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Therapeutic infusions of ketamine: Do the psychoactive effects matter?
Open accessAbstract
Background Sub-anesthetic ketamine infusions may benefit a variety of psychiatric disorders, including addiction. Though ketamine engenders transient alterations in consciousness, it is not known whether these alterations influence efficacy. This analysis evaluates the mystical-type effects of ketamine, which may have therapeutic potential according to prior research, and assesses whether these effects mediate improvements in dependence-related deficits, 24h postinfusion.Methods Eight cocaine dependent individuals completed this double-blind, randomized, inpatient study. Three counter-balanced infusions separated by 48h were received: lorazepam (2mg) and two doses of ketamine (0.41mg/kg and 0.71mg/kg, with the former dose always preceding the latter). Infusions were followed within 15min by measures of dissociation (Clinician Administered Dissociative Symptoms Scale: CADSS) and mystical-type effects (adapted from Hood's Mysticism Scale: HMS). At baseline and 24h postinfusion, participants underwent assessments of motivation to stop cocaine (University of Rhode Island Change Assessment) and cue-induced craving (by visual analogue scale for cocaine craving during cue exposure).Results Ketamine led to significantly greater acute mystical-type effects (by HMS) relative to the active control lorazepam; ketamine 0.71mg/kg was associated with significantly higher HMS scores than was the 0.41mg/kg dose. HMS score, but not CADSS score, was found to mediate the effect of ketamine on motivation to quit cocaine 24h postinfusion.Conclusions These findings suggest that psychological mechanisms may be involved in some of the anti-addiction benefits resulting from ketamine. Future research can evaluate whether the psychoactive effects of ketamine influence improvements in larger samples.
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“Many patients describe psychedelic-induced “peak” or “mystical” experiences as being among the most meaningful events of their lives, and the intensity of these events correlates with therapeutic responses (40, 220–226).”
From Psychedelics and Other Psychoplastogens for Treating Mental Illness. (2021) · cites this paper as [226]
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“This study demonstrated that embedding ketamine administration into a mindfulness-enhancing behavioural training framework successfully extended ketamine's anti-addictive properties, which had previously been reported only transiently, subsiding over several days (138, 139).”
From Examining the Potential Synergistic Effects Between Mindfulness Training and Psychedelic-Assisted Therapy (2021) · cites this paper as [138]
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Roseman, L., Nutt, D. J., & Carhart-Harris, R. L. (2018) · Frontiers in Pharmacology · doi:10.3389/fphar.2017.00974 · Cited by 808
Psychedelics and Psychedelic-Assisted Psychotherapy
Reiff, C. M., Richman, E. E., Nemeroff, C. B., Carpenter, L. L., Widge, A. S., Rodriguez, C. I., Kalin, N. H., McDonald, W. M., & and the Work Group on Biomarkers and Novel Treatments, A. D. O. T. A. P. A. C. O. R. (2020) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2019.19010035 · Cited by 649
Attenuation of Antidepressant Effects of Ketamine by Opioid Receptor Antagonism
Williams, N. R., Heifets, B. D., Blasey, C., Sudheimer, K., Pannu, J., Pankow, H., Hawkins, J., Birnbaum, J., Lyons, D. M., Rodriguez, C. I., et al. (2018) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2018.18020138 · Cited by 519
Psilocybin-Occasioned mystical experiences in the treatment of tobacco addiction.
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Emotional breakthrough and psychedelics: Validation of the Emotional Breakthrough Inventory
Roseman, L., Haijen, E., Idialu-Ikato, K., Kaelen, M., Watts, R., & Carhart-Harris, R. (2019) · Journal of Psychopharmacology · doi:10.1177/0269881119855974 · Cited by 413
Metadata
- Authors
- Dakwar, E., Anerella, C., Hart, C. L., Levin, F. R., Mathew, S. J., & Nunes, E. V.
- Affiliations
- New York State Psychiatric Institute (US)
- Michael E. DeBakey VA Medical Center (US)
- Corresponding author
- Dakwar, E.
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2014-03
- Volume
- 136
- Pages
- 153-157
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC4091719
- OpenAlex
- W2078153416
- Cited by
- 123
- References
- 34
- Citations by year
- 2026: 10 · 2025: 9 · 2024: 24 · 2023: 11 · 2022: 14 · 2021: 11 · 2020: 9 · 2019: 7 · 2018: 5 · 2017: 8 · 2016: 9 · 2015: 5
- FWCI
- 8.65
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH081870, MH081870)
- National Institute on Drug Abuse (K24DA022412, R21DA035472, DA022412, P50DA009236, DA031771, DA009236, K24DA029647, DA007294, DA035472, K23DA031771, T32DA007294)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychedelics and Drug Studies
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- ketamine, cocaine dependence, dissociation, psychoactive effects, cue-induced craving, lorazepam, addiction treatment, dose-response relationship
- MeSH terms
- Adult, Anesthetics, Dissociative, Cues, Data Interpretation, Statistical, Dissociative Disorders, Dose-Response Relationship, Drug, Double-Blind Method, Female, Humans, Hypnotics and Sedatives, Infusions, Intravenous, Inpatients, Ketamine, Lorazepam, Male, Motivation, Mysticism, Crack Cocaine, Cocaine-Related Disorders, Diagnostic and Statistical Manual of Mental Disorders
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