Dissociative

Dissociatives are a subclass of hallucinogens which distort perception of sight and sound and produce feelings of detachment – dissociation – from the environment and/or self. Although many kinds of drugs are capable of such action, dissociatives are unique in that they do so in such a way that they produce hallucinogenic effects, which may include dissociation, a general decrease in sensory experience, hallucinations, dream-like states or anesthesia.[1] Some of these substances, which are nonselective in action and affect the dopamine[2] and/or opioid[3] systems, may be capable of inducing euphoria or symptoms which are more akin to the effects of certain “hard drugs” or common drugs of abuse. This is likely why dissociatives are considered to be addictive with a fair to moderate potential for abuse, unlike psychedelics. Despite some dissociatives, such as phencyclidine (PCP) possessing stimulating properties, most dissociatives seem to have a general depressant effect and can produce sedation, respiratory depression, nausea, disorientation, analgesia, anesthesia, ataxia, cognitive and memory impairment as well as amnesia.

Effects

The effects of dissociatives can include sensory dissociation, hallucinations, mania, catalepsy, analgesia and amnesia.[4][5][6] According to Pender (1972), "the state has been designated as dissociative anesthesia since the patient truly seems disassociated from his environment."[7] Both Pender (1970) and Johnstone et al. (1959) reported that patients under anaesthesia due to either ketamine or phencyclidine were prone to purposeless movements and had hallucinations (or "dreams"[8]) during and after anaesthesia. Some patients found the hallucinations euphoric while others found them disturbing.

At sub-anesthetic doses, dissociatives alter many of the same cognitive and perceptual processes affected by other hallucinogenic drugs such as mescaline, LSD, and psilocybin; hence they are often contrasted and also considered hallucinogenic.[9][10][11] Perhaps the most significant subjective differences between dissociatives and the classical hallucinogens (such as LSD and mescaline) are the detaching effects, including: depersonalization, the feeling of being unreal, disconnected from one's self, or unable to control one's actions; and derealization, the feeling that the outside world is unreal or that one is dreaming.[12]

Use

Medical use

Many dissociatives such as ketamine are used as anesthetics for surgery or pain relief in medical contexts such as in hospitals. However, due to possible psychotomimetic reactions they are sometimes used reluctantly.[13][14] Certain morphinan dissociatives such as Dextromethorphan are also used in sub-psychoactive dosages to suppress coughing.[15]

Ketamine is also currently being studied and is showing promising results as a possible fast-acting antidepressant[16][17] It may also function as a possible palliative treatment for C-PTSD and chronic pain.[18]

Recreational use

Some dissociative drugs are used recreationally. Ketamine and nitrous oxide are club drugs. Phencyclidine (PCP or angel dust) is available as a street drug. Dextromethorphan-based cough syrups (often labeled DXM) are taken by some users in higher than medically recommended levels for their dissociative effects. Historically, chloroform and diethyl ether have been used recreationally (as was nitrous oxide, at laughing gas parties).

