Ketamine is administered either as an anesthetic, psychedelic, or psycholytic dose to yield different effects on the body and mind.
In this section, we’ll explore the expected effects of a client with a specific dose range. Later in the course, we’ll look at the recommended dose amount and the method of administration to trigger the desired effects.
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Psycholytic doses (IV dose of 0.5mg/kg) (Chong et al., 2009; Glue et al., 2021; Peltoniemi et al., 2016) generally lack the psychological effects seen in higher psychedelic doses, although some will experience an altered state of consciousness even from relatively smaller doses (Kohtala, 2021).
Those under the influence of ketamine can generally be expected to experience:
Reductions in pain
Reductions in anxiety
Reductions in depressive symptoms
When used as an antidepressant (and not within the context of ketamine-assisted therapy), a low psycholytic dose of ketamine seems to effectively manage depressive symptoms only in the short-term (Marcantoni et al., 2020). A recent review of the current literature observed that psycholytic doses of intravenous ketamine usually peak at 24 hours after infusion, with a significant decrease in ketamine’s effects in the subsequent seven days post-infusion (Marcantoni et al., 2020). Additionally, clinical relapse usually occurs from 7 to 30 days after the infusion, with approximately
30% of participants relapsing one week after infusion and
26% two weeks or more after (Marcantoni et al., 2020)
While psycholytic doses of ketamine produce only minor psychoactive effects, mitigating dissociative effects (Kohtala, 2021), psycholytic doses of ketamine still have therapeutic value.
At psychedelic doses (IV dose of 1mg/kg) (Chong et al., 2009; Glue et al., 2021; Peltoniemi et al., 2016), ketamine may induce:
Altered states of consciousness marked by dissociation or a "trance-like" state
Altered perceptions of time
A feeling of transcending normal time and space
Changes in sensory perception (especially vision and hearing)
Feelings of leaving one's body or becoming a non-physical being
Emotionally intense visions
Encounters with archetypal or non-terrestrial beings
Visits to mythological realms of consciousness
Feelings of being reborn
Vivid dreams or memories of past and future incarnations
Ego dissolution and loss of identity
Reliving one's life
Deep feelings of peace and joy
Feelings of interconnectedness with nature and others
Feelings of cosmic unity
A sense of sacredness
A sense of ineffability of the experience (Ceban et al., 2021; Domino, 2010; Kolp et al., 2014; Kolp et al., 2006; Krupitsky et al., 1992; Krupitsky & Grinenko, 1997).
At anesthetic doses (IV dose of 2-4.5mg/kg) (Rosenbaum et al., 2022), ketamine can cause a range of psychological effects, including:
Vivid dreams and dream-like states
Delirium
Hallucinations
Excitement
Irrational behaviour
Psychic abnormalities, such as confusion
Decreased ability to feel pain
Sedation
Reduced awareness of the environment (Domino, 2010; Kohtala, 2021; Marland et al., 2013; Sandoz Canada Inc., 2015)
These effects generally respond well to reassurance alone. They may persist for a few hours, and do not result in residual psychological effects (Sandoz Canada Inc., 2015).
Ceban, F., Rosenblat, J. D., Kratiuk, K., Lee, Y., Rodrigues, N. B., Gill, H., . . . McIntyre, R. S. (2021). Prevention and Management of Common Adverse Effects of Ketamine and Esketamine in Patients with Mood Disorders. CNS Drugs, 35(9), 925-934. https://doi.org/10.1007/s40263-021-00846-5
Chong, C., Schug, S. A., Page-Sharp, M., Jenkins, B., & Ilett, K. F. (2009). Development of a sublingual/oral formulation of ketamine for use in neuropathic pain: Preliminary findings from a three-way randomized, crossover study. Clin Drug Investig, 29(5), 317-324. https://doi.org/10.2165/00044011-200929050-00004
Domino, E. F. (2010). Taming the ketamine tiger. Anesthesiology, 113(3), 678-684. https://doi.org/10.1097/ALN.0b013e3181ed09a2
Glue, P., Russell, B., & Medlicott, N. J. (2021). Influence of formulation and route of administration on ketamine's safety and tolerability: systematic review. Eur J Clin Pharmacol, 77(5), 671-676. https://doi.org/10.1007/s00228-020-03047-z
Kohtala, S. (2021). Ketamine-50 years in use: from anesthesia to rapid antidepressant effects and neurobiological mechanisms. Pharmacol Rep, 73(2), 323-345. https://doi.org/10.1007/s43440- 021-00232-4
Kolp, E., Friedman, H. L., Krupitsky, E., Jansen, K., Sylvester, M., Young, M. S., & Kolp, A. (2014). Ketamine psychedelic psychotherapy: Focus on its pharmacology, phenomenology, and clinical applications. International Journal of Transpersonal Studies, 33(2), 84-140. https://doi.org/10.24972/ijts.2014.33.2.84
Kolp, E., Friedman, H. L., Young, M. S., & Krupitsky, E. (2006). Ketamine Enhanced Psychotherapy: Preliminary Clinical Observations on Its Effectiveness in Treating Alcoholism. The Humanistic Psychologist, 34(4), 399-422. https://doi.org/10.1207/s15473333thp3404_7
Krupitsky, E. M., Grineko, A. Y., Berkaliev, T. N., Paley, A. I., Tetrov, U. N., Mushkov, K. A., & Borodikin, Y. S. (1992). The Combination of Psychedelic and Aversive Approaches in Alcoholism Treatment. Alcoholism Treatment Quarterly, 9(1), 99-105. https://doi.org/10.1300/j020v09n01_09
Krupitsky, E. M., & Grinenko, A. Y. (1997). Ketamine psychedelic therapy (KPT): a review of the results of ten years of research. J Psychoactive Drugs, 29(2), 165-183. https://doi.org/10.1080/02791072.1997.10400185
Marcantoni, W. S., Akoumba, B. S., Wassef, M., Mayrand, J., Lai, H., Richard-Devantoy, S., & Beauchamp, S. (2020). A systematic review and meta-analysis of the efficacy of intravenous ketamine infusion for treatment resistant depression: January 2009 - January 2019. J Affect Disord, 277, 831-841. https://doi.org/10.1016/j.jad.2020.09.007
Marland, S., Ellerton, J., Andolfatto, G., Strapazzon, G., Thomassen, O., Brandner, B., . . . Paal, P. (2013). Ketamine: use in anesthesia. CNS Neurosci Ther, 19(6), 381-389. https://doi.org/10.1111/cns.12072
Peltoniemi, M. A., Hagelberg, N. M., Olkkola, K. T., & Saari, T. I. (2016). Ketamine: A Review of Clinical Pharmacokinetics and Pharmacodynamics in Anesthesia and Pain Therapy. Clin Pharmacokinet, 55(9), 1059-1077. https://doi.org/10.1007/s40262-016-0383-6
Rosenbaum, S. B., Gupta, V., Patel, P., & Palacios, J. L. (2022). Ketamine. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK470357/
Sandoz Canada Inc. (2015). Product Monograph: Ketamine Hydrochloride Injection USP & Ketamine Hydrochloride Injection SDZ. https://www.sandoz.ca/sites/www.sandoz.ca/files/Ketamine_HCl_PMe_20150506.pdf