Ketamine is a medication that has been approved by the United States Food and Drug Administration (FDA) for use as an anesthetic since 1970.
It’s the most widely used anesthetic across the globe due to its established record of safety. Ketamine is increasingly being prescribed off-label for a number of other uses, including pain management, substance use disorders, and treatment-resistant depression.
Although ketamine has a long history of safety when used in clinically-appropriate doses and settings, this medicine is not without risk. Like any medication, ketamine has a number of associated side effects, including elevated blood pressure and nausea.
Another side effect of ketamine use is the potential to develop a dependence on the medication.
Dependence can lead to a psychological or physiological need to continue using the medication despite negative consequences. Many side effects, including dependence, are minimized with safe use of ketamine in the proper clinical setting.
This article will examine the concepts of substance use and abuse, addiction, withdrawal, and overdose, all within the context of ketamine.
What is Ketamine Addiction?
Substance use, substance abuse, and addiction are all closely related terms with some important differences.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), substance use is any consumption of a potentially dependence-forming drug or medication.
A substance use disorder (SUD) forms when an individual continues using a substance despite negative consequences, whether those consequences are physical, psychological, or social.
Substance abuse (SA) is the misuse of any drug or medication, either by overusing the substance or using it in a manner other than how it is intended.
Addiction is a severe form of SUD, where the person with the SUD develops tolerance to the drug (more drug is needed for the desired effect). They often experience withdrawal symptoms when trying to stop using the substance, and are generally unable to stop using the substance without significant assistance, even when the person wishes to stop.
Addiction occurs because the brain itself is changed by repeated use of a substance for pleasurable effect. This repeated use leads to changes to the brain’s reward system, making cessation of the substance very difficult.
Outside of its clinical use, ketamine has increasingly become a drug of abuse due to its sometimes euphoric effects. Misuse of ketamine has caused SUD in some, and has led to dependence, withdrawal, and addiction.
Is Ketamine Addictive?
Any use of ketamine that is not under the direction of an appropriate clinician can be considered misuse. This misuse can take the form of consuming ketamine without the direction of an appropriate clinician, using more ketamine than prescribed, or using ketamine more often than prescribed.
When misused, ketamine can be addictive. This addiction will take the form of psychological dependence —needing to continue taking ketamine in order to meet the stresses of daily life— and physiological dependence in the form of withdrawal and tolerance.
Withdrawal refers to negative symptoms if the person tries to cut down on, or stop using ketamine. Tolerance is needing more and more ketamine to get the same euphoric effects.
Research has shown two things about ketamine addiction: almost all ketamine addiction occurs in those who misuse ketamine recreationally, and ketamine used as directed in an appropriate clinical setting very rarely leads to any dependence or addictive behaviors.
Signs of Ketamine Addiction
All substance use disorders, including ketamine addiction, share some common factors as classified in the DSM-IV:
- Taking the substance in greater amounts, or over a longer period of time, than was intended or prescribed
- A desire to, and inability to, reduce the use of the substance
- Increasing amounts of time dedicated to obtaining the substance, or to recovering from substance use
- Strong cravings or urges to use the substance
- Failing to meet daily responsibilities (such as work, school, or family) due to substance use
- Continuing to use the substance despite negative social problems (such as arguments with loved ones), unsafe conditions (e.g., driving while under the influence of the substance), or loss of previously enjoyed activities
- Continuing substance use even when the person knows that they are suffering psychologically or physically because of the use
- Tolerance, meaning the need to take more of the substance to achieve the same effect, or a diminishing effect despite increasing the dose
If you see any of these signs in others who are taking ketamine, whether recreationally or as prescribed, you should have a serious concern for that person having (or developing) an addiction to ketamine.
Likewise, if you are using ketamine, no matter what the setting, and you see these symptoms in yourself, you may be developing an addiction to ketamine.
If you believe that you or someone you know may have, or be developing, a SUD of any kind, please call the SAMHSA National Helpline at 1-800-662-4357. This is a free, confidential, always available referral service for individuals and families who are facing SUDs and other mental health concerns.
Side Effects of Ketamine Addiction
Ketamine addiction has a number of effects, both short term and long term.
