Is Ketamine Neurotoxic?
155 comments
·February 24, 2025floppiplopp
blitzar
On the plus side it appears to reverse the effects of balding.
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cactusplant7374
Not if you look at the evidence.
amelius
Been seeing a lot of these in the news lately.
croisillon
[flagged]
LiKao
Don't forget really bad jokes, such as making your product line spell out se*y and naming stuff after memes.
matthewdgreen
Bring back dorky middle-school sense of humor Musk. I’m fine with S*XY and fart mode and even flamethrowers. If you can find a history of Musk headlines through the years you see that almost everything before 2018 is just dorky engineer stuff and jokes, and then post-2018 it’s mean and destructive.
askl
> such as making your product line spell out se*y
Especially with exterior designs ranging between boring and ugly.
rsynnott
> roman salutes
It's worth noting that the Romans never did this. There was a fairly brief period in the 19th century where it was kind of a pop-culture Roman thing (it showed up in plays about Ancient Rome, that sort of thing), and then it was adopted by various nationalist groups, including the Italian fascists, and, ultimately, the Nazis.
Unless you're a theatre fan who's been in a coma for the last 150 years, though, it's a fascist (or Nazi) salute; the use of the 'roman salute' term is (potentially accidental; I think maybe some people do think it was a real thing) sanewashing.
mckirk
TIL about the term 'sanewashing'; thanks, I'll definitely use that.
In exchange, I offer a cool word I learned yesterday: The Broligarchs.
cogman10
> the use of the 'roman salute' term is (potentially accidental; I think maybe some people do think it was a real thing) sanewashing.
It's used because YouTube and tiktok will demonetized you for saying Nazi.
TikTok, in particular, has pretty aggressive live stream killing policies. It's lead to weird things like streamers saying "grape" for "rape" and "unalive" for "kill".
ErikBjare
The Bellamy salute on the other hand was actually used to accompany the US Pledge of Allegiance 1892-1942: https://en.wikipedia.org/wiki/Bellamy_salute
colanderman
Please don't use "autistic" as a slur.
goodpoint
s/autistic roman/nazi/
drawkward
It was a nazi salute.
>Later, during the 1920s and 1930s, Italian fascists and Nazi Germans adopted a salute which was very similar, which they attributed to the so-called Roman salute, a gesture that is wrongly thought to have been used in ancient Rome. This resulted in controversy over the use of the Bellamy salute in the United States. It was officially replaced by the hand-over-heart salute when Congress amended the Flag Code on December 22, 1942.
In other words, when people decided "fuck that, I don't want to look like a Nazi" they did something different.
There is no plausible deniability; it was a nazi salute.
bjoli
And Elon has had enough media exposure and training to know how it would be perceived. He knew what he was doing. We know what he was doing. He knows we know what he was doing.
Twitter guy had lost his cred with all his nazi twitter followers (the ones he retweets from time to time when they have spent enough time licking his behind) after the H1B visa kerfuffle. They were all thrilled he was heiling away on the national stage.
The amount of cowardice in US politics is astounding. And I don't mean the republican part, because to be a coward with regards to beliefs you must actually believe something.
stronglikedan
It's amazing to me that there are people that unironically believe this. But I guess record low viewership of MSM propaganda is still a non-zero amount of viewership.
reneberlin
Well said. On the other side it's very sad and true, that the consequences can be global in special individual cases.
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gyanchawdhary
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H8crilA
Regardless of the answer to the question posed here keep in mind that high powered psychiatric interventions can be very effective, even if they don't last forever. Whether it's ketamine or electroconvulsive therapy - it's certainly better than suicide. At least promise yourself to try such things first (in a hospital setting! yes they have those in hospitals in developed countries) before you make the conclusion that your life has become too painful to live it.
PS. there are many other treatments that doctors may give you before reaching for the big guns; those can be very effective too.
gehwartzen
>PS. there are many other treatments that doctors will give you before reaching for the big guns; those can be very effective too.
This part can sometimes be difficult if you are in crisis. There’s lots of other options like you mention but they tend to take longer to see an effect. Ketamine can be very immediate in that regard. I remember it being like a light switch and thinking “wow this is how others must feel!”. And just seeing, even once, that it is at least chemically possible for your own brain to work/think like that can be very inspiring and hopeful esp when it feels like it hadn’t been worked correctly for a long time (or ever)
pixelpoet
The DeepMind researcher's letter elsewhere in this thread suggests to me that ECT is infinitely worse than suicide.
