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ketamine_and_near_death_experience [2007-06-12 13:33] nikketamine_and_near_death_experience [2015-03-13 11:44] (current) nik
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 +==== Ketamine and the Near Death Experience ====
  
- +(see also http://www.near-death.com/experiences/lsd03.html ))
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-==== Ketamine and the Near Death Experience ====+
  
  
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 Much has been made of the apparent mystery surrounding the occasional ability of cardiac arrest survivors to describe the resuscitation in detail (Sabom, 1982). It is worth noting that ketamine can permit sufficient sensory input to allow accounts of procedures during which the patient appeared wholly unconscious (Siegel, 1981; Hejja and Galloon, 1975).These reports are not regarded by anaesthetists as particularly mysterious. Much has been made of the apparent mystery surrounding the occasional ability of cardiac arrest survivors to describe the resuscitation in detail (Sabom, 1982). It is worth noting that ketamine can permit sufficient sensory input to allow accounts of procedures during which the patient appeared wholly unconscious (Siegel, 1981; Hejja and Galloon, 1975).These reports are not regarded by anaesthetists as particularly mysterious.
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 the other statements are strongly supported by experimental data published in leading journals (Benveniste et al.,1984; Simon et al., 1984; Ben-Ari, 1985; King and Dingledine, 1986; Lobner and Lipton, 1990; Rothman et al., the other statements are strongly supported by experimental data published in leading journals (Benveniste et al.,1984; Simon et al., 1984; Ben-Ari, 1985; King and Dingledine, 1986; Lobner and Lipton, 1990; Rothman et al.,
  
- 1. ; Westerberg et al., 1987; Hoyer and Nitsch, 1989).+1.; Westerberg et al., 1987; Hoyer and Nitsch, 1989).
  
 Endogenous substances have been found in the brain which bind to the PCP receptor, one of which is a peptide called 'alpha-endopsychosin' (Quirion et al., 1984). However, this is a controversial area of research. We do know that ions such as magnesium and zinc can block the channel, and it may be that a flood of ions occurs rather than large molecules such as peptides. Endogenous substances have been found in the brain which bind to the PCP receptor, one of which is a peptide called 'alpha-endopsychosin' (Quirion et al., 1984). However, this is a controversial area of research. We do know that ions such as magnesium and zinc can block the channel, and it may be that a flood of ions occurs rather than large molecules such as peptides.
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- +1. Depersonalisation
- 1. Depersonalisation+
  
 The depersonalisation theory proposes that the NDE is an adaptive mechanism of the personality which alerts one to the threat of death while potentially overwhelming emotion is held at bay, allowing the reality to be integrated without panic (Greyson, 1983; Noyes and Kletti, 1976a,b). While protecting nerve cells from ischaemic damage is largely irrelevant when one is falling from a cliff, the NDE-producing situation which first resulted in this hypothesis, NMDA receptors would certainly be involved in producing the experience of depersonalisation as they play a central role in cognition and perception. The depersonalisation theory proposes that the NDE is an adaptive mechanism of the personality which alerts one to the threat of death while potentially overwhelming emotion is held at bay, allowing the reality to be integrated without panic (Greyson, 1983; Noyes and Kletti, 1976a,b). While protecting nerve cells from ischaemic damage is largely irrelevant when one is falling from a cliff, the NDE-producing situation which first resulted in this hypothesis, NMDA receptors would certainly be involved in producing the experience of depersonalisation as they play a central role in cognition and perception.
  
  
- +1. Regression in the service of the ego
- 1. Regression in the service of the ego+
  
 This theory maintains that confronting death leads to a cutting off the external world. The result is regression to a pre-verbal level which can be experienced as mystical ineffability (Greyson, 1983). Certainly a loss of contact with the external world is one of the most characteristic effects of ketamine.This is probably the result of blockade of NMDA receptors involved in sensory transmission. NMDA receptors play a key role in the transmission of incoming signals from all sensory modalities (Davies and Watkins, 1983; Greenamyre et al., 1984; Headley et al., This theory maintains that confronting death leads to a cutting off the external world. The result is regression to a pre-verbal level which can be experienced as mystical ineffability (Greyson, 1983). Certainly a loss of contact with the external world is one of the most characteristic effects of ketamine.This is probably the result of blockade of NMDA receptors involved in sensory transmission. NMDA receptors play a key role in the transmission of incoming signals from all sensory modalities (Davies and Watkins, 1983; Greenamyre et al., 1984; Headley et al.,
  
- 1. ; Cotman et al., 1987; Cline et al.,1987; Monaghan, Bridges and Cotman, 1988; Kisvardy et al., 1989; Oye et al.,+1. ; Cotman et al., 1987; Cline et al.,1987; Monaghan, Bridges and Cotman, 1988; Kisvardy et al., 1989; Oye et al.,
  
- 2. ).+2. ).
  
