Ketamine Withdrawal: Symptoms, Timeline & Detox

A Complete Guide to Withdrawing From Ketamine addiction

While ketamine is not as likely to cause addiction as opioids, it can still cause dependence issues, particularly if not used specifically as prescribed by a doctor. Therefore, it’s important to understand how the drug works, how to tell if someone is dependent, and treatment options.

Ketamine Withdrawal

What Is Ketamine?

Ketamine was first used to anesthetize animals in Belgium in 1963. It then was approved for treating people and was used in Vietnam to treat soldiers. Doctors then discovered that the drug could be a powerful aid against depression and suicidal thoughts.

In a clinical setting, the drug can help those who have not responded to other treatments for depression.
The only FDA-approved methodology for taking ketamine is through a nasal spray. It is only prescribed for those who are suicidal or have serious depression that has not been helped by other medications. They receive the drug in a health care facility where they are supervised for several hours after receiving their dose.

They typically receive a dose twice a week initially, and then, this dosage is tapered down to a dose every other week until they are no longer taking the drug.

Ketamine causes a dissociative experience. The following can be produced by the drug:

• Feelings of leaving reality
• Distorted sensory perceptions
• Distorted perceptions of one’s body
• Euphoria
• Unusual thoughts and beliefs

In a research setting, it was observed that these symptoms manifested after just 15-20 minutes. Those undergoing treatment often listen to music while they wait in the treatment center. They report feeling a reduction in stress. Even those who undergo treatment who do not report any of the above effects typically do report relief from the symptoms of depression within a few days of treatment.

This is because some research has shown that ketamine can help restore synapses in the brain. These are integral for the communication between nerve cells. While some medical professionals think that depression can reduce the number of synaptic connections, research has shown that ketamine can encourage these to grow.

Another way in which ketamine works is by reactivating glutamate receptors. These are often less active in those suffering from depression.

When ketamine helps synapses and receptors to grow, it can help cause a shift in the brain which can support the effects of other treatment modalities such as therapy and the use of antidepressants.

While the benefits of ketamine for those suffering from suicidal thoughts or severe, untreatable depression may make it a boon for some, there are also causes for concern. Ketamine apparently needs opioid receptors to work. Because of this, there is a concern that larger doses of ketamine might be needed over time to get the same effect, which currently occurs with medically prescribed opioids.

There have been cases of people who have shown signs of addiction despite using ketamine medicinally. The chances for abuse increase when the drug is not used under a doctor’s supervision.

Because of the experiences provided by ketamine, it is sometimes used recreationally in clubs or during parties. People will add it to marijuana cigarettes, put it into drinks, or snort it in order to experience the effects, which typically last a couple of hours.

However, there are grave risks involved with this behavior. The following are some of the results of using ketamine improperly:

• Unconsciousness
• High blood pressure
• Breathing becoming dangerously slow
• Death, particularly if used with alcohol

Long term side effects of using ketamine can include ulcers, stomach pain, issues with the kidneys, and, ironically, depression.

Ketamine addiction Withdrawal

Because ketamine is potentially addictive, it should only be used under medical supervision. If not managed, the use of the drug can lead to psychological dependence. When someone needs to take ever larger doses to achieve the same effects, that is a sign of addiction. If someone who is dependent on ketamine stops taking it, withdrawal can occur as the brain’s opioid receptors have changed in response to the drug.

Ketamine addiction Withdrawal Symptoms

The most dangerous result of withdrawal is an intense depression that can increase the client’s risk of suicide. Other symptoms of withdrawal could include:

• Agitation
• Inability to move, rigid muscles
• Convulsions
• Delusions, hallucinations, and other signs of psychosis
• Loss of Motor skills
• Rage
• Confusion
• Nausea
• Insomnia
• Cardiac and respiratory issues
• Experiencing tremors
• Fatigue
• Hearing loss
• Cognitive impairment

Unfortunately, during the withdrawal process, there is a chance that the client could be of danger to themselves or others. Therefore, it is generally advised that the individual is isolated while still being medically supervised.

Ketamine addiction Withdrawal Timeline

Withdrawal can last as little as three days or as long as many weeks. The process can be very uncomfortable but is not typically life-threatening as long as there is medical supervision. The length of time varies based on various factors including:
• How long the client used ketamine
• The client’s personal tolerance levels
• The level of drugs in the person’s system
• What other drugs the client is using in conjunction with ketamine
• The client’s physiology

Symptoms of withdrawal typically start within 24-72 hours after the client’s last use of the drug. The following is a typical timeline for withdrawal from ketamine.

Days 1-3

The client experiences acute withdrawal which can include fatigue, rage, insomnia, tremors, “the shakes,” vision problems such as double vision, depression, nausea, hallucinations, delusions, hearing loss, and difficulty breathing. Because of the severity of these symptoms, medical supervision is necessary during this time period.

Days 4-14

Typically, in even the worst cases, by the end of this phase, the client should see a lessening of symptoms.