H8crilA
I don't think he really blames ECT for what has happened to him. It's more like "ECT didn't fix it either", which is a possibility - ECT isn't a guaranteed cure. For example:
> They [the NHS] couldn’t prevent this. Hundreds of hours of therapy couldn’t prevent this. A large network of friends and family checking in with me constantly over the last year didn’t prevent this. Psychiatric hospitals certainly couldn’t prevent this. ECT couldn’t prevent this. The only person who could have prevented this was me.
And the memory loss he's talking about (which is indeed a common side effect of ECT) doesn't seem to be as severe as he claims to be. For one he is actually able to recall the events of his life well enough to write this letter. For another he has abused ketamine to the point of having a month long psychosis episode that ended in involuntary stay in a mental hospital, which could have had its own effects. For yet another depression itself slowly erases memories.
colanderman
Someone close to me did ECT for half a year after ketamine (in a clinical setting) became less effective.
The memory loss was worse than they were led to believe: near-dementia levels of short-term memory loss during treatment, and still now a year of missing memories from around the time of treatment.
The treatment itself left them without time or energy to do anything whatsoever on the days of treatment, and still weakened on the days off treatment.
And, it did seemingly nothing to address their depression.
So, YMMV.
Aurornis
When it comes to anything depression related, you should never rely on anecdotes alone.
The world is a big place. Many people have tried depression treatments. You can always find someone who had a very negative experience with something.
For a counter-anecdote: I know someone whose mother was deeply suicidal and unable to function for years. Eventually they tried ECT and it was the turning point in her depression. This was decades ago and she’s still doing okay today.
Do not let internet anecdotes steer depression treatment. ECT is an extreme example. I’ve seen countless people who avoided any depression medications for years because the internet told them SSRIs were evil drugs, only to experience life changing results for the better when they finally listened to their doctor and accepted treatment.
thirdtruck
Similar to xe and ADHD meds. Didn't even get xir ADHD diagnosis until xir late thirties even though the signs were there in xir childhood. There was wisdom in avoiding the adult-dose meds being mis-prescribed back then but there were so many other interventions (not to mention the incredible value of simple awareness that one isn't "lazy" or "undisciplined") that would have done xe worlds of good in the interim.
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throwaway4373
[dead]
d1sxeyes
> However, the average ketamine “user” consumes 500-1000mg of ketamine per day, which is 100-300x as much as therapeutic use (0.5mg/kg)
For users weighing one kilo. For users of a more normal weight, you’re off by an order of magnitude.
pantalaimon
Ketamine Georg, who consumes 420 kg of Ketamine per day, is an outlier and should not be counted.
rob74
You can (try to) consume 420 kg of Ketamine one day, but you surely won't be able to repeat it the next day...
daeken
The author clarifies later that the listed therapeutic dosage is weekly rather than daily, so that's 3500-7000mg/week versus 35mg/week for an average person (from a quick Google, 70kg).
Not sure where the 300x is coming from, since that's an average body weight.
d1sxeyes
Yeah, I'm not sure that 'weekly' is true either, most of the research I've done says 0.5mg/kg is a single 'dose', rather than anything timebound. A lot of the protocols seem to indicate that twice weekly is the most common dosing, but it depends on the usage:
https://www.drugs.com/dosage/ketamine.html says 1-4.5mg/kg for anaesthesia, with more as needed to maintain
https://reference.medscape.com/drug/ketalar-ketamine-343099 says 0.5mg/kg for depression off label, repeated twice weekly.
https://dancesafe.org/ketamine/#:~:text=30-60%20mg says that the common recreational dose is 30-60mg, so the number mentioned by the author is between 50 and 250 'bumps' a week? I'm not familiar with ketamine usage, but that seems to be a very high number.
GordonS
ROA (route of administration) also matters, and those figures you've given appear to be a mix of IV (intravenous) and IM (intramuscular) injection doses.
Many recreational users insulate (snort) ketamine, and that ROA has much lower bioavailability than IM or IV - IIRC, it's something like 20% for insulation, 80% for IM, and 100% for IV. Thus, you need a much higher dose for snorting.
pantalaimon
1g/day is a pretty extreme dose, even disregarding that most users don't consume it daily.
quchen
It is however not unheard of, or even uncommon. With moderate tolerance, binging a couple of hours will reach the 1g threshold quite quickly.
Ketamine tolerance upon continued use can reach some really wild levels. I’ve worked with people who reported that a 1g single dose nasally won’t get them properly high.
Aurornis
There are many things wrong with the claim, but even the math doesn’t make sense.
0.5mg/kg for a 70kg person would be 35mg, which is not 100-300X less than the 500-1000mg number.