  
  
- 1. A state dependent reactivation of birth memories+1. A state dependent reactivation of birth memories
  
 This theory explains the movement through tunnels towards 'the light' as a memory of being born (Grof and Halifax, This theory explains the movement through tunnels towards 'the light' as a memory of being born (Grof and Halifax,
  
- 1. ). The NDE is thus actually a 'near-birth experience' rather than a 'near-death experience'.+1. ). The NDE is thus actually a 'near-birth experience' rather than a 'near-death experience'.
  
 NMDA receptor blockade could certainly be the underlying mechanism for the release of extremely primitive memories not normally available to consciousness. NMDA receptor blockade could certainly be the underlying mechanism for the release of extremely primitive memories not normally available to consciousness.
  
  
- +1. The NDE as a sensory deprivation phenomenon
- 1. The NDE as a sensory deprivation phenomenon+
  
 This hypothesis maintains that memories may normally be suppressed by a mechanism which acts as a gate, admitting primarily external signals when we are fully conscious and concentrating upon an external task (Siegel,1980, 1981). If this input is dramatically reduced , for example when we are dreaming, have been given drugs such as ketamine, or have just had a heart attack, in combination with a high level of central stimulation (e.g. as would result from excessive glutamate release during hypoxia, ischaemia, epilepsy, or arising without external provocation), stored perceptions are released and become 'organised' by the mind into an experience with some symbolic meaning. According to Ron Siegel (1980), the 'white light' may result from CNS stimulation mimicing light on the retina, and a lowering of the phosphene perceptual threshold. Sensory deprivation itself produces a profound alteration in consciousness which is certainly mediated via NMDA receptors (see 'regression in the service of the ego' above (Lilly, 1961,1978). This hypothesis maintains that memories may normally be suppressed by a mechanism which acts as a gate, admitting primarily external signals when we are fully conscious and concentrating upon an external task (Siegel,1980, 1981). If this input is dramatically reduced , for example when we are dreaming, have been given drugs such as ketamine, or have just had a heart attack, in combination with a high level of central stimulation (e.g. as would result from excessive glutamate release during hypoxia, ischaemia, epilepsy, or arising without external provocation), stored perceptions are released and become 'organised' by the mind into an experience with some symbolic meaning. According to Ron Siegel (1980), the 'white light' may result from CNS stimulation mimicing light on the retina, and a lowering of the phosphene perceptual threshold. Sensory deprivation itself produces a profound alteration in consciousness which is certainly mediated via NMDA receptors (see 'regression in the service of the ego' above (Lilly, 1961,1978).
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 Ketamine blocks this channel at the molecular level and, at a higher level, closes the 'gate' to incoming information (Monaghan, Bridges and Cotman, 1989; Morris et al., 1986; Collingridge, 1987; McNaughton? and Morris, Ketamine blocks this channel at the molecular level and, at a higher level, closes the 'gate' to incoming information (Monaghan, Bridges and Cotman, 1989; Morris et al., 1986; Collingridge, 1987; McNaughton? and Morris,
  
- 1. ; Cotman, Monaghan and Ganong, 1988).+1. ; Cotman, Monaghan and Ganong, 1988).
  
  
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 The hypothesis presented in this paper is that much can be learnt about the mechanisms of the NDE by studying drug-induced hallucinations, specifically the state produced by ketamine. However, it is certainly not my argument that the NDE's reported by persons who have had heart attacks etc. are in any way due to drugs which they have been given. Administered drugs may explain a few cases of NDE's, but in most no drugs were given with effects which resemble the NDE (Sabom, 1982). The hypothesis presented in this paper is that much can be learnt about the mechanisms of the NDE by studying drug-induced hallucinations, specifically the state produced by ketamine. However, it is certainly not my argument that the NDE's reported by persons who have had heart attacks etc. are in any way due to drugs which they have been given. Administered drugs may explain a few cases of NDE's, but in most no drugs were given with effects which resemble the NDE (Sabom, 1982).
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 It is also possible that there is no protective mechanism against excitotoxicity. Rather than mimicing a natural protective process, ketamine may have some of its psychological effects by mimicing some of the processes seen in temporal lobe epilepsy. Ketamine does block glutamatergic neuro-transmission and prevents excitotoxic cell death. However, the effect of ketamine upon human electrical brain waves (the electroencephalograph, EEG) suggests a complex interplay of forces. There is a reduction in alpha wave activity, while beta, delta and theta wave activity are increased (Schwartz et al. 1974; Pichlmayr et al., 1984). Ketamine has been reported to act both as an anticonvulsant (i.e. substance which prevents epilepsy) (e.g. McCarthy? et al., 1965; Celesia and Chen, 1974; Taberner, It is also possible that there is no protective mechanism against excitotoxicity. Rather than mimicing a natural protective process, ketamine may have some of its psychological effects by mimicing some of the processes seen in temporal lobe epilepsy. Ketamine does block glutamatergic neuro-transmission and prevents excitotoxic cell death. However, the effect of ketamine upon human electrical brain waves (the electroencephalograph, EEG) suggests a complex interplay of forces. There is a reduction in alpha wave activity, while beta, delta and theta wave activity are increased (Schwartz et al. 1974; Pichlmayr et al., 1984). Ketamine has been reported to act both as an anticonvulsant (i.e. substance which prevents epilepsy) (e.g. McCarthy? et al., 1965; Celesia and Chen, 1974; Taberner,
  
