Depression, Ketamine Treatment, and the Theater of Consciousness

Abstract

In severe depression thoughts of suicide can develop over weeks or months. Traditional pharmacologic or psychotherapeutic treatments take several weeks before they begin to improve symptoms. This gradual improvement is consistent with our everyday experience of the self. However, a new treatment, ketamine, can alter depressive symptoms within hours or even minutes. Ketamine can stop suicidal thoughts in as little as 20 minutes and is being developed to treat suicidal patients in the emergency room. Rapid changes in a belief as complex as suicide raise new questions about the self and identity. More complicated models of the self are required to understand how rapid changes in complex beliefs are possible without invoking unrealistic specificity in the brain (i.e. grandmother cells for belief). If the brain has multiple competing selves within modules then ketamine could work by either turning a self module on or off. This is consistent with a modified version of the global workspace theory of consciousness where a self module provides the context for the spotlight of attention.