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| Journal | BJPsych open |
| Study Type | Pilot Study |
| Population | Human participants |
This case report documents rapid-onset ketamine addiction following a single clinical dose, highlighting addiction risk even in controlled therapeutic settings. As ketamine therapies expand for treatment-resistant depression and suicidality, clinicians need awareness of potential addiction liability in vulnerable populations.
A 25-year-old woman with complex psychiatric comorbidities (depression, OCD, autism spectrum disorder, anorexia nervosa) and prior substance use developed ketamine addiction after receiving a single intranasal ketamine dose in a suicidality study. Despite initial improvement in suicidal ideation, she sought illicit ketamine to recreate calming effects, rapidly escalating to daily use and polysubstance abuse including cocaine and 3-MMC. This led to functional deterioration, housing instability, and suicide attempt when access was restricted. The case illustrates addiction risk even from single exposure in psychiatrically complex patients.
“This case reinforces my clinical practice of thorough substance use screening and close monitoring when considering ketamine therapy. While rare, addiction potential exists and requires structured protocols, especially in patients with multiple psychiatric comorbidities or substance use history.”
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FAQ
Can a single dose of ketamine lead to addiction?
Yes, this case report demonstrates that even a single sub-anaesthetic dose of intranasal ketamine administered in a controlled clinical setting can trigger addiction. The 25-year-old patient developed ketamine dependence after one treatment dose, subsequently seeking illicit ketamine to recreate its calming effects on intrusive thoughts.
What patient factors may increase addiction risk with ketamine treatment?
Patients with multiple psychiatric comorbidities, including depression, OCD, autism spectrum disorder, and eating disorders, may be at higher risk. A history of substance use (even sporadic alcohol and cannabis use) and complex mental health presentations should prompt careful consideration before ketamine treatment.
How quickly can ketamine addiction escalate after initial exposure?
Addiction can escalate rapidly, with this patient progressing to daily use within weeks of the initial treatment. The escalation led to severe consequences including financial distress, housing instability, polysubstance use (cocaine and 3-MMC), and a suicide attempt when access was restricted.
Should ketamine treatment be avoided in patients with suicidal ideation?
This case presents a clinical dilemma, as the patient initially experienced transient reduction in suicidal ideation but later attempted suicide when ketamine access was cut off. Clinicians must carefully weigh the potential benefits against addiction risks, particularly in psychiatrically complex patients.
What monitoring is needed when prescribing ketamine for psychiatric conditions?
Close monitoring for signs of addiction, craving behaviors, and attempts to obtain illicit ketamine is essential even after single doses. Long-term follow-up is crucial as relapse can occur even after periods of cessation, as demonstrated by this patient’s later relapse into ketamine and cocaine addiction.
