Ketamine and Dissociation: What is it?

Ketamine therapy can be a great method of treating severe medication- and treatment-resistant depression. However, there are a few ketamine infusion side effects to be aware of before starting the therapy.

One of the most well-known side effects of ketamine is dissociation. Dissociation refers to a temporary mental state in which a person ‘detaches’ from their surroundings, meaning the person becomes less aware of what is actually around them and starts to feel disconnected from their body.

This article will look at the details of ketamine dissociation, including the CADSS scale, dissociative symptoms, ketamine’s effectiveness, the best places to receive ketamine infusions and other treatment options. Keep reading to learn more about how ketamine dissociation can affect patients.

What Is the CADSS Scale?

The Clinician-Administered Dissociative State Scale (CADSS) is an instrument used by clinicians to measure the degree of dissociation during ketamine infusions. By ranking the extent to which a symptom occurs, the CADSS can assess the psychoactive effects of ketamine. The higher the CADSS score, the more dissociative symptoms a patient is experiencing, and vice versa.

Dissociative Symptoms

To properly monitor the effects of ketamine, the CADSS looks at dissociative symptoms such as:

  • Feeling like things are in slow motion or seem unreal.
  • Feeling separated from reality.
  • Feeling as if looking at things from outside the body.
  • Feeling like you are a spectator or like you are observed.
  • Objects looking different.
  • Colors seeming duller or brighter than usual.
  • Time speeding up or slowing down.
  • Seeing things through a fog or having tunnel vision.
  • Losing track of time or what is happening in the environment.
  • Feeling as though your body has changed.

Most people find ketamine infusions to be quite pleasant and relaxing, even if they are experiencing dissociative symptoms. If someone is experiencing these symptoms and finds it unpleasant or frightening, there are ways to mitigate it.

What Is the K-Hole Effect?

In addition to mild dissociative symptoms, recreational users of ketamine may experience the k-hole effect. The k-hole effect typically only occurs when high doses of ketamine are taken. Because higher doses of ketamine result in more intense feelings of dissociation, those who experience the k-hole effect may feel their consciousness of the real world begin to fade. These alterations to the senses can occasionally lead to illusions and hallucinations.

At Principium Psychiatry our ketamine treatment process does not deliver a large enough dose to produce the k-hole effect. We safely administer all ketamine treatments in a clinical format. On the whole, patients report feeling a sense of calm and relaxation during the process without the k-hole effects that a large dose of ketamine can trigger.

Is There a Link Between Effectiveness and the Scale of Dissociation?

In terms of linking the occurrence of dissociation and the efficacy of ketamine as an antidepressant, studies are conflicting. While some studies have concluded that patients who experience more intense dissociation symptoms during ketamine infusions have greater antidepressant benefits, most have found no correlation between the degree of dissociative symptoms and antidepressant effects.

For this reason, at Principium Psychiatry, we believe the main goal during ketamine infusions is to make patients feel as comfortable and relaxed as possible. The treatment will only be effective if it is well-tolerated and patients look forward to returning for their infusions. It is therefore important to speak up to your ketamine provider if you are experiencing symptoms with which you are uncomfortable.

The Principium Psychiatry Ketamine Treatment Process

At Principium Psychiatry, we have found that our method of administering ketamine makes the experience much smoother. Under our ketamine administration protocol, patients report fewer adverse side effects such as dizziness, light-headedness and nausea, than they experienced at other centers. In addition, if dissociative symptoms are causing discomfort, medication can be administered during the infusion to limit them.

Ketamine infusions at Principium Psychiatry take place in a private room with state-of-the-art equipment. Each infusion takes approximately one hour to complete and is administered intravenously. The ketamine dose used to treat depression is about one-quarter of an anesthetic dose and administered under the expert supervision of our treatment staff. Principium is led by Dr. Ziv Cohen, medical director and clinical assistant professor of psychiatry at Weill Cornell Medicine. The Principium Team is a well rounded, multidisciplinary team of clinicians. While patients may see positive effects after a single treatment, it typically takes several treatment sessions to bring about results.

The Benefits of a Private Practice

Principium Psychiatry is one of the few psychiatric clinics in New York licensed to provide ketamine, Transcranial Magnetic Stimulation (TMS), buprenorphine and other cutting-edge medication therapy techniques. We also have various psychotherapists to support patients. The staff members at Principium are committed to delivering the most comprehensive and effective mental health treatments based on their insights and knowledge of multiple medical disciplines.

Our staff members have expertise in cognitive behavioral therapy, child and adolescent psychiatry and various other areas. Each member of the team is caring, compassionate and completely focused on doing whatever they can to make patients feel comfortable, welcome and heard at every appointment.

At Principium Psychiatry, ketamine infusions for depression in NYC are offered in a comfortable, private setting. Our offices in lower and mid-town Manhattan, near Columbus Circle and Wall Street, offer convenient and private locations for depression treatment that are accessible to the Tristate Area. We are near Penn Station, as well as all major subway lines, and our Wall Street location is a short distance from the Brooklyn Bridge and the large transportation hubs around Wall Street.

Ketamine Infusions and SPRAVATO™ (esketamine) Treatment Options

Principium Psychiatry is also proud to offer SPRAVATO™ as a treatment option for our patients. Used for treatment-resistant depression (TRD) in adults, SPRAVATO™ is a prescription medicine delivered as a nasal spray. SPRAVATO™ is taken along with an oral antidepressant.

To learn more about these treatment options, you can read about ketamineTMS and SPRAVATO™ on our website and call Principium Psychiatry at 212-335-0236 with any questions.

Learn More by Contacting Principium Psychiatry Today

At Principium Psychiatry, we are fully equipped to provide the right treatment for your condition. Dr. Cohen and the team at Principium are knowledgeable of the most current treatment options and are ready to care for mood and anxiety disorder patients who have various symptoms and needs.

To learn more about the treatment options available to you, contact Principium Psychiatry online or call 212-335-0236 today.


Original contribution by Estelle Autissier, RN 

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