Ketamine Addiction

Abstract

EditorialKetamine was developed in 1962 as an anaesthetic agent [1] for use in pediatrics, oncology, and veterinary practice [2]. Ketamine primarily and non-competitively antagonizes NMDA (N-methyl-D-aspartate) receptors, thereby interfering with the excitatory amino acid transmission, which underlines its analgesic and dissociative effects [2]. Ketamine also has weak effects on opioid, muscarinic and monoamine receptors [1], enhances the neurotransmission of noradrenaline, serotonin and dopamine in a dose-dependent fashion, which, together with its effects on glutaminergic system, accounts for its psychotomimetic and sympathomimetic effects [2] and addiction potential [3].During the past decade, ketamine has been proven efficacious in treatment-resistant depression [4]. Due to its unique neurochemical profile, ketamine, and its analogue phencyclidine, has also been tried as a new treatments for psychosis [5] and addiction [6,7]. In contrast to increasing research efforts to understand ketamine's potential as a therapeutic agent, only a few studies focused on understanding ketamine addiction.Ketamine misuse started in the United States in the 1970s, soon after its development and wider availability [2]. Ketamine is still a commonly abused drug around the world [8], particularly in East Asia [9]. Ketamine is the second and third most commonly abused drug in Hong Kong [10] and in mainland China and Taiwan [9], respectively. Ketamine is predominantly consumed by young people [10,11], gay clubbers [12,13] and poly-substance users [8].Heavy ketamine users suffer from both physical and mental problems. Serious lower urinary tracts symptoms (increased urinary frequency, urgency, incontinence, hematuria, and dysuria) [14][15][16], gastritis and liver and kidney dysfunction [16,17] are also common in this population. Psychiatric disorders are often comorbid by ketamine include depression, which is remarkably prevalent among chronic ketamine users [18,19] [29]. However, it is still not clear if chronic ketamine intake is the cause or consequence of these brain alterations due to the cross-sectional design of these studies [28].Further, white matter microstructural abnormalities were found predominantly in left prefrontal region in ketamine chronic users when [27], restricted to the right hemisphere white matter regions when compared with poly-drug users [26]. While a significant correlation between the subgenual ACCdorsal medial prefrontal cortex connectivity and depression score was found in female ketamine users but not in female controls, it is hard to draw a conclusion whether it was ketamine use or depression that accounted for the discrepancy between ketamine users and controls [30].To date, there has been no established treatment for ketamine addiction. Abstinence seems to be the essential step for treating physical symptoms induced by ketamine [31] and probably depressive symptoms as well as cognitive impairments [20]. Lamotrigine, a glutamate release inhibitor showed promising effect in reducing ketamine craving ...

<p>Management of Treatment-Resistant Depression in Real-World Clinical Practice Settings Across Asia</p>

“…47,48 In addition, abuse of ketamine has been observed in some parts of Asia, including Hong Kong, Mainland China, and Taiwan. 49 As such, ketamine is scheduled as a controlled substance in several countries across Asia and is currently not indicated for the treatment of TRD. [50][51][52] More information on ketamine use is available from a consensus statement developed by the American Psychiatric Association (APA) Council of Research Task Force on Novel Biomarkers and Treatments.…”

Clinical and behavior characteristics of individuals who used ketamine

“…These mental side effects have limited the use of ketamine in medical settings but led to its recreational use 2 . The nonmedical use of ketamine has sharply increased in Asian countries 3 , 4 , along the emergence of associated physical and mental problems 5 – 7 .…”

Long-term Safety and Efficacy of Esketamine Nasal Spray Plus an Oral Antidepressant in Patients with Treatment-resistant Depression– an Asian Sub-group Analysis from the SUSTAIN-2 Study

“…There is a concern regarding the potential for abuse with esketamine due to its similar pharmacological profile to ketamine, a known controlled substance [ 27 ]. Ketamine abuse is relatively common in some parts of Asia, including Hong Kong, Taiwan, and mainland China [ 28 , 29 ]. In the US, esketamine is only available through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) [ 19 ].…”