Ketamine administration in healthy participants caused an altered state of consciousness and changes in systemic physiology, including increased pulse rate and electrodermal activity. The drug led to a brain-wide reduction in the fractional amplitude of low frequency fluctuations and decreased global brain connectivity in the prefrontal region. Preliminary evidence suggests that a combination of neural and physiological metrics may predict subjective mystical experiences and reductions in depressive symptoms. The study demonstrates the successful use of fNIRS neuroimaging to measure physiological effects of ketamine in a clinical setting, representing a step toward larger clinical fNIRS studies of psychedelics.
Ibogaine, a naturally occurring hallucinogen used illegally for addiction treatment, can trigger manic episodes even in people with no prior bipolar diagnosis. This case series reports three patients who developed mania after using unregulated ibogaine—two for self-treating addictions and one for psycho-spiritual purposes. No previous reports of ibogaine-induced mania exist in the literature. Clinicians encountering new-onset mania should inquire about substance use, especially ibogaine, given its growing popularity among vulnerable populations seeking addiction treatment. The authors advise discussing the lack of safety and efficacy data with patients considering ibogaine.
In an addiction psychiatry practice offering intramuscular ketamine with psychotherapy for depression, 70 patients received 1,114 sessions over nearly seven years. Induction produced an 82% response, and improvement remained above 80% after six months of maintenance sessions given every 21 days at a mean dose of 1.13 mg/kg. Many patients (38%) stayed in treatment for at least a year. Dropouts were mostly due to logistical reasons (50%); side effects accounted for only 9.7%. One case of ketamine use disorder required residential treatment. Nausea was the main side effect managed with medication. Maintenance ketamine-assisted psychotherapy extended benefits for mood, anxiety, and substance use and was generally well tolerated.