Everything You Should Know About Taking Ketamine

Traditionally used as an anesthetic, ketamine is now being used to treat depression, OCD, and other mental health conditions.

by Suzannah Weiss
Aug 8 2018, 2:00pm

Jovo Jovanovic / Stocksy

By this spring, I’d tried most of the more common psychedelics, but ketamine seemed like a wild card. The stories people told me about it were all over the place—from a man who fell into a “K-hole” where he believed he was the carpet and couldn’t get up, to a woman who called it the "ultimate spiritually transcendent experience." I didn’t want to risk the former in pursuit of the latter.

Then, some friends were snorting it in their apartment, and curiosity got the best of me. I told my friend to give me a microdose, then cut that in half just to be prudent. A few minutes in, all my emotions intensified. The dog’s bark made me jump. But once we started talking, it was like my ego’s defenses eroded and I could see myself from the outside. I analyzed my life as if I were in therapy, suddenly seeing the perspectives of people I was mad at. And I really wanted to cuddle. My friends had told me I’d only feel ketamine for a few minutes, but I stayed in that state for hours. Unfortunately, what they’d told me about ketamine lacking a hangover didn’t hold up, either. I was foggy-headed and exhausted the next day.

Ketamine has traditionally been used as an anesthetic for medical procedures, first in veterinary clinics and then in people after the FDA approved it for human use in 1970. Shortly after that, it began taking off among psychonauts and then in ‘80s and ‘90s nightclubs, says Steven Levine, a New Jersey-based psychiatrist and founder of Actify Neurotherapies, a treatment center with locations in several US cities.

Still, it’s more popular as a recreational drug in the UK and southeast Asia than it is in the US. Ketamine is now also being used to treat depression, OCD, and other mental health conditions. It sometimes has transformative effects for people who haven’t responded to conventional psychiatric medications and were ready to give up hope, says Prakash Masand, a psychiatrist and founder of the Centers of Psychiatric Excellence, which specializes in Ketamine IV therapy for psychiatric conditions that haven’t been alleviated by other methods.

Because experiences with ketamine vary so drastically, it’s hard to know what you’ll feel on it. That said, here’s what you should know if you’re thinking of trying it.

What does it feel like to take ketamine?

Aside from being a sedative, Ketamine has dissociative properties, which means it can make you feel disconnected from your body and the world, Levine says. At low doses, this can be a pleasant experience, making someone feel "at one with the universe," says James Giordano, professor of neurology and biochemistry at Georgetown University Medical Center. Or, it might give them a more objective perspective on their lives, as it did with me. This is why ketamine can be helpful for PTSD patients, Levine says—they can work through their trauma without reliving all the emotions associated with it. Those with depression may find it helps them feel “less isolated and less alone,” he says.

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But at higher doses, you can experience derealization, or detachment from reality, which can lead you to make dangerous decisions, Giordano tells me. Some people fall into the aforementioned “K-holes,” where they’re temporarily paralyzed. “It is termed a ‘K-hole’ because a person is typically unable to process any external information and may appear to be immobile and not responding to verbal stimuli,” Masand says. “It may be accompanied by hallucinations and psychosis. There have been reports of individuals taking hours to come out of a K-hole."

Others get “profoundly melancholic” on ketamine, Giordano says. Another unpleasant effect is dizziness or a loss of balance that sometimes occurs, Masand adds. Patients often don’t enjoy the experience, and make comments like “time is going slowly” or “I feel a bit sunken in my chair,” he says. The drug often makes people feel like they’re on the edge of an epiphany, Levine says. But this feeling can be deceptive, leading people to chase a realization that isn’t actually awaiting them.

Ketamine might also affect your sensory perception. For some people, colors get brighter and more intense, Levine says. At higher doses, many have full-on hallucinations. Others find that their hearing becomes more acute, which could explain why my friend’s dog freaked me out so much. “When we use it clinically, if somebody is in a room and there are whispered voices in another room or the other side of the building, you can clearly hear them,” he adds.

How long does a ketamine trip last?

Ketamine’s effects typically last for just about an hour, but they can continue for as long as a day, depending on the dose and method of ingestion, Masand says. Some people just sleep off lower doses of ketamine, but others may continue experiencing a sense of derealization the day after taking it, especially at high doses, Giordano says. Ketamine hangovers can also include “dizziness, incoordination, [and] impaired attention and memory,” Masand adds.

What are the risks of taking ketamine?

While ketamine is widely deemed safe in medical settings, this is not the case when you use it recreationally, Levine says. Ketamine is difficult to dose, and when you overdose, you can experience potentially fatal side effects, including central nervous system inhibition that can lead to cardiac arrest, Giordano says. You also might get high blood pressure, which puts you at risk for heart attack, stroke, heart failure, aneurysm, renal failure, vision loss, and dementia, Masand says.

Another difference between recreational and medical use of ketamine is that, in medical settings, it’s administered intravenously so that it comes up gradually. It’s snorted or taken by mouth recreationally, so it all hits you at once. The typical recreational forms of ingestion also don’t lead as much ketamine to get absorbed as an IV, which means people take much more to feel it, Masand adds. There’s also a chance that ketamine obtained outside medical clinics could be laced with other drugs.

After overusing ketamine for an extended period of time, some experience ketamine cystitis — damage to the bladder that can lead to pain and frequent urination, Levine tells me. If you really overdo it, you could experience psychosis that resembles schizophrenia, even after you stop using ketamine.

So how should ketamine be dosed?

Self-treatment is not generally recommended, but here's the safest way to go about it: Since ketamine’s effects are very dose-dependent, you want to be careful about how much you take. Giordano doesn’t recommend exceeding a microdose, which would be around .02 mg under the tongue or .2 mg orally. At the very least, stay under .7 mg/kg of your body weight under the tongue and 1.4 mg/kg orally. Giordano also cautions against taking ketamine more than once in one sitting. People may feel tempted, since the effects wear off fairly quickly, but the effects of multiple doses add up.

Does ketamine show up on a drug test?

There are sophisticated urine and blood tests that can detect ketamine, but a standard urine drug test probably won’t pick it up, Masand says. So, while ketamine continues to be valuable in surgeons’ and even psychiatrists’ offices, the consequences of using it recreationally are dicier. If you venture into that territory, be as conservative as possible about how much you take and how often you take it.

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