Ketamine is an anesthetic drug that affects the central nervous system by antagonizing the n-methyl-d-aspartate (NMDA) receptor. Like most dissociative anesthetics, ketamine has a high potential for abuse.

Ketamine has hallucinogenic effects. It changes your perception of sounds and sights, makes you feel detached, and makes you feel like you aren’t in control.

Ketamine is FDA-approved for use as a pain reliever for chronic pain and anesthetic. Unfortunately, it is often abused.

Although ketamine has a long-standing reputation as a recreational drug, its FDA-approved version has become popular in its role as an anti-depressant. Additionally, studies have shown its effectiveness in reducing drug and alcohol abuse.

This article discusses ketamine therapy and its benefits under supervised care.

Ketamine therapy as addiction treatment

Clinical trials focusing on alcohol and cocaine addiction revealed that patients who were prescribed therapy and ketamine had better results than those who went for therapy minus ketamine treatment.

Patients addicted to cocaine received doses of IV ketamine for five days. Additionally, they went through a 5-week mindfulness relapse prevention therapy. On the other hand, patients struggling with alcohol addiction received a dose of ketamine on their second week of 5-week motivational enhancement therapy sessions.

At the end of the trial, researchers concluded that ketamine treatment played a role in preventing relapse. Researchers argued that ketamine treatment alters how patients’ brains deal with cravings. Additionally, they argued that ketamine motivates individuals to stop abusing drugs and control their behavioral interactions. Ketamine treatment may also improve the outcome of behavioral therapy.

The clinical trials discussed above are not conclusive. There is a need for extensive research on the role of ketamine in addiction treatment.

Note that the use of ketamine in addiction treatment should be under the strict supervision of medical practitioners in clinical settings. Patients should only receive doses of ketamine as and when prescribed by their doctors to avert ketamine abuse.

Ketamine for depression

Medical practitioners can use ketamine to treat depression. Additionally, it can be used as an antidote for suicidal thoughts.

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Most treatments for suicidal thoughts, including anti-depressants, talk therapy, electroconvulsive therapy (ECT), and transcranial magnetic stimulation (TMS), take several weeks to be effective. Sometimes, you may have to try multiple treatment options at once to gain relief.

Using ketamine for depression has proved effective. The doses that medical practitioners prescribe in treatment for depression are small.

How does it work?

It is still unclear how ketamine works. However, researchers suggest that it targets NMDA receptors in the brain, binds to the receptors, and consequently increases the amount of glutamate, a neurotransmitter, between the neurons.

The glutamate triggers connections in the AMPA receptors resulting in the release of molecules that allow neurons to communicate across new pathways. This process is called synaptogenesis. Synaptogenesis alters your cognition, mood, and thought patterns, making you less depressed.

Ketamine may also treat symptoms of depression by reducing the signals that take part in inflammation. These signals are often linked to mood disorders. Therefore, ketamine may prevent mood swings by reducing the signals.

How do you receive ketamine for depression treatment?

Ketamine comes in various forms, including white powder. The FDA-approved form for depression medication is a nasal spray known as esketamine/ Spravato.

Doctors prescribe esketamine to adults who have a major depressive disorder, treatment-resistant depression, or are suicidal.

Patients with treatment-resistant depression get the nasal spray twice weekly for the first four weeks, then once a week from the fifth to the ninth week. If they still need the nasal spray after the ninth week, they will get it once every two weeks.

The other forms of ketamine that are not approved by the FDA include; tablets, IV infusion, or a shot in the arm. IV infusions are done explicitly by doctors. Some doctors may prescribe pills for use at home. However, it is not recommended since ketamine has a high potential for abuse.

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The process of IV infusion takes place for approximately 30 minutes. Immediately after the drip ends, you will have the dissociative experience for about 20 minutes. Your doctor will be present during the entire process. The dissociative experience wears off after 20 minutes.

Research shows that most patients appear to be asleep during IV infusion. They neither talk, nor move. Most doctors prefer not to interfere unless the patient specifically asks for something or asks where they are.

After ketamine treatment, patients need to undergo talk therapy. Talk therapy is an essential part of depression treatment. During talk therapy, medical practitioners equip you with the relevant skills to handle your depression. It is practical and empowering for most patients. For those with mild depression, talk therapy may be sufficient.

