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Comment by dialamac | Hacker News Reader

Ketamine is a not uncommon thing in psych today. It is routinely prescribed. The problems are that it does seem for most people the effect is short lived (weeks) and psychosis is a thing (the poster below saying it’s never an issue even in pain setting is simply mistaken). The thing is that neither of these are uncommon problems for psych meds in general so ketamine shouldn’t be singled out for this, but it’s more complicated then some of the armchair docs here make it seem.

There is continuing research into regimens that might minimize the tachyphylaxis, but it’s an ongoing problem.

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>psychosis is a thing

Looking through Google scholar + personal experience I don't see evidence that this is an issue for non-schizophrenics.

You need to look harder. Schizophrenia and psychotic features are relative contraindications for use of ketamine per APA guidelines. “It is unclear whether patients with depression that is not treatment- refractory or patients with other psychiatric illnesses are ap- propriate candidates for ketamine treatment, and extreme caution must be exercised in patients with psychotic or substance use disorders.”

Side-effects associated with ketamine use in depression: a systematic review, Short 2018.

To summarize: A review of 60 studies found dissociation and psychotomimetic effects >70 percent of the studies at varying rates. And note that the time courses of observation were variable. Furthermore most of these studies excluded participants with psychotic features or known psychotic disorder.

But for any provider considering ketamine this is literally top of the list in consideration of adverse effects.

This review doesn't say all that much. I just took another look at it and it merely reports what % of the studies mention those effects without effect sizes or anything of the sort.

Also they clump psychotomimetic and dissociation effects together which is really weird as ketamine is a dissociative. It's literally the highest number in their analysis (72%) because dissociation is to be expected from a dissociative.

The point with referring to a review article/meta is that you are free to look at the references themselves. Adverse effects secondary to dissociation can obviously be troublesome for some using in a professional clinical setting, which is what this is about..

Anyway, in medicine statements of the form “x never happens unless y” or it “only” happens in certain circumstance are always wrong. The data is not perfect but your implication that only schizophrenics experience adverse effects is not only an idiotic statement on its face you can easily find case reports refuting it.

I didn't say it never happens. Everything is correlated but if the risk is extremely small, as I believe it is here for non-shizophrenics then I don't consider it a concern. And others definitely experience dissociation for example, that's not something I am questioning.

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