Psychopharmacology

, Volume 135, Issue 3, pp 213–229

Interactive effects of subanesthetic ketamine and subhypnotic lorazepam in humans

Authors

  • John H. Krystal
    • Department of Psychiatry, Yale University School of Medicine, Connecticut, USA
  • Laurence P. Karper
    • Department of Psychiatry, Yale University School of Medicine, Connecticut, USA
  • Alexandre Bennett
    • Department of Psychiatry, Yale University School of Medicine, Connecticut, USA
  • D. Cyril D’Souza
    • Department of Psychiatry, Yale University School of Medicine, Connecticut, USA
  • Anissa Abi-Dargham
    • Department of Psychiatry, Yale University School of Medicine, Connecticut, USA
  • Kristen Morrissey
    • Psychiatry Service (116-A), VA Medical Center, West Haven, CT 06516, USA
  • Danielle Abi-Saab
    • Psychiatry Service (116-A), VA Medical Center, West Haven, CT 06516, USA
  • J. Douglas Bremner
    • Department of Psychiatry, Yale University School of Medicine, Connecticut, USA
  • M. B. Bowers Jr.
    • Department of Psychiatry, Yale University School of Medicine, Connecticut, USA
  • Raymond F. Suckow
    • New York State Psychiatric Institute, 722 W. 168th Street, New York, NY 10032, USA
  • Philip Stetson
    • Upjohn Center for Clinical Pharmacology, University of Michigan Medical Center, Ann Arbor, MI 48109-0504, USA
  • George R. Heninger
    • Department of Psychiatry, Yale University School of Medicine, Connecticut, USA
  • Dennis S. Charney
    • Department of Psychiatry, Yale University School of Medicine, Connecticut, USA
ORIGINAL INVESTIGATION

DOI: 10.1007/s002130050503

Cite this article as:
Krystal, J., Karper, L., Bennett, A. et al. Psychopharmacology (1998) 135: 213. doi:10.1007/s002130050503

Abstract

 Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist with psychotogenic and dissociative effects in healthy humans. These cognitive and perceptual effects in humans are reportedly reduced by benzodiazepine premedication. This study assessed the interactive effects of a ketamine (IV bolus of 0.26 mg/kg followed by an infusion of 0.65 mg/kg per hour) and lorazepam 2 mg., PO, in humans. Twenty-three healthy subjects completed 4 test days involving the oral administration of lorazepam or matched placebo 2 h prior to the IV infusion of ketamine or placebo. Ketamine: 1) produced behaviors similar to the positive and negative symptoms of schizophrenia as assessed by the Brief Psychiatric Rating Scale (BPRS); 2) evoked perceptual alterations as measured by the Clinician-Administered Dissociative States Scale (CADSS); 3) impaired performance on the Wisconsin Card Sorting Test (WCST) and other tests sensitive to frontal cortical impairment; and 4) had amnestic effects. Lorazepam produced attention impairments, concrete proverb interpretations, and recall impairments. Lorazepam reduced ketamine-associated emotional distress and there was a non-significant trend for it to decrease perceptual alterations produced by ketamine. However, it failed to reduce many cognitive and behavioral effects of ketamine, including psychosis. Further, lorazepam exacerbated the sedative, attention-impairing, and amnestic effects of ketamine. There was no evidence of pharmacokinetic interaction between these medications. These data suggest that subhypnotic lorazepam and ketamine show a spectrum of interactive effects, ranging from antagonism to potentiation.

Key words KetamineN-methyl-D-aspartateGlutamatePsychosisDissociationGABABenzodiazepineMemoryAttentionFrontal cortexWisconsin Card Sorting Test

Copyright information

© Springer-Verlag Berlin Heidelberg 1998