Does ketamine make ADHD worse?

Introduction: Ketamine, a dissociative anesthetic and N-methyl-D-aspartate (NMDA) receptor antagonist, has gained attention for its rapid antidepressant effects and potential in treating various psychiatric conditions. Recent studies have explored the use of ketamine for ADHD as a novel approach to managing symptoms and improving cognitive function. However, its impact on attention-deficit/hyperactivity disorder (ADHD) remains poorly understood. ADHD, a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity, involves complex neurochemical dysregulations, including alterations in dopamine and norepinephrine pathways. Ketamine’s mechanisms, which modulate glutamate transmission and neuroplasticity, may influence these pathways in ways that could theoretically exacerbate or mitigate ADHD symptoms. This raises critical questions about whether ketamine could worsen ADHD symptoms, particularly given its known side effects, such as cognitive disruptions and mood instability, which might overlap with or intensify ADHD-related challenges. Understanding ketamine’s effects on ADHD is essential for determining its safety and therapeutic potential in this population. The essay seeks to inform healthcare providers and researchers about the safety and appropriateness of ketamine as a therapeutic agent for individuals with ADHD, highlighting gaps in knowledge and areas for future investigation.

What is Ketamine?

Ketamine is a dissociative anesthetic characterized by its hallucinogenic properties, which modulate sensory perception, particularly vision and auditory experiences. It induces a state of detachment from the external environment and self, making it a valuable short-acting anesthetic in human and veterinary medicine when administered via injection. Its classification as a dissociative anesthetic stems from its ability to disrupt the perception of pain and external stimuli.

Clinically, ketamine is associated with sedation, immobility, analgesia, and amnesia, with patients typically unable to recall experiences during its administration. However, its psychoactive effects have contributed to its misuse, as individuals exploit its capacity to evoke dissociative sensations and hallucinations.

Beyond its anesthetic applications, ketamine (marketed as Ketalar) has garnered attention in recent years for its potential in managing mental health disorders, including depression. Notably, there is emerging interest in its use for attention-deficit/hyperactivity disorder (ADHD), a prevalent neurodevelopmental disorder among children. Recent studies have shown that ketamine may hold promise as a treatment option for ADHD due to its rapid antidepressant and cognitive-enhancing effects. While the application of ketamine for ADHD is relatively novel, preliminary findings suggest promising outcomes. Recent studies have explored the potential of ketamine therapy for ADHD, investigating its effects on cognitive function and symptom management. Nevertheless, further investigation is required to substantiate its efficacy, as some individuals are utilizing ketamine to address severe ADHD symptoms. (2,4,3,1)

Ketamine and ADHD meds

New ADHD drugs have shown promising efficacy and safety profiles in recent clinical trials, offering potential improvements in the management of attention-deficit/hyperactivity disorder. Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition affecting more than 8% of adults across their lifetime. Characterized by impairments in attention, impulsivity, and hyperactivity, ADHD often disrupts professional productivity, interpersonal relationships, and overall quality of life. While pharmacological interventions remain a cornerstone of treatment, they are not universally effective, leaving many individuals without significant symptom relief. The pursuit of innovative treatments that provide durable, long-term benefits without adverse effects is therefore critical.

Ketamine has shown potential as a rapid-acting treatment option for individuals with ADHD, providing symptomatic relief through its unique mechanism of action. Ketamine and ADHD meds have been studied for their potential effects on neurotransmitter regulation and their implications in treating various psychiatric disorders. Ketamine, originally synthesized as a potent anesthetic, has recently gained attention for its novel applications in mental health treatment. Its unique mechanism of action sets it apart from traditional medications for conditions such as treatment-resistant depression, anxiety disorders, and post-traumatic stress disorder (PTSD). Unlike conventional treatments that primarily modulate serotonin pathways, ketamine exerts its effects via glutamate—a pivotal neurotransmitter involved in mood regulation, cognition, and behavior. By modulating glutamate signaling and enhancing neural plasticity, ketamine fosters the brain’s capacity to adapt and reorganize in response to environmental and cognitive demands. Low-dose ketamine has shown promising results in improving attention and focus in patients with ADHD.

As an N-methyl-D-aspartate (NMDA) receptor antagonist, ketamine blocks the activity of these receptors, which play critical roles in memory, learning, and focus. By regulating glutamate levels, ketamine facilitates improved synaptic communication and emotional processing, reducing symptoms such as pain perception and cognitive rigidity.

