One Dose Quieted Her Head for Two Hours. Within Weeks She Was Buying More.

She was twenty-five, living in sheltered psychiatric housing in the Netherlands, and she had already attempted suicide more than ten times. In November 2021, after the news that her psychiatrist was handing her care to another institution, police found her wandering near railway tracks. The next day she was enrolled in a small pilot study at the University Medical Centre Groningen and given a single spray of intranasal ketamine, 75 milligrams, according to the case report that Roelandt, Strous, Kamphuis, Schoevers and Marijnissen published in BJPsych Open this year. The authors call her “Mrs. S.” She had no history of addiction. She had used alcohol and cannabis only now and then.

A drug that turns down the worst voice in your head for two hours does not need to be fun to be dangerous.

The numbers from that day look like a success and then don’t. Her depression score fell from 37 to 31 an hour after the dose, and her suicidal-ideation score from 35 to 29. By the end of the week they had crept back to 36 and 31. What she told the researchers matters more than the scales. She said the dose pushed her intrusive, obsessive thoughts “to the side of her head,” and that about two hours later they came back. Hold onto that detail, because that is the loop.

What the drug did, in plain terms

Ketamine is a dissociative: it loosens the connection between you and your own thoughts and surroundings. In a hospital, at a controlled dose, that loosening can interrupt a suicidal spiral long enough for other treatment to work. The authors’ word for what she took is “sub-anaesthetic,” meaning a dose well below what would put you under for surgery. Their further point is that the route matters. Nasal and intravenous ketamine both absorb fast, and the report notes that fast absorption raises the drug’s abuse liability, which is a clinical phrase for how readily something hooks a person.

Over the next four weeks, her clinicians discovered, she had found a dealer. She was snorting illicit ketamine daily, in amounts reaching about a gram. She used it through the day, in her words partly to make time pass faster. When she had to leave the house she took cocaine or 3-MMC (a synthetic stimulant) to cancel out the ketamine’s heaviness, then came home and used ketamine to cancel the stimulant. Doses climbed. Money ran out. When she could not get more, she attempted suicide again, even though, the authors note, she had no physical withdrawal. This is what psychological dependence looks like from the inside: no shaking, no sweating, just a drug that has become the only thing between you and the intrusive thoughts, and the sudden sound of them coming back.

If you have ever taken something that, for two hours, made your own head a quieter place to live, you know the arithmetic that comes next. The relief is not the drug’s fault. It is the reason the drug works, and the reason it is dangerous for someone whose problem is that the quiet has an expiry time.

The part where it gets complicated, in the report’s own words

There is a door in this story that the authors leave open. Faced with eviction from her sheltered housing, Mrs. S. stopped. She told them her autism “helps her to really go for it when she has made a decision,” and that she saw the ketamine was causing more harm than good. Quitting was possible, and it was driven by something she cared about more: a place to live. She later relapsed into ketamine and cocaine. The report does not say what happened after that, and neither will we. A case report is one person. It cannot tell us how often this happens, it was an open-label pilot with no control group, and the patient had a heavy psychiatric history that makes her unlike most people who will ever be offered ketamine. The authors call for study of “patient-specific risk factors and dosing strategies” rather than a ban.

The report does not say what happened after that, and neither will we.

It is also one data point in a bigger argument. Mark Gold, MD, writing in Psychology Today on August 3, calls it the ketamine paradox: the same compound that relieves treatment-resistant depression is now fueling misuse. His summary of a 2026 study of ketamine providers in metropolitan New York found 233 clinics advertising treatment, more than a third offering at-home delivery, and only 51.5% listing a physician on the team. By Gold’s account, only 41% told patients on their websites about adverse effects, including the risk of addiction. Gold also cites survey data showing past-year ketamine use among New York nightclub-goers nearly doubled, from 7.4% in 2017 to 14.3% in 2024. We have not checked those figures against the primary papers, and Gold’s piece is commentary, not a study, but the direction is consistent with what the FDA has been saying. The agency warns that patients who get compounded ketamine from compounders and telemedicine platforms “may not receive important information about the potential risks associated with the product,” and lists abuse and misuse among the known safety problems on its compounding risk alerts page. We looked at this once already in our look at the ketamine clinic boom; the Groningen case is what that boom looks like at one bedside.

We have watched a medicine become a street drug before

Ketamine was first synthesized in 1962 and approved as an anesthetic in 1970. It was valued precisely because it was safe in the operating room: patients kept breathing. Through the 1990s the same quality made it a club drug known as “Special K,” and in 1999 the DEA placed it in Schedule III, the tier for drugs with accepted medical use and moderate potential for abuse. Then the clinical story swung back. In 2019 the FDA approved esketamine nasal spray for treatment-resistant depression, and in the years since, ketamine clinics have spread faster than rules about who may run them. Each swing came with the same sentence attached: it’s safe in the right hands. The hands changed faster than the sentence did. The pattern is not that ketamine is evil. It is that a drug’s reputation is set by its first, most controlled setting, and everyone downstream borrows it.

What to ask this week

If you work in a clinic, a program, or a referral role, three questions are worth raising at your next team meeting. Does intake ask about current and past substance use before any referral for ketamine, including illicit use that a patient might not volunteer? Does your referral partner say who the supervising physician is, whether doses are taken at home, and what its plan is if a patient starts seeking the drug outside treatment? And does your screening catch ketamine at all, since many standard drug panels don’t test for it? Ask your lab. Pair that with a direct question to the patient: what is the drug doing for you in the two hours after, and what happens in hour three?

If you are the person taking it, or considering it, the fair read of this case is not “don’t.” It is “tell someone before the second dose what you are hoping it will do.” Dependence on a dissociative is treatable, and the report itself shows a person who stopped when something she valued was on the line. If you are in crisis, 988 is still the number, and it is still answered.

The Groningen authors close by recommending “careful screening, monitoring and awareness of addiction potential.” Mrs. S. didn’t need a lecture. She needed someone to ask her about hour three.