Ketamine & Mental Health: What We Know Already

A very good friend sent me a landmark study surrounding Ketamine a little while ago.  In drug research, big effects and powerful findings are usually accompanied by tiny sample sizes and weird statistics magic to rig the findings. So when I read the meta-analysis and systematic review published in The American Journal of Psychiatry, I was heartened. This is serious science and serious stats, with 167 patients evaluated across multiple studies. Also, the reporting scales (MADRS, HAM-D, QIDS-SR & the BDI) are well understood, robust and respected in the field. All of this adds up to this results abstract being very, VERY important:

Ketamine rapidly (within 1 day) reduced suicidal ideation significantly on both the clinician-administered and self-report outcome measures. Effect sizes were moderate to large (Cohen’s d=0.48–0.85) at all time points after dosing. A sensitivity analysis demonstrated that compared with control treatments, ketamine had significant benefits on the individual suicide items of the MADRS, the HAM-D, and the QIDS-SR but not the BDI. Ketamine’s effect on suicidal ideation remained significant after adjusting for concurrent changes in severity of depressive symptoms.
~The Effect of a Single Dose of Intravenous Ketamine on Suicidal Ideation: A Systematic Review & Individual Participant Data Meta-Analysis (Wilkinson et al)

That’s a dense couple of sentences, so let me explain why it’s so earth shattering. Suicidal thoughts, (known as suicidal ideation in clinical psychology) and depressed feelings are very difficult to get rid of, especially for depressed people. Treatment-resistant depression is a term associated with someone who has attempted multiple types of treatment for their Axis I disorder, but it hasn’t gotten better. After trying multiple types of interventions with no success, people slide quickly into hopelessness and thoughts of self harm. Up until now, depression treatments like SSRI drugs and Cognitive Behavioral therapy take time to work, sometimes more than a month. If you’re not in a good place right now, these things can’t help you. Ketamine infusions help immediately, and the change is apparent both to the patient and to the interviewing physician afterwards. This bit is huge, as most drug research relies heavily on self-report, which leads to bias and distorted findings. But, people are already talking to the press swearing by it, and it’s getting quite a lot of press, so here’s what they’re talking about.

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Benzodiazepines : Socially Acceptable Drowning

As many people reading this have been with their families long enough at this point to start taking sedatives or hypnotics to cope, I figured that Black Friday’s harm reduction post should focus on benzodiazepines. They were developed early in the history of pharmaceuticals, with the first going on sale in 1960, becoming the most prescribed medication in 1977, with numbers dropping since.Benzos have a long  history. Which I have no part in, so I won’t be taking time to explain it here. As some of the people reading this have giant chunks of those memories voided by said benzos. Continue reading

Ketamine: Destroyer of Scenes, Savior of the Depressed

This week, I want to discuss a substance that has developed a huge global following and staunch defenders on both sides of the Atlantic. Ketamine has become one of the most used substances in the Burner, rave & dance music communities. Whether you’re in London, New York City, Hong Kong, Cairo or Seattle, you’ve seen it diffuse into your scene. A dissociative anesthetic that’s never actually been used on horses, the crystalline powder took many dance floors by storm. In recent years, it’s not just become tethered to dance parties, but to treatment-resistant depression as well, with Ketamine infusion centers popping up at a surprising pace. But first, a little bit of local history.
I can’t speak for how the Ketamine may have filtered into your personal scene, but I can speak about the parties that I cut my teeth on, back during the era that people still thought we’d be greeted as liberators in Iraq. My friends and I first saw the issue when people in the psytrance scene couldn’t find LSD here in the city. While some chose to do 2C-I or roll, others began using this psychedelic powder that seemed to only last 40-60min. The utility of having a powder that only lasted 40min vs. a tab that could last 6-8hrs seemed to be immediately apparent and it started being THE thing.

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