- 1. ; Leccese et al., 1986; Mares et al., 1992) and as a pro-convulsant (epilepsy inducing substance) (Bennet et al., 1973; Gourie et al., 1983; Myslobodsky, 1981). Myslobodsky (1981) reported that ketamine could produce EEG patterns in human limbic and thalamic regions resembling epileptic patterns, but that there was no evidence that this affected other cortical regions or that clinical seizures were likely to occur. This is quite consistent with the NDE model presented by Saavedra-Aguilar and Gomez-Jeria (1989) which involved limited electrical abnormalities in the limbic system.+1. ; Leccese et al., 1986; Mares et al., 1992) and as a pro-convulsant (epilepsy inducing substance) (Bennet et al., 1973; Gourie et al., 1983; Myslobodsky, 1981). Myslobodsky (1981) reported that ketamine could produce EEG patterns in human limbic and thalamic regions resembling epileptic patterns, but that there was no evidence that this affected other cortical regions or that clinical seizures were likely to occur. This is quite consistent with the NDE model presented by Saavedra-Aguilar and Gomez-Jeria (1989) which involved limited electrical abnormalities in the limbic system.
  
 The hippocampus is one of the core structures in the limbic system. Thus the production of NDE's by ketamine is not inconsistent with the hypothesis that NDE's may result from abnormal electrical activity in the brain. Reich and Silvay (1989) concluded: " it is hard to draw objective conclusions regarding the anti-convulsant properties of ketamine...animal data are particularly difficult to interpret because of interspecies variations". Nevertheless, most of the available evidence favors the conclusion that ketamine is anticonvulsant at doses required to produce NDE's (Myslobodsky, 1981), supporting the hypothesis that NMDA receptor blockade results in NDE's. The hippocampus is one of the core structures in the limbic system. Thus the production of NDE's by ketamine is not inconsistent with the hypothesis that NDE's may result from abnormal electrical activity in the brain. Reich and Silvay (1989) concluded: " it is hard to draw objective conclusions regarding the anti-convulsant properties of ketamine...animal data are particularly difficult to interpret because of interspecies variations". Nevertheless, most of the available evidence favors the conclusion that ketamine is anticonvulsant at doses required to produce NDE's (Myslobodsky, 1981), supporting the hypothesis that NMDA receptor blockade results in NDE's.
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 (+)ketamine is about four times more potent as a hypnotic (sleep-inducing agent) and analgesic, and has different effects upon the EEG from (-)ketamine (White et al., 1985). This may explain some of the confusion concerning whether ketamine is an anticonvulsant or a proconvulsant (Myslobodsky et al.,1981), and suggests that future NDE research might be better done with (-)ketamine rather than the mixture currently supplied to anaesthetists. (+)ketamine is about four times more potent as a hypnotic (sleep-inducing agent) and analgesic, and has different effects upon the EEG from (-)ketamine (White et al., 1985). This may explain some of the confusion concerning whether ketamine is an anticonvulsant or a proconvulsant (Myslobodsky et al.,1981), and suggests that future NDE research might be better done with (-)ketamine rather than the mixture currently supplied to anaesthetists.
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- 1. Hypoxia (low oxygen):+1. Hypoxia (low oxygen):
  
