New research continues to uncover the remarkable and diverse effects of ketamine, a dissociative anesthetic increasingly used for the treatment of depression, mood disorders, and pain conditions. While ketamine is widely known for its rapid antidepressant effects through NMDA receptor antagonism, another proposed mechanism involves its impact on brain activity, particularly within a region known as the default mode network. A recent study published in Human Brain Mapping investigated the impact of subanesthetic doses of ketamine on the default mode network. The researchers also explored ketamine’s effects on vigilance, or the state of wakefulness and alertness. These findings may provide crucial insights into how ketamine functions as an antidepressant, especially for treatment-resistant depression.
The default mode network is a collection of brain regions, including the medial prefrontal cortex and posterior cingulate cortex, that are primarily involved in internally directed activities such as daydreaming, recalling memories, thinking about the future, and sometimes, rumination. Typically, the default mode network "deactivates" when attention shifts to external tasks requiring focus or problem-solving. For example, when someone is surfing and intensely focused on reading the ocean, catching waves, and avoiding danger, they are fully immersed in the present moment—not preoccupied with thoughts about dinner plans or a recent workplace confrontation.
Altered activity in the default mode network has been linked to various mental health conditions, including depression, anxiety, and ADHD. In people with depression, the default mode network tends to be hyperactive, particularly during self-reflection, which contributes to the negative, repetitive thought patterns that characterize the condition. An overactive default mode network, often associated with persistent negative self-talk and rumination, can be highly disruptive to mental health and daily functioning. Research suggests that ketamine, other psychedelics, meditation, and certain therapeutic interventions can modulate default mode network activity, often reducing its overactivity and promoting positive cognitive and emotional shifts.
In this study, 24 healthy participants received subanesthetic doses of ketamine and underwent simultaneous functional MRI and electroencephalogram (EEG) recordings to assess changes in brain activity. Researchers found that ketamine led to a decrease in functional connectivity within the default mode network, specifically in the medial prefrontal cortex, while increasing connectivity in other regions, such as the intraparietal cortex. These shifts in brain connectivity were linked to a decrease in vigilance, as indicated by changes in EEG patterns.
Vigilance refers to a person’s state of alertness or hyper-awareness, often associated with mental health conditions like depression, anxiety, and PTSD. Ketamine has been shown to modulate vigilance by inducing changes in brain activity that resemble the transition from wakefulness to light sleep. On an EEG, this shift is marked by an increase in slow-wave activity (delta and theta waves), suggesting that ketamine’s effects on the brain mirror the restorative processes seen during light sleep, where neural networks undergo a kind of "reset."
This reduction in vigilance may partially explain ketamine’s antidepressant effects. By disrupting the hyperactive default mode network—frequently linked to depressive rumination—ketamine appears to quiet the brain's incessant internal dialogue.
Clinically, this manifests as what many patients describe during a ketamine infusion: the silencing of mental "chatter," or the constant stream of self-critical and negative thoughts. For many, this interruption in negative self-talk offers a profound sense of relief and much-needed mental calm.
This research provides a deeper understanding of ketamine's antidepressant effects and its potential to alleviate depression. The reduced default mode network connectivity and altered vigilance observed in the study may represent key mechanisms through which ketamine exerts its rapid antidepressant action. By shifting brain activity in a way that diminishes rumination and negative thought patterns, ketamine may offer relief for patients with treatment-resistant depression who do not respond to conventional therapies.
About the Author
Dr. Ray Rivas, a former general and trauma surgeon with over a decade of experience utilizing ketamine, became a ketamine therapy specialist to treat mental health and pain after witnessing its profound impact on his hospital trauma patients and his own mental health. As the founder and medical director of Innerbloom Ketamine Therapy in San Luis Obispo, California, Dr. Rivas applies his extensive medical expertise to provide safe, evidence-based ketamine treatments for mood disorders, including depression, anxiety, PTSD, and chronic pain. His passion lies in helping patients find relief and rediscover hope through personalized, compassionate care.
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