See also

References
  1. Snyder, Solomon H. (1980). "Phencyclidine". Nature. 285 (5764): 355–6. Bibcode:1980Natur.285..355S. doi:10.1038/285355a0. PMID 7189825.
  2. Giannini, AJ; Eighan, MS; Loiselle, RH; Giannini, MC (1984). "Comparison of haloperidol and chlorpromazine in the treatment of phencyclidine psychosis". Journal of Clinical Pharmacology. 24 (4): 202–4. doi:10.1002/j.1552-4604.1984.tb01831.x. PMID 6725621. S2CID 42278510.
  3. Giannini, A. James; Nageotte, Catherine; Loiselle, Robert H.; Malone, Donald A.; Price, William A. (1984). "Comparison of Chlorpromazine, Haloperidol and Pimozide in the Treatment of Phencyclidine Psychosis: Da-2 Receptor Specificity". Clinical Toxicology. 22 (6): 573–9. doi:10.3109/15563658408992586. PMID 6535849.
  4. Pender, John W. (1970). "Dissociative Anesthesia". California Medicine. 113 (5): 73. PMC 1501800. PMID 18730444.
  5. Johnstone, M.; Evans, V.; Baigel, S. (1959). "Sernyl (C1-395) in Clinical Anaesthesia". British Journal of Anaesthesia. 31 (10): 433–9. doi:10.1093/bja/31.10.433. PMID 14407580.
  6. Oduntan, S. A.; Gool, R. Y. (1970). "Clinical trial of ketamine (ci-581): A preliminary report". Canadian Anaesthetists' Society Journal. 17 (4): 411–6. doi:10.1007/BF03004705. PMID 5429682.
  7. Pender, John W. (October 1972). "Dissociative Anesthesia". California Medicine. 117 (4): 46–7. PMC 1518731. PMID 18730832.
  8. Virtue, RW; Alanis, JM; Mori, M; Lafargue, RT; Vogel, JH; Metcalf, DR (1967). "An anaesthetic agent: 2-orthochlorophenyl, 2-methylamino cyclohexanone HCl (CI-581)". Anesthesiology. 28 (5): 823–33. doi:10.1097/00000542-196709000-00008. PMID 6035012. S2CID 34414786.
  9. Mason, Oliver J.; Morgan, Celia J.M.; Stefanovic, Ana; Curran, H Valerie (2008). "The Psychotomimetic States Inventory (PSI): Measuring psychotic-type experiences from ketamine and cannabis". Schizophrenia Research. 103 (1–3): 138–42. doi:10.1016/j.schres.2008.02.020. PMID 18387788. S2CID 807162.
  10. Gouzoulis-Mayfrank, E.; Heekeren, K.; Neukirch, A.; Stoll, M.; Stock, C.; Obradovic, M.; Kovar, K.-A. (2005). "Psychological Effects of (S)-Ketamine and N,N-Dimethyltryptamine (DMT): A Double-Blind, Cross-Over Study in Healthy Volunteers". Pharmacopsychiatry. 38 (6): 301–11. doi:10.1055/s-2005-916185. PMID 16342002.
  11. Krupitsky, EM; Grinenko, AY (1997). "Ketamine psychedelic therapy (KPT): a review of the results of ten years of research". Journal of Psychoactive Drugs. 29 (2): 165–83. doi:10.1080/02791072.1997.10400185. PMID 9250944. Archived from the original on 2010-08-19. Retrieved 2010-10-25.
  12. Vollenweider, F; Geyer, MA (2001). "A systems model of altered consciousness: integrating natural and drug-induced psychoses". Brain Research Bulletin. 56 (5): 495–507. doi:10.1016/S0361-9230(01)00646-3. PMID 11750795. S2CID 230298.
  13. Adams HA (December 1997). "[S-(+)-ketamine. Circulatory interactions during total intravenous anesthesia and analgesia-sedation]" [S-(+)-ketamine. Circulatory interactions during total intravenous anesthesia and analgesia-sedation]. Der Anaesthesist (in German). 46 (12): 1081–7. doi:10.1007/s001010050510. PMID 9451493.
  14. Barrett W, Buxhoeveden M, Dhillon S (October 2020). "Ketamine: a versatile tool for anesthesia and analgesia". Current Opinion in Anesthesiology. 33 (5): 633–638. doi:10.1097/ACO.0000000000000916. PMID 32826629. S2CID 221236545.
  15. Rossi, S, ed. (2013). Australian Medicines Handbook. Adelaide: The Australian Medicines Handbook Unit Trust. ISBN 978-0-9805790-9-3.
  16. Sanacora G, Frye MA, McDonald W, Mathew SJ, Turner MS, Schatzberg AF, et al. (April 2017). "A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders". JAMA Psychiatry. 74 (4): 399–405. doi:10.1001/jamapsychiatry.2017.0080. PMID 28249076. S2CID 28320520.
  17. Marcantoni WS, Akoumba BS, Wassef M, Mayrand J, Lai H, Richard-Devantoy S, Beauchamp S (December 2020). "A systematic review and meta-analysis of the efficacy of intravenous ketamine infusion for treatment resistant depression: January 2009 - January 2019". J Affect Disord. 277: 831–841. doi:10.1016/j.jad.2020.09.007. PMID 33065824. S2CID 223557698.
  18. Duman, Ronald S. (24 May 2018). "Ketamine and rapid-acting antidepressants: a new era in the battle against depression and suicide". F1000Research. 7: 659. doi:10.12688/f1000research.14344.1. PMC 5968361. PMID 29899972.
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