In the meantime, please contact us know if you have any questions about ketamine. Domino, E. Taming the Ketamine Tiger. Anesthesiology, 1. Berman, R. Antidepressant effects of ketamine in depressed patients.
Biological Psychiatry,47 4 , Learn everything you need to know about ketamine from the science behind ketamine, its history, and how it is revolutionizing the treatment of mood and pain disorders in the blog and video. Twenty years ago, I began my course work as a pre-medical student at Seattle University in Washington.
During my time in college, I worked as a research technician at the University of Washington-Dept of Neurology studying neurosyphilis. To elucidate more about the bacteria, Treponema pallidum , I would perform a variety of procedures on laboratory animals to reduce their pain. By happenstance, the medication that I used regularly was ketamine!
At Reset Ketamine, we take a bio-psycho-social-spiritual approach to medicine. This is where the biopsychosocial model was founded. Not sure what ketamine is? Maybe you know it as a party drug, but now are hearing about its use as a medication to treat conditions such as chronic pain, post traumatic stress disorder PTSD , anxiety, and depression. Unclear of what to make of this medication? Our Team. The Story. Mailing List. Ketamine Treatments. Even a single-dose of ketamine may cause rapid antidepressant effects in otherwise treatment-resistant cases of bipolar DiazGranados et al.
Remarkably, this also includes the acute reduction of suicidal ideation DiazGranados et al. Recent neuroimaging studies support potential anti-anhedonic and anti-depressant effects, demonstrating its ability to alter glucose metabolism in regions implicated in mood disorders Lally et al. Repeated ketamine doses may improve depressive symptoms comparable to—and perhaps even more rapidly than—electroconvulsive therapy ECT; Ghasemi et al. Despite its observed promising antidepressant effects, however, more rigorous investigation is needed to establish its clinical use as an antidepressant.
The current evidence is limited by bias, small sample sizes, and limited data on important cofounding variables. In fact, a recent Cochrane Review determined that the efficacy of ketamine as an antidepressant may be limited beyond 1 week McCloud et al. One of the newer applications of ketamine is its role as a potential treatment for Post-Traumatic Stress Disorder PTSD , although studies examining this remain limited Feder et al.
For instance, Feder et al. A case reported by Donoghue et al. While it is postulated that ketamine may be useful in preventing the development of PTSD through the induction of stress resilience Brachman et al. Since its discovery, ketamine has been observed to produce symptoms similar to those of schizophrenia. As a result, researchers have used these drugs extensively as models to study schizophrenia.
While it now appears that overlaps in symptoms and even receptor effects are insufficient to explain the complex neuropathology of schizophrenia, ketamine and has undoubtedly facilitated and stimulated research efforts into understanding schizophrenia Domino and Luby, When the first clinical use of ketamine was reported in in Anesthesia and Analgesia, it quickly became a popular induction agent among anesthesiologists. Now, 50 years later, ketamine is increasingly being used beyond the operating room, demonstrating clinical utility in the fields of emergency medicine, critical care medicine, pain medicine and psychiatry.
The growing interest of ketamine in a range of settings and patient populations may reflect an impressive benefit-to-risk ratio. Unique compared to other anesthetic agents, ketamine produces potent anesthesia, sedation and analgesia while maintaining cardiopulmonary stability and airway patency.
Ketamine offers flexible options for administration, and the adverse psychological effects are often transient and either prevented by or alleviated with premedication or combined use with other agents.
Ketamine appears to inhibit information transfer in cortical networks Bonhomme et al. Perturbations in cortical network connectivity also correlate with pathological brain states, such as depression Muthukumaraswamy et al. Indeed, ketamine is being used as a tool for probing the mind to further inform our neurobiological framework of consciousness and altered brain states, and lines of investigation are actively ongoing Mashour, Over the past 50 years, countless patients have benefited greatly from ketamine.
We anticipate many more exciting discoveries in the next 50 years of investigating its clinical applications and mechanisms of modulating the mind. Both authors contributed to the writing of the manuscript, approved the final version to be published, and are accountable for manuscript accuracy and integrity.
