Yes, Chronic Ketamine Use CAN Cause Bladder Issues… Among Even Worse Issues

Due in part to recent reports about Matthew Perry and Elon Musk, ketamine seems to be taking up more and more space in the conversation about substance abuse.

But despite its recent spike in popularity, the medication has been around for decades. It was first approved by the Food and Drug Administration (FDA) as a surgical anesthetic in 1970s before scientists started exploring its off-label use for treatment-resistant depression in the early 2000s.

The treatment showed promise, and after a slew of research came out showing it can quickly and effectively relieve symptoms of depression, including sadness, hopelessness and irritability, many health care organizations began incorporating ketamine infusions into their treatment plans for major depressive disorder and suicide ideation. And in 2019, the FDA approved esketamine — a variation that’s administered as a nasal spray.

Now, you can access ketamine at clinics in major cities, order lozenges and pre-loaded vials from online pharmacies and even do ketamine-guided psychotherapy. While growing evidence shows that ketamine may benefit various health conditions, there’s a lot scientists are still learning about the drug — including what the long-time side effects of regular use are.

“We always take some risk by ingesting a drug, and ketamine is no different,” Dr. Boris D. Heifets, an associate professor of anesthesiology, perioperative and pain medicine at Stanford Medicine, told HuffPost.

Much of what we know about the long-term side effects has been sourced from studies investigating chronic recreational use. Less clear is how chronic clinical use of ketamine may affect our health in the long run. “We simply don’t have enough high-quality data on the risks of long-term use,” Heifets said. But here’s what we know so far:

Perhaps the most well-known complication — largely due to Musk’s alleged ketamine-driven urinary problems — is bladder damage. Dr. Christina Ni, a psychiatrist and Interventional Medical Director with Mindpath Health, says bladder issues, including a severe and urgent need to urinate, incontinence, pain when urinating and blood in the urine, are a relatively common side effect observed with chronic recreational use. “It even has a name and is known as ‘ketamine cystitis,’” she told HuffPost.

What causes this complication? According to Ni, ketamine and the products that it breaks down into are released through our urine and can therefore accumulate in the bladder. When this happens, these metabolites can inflame, irritate and damage the lining of the bladder. Over time, the bladder lining may break down and the body can enter an inflammatory state, Ni said. All that inflammation can lead to fibrosis (scarring of the bladder tissue), blood vessel damage, thinning of the bladder wall, ulcers and perforation of the bladder wall.

Long-term ketamine usage may also damage brain cells and lead to neuron death and brain shrinkage. These effects, which have been observed with repeated abuse of the drug, may affect parts of the brain involved in cognition, Ni said. As such, people who use ketamine for years may develop memory problems, problem-solving issues and a decline in cognitive function, research shows.

Those cognitive problems can also fuel mental health issues, like depression, anxiety and increased irritability. “This commonly results in worse cognitive function, concentration, focus, attention, ability to carry out tasks and problem-solve,” Ni said.

Third up on the list is liver damage. Though liver injuries are less likely to occur than cognitive issues and bladder damage, this complication is still seen in people who repeatedly use ketamine. A weakened liver may manifest as fatigue, nausea, excessive itching, jaundice, and pain where the liver is located (underneath your right rib cage), Ni said.

The reason? Chronic use can impair the liver’s ability to process, or break down, the drug, Ni said. “If the liver is overwhelmed by high doses and chronic ketamine use, it’s not able to keep up and this causes direct liver damage to liver cells,” she said. This can then set off a cascade of inflammation that may compromise your immune system. When this happens, the immune system may mistakenly attack the liver — a form of autoimmune hepatitis — and create even more liver damage. “The body recognizes that the liver is the source of inflammation, and the body does not want to be in an inflammatory state and will sometimes erroneously attack itself to ‘solve’ the inflammation problem,” Ni said.

While people are less likely to become addicted to ketamine than opioids or amphetamines, the drug does have potential for abuse, tolerance and physical dependence, according to American Addiction Centers (AAC). Some people may seek out progressively higher doses of ketamine, Heifets said, or find ways to access the drug outside of a prescriber or therapist setting.

If people who regularly use ketamine suddenly stop taking it, they may also experience withdrawal syndrome and develop depression, excessive sleepiness, and drug cravings, according to the AAC.

It’s unclear just how addictive ketamine is. Why? In many cases, ketamine isn’t a one-and-done treatment. People often need to repeat the infusions on a weekly or monthly basis to maintain the beneficial anti-depressive effects. The good news, according to Heifets, is that people tend to stay better while taking ketamine. The bad news? “It can be difficult to draw a clean line between maintenance and addiction,” he said.