This Is Why Ketamine Is Called Dissociative Anesthesia
Ketamine is a unique drug. It produces psychedelic effects yet it is not considered one of the classic psychedelics. Indeed, unlike any of the common psychedelic compounds, ketamine is dissociative anesthesia. You may be wondering why ketamine is called dissociative anesthesia. The short answer is that ketamine is both a dissociative drug and an anesthetic.
In this post, we will describe in detail the dissociative and anesthetic nature of ketamine. Then we will outline the benefits of using ketamine at sub-anesthetic doses.
Ketamine As Dissociative Anesthesia
Ketamine is a distinctly dissociative drug. This is because it leads to dissociative effects. When you take ketamine at high doses (high enough to produce anesthesia), the drug will also induce a feeling of disconnection or detachment from your environment and self. It can feel as if you are floating outside of your body.
Why Ketamine Causes Dissociation
Researchers state that the dissociative effects of ketamine are due to increased glutamate release. Glutamate is a neurotransmitter. It is the most abundant excitatory neurotransmitter in the vertebrate nervous system. As an excitatory transmitter, it excites or stimulates nerve cells, encouraging them to take action.
Ketamine increases levels of glutamate in the brain by binding to NMDA receptors. Paradoxically, ketamine actually blocks these receptors, and this is what leads to a surge in glutamate.
Ketamine: A Unique Anesthetic
In 1970, the Food and Drug Administration (FDA) approved the use of ketamine (brand name: Ketalar) as an anesthetic. After this FDA approval, Americans used the drug during the Vietnam war to treat wounded soldiers. Medics used the drug in cases of amputees, gashes, and shock wounds.
As an anesthetic, ketamine worked effectively to provide amnesia and pain relief during medical treatment. It also helped to subdue distraught and frightened soldiers. Soldiers who have received a high, anesthetic dose of ketamine are much easier to load and transfer away from danger.
Ketamine acts as a quick anesthetic and analgesic. On the battlefield, the use of ketamine led to improvements in the medical process, with soldiers receiving better pain relief and recovery.
Another benefit of ketamine as an anesthetic is that the drug increases heart rate and blood pressure, which helps with blood loss. It also doesn’t lower the breathing rate. Ketamine is one of the safest anesthetics for these reasons. Other anesthetics lower heart rate, blood pressure, and breathing rate, which make them unsuitable in certain medical emergencies and procedures.
In 1999, ketamine became a Schedule III drug in the U.S. Since then, it has been used in hospitals and medical settings for anesthetic purposes. Pets and other animals also receive ketamine as an anesthetic when they undergo medical procedures, spaying, or neutering. Ketamine is the most common veterinary drug.
RELATED: What Does Ketamine Feel Like?
How Ketamine Impacts Humans
When given to humans in a medical setting, ketamine induces dissociative anesthesia during, before, and after surgery. In hospital settings, ketamine is common during the following procedures.
- Eye, ear, nose, and throat procedures
- Orthopedic procedures
- Amputee relief
- Dental extractions, such as wisdom teeth removal
- Skin grafts
- Helping patients with seizures
- Cardiac catheterization
- General pain relief
Ketamine is also unique as an anesthetic because it does not need refrigeration, special preparation, oxygen, electricity, or an anesthetic expert to administer it. This means the drug is particularly helpful in third-world countries.
Another unique aspect of ketamine as dissociative anesthesia is that you will be awake during a medical procedure. This is not the case with general anesthesia. When you receive an anesthetic dose of ketamine, your eyes will be open but you will be detached from the surroundings that you see. You can be aware of medical professionals carrying out a procedure on you but you won’t feel any pain, discomfort, or psychological distress.
The Benefits Of Ketamine As Dissociative Anesthesia
Ketamine is dissociative anesthesia, but it also causes dissociative effects at sub-anesthetic doses. These are the doses used when you undergo ketamine-assisted therapy for:
- Major depressive disorder
- Treatment-resistant depression
- Suicidal depression
- Post-traumatic stress disorder (PTSD)
- Generalized anxiety disorder (GAD)
- Social anxiety disorder (SAD)
In studies investigating ketamine infusions and dissociation, researchers use the Clinician-Administered Dissociative State Scale (CADSS) to measure the degree of dissociation. The CADSS looks at dissociative symptoms such as the below.
- Feeling like things are in slow motion or seem unreal
- Objects looking different
- Feeling like you’re a spectator
- Time speeding up or slowing down
- Feeling as if looking at things from outside the body
- Losing track of time or what is happening in the environment
- Seeing things through a fog or having tunnel vision
- Feel as though your body has changed
Most people find ketamine infusions pleasant and relaxing, even if experiencing dissociative symptoms. Nevertheless, it is possible to find these effects unpleasant or confusing. In these cases, accepting the experience and focusing on your breathing can help.
What Do Studies Suggest?
Currently, the scientific literature does not support the conclusion that dissociation is necessary for ketamine’s antidepressant effects. According to a study published in the American Journal of Psychiatry, the dissociative effects of ketamine do not appear sufficient to cause antidepressant effects. It seems that ketamine’s effect on the opioid system is necessary for the acute improvements in depression. However, these changes to the opioid system are not involved in the dissociative effects of ketamine.
The dissociative effects of ketamine, nonetheless, still play an important role in ketamine’s therapeutic benefits. For example, a study published in the Journal of Affective Disorders discovered a significant correlation between dissociative effects and improvements in depressive symptoms. The more dissociation participants had, the more clinical improvements they experienced.
A separate study arrived at the same conclusion. However, the specific dissociative feature that was most strongly associated with the antidepressant response was depersonalization (detachment from your sense of self).
Indeed, the subjective effects — as with other psychedelics — seem to be part of what makes a difference to patients’ lives. Yet researchers believe that dissociation is neither necessary nor sufficient for ketamine’s antidepressant effects. What seems to be happening, then, is that ketamine’s therapeutic benefits are based on a combination of changes. Dissociation is a contributing factor but so are ketamine’s effects on the opioid system, serotonin, dopamine, and key brain regions.
The medical application of ketamine very much depends on its dose. In high doses, ketamine is dissociative anesthesia and uniquely beneficial in that respect. At lower doses, ketamine can be an impressively effective antidepressant. When you opt for ketamine-assisted therapy, you won’t ever be administered an anesthetic dose. However, you can still expect to experience dissociative effects.