Possible side effects

All drugs have side effects. However, the benefits you will get from using ketamine for depression outweigh the side effects you will experience.

Here are some side effects that you may experience after ketamine infusions:

Usually, dissociation and perception disturbances are noticeable when you get the first infusion but fade away afterward.

Long-term use of ketamine may have additional side effects. Scientists are still researching the issues surrounding ketamine abuse.

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Concerns on using ketamine therapy for depression and addiction treatment

The main problem regarding ketamine therapy is addiction. Ketamine shows a lot of promise in treating mental health conditions and addiction. However, ketamine is a highly addictive narcotic, and addicts can still get high off it.

There is a possibility that patients who undergo ketamine therapy may become dependent on it. Long-term use of ketamine may have long-term effects. Patients may develop tolerance or unidentified side effects.

Another concern is the risk of cross-addiction. Cross addiction refers to instances when an addict develops a second addiction, in this case, ketamine addiction.

There is a need for more studies on ketamine treatment to realize its benefits in addiction and depression treatment.

If you are struggling with an addiction, check out treatment addiction programs that you can enroll in. You can also check our blog for resources on addiction and mental health issues.

There is a strong connection between mental health and substance use disorders. Results from the 2019 National Survey on Drug Use and Health revealed that 31.3% of adults with any mental illness were binge drinkers compared to 25.3% of adults with no mental illness. Also, 49.4% of adults with mental illness used illegal drugs, compared to only 15.7% who had no mental illness. When someone struggles with a mental illness, like depression and a substance abuse problem at the same time, they have a co-occurring disorder or dual-diagnosis.

Roughly 9.5 million American adults reported having a dual diagnosis in the 2019 NSDUH survey on Drug Use and Health. The reason is that people with mental health issues like depression turn to alcohol or drugs as they try to cope with sad feelings. On the flip side, depressant drugs and alcohol can increase feelings of fatigue and sadness, and people can experience depression as the effects of drugs wear off or as they face the impact of addiction.

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Which one comes first – addiction or depression?

Whenever addiction and depression are discussed together, the question becomes, which one comes first. The basic addiction disease model dictates that substance misuse changes the brain so that it can’t self-regulate. For many, depression serves as a gateway to addiction. For others, substance abuse can lead to depression. Either way, these two disorders always seem to co-occur.

Depression and substance abuse

Everyone has bad days, whether it’s because of loss, relationships, family, or workplace issues. Most people shake the feelings off and get on with their lives. But for people with depression, the periods of unhappiness don’t go away. They feel sad, helpless, and worthless for days to weeks. Depression is a severe mental health problem that affects about 10% of adults in the US. Data from the Centers for Disease Control indicate the following as risk factors for depression.

People with depression tend to turn to drugs to try to relieve these depressive symptoms. As estimated, one-third of people with major depressive disorder engage in substance abuse as a way to self-medicate to relieve feelings of despair, low self-esteem, and hopelessness. Unfortunately, abusing alcohol and drugs doesn’t resolve these feelings. It only makes them worse. In fact, it can lead to depression symptoms like sadness, hopelessness, lethargy and in some cases, they can turn to acts of self-harm.

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Types of depression

There are many different types of depression. Here are some common examples:

Major depressive disorder (clinical depression)

Major depression is a common type of depression that affects about 7% of people in the US. If untreated, the major depressive disorder can recur throughout the person’s life.

Persistent depressive disorder (dysthymia)

Persistent depressive disorder is a chronic form of depression that lasts for a year or more. Since it's milder, it’s usually easier to cover with drugs or alcohol. However, the condition may eventually lead to major depressive disorder.

Seasonal affective disorder

As the name implies, seasonal affective disorder is seasonal, mostly happening in winter months. The disorder is diagnosed when someone exhibits the symptoms of depression over three consecutive winters.

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Depression as a gateway to addiction

Depression serves as an entry point into alcohol and drug use. As mentioned earlier, those struggling with depressive disorders turn to substances to escape the symptoms of depression. But drugs don’t do much to help them feel better. If anything, one feels worse once the effects of drugs start to wear off. Yet, the person keeps using it to try to forget their problems. It is like a catch 22. Eventually, their bodies become tolerant and need larger doses to attain the same effects.

At this point, they can’t stop using or reduce intake because of withdrawal symptoms like trembling, nervousness, agitation, cold, sweats, or nausea set in. So they may start feeling sad and guilty because they are abusing drugs. Some try to quit cold turkey. But with the withdrawal symptoms and mental disorder, it’s almost impossible.

