Ketamine is known for its medical uses as an anesthetic and its recreational use due to mood-altering effects. At higher doses, it can lead to psychosis, a severe mental state where an individual experiences a significant disconnection from reality.
Understanding Psychosis and Ketamine
Psychosis describes a state where an individual loses contact with reality, often experiencing disruptions in thoughts and perceptions. Common features include delusions, which are false beliefs, and hallucinations, such as seeing or hearing things that are not present. This condition can be a symptom of various mental illnesses or can be induced by certain substances.
Ketamine is a dissociative anesthetic approved by the FDA for medical use, including a derivative, esketamine, for treatment-resistant depression. As a recreational drug, it’s known as “Special K” or “K.” Its dissociative properties, which cause detachment from one’s body or surroundings, can trigger psychotic experiences, especially at higher doses.
Identifying Ketamine-Induced Psychosis Symptoms
Hallucinations are a prominent feature, often presenting as vivid and unusual visual or auditory experiences, distinct from typical drug-induced “trips.” Individuals may report seeing things that are not there or hearing voices.
Delusions, which are firmly held false beliefs, also occur. These can include paranoia, where a person believes others are trying to harm them, or grandiose beliefs about their own importance.
Disorganized thinking and speech are common, making it difficult for the individual to form coherent thoughts or communicate clearly, leading to rambling or illogical statements. Feelings of depersonalization, a sense of being detached from one’s own body, or derealization, a feeling that one’s surroundings are not real, can be particularly intense with ketamine.
In some cases, severe agitation, characterized by extreme restlessness, or conversely, catatonia-like states, involving profound withdrawal and unresponsiveness, may be observed. Additionally, cognitive impairments such as difficulty with memory, attention, and executive functions can be present.
The Brain’s Response to Ketamine
Ketamine primarily blocks N-methyl-D-aspartate (NMDA) receptors in the brain. These glutamate receptors are crucial for normal glutamate neurotransmission, the brain’s primary excitatory signaling system. Disrupting these pathways imbalances brain activity, mimicking aspects of psychotic disorders.
While NMDA receptor antagonism is the main mechanism, secondary effects on the dopamine system are also implicated. Ketamine increases dopamine release in regions like the prefrontal cortex. Dopamine dysregulation is a central feature in many forms of psychosis, suggesting its involvement in ketamine’s psychotomimetic effects, particularly affecting the prefrontal cortex and limbic system.
Factors Influencing Ketamine Psychosis
The dose and frequency of ketamine use play a significant role, with higher doses and chronic use increasing the risk. Individuals with a pre-existing mental health condition, particularly a history or predisposition to psychotic disorders like schizophrenia or bipolar disorder, are at a substantially higher risk. Genetic predisposition also contributes, as certain genetic factors may influence an individual’s vulnerability to ketamine-induced psychosis. The concurrent use of ketamine with other substances, known as poly-drug use, can exacerbate its effects and heighten the risk of psychosis. Individual sensitivity to ketamine varies, meaning different people may react differently to the same dose. While symptoms are usually acute and resolve upon cessation of the drug, persistent psychosis can occur, especially with chronic abuse.
Responding to Ketamine Psychosis
If someone experiences ketamine-induced psychosis, immediate steps should focus on ensuring the safety of the individual and those around them. This involves removing the person from stimulating environments, maintaining a calm atmosphere, and seeking immediate professional medical attention, such as contacting emergency services.
Healthcare providers will offer supportive care, which includes monitoring vital signs. They may administer pharmacological interventions to manage acute agitation and psychotic symptoms. Benzodiazepines, such as lorazepam or diazepam, are often used to alleviate agitation, and antipsychotics may also be given to help control the psychotic symptoms.
Long-term management involves abstinence from ketamine and may include follow-up mental health support to address any underlying vulnerabilities or persistent symptoms.