These neurochemical properties position ketamine as a promising candidate for managing core ADHD symptoms. Its modulation of neural circuits enhances attention, reduces impulsivity, and mitigates hyperactivity. Additionally, ketamine has demonstrated efficacy in addressing comorbid conditions such as depression and anxiety, which are frequently observed in individuals with ADHD. By improving cognitive clarity and emotional regulation, ketamine therapy offers potential benefits across occupational, academic, social, and familial domains, paving the way for enhanced overall functioning in affected individuals. Ketamine treatment for ADHD has shown potential in preliminary studies, highlighting the need for further research to evaluate its efficacy and safety in managing symptoms. (5,8,6,9)

Please watch: Ketamine for adhd? with dr. John Kruse.

Ketamine dosage for ADHD

The ketamine effect on ADHD has been investigated to explore its potential therapeutic benefits and underlying mechanisms. Ketamine is a pharmacological agent increasingly recognized for its therapeutic potential in mood disorders such as depression. Its efficacy is attributed to its ability to block N-methyl-D-aspartate (NMDA) receptors, which play a crucial role in synaptic signal transmission in the central nervous system. Recent investigations have explored the use of ketamine as a novel treatment for attention-deficit/hyperactivity disorder (ADHD), yielding encouraging preliminary outcomes. However, the application of ketamine in ADHD management remains in its nascent stages, necessitating further rigorous research.

Intravenous (IV) ketamine, in particular, has demonstrated potential for alleviating severe ADHD symptoms. Administered via IV injection, this formulation provides longer-lasting effects compared to intramuscular (IM) or subcutaneous (SQ) administration routes. While extensively studied for depression and chronic pain, IV ketamine has also shown promise in addressing ADHD. Nonetheless, dosing precision is critical, as even sub-anesthetic doses can elicit significant adverse effects. Among these are the risks of addiction and dissociative experiences, characterized by a profound sense of detachment from one’s environment. (11,12,15,19)

Does ketamine help with ADHD?

Examples illustrating the experiences of individuals regarding the effects of ketamine therapy on ADHD:

A colleague recounted an anecdote involving one of their clients:

The observed impact of ketamine therapy on ADHD symptoms and overall mental health in a patient with severe mental illness, including monopolar depression and debilitating anxiety, presents an intriguing clinical development. The patient initially relied on Concerta, a time-release stimulant medication commonly prescribed for ADHD, to manage daily functioning. However, over the course of nearly a year of at-home ketamine therapy, a significant reduction in the need for ADHD medication has been observed. Initially, forgetting to take the ADHD medication was accidental, yet it did not result in the severe functional impairments previously experienced when off medication. The patient’s routine ketamine therapy sessions involved blood pressure monitoring, during which they noticed that the ADHD medication contributed to elevated blood pressure throughout the day. This observation prompted a gradual reduction, and eventually near cessation, of ADHD medication use. Prior to ketamine therapy, the patient’s inability to perform basic daily tasks without ADHD medication underscored the severity of their condition. Activities such as preparing for a social outing were contingent upon the stimulant’s effects. However, with sustained remission of anxiety and depressive symptoms attributed to ketamine therapy, functional independence emerged even in the absence of Concerta. The shift from a necessity for ADHD medication to the ability to manage without it is particularly notable, given the profound cognitive and executive dysfunction observed during earlier periods without medication. Behavioral changes, such as minor forgetfulness or decreased interest in extended activities like watching a full movie, have been reported but are perceived as manageable and non-disruptive. These changes contrast sharply with prior experiences of cognitive disarray and loss of focus, highlighting a marked improvement in overall quality of life. This case aligns with anecdotal discussions suggesting that ketamine therapy may facilitate reductions in ADHD medication usage. However, it appears this outcome was only possible after substantial remission of anxiety and depressive symptoms. The therapeutic effect has been transformative, extending beyond anticipated improvements in quality of life to unprecedented functional independence. These findings highlight the potential for ketamine therapy to influence not only mood disorders but also comorbid conditions like ADHD, potentially reducing the reliance on stimulant medications. Further investigation is warranted to explore the mechanisms and broader applicability of these outcomes.