The claim isn’t even close to mathematically correct. It’s also easy to find clinics giving IV or IM doses at significantly higher rates.
This entire article does not leave a good impression, to be honest. It feels like the author started with one conclusion and then made assumptions to fill in the blanks to write the article.
wizzwizz4
That's a therapeutic dose for users weighing one to two tonnes. I don't think they're off by any orders of magnitude.
cactusplant7374
They are confusing oral vs. IV. There are different amounts of ketamine used for different ROA's. Typical dose for prescribed lozenges is 200-250mg.
superb-owl
> However, the average ketamine “user” consumes 500-1000mg of ketamine per day
This is an outrageous claim with no citation. I'm a regular user, and this is roughly what I consume per month, if I'm going hard
sweezyjeezy
Definitely on the high side, but I'm guessing they mean "chronic abusers" rather than just "user". The serious ketamine addicts I've known took the drug every single day, and at multiple points during the day, and I don't think that figure seems crazy (a single line can be 200mg+).
And I know: I can't imagine it either - absolutely one of the worst things I can think of to get addicted to.
siva7
It feels like a low-quality article in which the author is writing about a scientific topic but has no qualifications or expert knowledge (and therefore making wrong conclusions due to their lack of understanding around the research they cite). I don't understand why people feel the need to publish such blogs.
plsbenice34
Agreed. It's an absurd dose assumption. According to Erowid, a common dose is 30 mg to 75 mg.
I spent some time reading papers about ketamine before, and it seemed that all the negative side-effects (like bladder damage) are only ever observed in extreme cases where someone takes massive, abnormal doses for an extended period of time. I think it is not relevant to the vast majority of recreational users.
__MatrixMan__
I once did 75mg in a session and left with the feeling that that was way too much. I can't fathom 500.
MavisBacon
It's also worth noting that ketamine does appear to increase neural plasticity and can promote the formation of new synaptic connections (synaptogenesis), particularly in areas of the brain involved in mood regulation.
That being said, I too have experienced tolerance with ketamine infusions- even with a month between doses. Always found it a bit troubling and I'd rather not have to continue to increase the dose.
redrove
It would certainly explain Musk appearing to grow dumber.
ZeroGravitas
South Africa phased lead out of petrol in January 2006.
jeltz
Is it actually known if he regularly uses ketamine? I have seen lot of claims but never any source.
actionfromafar
https://www.youtube.com/watch?v=NH4_rcq4jgQ Bloomberg
https://www.youtube.com/watch?v=SC2Z0mb1W2A interview
But I'm sure he uses in moderation, he's a very balanced and stable guy. Definitely not enough to cause bladder issues.
mexicocitinluez
> But I'm sure he uses in moderation, he's a very balanced and stable guy.
This is a joke, right?
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rsynnott
I mean, it's possible he's lying about it for street cred?
But he has claimed to take it: https://www.cnn.com/2024/03/18/tech/elon-musk-ketamine-use-d...
flir
He's claimed a lot of things. Pick pretty much any neurodivergency, and it seems like you can find an interview where Musk claimed he hasn't been diagnosed, but he's totally got it.
Except hypochondria, obviously.
I don't think it's productive to try and armchair-diagnose him (although it is fun). Maybe, someday, a court-appointed psychologist will give us an official answer.
bjoli
He also claimed to be top 100 diablo 4 gamer.
dartos
That’s a good point. It’d be one of the few truths he publicly states.
gyanchawdhary
[flagged]
throwaway835174
> Nonetheless, it’s widely recognized that individuals who occasionally use ketamine find they need significantly higher doses than when they first started, even after prolonged periods of abstinence.
Sorry for the slight divergence from the focus on ketamine, but more generally, does anyone know if this applies to other medications that alter the brain's function?
I've noticed the same phenomenon with the adderall I am prescribed for ADHD, and despite the tolerance buildup and the offer from my psychiatrist, I refuse to bump up the dose further due to fears of long-term changes in the brain. Honestly, I'm considering ditching it altogether after about a decade of prescription because I become more paranoid over time about unknown, long-term effects. Posts like this about ketamine don't help my suspicions.
loves_mangoes
>Sorry for the slight divergence from the focus on ketamine, but more generally, does anyone know if this applies to other medications that alter the brain's function?
Tolerance is a phemomenon where after using a drug regularly for enough time, you will eventually need higher doses to achieve the same effect. A tolerance effect exists for many classes of medication, but in this case there is something specific to Ketamine.
