Motivation and emotion/Book/2019/Ketamine and emotion

Overview
The purpose of this book chapter is to understand the emotional effects ketamine has on individuals. There has recently been an influx in research regarding ketamine. Empirical research has expressed the potential benefits for those suffering certain illnesses. This includes depression, chronic pain and refractory cancer pain.


 * Focus question
 * How does ketamine effect emotions?
 * Is ketamine more beneficial or detrimental to one's emotions?
 * How do the emotion theories apply to ketamine use

What is ketamine?
Ketamine is a medication typically used by practitioners and veterinarians as an anaesthetic (Figure 1). As an alternative anaesthetic to Phencyclidine (PCP), ketamine was produced as a safer substitute in the early 1960’s (Stirling & McCoy, 2010). It is a dissociative anaesthetic and remains an integral medication regarding current medical procedures. Ketamine is also be used recreationally and illegally. Over the past several years, the abuse of this substance has declined. Although, it is still reasonably common (Bokor & Anderson, 2014). It obtains many street names, including K, ket, special k and vitamin k (Li et al., 2011). When used recreationally, effects may include feeling happy, relaxed, alter perception of time and space, potential hallucinations, decreased sensitivity to pain, increased heart-rate and blood pressure and a sense of floating. When an individual consumes a large amount of ketamine, this is when one might fall into the "k-hole". This can either be extremely euphoric or particularly unpleasant. There are notably very few reports of overdose with regard to pure ketamine (Copeland & Dillon, 2005). It is additionally reported to have a wide margin of safety (Copeland & Dillon, 2005).

Case study
This case study investigates the phenomenology implications of ketamine:  This case study focused on the effects of ketamine when entering a "trip". A United Kingdom recurrent research enterprise named Psychonautics Project, was developed in the 1990’s to investigate the variety of approaches to the phenomenology of hallucinogenic drugs. In this particular case study, a British academic in 1996 participated in a ketamine “trip” to understand the effects of its unique nature. The study examines the participant’s experience of an alternative reality, including visual hallucinations, repetition of specific sentences or words and disembodied beings. More importantly, the study considers the potential implications of ketamine on depression and the vital function of psychonautics regarding improvements surrounding effective drug policies. It was reported by the participant that when he engaged in more experiences with ketamine, the same main phrases he spoke on the original “trip”, were repeated in more recent “trips”.

(Newcombe, 2008).

Medical use
Ketamine is utilised in the treatment of numerous medical issues. These issues include cancer, depression, chronic pain and anaesthetic for veterinary and human medicine.



Depression
There has been an increase in research investigated the effects of ketamine in the treatment for Major Depressive Disorder (Figure 2.). Katalinic et al. (2013) investigated the efficacy and adverse effects of utilising ketamine in the treatment for depression. This study discovered consistent reports regarding the efficacy and high response to ketamine on depression levels. The antidepressant properties of ketamine provided rapid and extensive developments in patient’s mood. However, early relapse is common, and the improvements are short lived (Katalinic et al., 2013). A study conducted by Okamoto et al., (2010) support the notion that the appropriate use of ketamine can be beneficial for those suffering from depression. The results expressed an improvement in early symptoms of depression after utilising ketamine, which can be extremely useful for moderating one’s emotions and moods (Okamoto et al., 2010). Moreover, Zhang and Ho (2016) state a recent trial involving ketamine, expressed results of 77% of patients portraying an improvement in mood, as well as cognition. The correlation between emotion and cognition was originally viewed as two separate domains. However, recent research suggests that there could be a constant interplay between the two (Scheidegger et al., 2016). This is particularly relevant to the influence of ketamine on cognition and emotion, as previously mentioned. Major depressive disorder comprises of deficits to cognitive and emotional processes, resulting in the need to understand the influence of ketamine on these processes, as it can be extremely beneficial (Scheidegger et al., 2016). It is evident that the benefits of the utilising ketamine when within speciality areas far outweigh the risks (Chen & Malek, 2011). Thus, supporting the use of ketamine medically, when treating depression.