Aho, one of my clients, articulated their circumstances as follows:

Approximately two years ago, under the guidance of Dr. Amiri, I began using ketamine at a dosage of 400 mg every fourth day. At that time, I had not yet been diagnosed with inattentive-type ADHD. Despite consistent use, I did not experience any notable therapeutic benefits or psychedelic effects. Instead, the treatment induced a profound sensation of heaviness, prompting me to remain in bed for extended periods. Typically, I would use my CPAP machine, wrap myself in blankets, and enter a state of detachment for 2–3 hours. Post-treatment, I often felt mentally foggy, unfocused, and physically fatigued for the remainder of the day, with lingering fatigue the following day. These effects mirrored my depressive symptoms and ultimately contributed to a subjective sense of worsening. After three months of treatment, I chose to discontinue ketamine therapy. Subsequently, I received a diagnosis of ADHD and began treatment with Focalin, which I take on workdays. However, this medication has not significantly improved my focus or productivity. I continue to experience difficulties with concentration and motivation, accompanied by pervasive feelings of apathy and emotional numbness. Recently, I initiated treatment with Joyous at a lower daily dose of 30 mg. Unfortunately, this dosage has produced effects similar to those experienced with higher doses of ketamine: a sensation of heaviness, a desire to isolate in bed, and subsequent mental fuzziness and reduced focus. These outcomes have left me questioning whether this response is typical among other patients. I am also uncertain whether persistence with this treatment could yield improved outcomes over time. For context, I consulted with my primary psychiatric provider before starting Joyous. While she approved my trial of this treatment, her office does not prescribe ketamine. They do, however, offer Spravato sessions, though she did not specifically recommend that option. I would appreciate insights from others with similar experiences or guidance on the potential trajectory of this treatment.

Please Listen To: Ketamine: Benefits and Risks for Depression, PTSD & Neuroplasticity from Huberman Lab Podcast.

ketamine drug interactions

Ketamine interactions with neurotransmitter systems, particularly NMDA receptors, play a critical role in its anesthetic and antidepressant effects. The therapeutic application of ketamine for depression has grown significantly over the past decades. While ketamine is commonly used as an adjunctive treatment in psychiatric conditions, its interactions with other medications remain underexplored. The following summarizes key pharmacological interactions and considerations for co-administration.

ketamine and Lexapro (Escitalopram)

The concomitant use of ketamine and escitalopram, a selective serotonin reuptake inhibitor (SSRI), may exacerbate central nervous system side effects, including dizziness, drowsiness, confusion, and impaired cognitive function. Excessive sedation and respiratory depression are potential risks. Patients should minimize alcohol consumption and avoid engaging in tasks requiring high mental alertness, such as driving, until individual tolerance is assessed.

Ketamine and Antibiotics

Certain antibiotics, particularly macrolides (e.g., erythromycin, clarithromycin), inhibit cytochrome P450 enzymes, potentially reducing ketamine clearance and increasing its sedative effects. Conversely, enzyme inducers like rifampin may enhance ketamine metabolism, lowering its efficacy. Additionally, ketamine’s NMDA receptor antagonism may interfere with pain modulation and inflammation pathways, influencing antibiotic effectiveness. Dose adjustments and close monitoring are advised when co-administering these agents.

Hydroxyzine and ketamine

The combination of ketamine and hydroxyzine may intensify central nervous system depression, manifesting as excessive sedation, dizziness, cognitive impairment, and reduced motor coordination. Special caution is warranted in elderly patients. As with other sedatives, alcohol and hazardous activities should be avoided during treatment.

Ibuprofen and ketamine

While ketamine does not directly interact with ibuprofen, co-administration requires caution when considering hemodynamic effects. Both drugs may affect cardiovascular parameters, and monitoring is recommended, particularly in patients with pre-existing hypertension or cardiovascular disease.

Bonine (Meclizine) and ketamine

The concurrent use of ketamine and meclizine, a histamine H1 antagonist, can amplify sedation, dizziness, and cognitive dysfunction. Elderly individuals are particularly susceptible. Patients should limit alcohol consumption and avoid activities requiring heightened alertness until their response to the combination is established.

Benadryl (Diphenhydramine) and ketamine

Ketamine and diphenhydramine co-administration may lead to augmented sedative effects, including drowsiness, confusion, and respiratory depression. As with other sedative combinations, avoiding alcohol and tasks requiring significant mental or physical coordination is recommended.

