According to World Health Organization, nearly 280 million people worldwide suffer from depression, and 301 million suffer from anxiety disorders, with suicide accounting for up to 700,000 deaths per year, making it a leading cause of death among young people. The statistics for substance use disorder are no better. In 2021, 300 million have had an alcohol use disorder and 16 million people have had or currently suffer from opioid use disorder. Notably, between 20% and 60% of psychiatric patients experience treatment resistance, resulting in increased healthcare demands and costs. These numbers have urged for a new solution for the mental health crisis. Ketamine, a substance renowned for its duality, serves as an intriguing case study in the world of pharmaceuticals and illicit drugs, as a new promising antidepressant. 

In recent years, the medical community has been re-embracing substances once taboo, with Ketamine, a drug known for its anesthetic and dissociative properties, gaining prominence in psychiatric treatment for conditions such as treatment-resistant depression, substance abuse, and PTSD. This also represents a cultural and societal shift towards stigmatized psychedelics, drug policy and medical treatment, in which traditional treatment is not always effective. Although ketamine's promising medical value for the treatment of resistant behavioral disorders has become significant, worries about its side effects and the growing accessibility for recreational purposes overshadow and limit its therapeutic potential. 

Due to its unique action on the brain’s glutamate system, ketamine treatment has shown promising results in reducing cravings, withdrawal symptoms, and relapse rates in substance use disorders, such as opioid addiction. Similarly, ketamine's role in treating alcohol use disorder is also remarkable. In controlled examinations, patients who had ketamine infusions in conjunction with psychological therapy had greater rates of alcohol abstinence, demonstrating ketamine's capacity as a possible therapy solution. Research into ketamine’s medical potential shows its rapid action,  an advantage over conventional antidepressants, in reducing suicidal thoughts, providing immediate relief in cases of severe and treatment-ressistant depression (TRD) within hours of consumption, setting it apart from traditional antidepressants which often have a delayed effect. A drug with such broad therapeutic scope has also shown potential in treating refractory anxiety disorders (anxiety persisting after unsuccessful or marginally effective standard treatment), by rapidly reducing anxiety symptoms, and feelings of fear and avoidance. Therefore, ketamine appears to offer more rapid relief than traditional anxiolytics, providing hope for patients who don't respond to standard antidepressants. 

Ketamine is available in two forms for medical use: esketamine and infusion ketamine. Esketamine, a nasal spray, has been approved by the FDA in 2019 for medicating treatment-resistant depression (TRD). Infusion ketamine, administered intravenously, provides rapid relief of severe depression symptoms, including suicidal thoughts. Both forms offer new hope for patients struggling with traditional  therapies, but not without caution. The recent news concerning the death of Matthew Perry, fondly regarded for his portrayal of Chandler from Friends, has been sad and distressing to many. According to the autopsy report, Perry was under ketamine infusion therapy around 11 weeks prior to his death. His passing was ruled an accident due to the acute effects of the treatment combined with the individual's medical reasons. This case unravels the enigma of ketamine’s therapeutic capacity, showing how much is still left to understand. What insights await us? The call for further research is needed, urging for a deeper analysis of its long-term effects and  most effective ways to harness ketamine's potential. This journey illuminates both the complexity and promise on the horizon of psychiatric treatment.

Another concern for ketamine’s medical rise lies in the potential misuse and recent rise in its recreational use. Ketamine is popular in recreational drug circles due to its unique dissociative and hallucinogenic effects. Misuse, often dubbed "Special K," raises concerns about addiction, cognitive impairment and potential to alter the brain structure long-term.  Recent research shows a rise in recreational ketamine consumption and accessibility, particularly since 2019, which correlates with the FDA approval for ketamine depression treatment. Additionally, the US clinic network for ketamine infusion has grown rapidly, with physicians and health startups prescribing it in lozenge form for home use, contributing to a rise in recreational ketamine consumption and related poisonings. The growing recreational market for ketamine undermines its medical value and poses challenges for law enforcement and public health policies due to its easy access and difficulty in regulation. 

So we stand at the intersection of two markets: How do we harness the therapeutic potential of ketamine without enabling its misuse? Can regulatory regimes ever be adjusted to ensure that those in need get the life-saving aspects of ketamine whilst restraining its recreational abuse? The story of ketamine simultaneously highlights the challenges in modern medicine and mental health treatments, and reflects society's relationship towards psychoactive substances. It proposes the demand for a balanced approach that considers their mutual correlation. Does the rise of ketamine in psychiatric treatment signal a broader shift towards acceptance of psychedelic and dissociative drugs in medicine, and if so, how do we prepare for the ethical and societal implications?