If the treatments are self-pay, they can reach several thousand dollars in cost because Sprovato cost around $1000 for a 2 spray cannister.