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See also: See also.

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{{Short description|Class of psychoactive drugs}}
{{About|the class of hallucinogen|the psychological state|Dissociation (psychology)|the Australian band|The Dissociatives|other uses|Dissociation (disambiguation){{!}}Dissociation}}
{{Infobox drug class
| Name =
| Image = File:Ketamine2DCSD.svg
| ImageClass =
| Alt =
| Caption = [[Chemical structure]] of [[ketamine]], one of the most well-known dissociatives.
| Width = 150px
| Pronounce =
| Synonyms =

| Use = [[Recreational drug use|Recreational]], [[entheogen|spiritual]], [[medicine|medical]]
| ATC_prefix =
| Mode_of_action =
| Mechanism_of_action = [[NMDA receptor antagonism]] (most dissociatives)
| Biological_target = [[NMDA receptor]] (most dissociatives)
| Chemical_class = [[Adamantane]]s, [[arylcyclohexylamine]]s, [[diarylethylamine]]s, [[morphinan]]s, simple [[inhalant]]s, others

| Drugs.com = 
| Consumer_Reports =
| medicinenet =
| rxlist =
| rxlist_name =

| MeshID =

| legal_status = Variable
}}

'''Dissociatives''', colloquially '''dissos''', are a subclass of [[hallucinogen]]s that distort perception of sight and sound and produce feelings of detachment – dissociation – from the environment and/or self. Although many kinds of drugs are capable of such an effect, dissociatives are unique in that they do so in such a way that they produce [[hallucinogen]]ic effects, which may include [[dissociation (psychology)|dissociation]], a general decrease in [[sensory experience]], [[hallucination]]s, [[oneirogen|dream-like states]] or [[anesthesia]].<ref>{{cite journal |last1=Snyder |first1=Solomon H. |title=Phencyclidine |journal=Nature |volume=285 |issue=5764 |pages=355–6 |year=1980 |pmid=7189825 |doi=10.1038/285355a0|bibcode=1980Natur.285..355S |s2cid=208653777 }}</ref>

Despite most dissociatives' main [[mechanism of action]] being tied to [[NMDA receptor antagonism]], some of these substances, which are nonselective in action and affect the [[dopamine]]<ref>{{cite journal |last1=Giannini |first1=AJ |last2=Eighan |first2=MS |last3=Loiselle |first3=RH |last4=Giannini |first4=MC |title=Comparison of haloperidol and chlorpromazine in the treatment of phencyclidine psychosis |journal=Journal of Clinical Pharmacology |volume=24 |issue=4 |pages=202–4 |year=1984 |pmid=6725621 |doi=10.1002/j.1552-4604.1984.tb01831.x|s2cid=42278510 }}</ref> and/or [[opioid]]<ref>{{cite journal |last1=Giannini |first1=A. James |last2=Nageotte |first2=Catherine |last3=Loiselle |first3=Robert H. |last4=Malone |first4=Donald A. |last5=Price |first5=William A. |title=Comparison of Chlorpromazine, Haloperidol and Pimozide in the Treatment of Phencyclidine Psychosis: Da-2 Receptor Specificity |journal=Clinical Toxicology |volume=22 |issue=6 |pages=573–9 |year=1984 |pmid=6535849 |doi=10.3109/15563658408992586}}</ref> systems, may be capable of inducing more ''direct'' and repeatable [[euphoria]] or symptoms which are more akin to the effects of typical "[[Hard and soft drugs|hard drugs]]" or common drugs of abuse. This is likely why dissociatives are considered to be [[Addiction|addictive]] with a fair to moderate potential for [[Drug abuse|abuse]], unlike [[psychedelics]]. Despite some dissociatives, such as [[phencyclidine]] (PCP) possessing stimulating properties, most dissociatives seem to have a general [[depressant]] effect and can produce [[sedation]], [[respiratory depression]], [[nausea]], [[disorientation]], analgesia, anesthesia, [[ataxia]], [[cognitive deficit|cognitive and memory impairment]] as well as [[amnesia]].

