Ketamine: A Pathway to Happiness
Too good to be true?
Ketamine helps with depression, anxiety, pain, PTSD, bipolar disorder, OCD and on and on. How can this drug do it all? Be such a pharmaceutical Swiss Army knife?
First the statistics.
There are hundreds of studies showing the immediate benefits of ketamine, and the majority of this clinical research focused on the anti depression effects. The most relevant clinical ketamine study reported that ketamine decreased depressive symptoms within four hours and this improvement was maintained for at least three days. In another study, ketamine was effective within two hours, and 71% of patients were responsive to treatment within one day. Subsequent studies have confirmed the efficacy of ketamine, but not for all patients; the response rate in the clinical studies on ketamine is in the range 25% to 71% within one day and 8% to 45% after one week.
Pathways to health.
And then there are the biological pathway studies which try to explain how the brain chemistry around ketamine works. The details of this chemistry are still a mystery, but the overarching mechanisms are well understood. Ketamine blocks one and triggers two other important brain receptors. As a "side effect" it also releases a growth hormone that builds new neuronal pathways (axons) in the brain. This two prong mechanism of immediate mood change and a long term neuronal healing is well documented.
How does it work?
Ketamine reduces our pain experience, because as an antagonist it blocks the NMDA brain receptor. NMDA is associated with both depression and chronic pain. This is important for therapy purposes, because a temporary dissociation from both physical as well as emotional pain creates a window of opportunity in which the healing process can begin. The sedative effect of ketamine is immediate and obvious, lies at the core of the out-of-body and mind-altering experience, and explains why at significantly higher doses ketamine is used as an anesthetic drug.
But wait, ketamine does more. While the drug mechanically blocks the NMDA receptor, it also triggers the release of the neurotransmitter glutamate, which as a messenger activates the AMPA brain receptor. AMPA then releases a growth hormone called Brain-derived Neurotrophic Factor (BDNF). These BDNF molecules do the following two wonderful things for our healing:
First: BDNF activates the mTOR receptor, which is generally associated with depressive symptoms. More mTOR activity means less depression, and ketamine's boost to mTOR explains the immediate bliss and happiness that can be experienced from a sub-sedative dose. However, this instant relief does not last long without re-dosing, because the half life of ketamine is only between 10 and 15 minutes. A therapeutic dose will have fully worn off after 1.5 to two hours.
Second: The main purpose of BDNF neurotrophic growth factor is to grow new neurons. This neuronal growth of axon connections happens not only quickly, but also while we are in a relatively good mindset and pleasant setting with very little physical and emotional pain.
New neuron connections grow like new branches on a tree, and from-where-to-where they grow is determined by what we are doing at that very moment. If we are happy while they grow, they grow a highway to happiness. In neurobiology they say "what fires together, wires together". What they mean by this is that the software (the fire, the thought, or the electricity) in the brain creates the hardware (the wire, the string of cellular connections, or the neural path). The reverse may be easier to understand: if you do not use it, you lose it. This is how we learn and how we forget.
Re-wiring the brain.
When we look at this from a psychology perspective, it becomes apparent that while ketamine triggers all the right brain chemistry, it is even more important how we fire and permanently re-wire the brain during the BDNF release. When athletes train to improve their performance, they repeat the best possible movement over and over again. This entrainment tweaks their neural pathways to perfection. This is no different for a depressed or anxious person who imagines how their blissful psychedelic experience can be extended into their normal daily life. This transformational exercise is what we call at our Boulder Ketamine Clinic "integration".
Traditional ketamine therapy ignores the neuronal growth, and that this growth can be manipulated to be very specific. Brain plasticity, or our ability to establish new behaviors, feelings, moods and routines, does not happen haphazardly. Shaping brain plasticity requires mental, physical and emotional action. Well targeted action. And it is therefor paramount to integrate psychotherapy into the extraordinary ketamine experience to make the blessings a permanent part of our ordinary state of mind.
Happy travels!
In psychedelic parlance: ketamine opens a door (a new pathway) and Intention, Set, Setting, Skill and Integration pave the path to a beautiful destination!