Ketamine can produce effects that resemble psychosis, so it’s generally not recommended for people with a history of psychotic disorders. However, research suggests it may be safe in some cases—and could even reduce symptoms of schizophrenia.
In this article, we’ll explore the connection between ketamine and psychosis, examining the potential risks to help you make an informed decision about whether it may be right for you.
What Is Psychosis?
Psychosis is characterized by losing touch with reality. People may see, hear, and understand the world differently from other people. It goes beyond unconventional thinking and can debilitate various aspects of life, including work and relationships.
Psychosis manifests differently for each unique individual, but core features include:
- Hallucinations: seeing things which other people don’t
- Delusions: Beliefs and ideas that are fixed despite conflicting evidence to suggest they aren’t true
- Disorganized thinking: thoughts become jumbled and difficult to express in a logical way
Psychosis is a symptom of different mental health disorders. For some people, it’s transient, and they may only have one or two psychotic episodes in their lifetime. For others, it’s ongoing.
Mental health conditions associated with psychosis include:
- Schizophrenia
- Schizoaffective disorder (a mixture of schizophrenic and mood disorder symptoms)
- Brief psychotic disorder (psychotic symptoms last less than one month)
- Major depression or bipolar disorder with psychotic features
Can Ketamine Trigger Psychosis?
Ketamine is a sought-after treatment for depression and other mood and pain disorders, as well as an anesthetic for surgery. It’s a dissociative, meaning it can make people feel disconnected from their bodies and their usual sense of space and time.
Ketamine’s psychoactive effects have been likened to psychosis. People can have non-ordinary ways of thinking during ketamine experiences, including perspectives and beliefs. In rare cases, particularly with high doses, people can also experience hallucinations.
In addition, ketamine works by blocking proteins called NMDA receptors in the brain, which play a crucial role in learning and memory. Scientists have proposed that schizophrenia could be caused by abnormal NMDA receptor activity, and so ketamine may be mimicking the neurological mechanisms underlying this disorder.
However, unlike in clinical psychosis, ketamine’s psychoactive effects are mostly temporary and wear off once the drug effects are over.
At Emerge, we pay close attention to dosing during ketamine treatment, using relatively small doses with only mild psychoactive effects. We adjust the dose in real time while our patients are undergoing treatment to ensure the balance between effectiveness and minimal side effects.
Ketamine and Schizophrenia Symptoms
Schizophrenia is a psychotic disorder characterized by positive and negative symptoms. Positive symptoms are more associated with psychosis, including hallucinations and delusions. Negative symptoms, on the other hand, include things like emotional flatness, lack of motivation, and social withdrawal.
In one study, ketamine produced effects in people without schizophrenia that resembled both the positive and negative symptoms. These effects disappeared within ninety minutes. Based on this finding, the researchers suggest that ketamine may serve as a valuable model for studying schizophrenia.
In participants who did have schizophrenia, ketamine temporarily intensified positive symptoms. However, negative symptoms decreased significantly between the start of treatment and two hours afterward. As negative symptoms overlap with depression, ketamine’s antidepressant benefits could help explain this finding.
Is Ketamine Therapy Safe for People With a History of Psychosis?
Many clinics won’t provide ketamine to people with a personal history of psychosis. For Spravato, an FDA-approved nasal spray form of ketamine, there is an official exclusion criterion that prevents people with psychotic disorders from receiving the medication.
However, growing evidence suggests that ketamine is, in fact, low risk for people with this psychiatric history.
A study review looked at the effect of ketamine on 41 patients with depression combined with a history of or current psychotic disorder. The results found that ketamine was safe and effective, with side effects being mild and temporary.
However, the studies mostly accounted for the effects of short-term treatment. More long-term studies are needed to fully understand the risks when it comes to repeated ketamine treatments and psychosis.
Ketamine Abuse and Permanent Psychosis Risk
In clinical settings, ketamine therapy has a low risk of persistent psychosis. However, ketamine is a drug of abuse, with addictive qualities, and long-term use has been associated with an elevated risk of prolonged psychotic symptoms.
It’s important that patients seeking relief take ketamine in established clinics, like Emerge, rather than self-administering at home because of the various physical and mental risks.
Ketamine Therapy at Emerge Wellness
At Emerge, we provide expert-led ketamine therapy for a range of mental health conditions. Every patient begins with a thorough screening to ensure ketamine is a safe and appropriate option, minimizing risks such as psychosis. If you’re eligible, we’ll design a personalized treatment plan tailored to your needs, with your safety and healing as our top priorities.
Get in touch to find out more.