The Therapeutic Effects of Ketamine in Mental Health Disorders: A Narrative Review

Abstract

Ketamine, a non-competitive N-methyl-d-aspartate receptor antagonist, is commonly used as an anesthetic and analgesic but has recently shown promising research in treating certain psychiatric conditions such as depression, post-traumatic stress disorder (PTSD), suicidal ideation, and substance use disorder. Due to its euphoric, dissociative, and hallucinogenic properties, ketamine has been abused as a recreational drug, which has led to rigid regulation of medication. The COVID-19 pandemic has been an unprecedented challenge for the American population which was reflected in increased reports of problems regarding their mental health. Mood disorders have dramatically increased in the past two years. Approximately one in ten people stated that they had started or increased substance use because of the COVID-19 pandemic. Furthermore, rates of suicidal ideation have significantly increased when compared to pre-pandemic levels, with more than twice the number of adults surveyed in 2018 indicating suicidal thoughts “within the last 30 days” at the time they were surveyed. Moreover, many responders indicated they had symptoms of PTSD. The PubMed database was searched using the keyword “ketamine,” in conjunction with “depression,” “suicidal ideation,” “substance use disorder,” and “post-traumatic stress disorder.” The inclusion criteria encompassed articles from 2017 to 2022 published in the English language that addressed the relationship between ketamine and mental health disorders. With this sharp increase in the prevalence of psychiatric disorders and an increased public interest in mental health combined with the promise of the therapeutic value of ketamine for certain mental health conditions, including suicidal ideation, this narrative review sought to identify recently published studies that describe the therapeutic uses of ketamine for mental health. Results of this review indicate that ketamine’s therapeutic effects offer a potential alternative treatment for depression, suicidal ideation, substance use disorders, and PTSD.

Mental health facilities with ketamine infusion therapy in the United States in 2020: Co-location of dual diagnosis mental health and substance use disorder treatment.

“…Notably, examining the effectiveness of KIT in treating SUD is an evolving research area. Some treatment providers may be hesitant to provide KIT for SUD due to concerns related to dosing, effectiveness, and safety, as more studies are needed to establish a strong evidence base of ketamine’s effectiveness in treating SUDs (Cosci & Chouinard, 2020; Dakwar, Anerella, et al, 2014; Domino, 2010; Garel et al, 2022; Sanacora et al, 2017; Sepulveda Ramos et al, 2022; Williams et al, 2018). Thus, results from this study highlight the potential of current KIT providers to offer co-located dual diagnosis MH and SUD treatment, but not necessarily providing KIT for SUD in all cases.…”

“…Further, studies indicate that ketamine can reduce substance use among individuals receiving treatment for a SUD (Grabski et al, 2022; Jones et al, 2018; Martinotti et al, 2021) and increase abstinence rates of individuals being treated for an alcohol use disorder, cocaine use disorder, or opioid use disorder (Jones et al, 2018). It should also be noted that the dissociative properties of ketamine may cause some individuals to develop a SUD (Cosci & Chouinard, 2020; Domino, 2010; Sanacora et al, 2017; Sepulveda Ramos et al, 2022), specifically a hallucinogen use disorder (American Psychiatric Association, 2022). Further, a systematic review of ketamine’s effectiveness in treating problematic alcohol use or alcohol use disorder found mixed results regarding its ability to treat alcohol cravings, and noted methodological concerns (e.g., potential confounding variables, clinician-rated scales) in studies affirming its ability to do so (Garel et al, 2022).…”

Ketamine: Recent evidence and current uses

“…For example, the long-term safety of repeated ketamine use is not well established, particularly in psychiatric populations. Additionally, there is ongoing debate around the optimal dosing strategies for ketamine, particularly in the treatment of depression, where there is variability in response rates and optimal dosing regimens [34]. monitoring, and management of potential adverse effects [35].…”

Ketamine, an Old–New Drug: Uses and Abuses

“…However, due to its properties, dose- and duration-related neurological and peripheral adverse effects are usually reported. Ketamine is known as a powerful psychostimulant, and because of its rewarding and reinforcing effects, it has become a recreational drug, accounting for the steady worldwide increase in its non-medical use [ 4 , 5 , 6 ].…”