Examples of dissociatives include [[arylcyclohexylamine]]s like [[ketamine]] and [[phencyclidine]] (PCP); [[morphinan]]s like [[dextromethorphan]] (DXM); [[inhalant]]s like [[nitrous oxide]] (N<sub>2</sub>O); [[diarylethylamine]]s like [[diphenidine]]; and [[adamantane]]s like [[memantine]], among others.

== Effects ==
The effects of dissociatives can include sensory dissociation, hallucinations, [[mania]], [[catalepsy]], analgesia and amnesia.<ref name="Pender1970">{{cite journal |first1=John W. |last1=Pender |year=1970 |title=Dissociative Anesthesia |journal=California Medicine |pmid=18730444 |volume=113 |issue=5 |pages=73 |pmc=1501800}}</ref><ref>{{cite journal |last1=Johnstone |first1=M. |last2=Evans |first2=V. |last3=Baigel |first3=S. |title=Sernyl (C1-395) in Clinical Anaesthesia |journal=British Journal of Anaesthesia |volume=31 |pages=433–9 |year=1959 |issue=10 |doi=10.1093/bja/31.10.433|pmid=14407580 |doi-access=free }}</ref><ref>{{cite journal |last1=Oduntan |first1=S. A. |last2=Gool |first2=R. Y. |title=Clinical trial of ketamine (ci-581): A preliminary report |journal=Canadian Anaesthetists' Society Journal |volume=17 |pages=411–6 |year=1970 |issue=4 |doi=10.1007/BF03004705|pmid=5429682 |doi-access=free }}</ref> According to Pender (1972), "the state has been designated as dissociative anesthesia since the patient truly seems disassociated from his environment."<ref>{{cite journal |first1=John W. |last1=Pender |date=October 1972 |title=Dissociative Anesthesia |journal=California Medicine |pmid=18730832 |volume=117 |issue=4 |pages=46–7 |pmc=1518731}}</ref> Both Pender (1970) and Johnstone et al. (1959) reported that patients under anaesthesia due to either [[ketamine]] or [[phencyclidine]] were prone to purposeless movements and had hallucinations (or "dreams"<ref>{{cite journal |last1=Virtue |first1=RW |last2=Alanis |first2=JM |last3=Mori |first3=M |last4=Lafargue |first4=RT |last5=Vogel |first5=JH |last6=Metcalf |first6=DR |title=An anaesthetic agent: 2-orthochlorophenyl, 2-methylamino cyclohexanone HCl (CI-581). |journal=Anesthesiology |volume=28 |issue=5 |pages=823–33 |year=1967 |pmid=6035012 |doi=10.1097/00000542-196709000-00008|s2cid=34414786 |doi-access=free }}</ref>) during and after anaesthesia. Some patients found the hallucinations euphoric while others found them disturbing.