In the short term, ketamine addiction can lead to craving for the drug, preoccupation with obtaining ketamine, and disruptions to social relationships due to ketamine use.
In the long term, taken at doses higher than those prescribed by health care professionals, ketamine abuse can lead to severe cognitive deficits, damage to the bladder and kidneys, and delusional thinking.
Research and clinical practice show little or no withdrawal symptoms when ketamine is used at clinically appropriate doses and under proper clinical supervision.
At recreational doses, people who misuse ketamine can experience a number of withdrawal symptoms. These include:
- Increased craving for ketamine
- Increased depression
- Increased anxiety
- Palpitations (sensation of a racing heart beat)
- Sleep disturbance
Overall, ketamine has a very wide margin of safety, making overdose unlikely, especially at clinically-appropriate doses.
At the doses seen in recreational misuse of ketamine, overdose can occur. If the person who overdosed has underlying health conditions, ketamine can cause severe events such as arrhythmias (abnormal heart beats), strokes, increased pressure in the brain, and myocardial infarctions (heart attacks).
The best way to avoid an overdose with ketamine is to only use ketamine as directed by a qualified clinician in an appropriate treatment setting.
Ketamine is a prescription medication with demonstrated success in treating a multitude of conditions. Ketamine can be used safely, as long as its use is directed by an appropriate clinician in the correct clinical environment.
If you feel like you or someone you know is at risk for addiction to ketamine, call the SAMHSA National Helpline at 1-800-662-4357 in order to be directed to the appropriate treatment setting. In case of misuse or overdose of ketamine, call 911 immediately or go to your nearest emergency department.
If you'd like to experience ketamine in a safe clinical environment, see if you're eligible for Mindbloom treatment here.
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This article is for informational purposes only and is not intended to be a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. If you are in a life-threatening situation, call, text, or chat the National Suicide Prevention Line at 988 or +1 (800) 273-8255, call 911, or go to the nearest emergency room.
Important FDA Safety Information
Ketamine is not FDA-approved for the treatment of depression or anxiety. Learn more about off-label uses here.
Side effects of ketamine treatment may include: altered sense of time, anxiety, blurred vision, diminished ability to see/hear/feel, dry mouth, elevated blood pressure or heart rate, elevated intraocular or intracranial pressure, excitability, loss of appetite, mental confusion, nausea/vomiting, nystagmus (rapid eye movements), restlessness, slurred speech, synesthesia (a mingling of the senses).
Do not proceed with ketamine treatment if any of the following apply to you:
- Allergic to ketamine
- Symptoms of psychosis or mania
- Uncontrolled high blood pressure
- CHF or other serious heart problem
- Severe breathing problem
- History of elevated intraocular or intracranial pressure
- History of hyperthyroidism
- Other serious medical illness
- Pregnant, nursing, or trying to become pregnant
Ketamine has been reported to produce issues including, but not limited to, those listed below. However, lasting adverse side-effects are rare when medical protocols are carefully followed.
While ketamine has not been shown to be physically addictive, it has been shown to cause moderate psychological dependency in some recreational users.
- In rare cases, frequent, heavy users have reported increased frequency of urination, urinary incontinence, pain urinating, passing blood in the urine, or reduced bladder size
- Ketamine may worsen problems in people with schizophrenia, severe personality disorders, or other serious mental disorders.
- Users with a personal or family history of psychosis should be cautious using any psychoactive substance, including ketamine, and discuss potential risks with your MindBloom® clinician before proceeding with treatment.
- The dissociative effects of ketamine may increase patient vulnerability and the risk of accidents.
To promote positive outcomes and ensure safety, follow these ketamine treatment guidelines:
- Do not operate a vehicle (e.g., car, motorcycle, bicycle) or heavy machinery following treatment until you’ve had a full night of sleep
- Refrain from taking benzodiazepines or stimulants for 24 hours prior to treatment
- Continue to take antihypertensive medication as prescribed
- Avoid hangovers or alcohol intake
- Refrain from consuming solid foods within 3 hours prior to treatment and liquids within 1 hour prior to treatment
- Ketamine treatment should never be conducted without a monitor present to ensure your safety