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Drug Alcohol Depend. 2014 Mar 1;136:153-7. doi: 10.1016/j.drugalcdep.2013.12.019. Epub 2014 Jan 15.

Therapeutic infusions of ketamine: do the psychoactive effects matter?

Author information

1
New York State Psychiatric Institute, New York, NY, United States; Columbia College of Physicians and Surgeons, New York, NY, United States. Electronic address: dakware@nyspi.columbia.edu.
2
New York State Psychiatric Institute, New York, NY, United States.
3
New York State Psychiatric Institute, New York, NY, United States; Columbia College of Physicians and Surgeons, New York, NY, United States; Department of Psychology, Columbia University, New York, NY, United States.
4
New York State Psychiatric Institute, New York, NY, United States; Columbia College of Physicians and Surgeons, New York, NY, United States.
5
Michael E. Debakey VA Medical Center, Houston, TX, United States; Menninger Department of Psychiatry & Behavioral Sciences/Baylor College of Medicine, Houston, TX, United States.

Abstract

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.

KEYWORDS:

Cocaine; Dependence; Ketamine; Mystical experience

PMID:
24480515
PMCID:
PMC4091719
DOI:
10.1016/j.drugalcdep.2013.12.019
[Indexed for MEDLINE]
Free PMC Article

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