Ketamine and Benzodiazepines

Benzodiazepines such as lorazepam, clonazepam (klonopin) and diazepam may enhance ketamine’s sedative and respiratory depressant effects. Furthermore, benzodiazepines may attenuate ketamine’s antidepressant efficacy. Some benzodiazepines also inhibit CYP3A4 enzymes, which could alter ketamine metabolism. Careful dose titration and monitoring are essential to balance therapeutic benefits and risks.

Ketamine and ssri interaction

Ketamine’s rapid antidepressant action, mediated through NMDA receptor antagonism, may synergize with SSRIs like escitalopram to enhance antidepressant effects. However, this combination poses risks of heightened blood pressure and serotonin syndrome, a potentially life-threatening condition linked to excessive serotonergic activity. Controlled studies and personalized assessments are critical before clinical application.

Given ketamine’s complex pharmacokinetics and interactions, clinicians should evaluate each patient’s medication profile, including prescription drugs, over-the-counter medications, vitamins, and herbal supplements. Tailored dosing, vigilant monitoring, and patient education are essential to mitigate risks and optimize therapeutic outcomes. Always consult a healthcare professional before initiating, discontinuing, or adjusting treatment regimens. (11,12,13,14,15,16,17)

Iv ketamine drug interactions

Intravenous (IV) ketamine infusion therapy is currently being employed as a treatment for individuals with drug-resistant depression. Although its use is considered “off-label” due to the absence of FDA approval as a generic medication, both patients and researchers have reported promising outcomes. The primary concerns associated with ketamine arise from its overuse and misuse as a recreational substance. However, when administered in controlled doses under medical supervision, IV ketamine infusion therapy demonstrates relative safety and efficacy in managing depressive symptoms.

This medicine may interact with the following medications:

aminophylline
antihistamines for allergy, cough, and cold
certain medicines for anxiety or sleep
certain medicines for blood pressure, heart disease, irregular heartbeat
certain medicines for depression like amitriptyline, fluoxetine, sertraline
certain medicines for seizures like phenobarbital, primidone
medicines that relax muscles for surgery
narcotic medicines for pain
other general anesthetics like isoflurane, propofol
phenothiazines like chlorpromazine, mesoridazine, prochlorperazine, thioridazine
theophylline

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

Conclusion

Recent studies have explored the use of ketamine for ADHD treatment, showing promising results in reducing symptoms of inattention and hyperactivity. The investigation into the potential impact of ketamine on Attention-Deficit/Hyperactivity Disorder (ADHD) highlights a complex relationship between the two. Current research suggests that ketamine, a dissociative anesthetic and N-methyl-D-aspartate (NMDA) receptor antagonist, may have both therapeutic and adverse effects on individuals with ADHD. While some studies indicate that ketamine may provide temporary relief from symptoms such as impulsivity and hyperactivity, its long-term effects remain uncertain and warrant further investigation. Additionally, concerns regarding potential side effects, such as cognitive impairment and dependency, underscore the need for careful consideration before its use in ADHD management. Therefore, more comprehensive clinical trials are essential to fully understand the implications of ketamine administration for individuals with ADHD, ensuring both efficacy and safety.

Frequently Asked Questions

Frequently Asked Questions about ketamine and ADHD.

Is ketamine right for me/my child?

Ketamine is recommended for patients suffering from major depression, suicidal ideation, anxiety, PTSD, and chronic pain, who have tried other treatments.

Can you take ketamine with antidepressants?

Broadly, there seems to be no significant adverse interactions between ketamine and regularly prescribed antidepressants, with the exception of a few. Some psychiatrists believe that combining ketamine with certain antidepressant medications can be done safely, with careful monitoring.

Can I take ibuprofen before ketamine?

Both ketamine and phenylephrine can increase blood pressure and heart rate, and combining them may enhance these effects. Talk to your doctor before using these medications, especially if you have a history of high blood pressure or heart disease.

Does Xanax help ADHD?

It is prescribed for the treatment of attention-deficit/hyperactivity disorder (ADHD), as well as the sleep disorder narcolepsy. When used as directed in people with ADHD, users may feel more focused and able to concentrate more than they normally would, while experiencing relief from hyperactivity and restlessness.

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