LL: conception, design and drafting of the initial manuscript. PEV: critical manuscript review and revision of all final content. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors would like to acknowledge support from the Department of Anesthesiology at the University of Michigan Medical School.
Additionally, the authors would like to thank Dr. George Mashour for expert consultation throughout the manuscript writing process. National Center for Biotechnology Information , U. Journal List Front Hum Neurosci v. Front Hum Neurosci.
Published online Nov Linda Li 1 and Phillip E. Phillip E. Author information Article notes Copyright and License information Disclaimer. Vlisides ude. Received Sep 6; Accepted Nov The use, distribution and reproduction in other forums is permitted, provided the original author s or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice.
No use, distribution or reproduction is permitted which does not comply with these terms. This article has been cited by other articles in PMC. Abstract Ketamine was introduced into clinical practice in the s and continues to be both clinically useful and scientifically fascinating. Keywords: ketamine, neuropharmacology, consciousness, anesthesia, functional connectivity, depression, post-traumatic stress disorder. Introduction Fifty years ago, Corssen and Domino published the first clinical study of ketamine as a human anesthetic.
Open in a separate window. Figure 1. Figure 2. Pharmacokinetics and Pharmacodynamics Administration and Bioavailability Soluble in both water and lipids, ketamine can be safely administered through multiple routes: intravenous IV , intramuscular IM , oral, nasal, rectal, subcutaneous and epidural. Table 1 Basic pharmacologic profiles of ketamine.
Systemic Effects Cardiovascular At both subanesthetic and anesthetic doses, ketamine is predominantly a sympathomimetic, producing increased arterial pressures and heart rate Corssen and Domino, through direct stimulation of central nervous system structures Traber et al.
Pulmonary Ketamine does not cause clinically significant respiratory depression in patients Corssen and Domino, , though arterial hypoxemia following rapid IV infusion of ketamine has been reported Zsigmond et al. Neurological Because ketamine increases cerebral metabolism, it can potentially increase intracranial pressure ICP and has been used cautiously in patients with space-occupying cerebral lesions brain injury Gardner et al.
Side Effects, Toxicities, Interactions and Abuse Ketamine has multiple dose-dependent side effects, though most of which are self-resolving. Proposed Mechanisms of Actions Molecular Targets Unlike the IV and inhaled anesthetics in common clinical use, ketamine is not thought to act primarily through the potentiation of gamma-aminobutyric acid GABA transmission. Table 2 Receptor and channel targets of ketamine and related clinical effects.
Figure 3. Table 3 Summary of clinical uses for ketamine. Pediatrics The ability to administer ketamine intramuscularly has made it advantageous for patients in which IV administration may be difficult, including neonates, infants and young children. Traumatic Brain Injury TBI Despite historic concerns that ketamine may cause harmful increases in ICP, recent reports have challenged this with evidence that ketamine can be safely and effectively used in patients with head injuries or risk of intracranial hypertension Bourgoin et al.
Trauma Medicine Upon being marketed as a human anesthetic in the s, ketamine quickly became a popular battlefield anesthetic and continues to be used in military conflict Mercer, Analgesia and Sedation Unlike most other agents, ketamine offers the important advantage of being able to provide both profound analgesia and adequate sedation without significantly compromising airway reflexes or respiratory function Corssen and Domino, Burn medicine Historically, ketamine has played a prominent role in burn care protocols, providing effective analgesia and sedation for burn patients who must undergo debridements, grafts, and repeated dressing changes Demling et al.
Acute agitation Ketamine is also used to treat acutely agitated and violent patients in the ED. Acute pain More recently, low-dose ketamine infusions have been advocated to provide pain relief in the ED. Postoperative pain The use of ketamine infusions has been shown to be an opiate-sparing technique in managing post-operative pain following a variety of surgeries, including abdominal Guillou et al.