Besides, quitting leads to an even stickier situation for those with severe depression. People who’ve been abusing substances for years may have a more pronounced depression when they stop using. It is, therefore, a good idea to seek dual diagnosis treatment that addresses both issues in one go.

Why depression leads to addiction

Depression itself isn’t a cause of substance abuse – but it makes one more susceptible to addiction. The inability to cope with hard feelings and life stressors is one of the causes of depression and addiction. Here are some ways depression may lead to addiction.

Feelings of guilt and shame make one scared to ask for help

People struggling with depression are afraid to ask for help. They fear that people will judge them for their condition, so they choose to keep it to themselves. Again, unlike other medical conditions, it is hard to identify the symptoms of depression. So, even if the person gathers the courage to seek help, they may find it hard to explain what they’re going through. So, most people may turn to substances as a way to cope.

Not knowing its depression

One of the hidden risks of drug use is that mental health issues happen gradually. So, a person might not even realize they have depression. So, they’ll take stimulants to keep up with work or a bottle of wine to try to cheer up. When someone doesn’t know they’re dealing with a mental disorder, they’ll keep up with the unhealthy coping mechanism.

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Being scared of psychiatric drugs

Many people are afraid of taking psychiatric medication, not just because of how others will view them but also because of the “damaging effects.” They are scared that the drugs will change their personality or ability to function and that they might not handle the side effects. So they turn to drugs assuming that they are a safer option. Alcohol and drugs offer instant fixes without the hassle of getting a prescription.

There’s hope for co-occurring disorders

Luckily, dual disorders are treatable. If you or someone close to you is struggling with addiction and depression, it’s a good idea to enroll in a rehab that offers holistic treatment. This way, you won’t have to treat depression or addiction separately.

It is easy to wonder why or how someone in their right minds would self-harm. But as it turns out, "normal" people intentionally hurt themselves every day. Some do it to cope with stress and discomfort or to feel real and alive. Others do it to punish their bodies or to feel empowered. Sometimes, people don't even know why they cause self-harm, but they still do it anyway.

Self-harm and cutting are a form of addiction as many young adults crave the relief that these behaviors elicit. Like substance abuse, users continually cut, punch, bang, and burn themselves to self-medicate but end up having trouble stopping. Most of them describe a specific type of high, connectedness, release, or a sense of calm after the self-injury.

Individuals who inflict self-injury are trying to release pent-up emotions. They see their actions as positive as it allows them to express feelings and remain in control. So they keep hurting themselves to try to release or control feeling of sadness, fear, frustration, anger, overwhelm, or even happiness.

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But sadly, hurting yourself never truly resolves the feeling. It only leaves behind a sense of guilt or shame. Eventually, the person may have to perform more intense or prolonged self-injury to achieve the same release. This may go on and on that the individual feels unable to stop. Addiction to self-harm mimics addiction to drugs and alcohol in many ways. For instance, people who cause themselves harm aren't in full control of their actions just like those with SUD. Besides, most underlying pieces (conditions, triggers, causes, etc.), are the same in both cases.

Who self-injures?

Self-harm is more common than many people realize. About two million cases of self-harm cases are reported in the United States every year. The condition – clinically referred to as non-suicidal self-injury (NSSI) – is characterized by an intentional self-induced injury that's not meant to be fatal. Estimates show that 1 in 5 females and 1 in 7 males engage in self-harm behaviors. 90% of those who self-harm start during their pre-adolescent years, and that 50% of them have been sexually abused. Reports also show that 70% of young adults who engage in self-harm have made at least one suicide attempt. But note that NSSI and a suicide attempt are two different things.

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Self-harm and co-occurring disorders

Intentionally hurting yourself isn't a mental disorder in or of itself. But it is a behavior that's often associated with anxiety, stress, depression, borderline personality disorder, PTSD, and substance abuse disorder. The cutting and banging and burning tend to worsen over time, especially when the co-occurring problem remains unaddressed.

Since self-harm is a coping mechanism, the frequency of harm increases as the person's mental health degrades. This escalates the overall risk and danger. Besides, when substances are involved, there's an increase in harming behavior with more chance of severe injury. Most ER visits from self-harm happen when the individual has been abusing drugs or alcohol and harms themselves more severely than intended.