Anaesthesia
As an Anaesthetic, ketamine has excellent and effective reports when utilised in medical settings for humans and veterinaries (Wood et al., 2011). It is successful for anaesthesia, as it maintains protection for the airway reflexes and cardiopulmonary function analgesia (Bokor & Anderson, 2014). It is also extremely effective for paediatrics when conducting large procedures, as it results in sedation, amnesia and analgesia (Bokor & Anderson, 2014). As opposed to other anaesthetic options, ketamine requires less equipment for monitoring (Bokor & Anderson, 2014). When taking into consideration the pharmacological and mechanisms of ketamine, the NDMA receptor which is antagonistic by ketamine, has associations with analgesic influences (Li et al., 2011). Hence when factoring in the biological construct, ketamine is extremely beneficial for anaesthetic (Li et al., 2011).

Case study continued
Effectiveness of ketamine in treating depressive symptoms within the case study:  With regard to the case study and depression, it was revealed that ketamine alleviated the participant’s depression. Ketamine unlike hallucinogens, did not cause after-effects such as insomnia and depressed mood. This supports the notion that ketamine does not have usually come down implications and would be extremely beneficial for those suffering from depression. However, further investigation is required to explore whether the ketamine “trip” is enough to give insight and alleviate the depression. While also further investigating whether anti-depressant effects of ketamine are solely psychopharmacological{{gr}. Future research utilising this method of treatment should be investigated, as the early research has expressed promising results.

(Newcombe, 2008).

Recreational use


Since the creation of ketamine, recreation use of the substance has been quite common. A unique aspect of ketamine use is the “k-hole” experience. A k-hole is experienced when ketamine is heavily consumed and a collection of dissociative and psychedelic experiences occur (Stirling & McCoy, 2010). This is the result of an abuse of ketamine, predominantly occurring when consumed recreationally (Li et al., 2011). Recreationally, it is commonly consumed in powder form (see Figure 3) by inhalation through the nostril.

The effects of the k-hole were expressed to include confusion, hallucinatory effects, mind and body dissociation, trouble speaking and sensations of floating (Stirling & McCoy, 2010). As reported by Stirling and McCoy (2010), the most frequent experiences of the k-hole included 79% of participants experiencing confusion, 71% had disturbed speech, 71% felt a sense of floating and 71% had a sense of things being unexplainable. Moreover, 66% reported phenomena of body-mind dissociation, 57% reported oneness and 57% also expressed a sense of love and peace (Stirling & McCoy, 2010). These relate more to the psychedelic components of the k-hole and were expressed by the majority of ketamine users (Stirling & McCoy, 2010). Depending on the individual, this may be extremely beneficial for one’s emotion as it can elevate emotions and create a sense of euphoria. However, this can result in adverse effects on other individual's emotion. It may create a sense of panic and confusion, resulting in significant distress (Muetzelfeldt et al., 2008).

Side effects of chronic use
Ketamine can have some side effects, more specifically if it is utilised heavily long term. These can be physiological, while also resulting in dependence on the substance.

Table 1. Summary of side effects of ketamine use.

Source: Effects of ketamine (Alcohol and Drug Foundation, 2019)

Theories of emotion
With regard to theories of emotion, the focal theories focused on are the James-Lange Theory and Cognitive Appraisal Theory of emotion. Moreover, ketamine has a significant influence on physiological and neurological processes.

James-Lange theory of emotion


The James-Lange theory of emotion is one of the earliest theories of emotion in modern psychology. It was developed by an American psychologist William James, and a Danish psychologist Carl Lange. Their views on emotion coincided and thus the formation of this theory occurred. This theory of emotion expresses that an immediate, primary cause of emotion is physical. Environmental stimuli encourage physiological processes and bodily alterations, which result in specific feelings or emotions in the conscious mind (Coleman & Snarey, 2011). Furthermore, this theory emphasises emotions as bodily sensations and the focus is on physiological rather than psychological reasoning. As seen in Figure 4, an analogy is shown using this theory. It begins with an environmental stimulus, following a physiological reaction, resulting in an emotional response. This is extremely relevant when investigating the effects of ketamine on emotion. The activating event would be ingesting the ketamine, following an increase in blood pressure and heart rate. The emotional response would involve happiness, feeling of content and even euphoria.

Dillon, Copeland and Jansen (2003) state that ketamine appears to be another addition to the already existing drug repertoire and feel as though it is unnecessary. They deem through their study, that ketamine should not be used as many participants experienced significant negative effects. This resulted in reducing the dose or pausing consumption altogether for participants (Dillon, Copeland & Jansen, 2003). The negative physiological responses such as increased body temperature, lack of co-ordination and inability to speak, was the reasoning as to why participants were hesitant or motivated to stop consuming the substance. This evidently resulted in a negative emotional response, linking back to this theory of emotion. Careful assessment and appropriate evaluation are required, when developing harm minimisation campaigns.