Non-cancer pain Ketamine is increasingly used as an adjunct in treating chronic pain states and appears to provide analgesia through its direct NMDA-receptor antagonism as well as modulation of descending inhibitory paths of pain often implicated in chronic pain states Niesters et al.
Psychiatric Uses Depression There has been surging interest in the use of ketamine as a potential therapeutic agent for affective disorders, particularly depression. Models of Schizophrenia Since its discovery, ketamine has been observed to produce symptoms similar to those of schizophrenia.
Conclusions and Future Directions When the first clinical use of ketamine was reported in in Anesthesia and Analgesia, it quickly became a popular induction agent among anesthesiologists. Author Contributions Both authors contributed to the writing of the manuscript, approved the final version to be published, and are accountable for manuscript accuracy and integrity. Conflict of Interest Statement The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Acknowledgments The authors would like to acknowledge support from the Department of Anesthesiology at the University of Michigan Medical School. References Adam F. Small-dose ketamine infusion improves postoperative analgesia and rehabilitation after total knee arthroplasty. A randomized controlled trial of intranasal ketamine in migraine with prolonged aura. Neurology 80 , — Low-Dose ketamine infusion for emergency department patients with severe pain.
Pain Med. Mechanisms of direct inhibitory action of ketamine on vascular smooth muscle in mesenteric resistance arteries. Anesthesiology 95 , — Evaluation the effects of adding ketamine to morphine in intravenous patient-controlled analgesia after orthopedic surgery.
Ketamine decreases intracranial pressure and electroencephalographic activity in traumatic brain injury patients during propofol sedation. Anesthesiology 87 , — Intraosseous anesthesia in hemodynamic studies in children with cardiopathy.
The efficacy of ketamine in pediatric emergency department patients who present with acute severe asthma. Case report: efficacy and tolerability of ketamine in opioid-refractory cancer pain. Pain Palliat. Care Pharmacother. A prospective case series of pediatric procedural sedation and analgesia in the emergency department using single-syringe ketamine-propofol combination ketofol.
Intranasal ketamine for analgesia in the emergency department: a prospective observational series. The dissociative anaesthetics, ketamine and phencyclidine, selectively reduce excitation of central mammalian neurones by N-methyl-aspartate. Prehospital management of earthquake casualties buried under rubble. Disaster Med. Effectiveness of ketamine in decreasing intracranial pressure in children with intracranial hypertension.
Ketamine inhibits transsarcolemmal calcium entry in guinea pig myocardium: direct evidence by single cell voltage clamp. NMDA receptor-dependent and -independent immediate early gene expression induced by focal mechanical brain injury.
Procedural pain management patterns in academic pediatric emergency departments. Electroencephalographic effects of ketamine on power, cross-frequency coupling and connectivity in the alpha bandwidth.
Use of oral ketamine in chronic pain management: a review. Pain 14 , — Resting-state network-specific breakdown of functional connectivity during ketamine alteration of consciousness in volunteers. Anesthesiology , — Effects of sufentanil or ketamine administered in target-controlled infusion on the cerebral hemodynamics of severely brain-injured patients. Care Med. Safety of sedation with ketamine in severe head injury patients: comparison with sufentanil.
Ketamine as a prophylactic against stress-induced depressive-like behavior. Psychiatry 79 , — General anesthesia and altered states of arousal: a systems neuroscience analysis. Mechanisms of bronchoprotection by anesthetic induction agents: propofol versus ketamine.
Anesthesiology 90 , — Ketamine-propofol vs. Burn Care Res. Safety and efficacy of intranasal ketamine for the treatment of breakthrough pain in patients with chronic pain: a randomized, double-blind, placebo-controlled, crossover study. Pain , 17— Sex differences in the antidepressant-like effects of ketamine.
Neuropharmacology 70 , 27— Beneficial effects of adding ketamine to intravenous patient-controlled analgesia with fentanyl after the Nuss procedure in pediatric patients. Yonsei Med. Low-dose ketamine via intravenous patient-controlled analgesia device after various transthoracic procedures improves analgesia and patient and family satisfaction. Pain Manag.