At sub-anesthetic doses, dissociatives alter many of the same cognitive and perceptual processes affected by other hallucinogenic drugs such as [[mescaline]], [[LSD]], and [[psilocybin]]; hence they are often contrasted and also considered [[hallucinogenic]].<ref>{{cite journal |last1=Mason |first1=Oliver J. |last2=Morgan |first2=Celia J.M. |last3=Stefanovic |first3=Ana |last4=Curran |first4=H Valerie |title=The Psychotomimetic States Inventory (PSI): Measuring psychotic-type experiences from ketamine and cannabis |journal=Schizophrenia Research |volume=103 |issue=1–3 |pages=138–42 |year=2008 |pmid=18387788 |doi=10.1016/j.schres.2008.02.020|s2cid=807162 }}</ref><ref>{{cite journal |last1=Gouzoulis-Mayfrank |first1=E. |last2=Heekeren |first2=K. |last3=Neukirch |first3=A. |last4=Stoll |first4=M. |last5=Stock |first5=C. |last6=Obradovic |first6=M. |last7=Kovar |first7=K.-A. |title=Psychological Effects of (S)-Ketamine and N,N-Dimethyltryptamine (DMT): A Double-Blind, Cross-Over Study in Healthy Volunteers |journal=Pharmacopsychiatry |volume=38 |issue=6 |pages=301–11 |year=2005 |pmid=16342002 |doi=10.1055/s-2005-916185|s2cid=260241166 }}</ref><ref>{{cite journal |pmid=9250944 |last1=Krupitsky |year=1997 |first1=EM |pages=165–83 |issue=2 |volume=29 |last2=Grinenko |journal=Journal of Psychoactive Drugs |first2=AY |title=Ketamine psychedelic therapy (KPT): a review of the results of ten years of research. |url=http://www.eleusis.us/resource-center/references/kpt10yrs.php |doi=10.1080/02791072.1997.10400185 |access-date=2010-10-25 |archive-url=https://web.archive.org/web/20100819091706/http://www.eleusis.us/resource-center/references/kpt10yrs.php |archive-date=2010-08-19 |url-status=dead |url-access=subscription }}</ref> Perhaps the most significant subjective differences between dissociatives and the [[serotonergic psychedelic|classical hallucinogens]] (such as [[LSD]] and [[mescaline]]) are the detaching effects, including: [[depersonalization]], the feeling of being unreal, disconnected from one's self, or unable to control one's actions; and [[derealization]], the feeling that the outside world is unreal or that one is dreaming.<ref>{{cite journal |last1=Vollenweider |first1=F |last2=Geyer |first2=MA |title=A systems model of altered consciousness: integrating natural and drug-induced psychoses |journal=Brain Research Bulletin |volume=56 |issue=5 |pages=495–507 |year=2001 |pmid=11750795 |doi=10.1016/S0361-9230(01)00646-3|s2cid=230298 }}</ref>

== Use ==

===Medical use===
Many dissociatives such as [[ketamine]] are used as [[anesthetics]] for [[surgery]] or pain relief in medical contexts such as in hospitals. However, due to possible [[psychotomimetic]] reactions they are sometimes used reluctantly.<ref>{{cite journal | vauthors = Adams HA | title = [S-(+)-ketamine. Circulatory interactions during total intravenous anesthesia and analgesia-sedation] | language = DE | journal = Der Anaesthesist | volume = 46 | issue = 12 | pages = 1081–7 | date = December 1997 | pmid = 9451493 | doi = 10.1007/s001010050510 | s2cid = 36323023 | trans-title = S-(+)-ketamine. Circulatory interactions during total intravenous anesthesia and analgesia-sedation }}</ref><ref name="pmid32826629">{{cite journal |vauthors=Barrett W, Buxhoeveden M, Dhillon S |title=Ketamine: a versatile tool for anesthesia and analgesia |journal=Current Opinion in Anesthesiology |volume=33 |issue=5 |pages=633–638 |date=October 2020 |pmid=32826629 |doi=10.1097/ACO.0000000000000916 |s2cid=221236545 }}</ref> Certain [[morphinan]] dissociatives such as dextromethorphan are also used in sub-psychoactive dosages to [[Cough suppressant|suppress coughing]].<ref name = AMH>{{cite book | title = Australian Medicines Handbook | year = 2013 | publisher = The Australian Medicines Handbook Unit Trust | isbn = 978-0-9805790-9-3 | place = Adelaide | editor = Rossi, S }}{{page needed|date=April 2015}}</ref>

