The Revolutionary Ketamine - Chapter 2 excerpt
Ketamine and Autism Spectrum Disorder
The autism spectrum, also called autism spectrum disorders (ASD), is an array of psychological conditions characterized by abnormalities of social interactions and communication, as well as severely restricted interests and repetitive behavior. Some researchers predict that half of all kids could be diagnosed with ASD by 2025 (Seneff). Nearly fifty percent of children with ASD have anxiety disorder and depression. The journey from suicidal ideations to suicidal behaviors is a circuitous road for people with ASD, and they have unique risk factors compared with the general population. As reported by the CDC, the rate of ASD has skyrocketed from 1 in 150 in 2000 to 1 in 44 in 2018. Even more, suicidality is under-appreciated in children with ASD (Ignaszewski), who are twice as likely to report suicidal thoughts (Rybczynski). A 2014 Lancet study reported that 66 percent reported suicidal ideations (Cassidy). The culmination of these factors unfortunately results in the children being institutionalized. And consider that thousands of parents and caretakers must care for these children; over seventy-five percent of caretakers become depressed.
Psychedelics as therapies for autism has a documented history however, little work has directly investigated the role ketamine in easing autism behaviors and improving their outlook. About a dozen small studies conducted from the late 1950s to the 1970s tested psychedelic compounds — mainly LSD and psilocybin in autistic children and adolescents (Danforth). To understand whether and how psychedelic compounds could potentially be used to treat autism, researchers must carefully delineate the underlying biology.
Ketamine has the potential to help with the many conditions present in patients with ASD. The drug has an excellent safety record, and is regularly given to children with ASD before surgery. One study gave intranasal ketamine to twenty-one patients with ASD and found no significant impact on clinical tests, but the ketamine was well tolerated.
One area where ketamine could help with ASD is regulating N-Methyl-D-Aspartate (NMDA) receptors in the brain; it is well-known that humans with ASD have NMDA receptor dysfunction, thus opening up the possibility for drugs like ketamine which affect the NMDA receptors (Lee). One such study along these lines found that ketamine restored thalamic pre-frontal cortex (PFC) connectivity in a mouse model of ASD (Hughes).
Activity-dependent neuroprotective protein (ADNP) syndrome is a rare genetic cause of ASD. Ketamine was given to children with ADNP in a pilot study, producing positive results. This supports continuing the ketamine clinical development program in ADNP syndrome and identifies functional endpoints for such a program (Kolvzon).
Case Report: A 60-year-old male veterinarian with a history of ASD, major depressive disorder, and suicidality benefited from ketamine. Like many with ASD, he had been treated with multiple psychotropic medications, was admitted to inpatient care several times, and had suicide attempts. He chronically suffered from decreased social functioning, repetitive behavior, sensory hypersensitivity, anxiety, low mood, anhedonia, lack of energy, and suicidality. Despite intensive treatment with therapy and medications, he remained impaired and could not return to work. After taking ketamine, he reported that his depressive and suicidal complaints had disappeared, and his autism-related complaints had diminished. This case - together with previous clinical research - suggests that ketamine is likely to be effective against depression and suicidality and that ketamine is potentially effective against autism-related symptoms.
Recent interest has increased in treating children with ASD using ketamine and other psychedelics. The mechanism of action of ketamine closely overlaps with the theory of ASD as a disorder of synaptic communication and neuronal networks (Wink). A small trial published in 2018 yielded some promising results. Eight autistic adults with low support needs took the psychedelic MDMA, and four took a placebo during two eight-hour psychotherapy sessions about a month apart. All the participants then attended three more psychotherapy sessions. Those who had taken MDMA experienced a marked reduction in social anxiety, as measured by a clinician-administered social anxiety scale — an effect that lasted at least several months. Afterward, the four people who had received the placebo were offered — and accepted — the option to take MDMA (Danforth).
Individual differences in people’s biological responses to psychedelics may also be revealing. McAlonan and her colleagues are working to enroll 40 autistic individuals whose autism has no known genetic cause, plus 30 non-autistic people, to study how small doses of psilocybin affect brain circuitry and responses to sensory stimuli. She says that, “looking closely at the underlying biology can begin to identify patterns in these drugs and that there will be a difference in response to psilocybin in people with and without autism.”
Many companies are actively exploring psychedelics for conditions that frequently co-occur in people with autism. Though psychedelics may not work for everyone, they may be a step forward and provide optimism where, for now, little exists.
Psychedelics have inspired new hope for treating many conditions, as they seem to be unlike any treatments currently available. You might be wondering how ketamine and other psychedelics can treat these conditions. In short, psychedelic medications have long been used to treat mental diseases.
Their benefits can be broken down into four effects:
1. Psychedelics produce a safe environment through enhanced fear extinction, and they go to the root of the psychological trauma. Whether from childhood, war, or whatever, psychedelics subconsciously bring up repressed traumas and allow the person to work and confront them in a safe, nurturing environment.
2. Psychedelics provide an anti-addictive benefit. Ketamine treats addiction to alcohol, cocaine, and opioids, along with psychotherapy, which is KAP.
3. Psychedelics belong to a class of compounds known as psychoplastogens, which promote structural and functional neuroplasticity in the brain, creating new neural pathways (Vargas).
4. Finally, psychedelics bring a spiritual connection or a reconnection. Many of these effects are present long after taking psychedelics, and science has difficulty explaining this phenomenon. A spiritual connection helps some feel like a higher power put them on this earth and that we are all connected. It helps us realize that grass, animals, and the ecosystem are alive. Acceptance begins with allowing things to be as they are, with nothing to do with complacency or resignation. Psychedelics help now, and things cannot be other than how they are—accepting the difficulty of the situation; or decreasing the resistance to accepting the situation. Psychedelics help you feel like you have a place to belong again, which answers many societal issues.
References can all be found in The Revolutionary Ketamine book