Guess What Ketamine Does To Your Bladder

If you guessed “nothing good”, then you got that part right, but it can be rather more dramatic than you might think:

The problem with ketamine is mostly not the ketamine

Ketamine has its benefits. Its an anaesthetic, and thus a pain relief drug, and it has its uses against depression too.

It’s not without its controversies: A ketamine nasal spray will be subsidised for treatment-resistant depression. Here’s what you need to know about Spravato

And even Elon Musk, the emerald mine heir, has an opinion: Elon Musk says ketamine can get you out of a “negative frame of mind”. What does the research say?

But, there are problems.

An immediate issue, which isn’t usually too much of a problem for most people, is the common spike in blood pressure, about 40 minutes after taking it.

You can read about that here: Blood pressure changes during ketamine infusion for the treatment of depression

But if that doesn’t happen or comes and goes without incident, and the other common side effects are minor or absent, for example:

❝Forty-four of 120 side effects occurred in at least 5% of participants over all trials. Thirty-three of these 44 side effects were significantly associated with active drug administration (versus placebo).

The most common side effect was feeling strange/weird/loopy. Most side effects peaked within an hour of ketamine administration and resolved completely by two hours post-infusion.

No serious drug-related adverse events or increased ketamine craving/abuse post-administration were observed.❞

Read in full: Comprehensive assessment of side effects associated with a single dose of ketamine in treatment-resistant depression

…then we get to the promised stage of “the problem with ketamine is mostly not the ketamine”.

The esketamine escalation

Ok, it’s not just esketamine, it’s ketamine in general (there are right- and left-handed ketamine molecules, the latter are called “esketamine”), but we can’t resist a good alliteration.

But yes, it escalates quickly: ketamine tolerance develops not quite immediately but very promptly after a few uses, meaning frequent users often need much higher doses than one-off users to achieve the same effects, increasing the risk of harm.

See: Repeated ketamine administration alters N-methyl-d-aspartic acid receptor subunit gene expression

As to the nature of that harm, the problem is indirect: when ketamine is metabolized, it’s broken down into toxic by-products that are excreted in urine, where prolonged contact irritates and damages the urinary tract, with the bladder affected first because it holds urine the longest, so its presence there finds it killing bladder cells and breaking down the protective lining, which makes the bladder leaky, overly sensitive, painful, and overactive.

Thereafter, damage can spread from the bladder to the ureters and kidneys, causing bladder shrinkage and stiffness, narrowed and bent ureters (which is not fun), and backed-up urine in the kidneys (very not fun).

For this reason, ketamine overuse can cause the array of symptoms you might be able to guess: frequent urination, nighttime urination, sudden urgency, leakage, bladder or lower back pain, inflammation, and blood in the urine, with symptoms that can be severe and sometimes permanent.

By the numbers: The epidemiology and patterns of acute and chronic toxicity associated with recreational ketamine use

Progression goes as follows:

• Stage one: early inflammation of the bladder can often be reversed by stopping ketamine use and using medications such as anti-inflammatory drugs, pain relievers, and drugs that reduce urgency and help the bladder lining heal.
• Stage two: as the bladder shrinks or stiffens, treatment may include medication, bladder washes delivered by catheter to restore the protective lining, and botulinum toxin injections to relax the bladder and reduce pain and urgency, with stopping ketamine still essential.
• Stage three: permanent injury to the bladder and kidneys can lead to kidney failure, requiring dialysis or surgery to manage kidney function and repair the urinary system.

You can learn more about that, here: British Association of Urological Surgeons Consensus statements on the management of ketamine uropathy

In short: ketamine, for all its strengths in some regards, is probably not a good long-term solution to anything.

Even if you’re willing to let your bladder pay the price, you really do need your kidneys working correctly!

Want to learn more?

You might like to check out:

• Overactive Bladder? How’s Your Magnesium Depletion Score?
• Foods Linked To Urinary Incontinence In Middle-Age (& Foods That Avert It)

And about your kidneys:

• Keeping Your Kidneys Healthy (Especially After 60) ← it’s about much more than just hydration!
• Are Your Kidneys Ok? Detect Early To Protect Kidney Health (Here’s How)

Take care!