[[Ketamine]] is also currently being studied and is showing promising results as a possible fast-acting [[antidepressant]].<ref name="pmid28249076">{{cite journal | vauthors = Sanacora G, Frye MA, McDonald W, Mathew SJ, Turner MS, Schatzberg AF, Summergrad P, Nemeroff CB | display-authors = 6 | title = A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders | journal = JAMA Psychiatry | volume = 74 | issue = 4 | pages = 399–405 | date = April 2017 | pmid = 28249076 | doi = 10.1001/jamapsychiatry.2017.0080 | s2cid = 28320520 }}</ref><ref name="pmid33065824">{{cite journal |vauthors=Marcantoni WS, Akoumba BS, Wassef M, Mayrand J, Lai H, Richard-Devantoy S, Beauchamp S |title=A systematic review and meta-analysis of the efficacy of intravenous ketamine infusion for treatment resistant depression: January 2009 - January 2019 |journal=J Affect Disord |volume=277 |pages=831–841 |date=December 2020 |pmid=33065824 |doi=10.1016/j.jad.2020.09.007 |s2cid=223557698 }}</ref> It may also function as a possible [[palliative]] treatment for [[C-PTSD]] and [[chronic pain]].<ref>{{cite journal |last1=Oyetunji |first1=Aderonke |last2=Huelga |first2=Christian |last3=Bunte |first3=Kailee |last4=Tao |first4=Rachel |last5=Bellman |first5=Val |last6=Oyetunji |first6=Aderonke |last7=Huelga |first7=Christian |last8=Bunte |first8=Kailee |last9=Tao |first9=Rachel |last10=Bellman |first10=Val |title=Use of ketamine for depression and suicidality in cancer and terminal patients: Review of current data |journal=AIMS Public Health |date=2023 |volume=10 |issue=3 |pages=610–626 |doi=10.3934/publichealth.2023043 |pmid=37842268 |pmc=10567968 }}</ref><ref>{{cite journal |last1=Midega |first1=Thais Dias |last2=Chaves |first2=Renato Carneiro de Freitas |last3=Ashihara |first3=Carolina |last4=Alencar |first4=Roger Monteiro |last5=Queiroz |first5=Verônica Neves Fialho |last6=Zelezoglo |first6=Giovana Roberta |last7=Vilanova |first7=Luiz Carlos da Silva |last8=Olivato |first8=Guilherme Benfatti |last9=Cordioli |first9=Ricardo Luiz |last10=Bravim |first10=Bruno de Arruda |last11=Corrêa |first11=Thiago Domingos |title=Ketamine use in critically ill patients: a narrative review |journal=Revista Brasileira de Terapia Intensiva |date=2022 |volume=34 |issue=2 |doi=10.5935/0103-507X.20220027-en |pmc=9354105 }}</ref><ref>{{cite journal |last1=Ragnhildstveit |first1=Anya |last2=Roscoe |first2=Jeremy |last3=Bass |first3=Lisa C. |last4=Averill |first4=Christopher L. |last5=Abdallah |first5=Chadi G. |last6=Averill |first6=Lynnette A. |title=The potential of ketamine for posttraumatic stress disorder: a review of clinical evidence |journal=Therapeutic Advances in Psychopharmacology |date=January 2023 |volume=13 |pages=204512532311541 |doi=10.1177/20451253231154125 |pmid=36895431 |pmc=9989422 }}</ref>

=== Recreational use ===
Some dissociative drugs are used recreationally. [[Ketamine]] and [[nitrous oxide]] are [[club drugs]]. [[Phencyclidine]] (PCP or angel dust) is available as a street drug. [[Dextromethorphan]]-based cough syrups (often labeled DXM) are taken by some users in higher than medically recommended levels for their dissociative effects. Historically, [[chloroform]] and [[diethyl ether]] have been used recreationally.

== See also ==
* [[Arylcyclohexylamine]]
* [[List of hallucinogens]]
* [[List of investigational hallucinogens and entactogens]]
* [[Morphinan]]
* [[NMDA receptor antagonist]]
* [[Recreational use of nitrous oxide]]
* [[Hallucinogen]]
* [[Deliriant]]
* [[Dissociation (neuropsychology)]]
* [[Dissociation (psychology)]]
* [[Trip report]]

==References==
{{Reflist}}

==External links==
* {{Commonscat-inline|Dissociatives}}

{{Major Drug Groups}}
{{Drug use}}
{{Hallucinogens}}
{{Depressants}}
{{Chemical classes of psychoactive drugs}}

[[Category:Dissociative drugs| ]]
[[Category:Drugs by psychological effects]]

[[fr:Hallucinogène#Les hallucinogènes dissociatifs]]

Dissociative - Revision history

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