If a loved one has co-occurring disorders, he or she should seek professional help. According to National Institute on Drug Abuse, anyone seeking help for comorbid conditions should be evaluated for both disorders and treated accordingly. That’s why you have to find a reputable addiction treatment center that offers effective behavioral therapies like:

Self-harm and substance abuse

As mentioned above, self-harm can happen when an individual has an addiction problem. However, the opposite is also true. And individual can turn to drugs and alcohol in an attempt to numb their feelings or alleviate stress. But since drugs and alcohol impair motor skills, slow reaction times, and interfere with nerve ending connections, they may make it hard for an individual to control their self-harm behaviors.

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In addition to substance use disorders and mental health issues, other self-harm risk factors include:

How do you know that a loved one is cutting or self-harming?

Many people who engage in these acts don't want others to find out. So they do so in secrecy and cut places that are hard to spot, like on the stomach, higher up on the thighs, or arms. Most of them seem normal or even happier on the outside, with no sign tell-tale sign of the habit. This makes it hard to know if your loved one is self-harming or cutting. However, some signs of self-harm include:

Strange scars: if a loved one is cutting or scratching, chances are they will have strange scars on their body. Look out for scar tissue or multiple cuts in one location. Cutting addiction may also include thin lines like those from a sharp object.

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Unexplained abrasions or cuts:  Your loved one could be cutting if they always blame accidents or clumsiness for their injuries or bandages.

Bloodstains on clothes: Nothing is alarming about spotting blood on your loved one's belongings. However, if you notice blood on the sink, toilet paper, hand towels, or clothes, it could be a sign they are self-harming.

Covering the skin: Your loved one may insist on wearing pants and long-sleeved clothes even when it’s hot outside. That's because they don't want you to see the scars.

Isolation: People who cut tend to isolate themselves because of depression or the need to hide their behavior. They may also feel irritable or uncomfortable in public.

Keep in mind that these warning signs vary among individuals. So, it is worth looking into any strange behaviors your loved one is showing. They could be crying out for help, but you don't even notice. And even if self-harm is not the issue, your loved one could be struggling with another serious issue, like substance abuse or depression.

Common side effects of self-harm

Self-harm like burning or cutting may offer temporary relief to physical and emotional pain. However, in the end, it may cause feelings of shame and guilt along with physical side effects like anemia and infections. A cutting addiction is hazardous because one may cut a vein and bleed to death or cause long-term nerve or tendon damage.

Finding help for self-harm

Growing evidence suggests that behavioral addictions like cutting and self-harm mimic substance addictions in many ways. They have similar phenomenology, natural history, overlapping genetic contribution, comorbidity, tolerance, neurobiological mechanism, and response to treatment. So, self-harm patients may benefit from various therapies that we mentioned above and treatments offered in addiction centers.

Have you ever wondered why people use more drugs during the holidays than any other time of the year? Well, as it turns out, holidays can be a mixed bag of emotions. Although people look forward to the season, it is not uncommon for loneliness, grief, financial strain, family conflict, and seasonal affective disorder (SAD) to creep in. Many overindulge during the holidays, not just because of the countless opportunities for using substances, but rather the need for extra comfort because of heightened stress.

The fact is that holidays aren’t holidays for those who find themselves burdened with other additional obligations and tasks while their everyday lives must go on as usual. So they tend to be more vulnerable and so inclined to succumb to drug use because stress sources multiply. This, at least, may be one reason why people use more drugs during holidays. But there are more reasons, as you will notice in this article.

Using drugs during the holidays

A holiday season isn’t entirely to blame for drug use issues, but it contributes, of course. It’s the time of year when people are more inclined to participate in different social events where drugs and alcohol are the glue that holds everything together.

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Alcohol is sometimes the focal point of holiday celebrations.

Again, many people base expectations about holidays on unrealistic displays of healthy, affluent families from TV ads and shows. But this only fuels anxiety during the holiday season. When someone tries to live up to what they see on TV, yet it is not realistic, they may become anxious and try to numb their feelings with drugs.

Seasonal pressures arise from various sources, including financial obligations, increased demands on time and energy, and even final exam and grade reports. There’s usually a ton of extra demands. People want to do it right, so they end up becoming exhausted.

Seasonal affective disorder or winter depression is also pretty common around this time of year. SAD is a type of depression linked to low-light conditions that occur during long, dark winter months.