Day 15 +

While at this point, withdrawal symptoms have either dramatically lessened or ceased altogether, there may be persistent psychological issues as well as brain damage that must be addressed.

Ketamine addiction Detox

This is the first step that clients need to face in order to recover from the abuse of ketamine. It occurs after the client stops taking the drug and occurs as the amount of ketamine in the user’s system decreases. During this time, intense cravings for the drug are typical as are other unpleasant psychological symptoms.

It is important that clients know that there are medications that can help with minimizing the effects of ketamine withdrawal. Having access to these medications as well as having their heart rate and breathing monitored are reasons to check into a treatment facility when undergoing detox. It is a very bad idea to attempt detoxification on your own.

Treatment Options

While it is tough to overcome an addiction to ketamine, it can be done. Treatment options have come a long way and are more effective than ever.

Because of the risks of withdrawal and the complexities of overcoming an addiction, it is very important to work with professionals who understand the issues involved with ketamine addiction. One factor is that many clients may also be abusing other substances such as alcohol or opioids in addition to ketamine. There may also be untreated mental health issues that complicate recovery.

By working with a team of professionals, the possibility of addressing all of the concurrent and related issues is enhanced. While it is daunting to many clients as inpatient rehab can take time, clients have to look at the big picture. Even a treatment program that takes several months will be worth it if the end result is that the person is no longer dependent on drugs and is able to lead a healthy, happy, and productive life.

Because of the severity of issues that might need to be addressed, it may take as little as 28 days to achieve outstanding results, but realistically, the client should be prepared for a longer period of time if necessary. To provide ongoing support, there are often outpatient programs as well.

Modalities of Treatment

There are several modes of treatment that have been used with positive results for clients who suffer from ketamine dependence. They address the fact that this type of addiction is mainly psychological in nature.

Cognitive-behavioral Therapy

Cognitive-behavioral therapy, or CBT, has been proven effective in the treatment of many behavioral issues. It is used to treat depression and anxiety as well as for those dealing with substance abuse issues. Sometimes, these factors are related, so CBT can address multiple issues for a particular client.

CBT’s purpose is to facilitate the client’s examination of their patterns of thought and behavior. The client gains a greater awareness of their own triggers and is helped to achieve healthier responses to replace past behaviors. This can be used to avoid responses that can trigger a relapse. CBT is based on the following three principles:

1. Psychological problems are caused by unproductive thought patterns.
2. Psychological problems are partially derived from habitual unproductive behavior. Because this behavior has been learned, it can be unlearned.
3. Training can help clients who suffer from these issues to overcome them.

The strategies encouraged by CBT include learning to face fears instead of using mechanisms to avoid them and using role-playing and other strategies to anticipate potential situations so that coping strategies can be figured out while the client is in a safe space rather than waiting for a stressful situation. In CBT, you will also practice mindful thinking and other strategies to remain calm and relaxed.

CBT can be individualized for each client’s particular needs. It is a collaborative treatment plan as a psychologist works collaboratively with the client. Because empowerment is emphasized, the client learns how to manage their responses on their own. That makes this a powerful therapy as it gives a client the tools necessary for long-term progress.

Other therapies

In addition to CBT, two other therapies that are often used to help those in ketamine treatment programs include dialectical behavioral therapy (DBT) and acceptance and commitment therapy (ACT). The former uses mindful awareness as well as stress management techniques. The latter combines acceptance therapies with mindfulness, as well as including strategies that emphasize commitment and behavioral change.

DBT uses a dialectical approach, which means two opposite ideas are combined. In the case of DBT, these two concepts are acceptance of one’s current status along with creating change. The therapist will attempt to help the client accept their experiences while still working to change behaviors that are non-productive. The idea is to find a balance.

This therapy combines individual and group therapy sessions along with phone counseling as needed. Clients are expected to do “homework” – this means they are asked to practice their newly acquired skills in their daily lives.

ACT aims to help clients move through difficult emotions with the goal of expending energy on healing instead of focusing on the negative. The idea is that the client develops their own coping mechanisms. This enables them to deal with challenges without using drugs.

ACT uses mindfulness exercises to help clients accept their own emotions and to accept the experience when they feel they are not in control. They set a direction by which they commit to positive approaches that help them move forward.

While ketamine can be hard for those suffering from addiction to detox from, fortunately, professional help is available. This type of assistance is critical for those dealing with dependence on this drug.

In addition to making sure to use a reputable treatment center, it’s critical to have a support system to provide both emotional support and accountability after the client has completed treatment. With the proper systems in place, it is possible for those suffering from dependence to recover and go on to lead good lives.

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Reviewed By:

Dr. John Elgin Wilkaitis

Dr. John Elgin Wilkaitis completed medical school at The University of Mississippi Medical Center and residency in general psychiatry in 2003. He completed a fellowship in Child and Adolescent Psychiatry at Cincinnati Children’s Hospital in 2005. Following this, he served as Chief Medical Officer for 10 years of Brentwood Behavioral Healthcare a private health system including a 105-bed hospital, residential treatment, and intensive outpatient services.

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