Cognitive appraisal theory
The cognitive appraisal approach of stress was developed in the 1980’s by Magda Arnold Richard Lazarus and Susan Folkman. This then led to the introduction of Ira Roseman’s appraisal theory of emotions in the 1990’s, which built on Lazarus’ model. Lazarus’ model of emotion highlighted that our emotions are obtained through appraisals. This includes one’s explanations, interpretations and evaluations of an event. Hence, resulting in different individuals experiencing different perceptions and emotional responses to the same condition. Ira Roseman followed on from this original theory and aimed to develop a more accurate, integrative and complete theory with regard to causes of emotion. Roseman’s studies in the 1990’s revealed appraisals of situational, motivational, unexpectedness, probability, control potential and problem source all influenced a wide variety of emotions. This allowed for a revised, comprehensive and more empirically grounded model, highlighting the 17 different emotions caused by the appraisals (Roseman, 1996).

With relation to ketamine, when consumed the physiological responses can be interpreted very differently, depending on the individual. Relating back to cognitive appraisal, if an individual has ingested ketamine, assessed the effects it is having on themselves and enjoy it, this can be very positive for one’s emotions. However, if someone is not enjoying the effects ketamine is producing, then this can result in extreme discomfort and unease. Micallef et al. (2003) support this. They state that the effects of ketamine can result in positive symptoms such as perceptual distortions, as well as negative symptoms including social withdrawal, deficits in emotion and apathy (Micallef et al., 2003). Moreover, it is evident that the way ketamine influences one’s emotions, depends on one’s own assessment and opinion towards their personal experience with the substance.

Physiological and neurological responses
There is extensive research regarding ketamine and its effects on neurological and physiological mechanisms. The implications involved with ketamine are largely neurologically based. Ketamine can be categorised as a controlled schedule III substance (Bokor & Anderson, 2014). Neurologically, the main course of action for ketamine is its ability to block the NMDA receptors. It can additionally indirectly or directly influence neurotransmitters, including an increase in norepinephrine, serotonin and dopamine (Bokor & Anderson, 2014). Moreover, ketamine may also impact the frontal lobe, through the increase of glutamate (Bokor & Anderson, 2014). Murrough et al., (2015) support the notion that the neurological effects of ketamine on emotion are positive. The recent study states there was an association with improvements in depressive levels and severity, following the use of ketamine. This was associated with the greater connectivity from the right caudate throughout the perception of positive emotion (Murrough et al., 2015). The results expressed ketamine enhances neural responses in the right caudate for depressed people. This is vital when considering treatment for individuals suffering from depression, as ketamine promptly increases brain responses when positive emotion is present.

Contrary to previously stated studies, Zhang and Ho (2016) express concern regarding the neurological implications of ketamine. Abuse of the substance can lead to spatial memory disturbances. This is as a result of the decrease in activation involving the left parahippocampus gyrus and the right hippocampus, which was discovered through functional imaging studies (Zhang & Ho, 2016). However, it should be emphasised that this neurological implication relates to the abuse of ketamine.

Quiz
Choose the correct answers and click "Submit": {Ketamine is used as an anaesthetic.} + True - False

{When in the k-hole, ________ of users expressed a sense of floating. + 71% - 79% - 66% - None of the above
 * type=""}

Conclusion
Ketamine can have extremely beneficial implications on one’s emotion. It is expressed that the benefits far outweigh the negative effects and if utilised appropriately, can be extremely effective when treating major depressive disorder. Any pharmaceutical substance consumed in large and dangerous quantities will have detrimental implications. This is apparent with ketamine. It has become increasingly popular with regard to recreational use and consumption. When large amounts of ketamine are consumed, it may lead to a “k-hole”. This can either be extremely euphoric and include psychedelic properties or be quite unpleasant and uncomfortable. Thus, the stigmatisation and stereotyping of ketamine use is common. Most people refer to it as “horse tranquiliser”, when in reality it is much more than this. Future research should investigate alternative dosing schedules. This can assist in understanding how to preserve the antidepressant results, as the benefits are short lived (Katalinic et al., 2013). More research surrounding the benefits and negative implications of the clinic use of ketamine is indispensable (Li et al., 2011).