Here are the reasons why people use more drugs during the holidays:

Family problems tied to using drugs

Holidays evoke images of family bliss: loved ones gathering around a fireplace, lots of music and dancing, gift exchanges and catching up, etc. But for many, this dreamy image is usually nothing more than that – a dream.

For some people, a holiday is a time of loneliness because they live far from family or have lost their loved ones. For this group, holidays can be a time of sad memories and additional stress because it reminds them of relationships they don’t have. Some may turn to drugs and alcohol to blow off some steam or disconnect with the world.

The same applies to people who dread holidays because of family drama and strained relationships. The thought of a perfect holiday gathering can make a normal social tension unbearable.

Financial stress

Lack of finances is a common reason for seasonal sadness. One survey by the American Addiction Centers revealed that finances and gift-giving were the leading cause of holiday stress. An average person spends about $750 on gifts. And this figure can go even higher for those with more children, friends, co-workers and so on.

While gifting may not seem like a problem, it can be a major depressor among those who are strained financially. The effects of this stress can be detrimental on many levels and may lead to an increase in drug use during the holiday seasons. Studies show a strong connection between substance abuse and depression. For some, this stress becomes too much to bear and many with deep mental health issues can succumb to suicide.

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Stress around the holidays can come from a variety of sources. Loneliness, anxiety, financial worries can all lead a person to using drugs or alcohol to cope with their pain.

Holiday anxiety

Large gatherings, tense family relationships, and all the preparations can be overwhelming to some people. This is because of the constant worry that something might go wrong or that people will judge. Social anxiety is also pretty common around holidays, considering many events involving groups of peers, friends, and families. People with anxiety issues turn to drugs to help lessen the anxiety – though this only worsens the situation.

A study by the American Psychological Association and Greenberg Research tried to find out those who suffered from elevated stress levels during holidays, and the findings were surprising. Of the respondents in the study:

A sad, anxious, stressed, or angry person might lose sleep and be unable to focus on the celebrations and events happening around them. And as it turns out, these mental disorders often travel in the company or drug abuse. Drugs may help one feel less inhibited and more comfortable in social settings. But anxiety robs one the ability to know when enough is enough, or that drugs in any amount can be dangerous, or that they need therapy and treatment and not drugs for their disorder.

Personality

Impulsivity, a personality trait, is a risk factor for substance misuse. Those who are struggling with addiction assign higher values to immediate values than the delayed ones. And with lots of events, parties, and the general craze going on, the impulsivity only tends to heighten during holidays.  

Nostalgia

Nostalgia, a sentimental yearning or longing for the past, is a big part of the holiday season. Like birthdays and anniversaries, holidays trigger nostalgia because they act as temporary landmarks. Nostalgic depression is a holiday syndrome and may be accompanied by feelings of bitterness, helplessness, anxiety, and depression. It is common among loners with a history of family disruption.

Nostalgia is beneficial as it helps people cope with boredom, grief, and loneliness. It also strengthens social connectedness and reinforces a sense of identity. But to some extent, nostalgia can be toxic. Toxic nostalgia is especially harmful to recovering addicts, as it can make them believe that the time they spend using drugs is worth returning to. It may also make them forget all about the negative impacts and stresses of addiction that made them quit in the first place.

Seasonal binge-drinking

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Traditions can be hard to break. For many, drinking to excess has been a normal part of their holiday experience, for most of their lives.

It doesn’t come as a surprise that people indulge in seasonal binge-drinking during the holiday season. In fact, the Distilled Spirits Council of the US says that a quarter of the $49 billion-a-year profits in the distilled spirits industry come from late November through to New Year. So whether it’s peer pressure or excitement or the desire to unwind, people – including the moderate drug or alcohol users – tend to increase their consumption rates. Moderation is rarely taken seriously during holidays – with many believing that they’ll compensate for all their bad consumption in January. So, they keep overindulging in drugs, alcohol, and even food.

When all these things come together, one is likely to experience symptoms like:

Unfortunately, these symptoms can have far-reaching effects, especially for those with no support systems. In addition to using drugs, the symptoms can increase the risk of suicide, personal injury, violence, and relapse. That is why it’s essential for those who experience such symptoms to get professional help. It also helps to have friends to talk to whenever sad memories or feelings of loneliness come up.

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