Abstract
The use of ketamine for treatment of comorbid pain, depression, and substance use disorders (SUDs) is becoming an option of increasing interest, as multiple clinical studies demonstrate its efficacy. Ketamine's efficacy in this diagnostically complex population is mechanistically based on a wide array of affected brain areas in addition to presynaptic neurons of the spine. Efficacy has been shown in both depressive and pain disorders with durability lasting 3 to 4 weeks after discontinuation of ketamine. Although ketamine itself is a drug of potential abuse when used recreationally, its lasting effects without repeated daily use have also shown promise for patients with SUDs. Assisted psychotherapy concurrent with ketamine treatment can help dependent patients cultivate new perceptions and ideals consistent with sobriety. Decreased opiate cravings in patients with SUDs may be related to ketamine's effects on reducing opiate-induced hyperalgesia. Given this and additional properties, ketamine can help reduce opiate medication burden, augment opiates in the hospice setting, or acutely alleviate symptoms of opiate withdrawal. [ Psychiatr Ann. 2018;48(4):180–183.]
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