Ketamine for acute and subacute pain in opioid-tolerant patients. Opioid Manag. HCN1 channel subunits are a molecular substrate for hypnotic actions of ketamine.
Ketamine produces antidepressant-like effects through phosphorylation-dependent nuclear export of histone deacetylase 5 HDAC5 in rats. U S A , — Drug Investig. The destruction of the lower urinary tract by ketamine abuse: a new syndrome? BJU Int. Pharmacokinetics and analgesic effect of ketamine in man. Bioavailability, pharmacokinetics and analgesic activity of ketamine in humans. On the cerebral accumulation of ketamine and the relationship between metabolism of the drug and its pharmacological effects.
Subanesthetic ketamine infusion therapy: a retrospective analysis of a novel therapeutic approach to complex regional pain syndrome. Dissociative anesthesia: further pharmacologic studies and first clinical experience with the phencyclidine derivative CI Effect of intravenous patient controlled ketamine analgesiaon postoperative pain in opium abusers.
Regionally specific alterations in functional connectivity of the anterior cingulate cortex in major depressive disorder. Ketamine anesthesia for tangenital excision of burn eschar: a burn unit procedure. Trauma 18 , — Cardiac arrest following ketamine administration for rapid sequence intubation. Intensive Care Med. Effects of ketamine on canine cardiovascular function. Rapid resolution of suicidal ideation after a single infusion of an N-methyl-D-aspartate antagonist in patients with treatment-resistant major depressive disorder.
Psychiatry 71 , — A randomized add-on trial of an N-methyl-D-aspartate antagonist in treatment-resistant bipolar depression. Psychiatry 67 , — Psychedelic Drugs 12 , — Taming the ketamine tiger. Pharmacologic effects of CI, a new dissociative anesthetic, in man. Ketamine kinetics in unmedicated and diazepam-premedicated subjects. Remission from behavioral dysregulation in a child with PTSD after receiving procedural ketamine. Pediatrics , e—e Signaling pathways underlying the pathophysiology and treatment of depression: novel mechanisms for rapid-acting agents.
Trends Neurosci. Attenuation of psychic sequelae of ketamine by lorazepam. Anaesthesia 33 , — Ketamine activates breathing and abolishes the coupling between loss of consciousness and upper airway dilator muscle dysfunction. Anesthesiology , 35— Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial.
JAMA Psychiatry 71 , — Reduction of allodynia in patients with complex regional pain syndrome: a double-blind placebo-controlled trial of topical ketamine. Pain , 18— Opiate receptor mediation of ketamine analgesia. Anesthesiology 56 , — Low-dose ketamine in the management of opioid nonresponsive terminal cancer pain. Pain Symptom Manage. Neuroscience , 49— Molecular actions of racemic ketamine on human CNS sodium channels.
Acute administration of ketamine induces antidepressant-like effects in the forced swimming test and increases BDNF levels in the rat hippocampus. Psychiatry 32 , — Cerebrospinal-fluid pressure during dissociative anesthesia with ketamine.
Anesthesiology 35 , — Symptoms include:. Not sure what you are looking for? Try our intuitive Path2Help tool and be matched with support information and services tailored to you. Legally produced ketamine is a restricted substance and only a doctor or vet may prescribe or administer it.
All other ketamine is illegal in Australia. Federal and state laws provide penalties for the illegal use, possession, production, selling or driving under the influence of ketamine. Penalties can include fines, imprisonment and disqualification from driving.
K , horse trank , k-hole , ket , kitkat , special K , super k. Last published: November 05, What is ketamine? Other types of dissociatives Methoxetamine Nitrous oxide. How is it used? Withdrawal Giving up ketamine after a long time is challenging because the body has to get used to functioning without it. Symptoms include: cravings for ketamine no appetite tiredness chills, sweating restlessness, tremors nightmares, anxiety, depression irregular and rapid heartbeat risk of inujry 3.
Ketamine Fact sheet Read more about withdrawal. Path2Help Not sure what you are looking for? Find out more. See also, drugs and the law. Ketamine 3.
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