With Ketamine, it can (reportedly) be much harder to reverse this built-up tolerance. That's what they mean by "even after prolonged periods of abstinence". Heavy abusers of Ketamine report having stopped for several years, and finding that the tolerance comes right back the first time they use it again.
With stimulants, this tolerance goes down after a period of abstinence (e.g. switching to a n̶o̶n̶-̶s̶t̶i̶m̶u̶l̶a̶n̶t non-amphetamine ADHD medication like Metylphenidate for a few weeks is known to lower tolerance to other ADHD drugs).
I would generally not worry about tolerance to stimulants at prescribed doses. You should try to avoid taking medication you don't need, but if you need the stimulants to function, the cost/benefit of stimulant medication for ADHD is highly favorable. Even if there is a slow tolerance effect, it can be reversed.
Taking stimulants for ADHD is not dangerous like taking Ketamine for partying is dangerous. Stimulants have the highest efficacy of any known drug in psychiatry. The medical interventions with the lowest NNT are things like insulin for diabetus, or not very far down, stimulants for ADHD. It's more than fine.
iroddis
Methylphenidate is a stimulant medication [0]. Maybe you meant something else, like atomoxetine?
[0] https://en.wikipedia.org/wiki/Methylphenidate?wprov=sfti1#
loves_mangoes
You're right, of course. There is a difference between methylphenidate and other amphetamine-class stimulants for ADHD, but I didn't know what to call it.
I should have said it's not a direct agonist. Instead of directly causing dopamine release, it acts as an allosteric modulator on DAT to affect reuptake.
I had a study in mind that found switching to MPH was effective at lowering the equivalent dose (the tolerance did not carry over), but my Googling is failing me right now. Appreciate the correction.
janejeon
When it comes to things like this, as cliche as it may sound, your best bet is to probably bring up those fears with your psychiatrist to evaluate the pros/cons with them.
Like most things, there is most likely a tradeoff - but your doctor also most likely prescribed the dosages based on the pros outweighing the cons, but only you can bring up how you feel about specific cons to the doctor.
ykonstant
In general you should listen to your doctor for these things; if they say that an increase in dosage is recommended, listen to them. Although I am not very sure about the word "offer". What do you mean "offer" from your psychiatrist?
If you are worried about long term effects of stimulant medication (which is a very valid worry), you may want to ask your doctor for an intermittent schedule. Sadly, as we know, many of us need the medication to function reasonably in daily life. However, if you are building tolerance to the medication, it is probably worth it.
ycombinete
I looked into this a while back, and found some reviews from some branch of the Canadian health authorities, that said that euphoric effect of methylphenidate fades more with tolerance than the therapeutic effect.
So you will still be getting some adhd related benefits from it, even if you're not feeling that little rush that you felt when you first started taking it.
Like the other commentator, I do like to skip some days occasionally (mostly on weekends). I usually see on day 1 that I was most definitely getting some benefit from it the day before, even when it didn't feel like it.
colechristensen
If you give it a break the adderall tolerance goes away. It’s good to regularly skip days. Ketamine abuse is particularly dangerous compared to so many things, particularly amphetamines taken at therapeutic doses which is safe to the level of no particularly clear long term effects.
Muromec
>because I become more paranoid over time about unknown, long-term effects.
Being paranoid sounds about the right time to bump the dose to what your doc suggests.
zug_zug
I'm finding this draft article pretty confusing, and am not sure why it's shared in its current state. I think it should also cite sources.
> "However, the average ketamine “user” consumes 500-1000mg
My impression was that the majority who try ketamine do it a handful of times in their whole lives, usually <200mg.
rsynnott
They almost certainly mean habitual user.
mallomarmeasle
For anyone interested in the therapeutic (or otherwise) use of ketamine, I strongly recommend the autobiography of John Lilly, the neuroscientist who developed the sensory deprivation tank. His discussion of ketamine-aided spiritual entity discovery and dolphin communication are enlightening.
https://archive.org/details/scientistnovelau00lill/page/n5/m...
alecst
Regarding lesions, a recent pair of articles about Ibogaine.
rscho
Everything acting on the brain is neurotoxic at sufficient doses. However, I would be far more worried about cardiovascular effects, for which life threatening complications are much more immediate.
cactusplant7374
Ketamine is widely used and it's very difficult to find deaths. Sure, one can die by taking it and getting in a hot tub or using it with other drugs. But on its own its safety profile is better than acetaminophen.
puppycodes
not a neurologist but pretty sure your "gut feeling" isn't science.
Side effect include illusions of grandeur, hubris, megalomania, the desire to destroy everything others build, and unsolicitously offering your spooge to the ladies.