 The proposal that lack of oxygen might precipitate NDE's (Blacher, 1980) has been criticized (e.g. Sabom, 1982) because experiments in which the inspired oxygen was made to fall slowly resulted in mental clouding rather than states of consciousness resembling the NDE (Henderson et al., 1927). However, these experiments are clearly not a satifactory reproduction of events in, for example, cardiac arrest, a drug overdose or other types of medical emergency associated with NDE's. Hypoxia has been clearly shown to cause an excessive release of glutamate with resulting excitotoxicity and cell death, which can be prevented by ketamine (see previous references). The proposal that lack of oxygen might precipitate NDE's (Blacher, 1980) has been criticized (e.g. Sabom, 1982) because experiments in which the inspired oxygen was made to fall slowly resulted in mental clouding rather than states of consciousness resembling the NDE (Henderson et al., 1927). However, these experiments are clearly not a satifactory reproduction of events in, for example, cardiac arrest, a drug overdose or other types of medical emergency associated with NDE's. Hypoxia has been clearly shown to cause an excessive release of glutamate with resulting excitotoxicity and cell death, which can be prevented by ketamine (see previous references).
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- 1. Hypercarbia (excessive CO2):+1. Hypercarbia (excessive CO2):
  
 In experimental paradigms, CO2-enriched breathing mixtures can result in NDE phenomena such as bodily detachment, being drawn towards a bright light etc. As with NDE's, diverse personality types report similar experiences, suggesting that a shared neurological substrate is at work (Meduna, 1950). It is again likely that NMDA receptor blockade is involved in producing the effects. In experimental paradigms, CO2-enriched breathing mixtures can result in NDE phenomena such as bodily detachment, being drawn towards a bright light etc. As with NDE's, diverse personality types report similar experiences, suggesting that a shared neurological substrate is at work (Meduna, 1950). It is again likely that NMDA receptor blockade is involved in producing the effects.
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 Like endorphins, serotonergic effects may be contributory but do not play a central role in producing NDE's. Psychedelic drugs such as LSD and DMT are serotonergic in action. The psychedelic mental state is very different from the NDE. One of the most important differences is that LSD frequently involves an overwhelming increase in sensory input from the environment (review: Grinspoon and Bakalar, 1981), in sharp contrast to the dramatic decrease in input, the cataleptic dissociation produced by ketamine. Psychedelic visual phenomena are largely based in the environment, and bear little relationship to the dream-like images of ketamine and the NDE. Ketamine removes the mind from the environment altogether. The 'ego dissolution' experienced on LSD has a very different quality from the conviction of having died which may arise with ketamine, and loss of contact with the environment leading rapidly to the 'tunnel experience' is not a typical psychedelic drug effect, although it may occur. Like endorphins, serotonergic effects may be contributory but do not play a central role in producing NDE's. Psychedelic drugs such as LSD and DMT are serotonergic in action. The psychedelic mental state is very different from the NDE. One of the most important differences is that LSD frequently involves an overwhelming increase in sensory input from the environment (review: Grinspoon and Bakalar, 1981), in sharp contrast to the dramatic decrease in input, the cataleptic dissociation produced by ketamine. Psychedelic visual phenomena are largely based in the environment, and bear little relationship to the dream-like images of ketamine and the NDE. Ketamine removes the mind from the environment altogether. The 'ego dissolution' experienced on LSD has a very different quality from the conviction of having died which may arise with ketamine, and loss of contact with the environment leading rapidly to the 'tunnel experience' is not a typical psychedelic drug effect, although it may occur.
 +
  
  
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 The event can be a pivotal turning point, encouraging significant and positive life changes. Suicide attempts which result in 'transcendental' NDE's may be followed by a reduced risk of subsequently committing suicide (Greyson, The event can be a pivotal turning point, encouraging significant and positive life changes. Suicide attempts which result in 'transcendental' NDE's may be followed by a reduced risk of subsequently committing suicide (Greyson,
  
- 1. ).+1.).
  
 In contrast, in those who attempt suicide considered as a complete group, the subsequent risk for completed suicide is 50 -100 times greater (Greyson, 1983). Of those who survived a jump from the Golden Gate bridge and had such an NDE, none went on to completed suicide, and all were united in their support for a barrier to prevent further attempts ( Rosen, 1975). This occurred despite an increased belief in an after-life. Psychodynamic explanations have centered around the idea of 'ego death' followed by 'rebirth' (Greyson, 1981). In contrast, in those who attempt suicide considered as a complete group, the subsequent risk for completed suicide is 50 -100 times greater (Greyson, 1983). Of those who survived a jump from the Golden Gate bridge and had such an NDE, none went on to completed suicide, and all were united in their support for a barrier to prevent further attempts ( Rosen, 1975). This occurred despite an increased belief in an after-life. Psychodynamic explanations have centered around the idea of 'ego death' followed by 'rebirth' (Greyson, 1981).
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