Abstract
Background and Objectives:
Ketamine is efficacious in treating treatment-resistant depression in medical settings and the drug was approved for such use by the US Federal Drug Administration in 2019. However, little is known about how use outside of medical settings relates to depression. We determined whether recreational ketamine use, relative to the use of other drugs, is related to the current experience of depression among adolescents.
Methods:
We examined data from the 2016 to 2019 Monitoring the Future nationally representative survey of high school seniors in the United States (N = 15,673). We determined how past-year drug use and frequency of past-year drug use were associated with students reporting a high level of current depressive symptoms relative to other students.
Results:
Ketamine use was associated with highest risk for a high level of depression (aPR = 1.55, 95% confidence interval [CI]: 1.24–1.94), followed by use of cannabis (aPR = 1.29, 95% CI: 1.19–1.39), and nonmedical use of tranquilizers (aPR = 1.22, 95% CI: 1.04–1.44) and amphetamine (aPR = 1.17, 95% CI: 1.01–1.34). Alcohol use was associated with decreased risk (aPR = 0.92, 95% CI: 0.85–0.99). With respect to frequency of past-year use, more frequent use of ketamine and cannabis was associated with increased risk for a high level of depression in a dose-response-like manner, with past-year use of ketamine and cannabis ≥10 times associated with increased risk for depression by 70% and 40%, respectively.
Discussion and Conclusions:
Past-year recreational ketamine use is a risk factor for reporting current depression than most other drugs.
Scientific Significance:
This was the first study to compare the risk of use of various drugs in relation to depression.
INTRODUCTION
Depression is common among adolescents and increasing in the United States (US). A recent nationally representative study of adolescents (age 12–17) in the US estimated that the past-month prevalence of major depressive episodes increased from 2005 to 2014 from 8.7% to 11.3%.1 As the prevalence of major depressive episodes among adolescents is on the rise, adolescents with major depressive disorder (MDD), including treatment-resistant depression, are more likely to use psychoactive substances, such as alcohol, cannabis, and other illegal drugs, compared to those without MDD.2,3 The association between major depressive episodes and substance use among adolescents is well established, particularly with respect to cannabis use,4 alcohol use disorder,5 heroin use,6 and nonmedical opioid use.7 As such, it appears that adolescents experiencing untreated or treatment-resistant depression may be at risk for other psychoactive substance use as well.
More recently, studies have demonstrated that ketamine, a dissociative anesthetic, is efficacious in managing treatment-resistant depression,8,9 with research also demonstrating efficacy among adolescents.10 However, outside of medical settings, ketamine has misuse potential, especially for adolescents and young adults. While the prevalence of ketamine use among US high school seniors (12th graders) is low (ranging from 0.7% to 1.6% over the past decade),11 its use and availability appear to be slightly increasing in the general population.12 Its use as a recreational drug in nightclubs is also particularly common and increasing. Among adult electronic dance music (EDM) party attendees in New York City, the past-year prevalence of ketamine increased from 5.9% in 2016 to 15.3% in 2019.13 Research has shown that people who engage in heavy recreational ketamine use tend to score higher on depression and anxiety scales compared to non-ketamine users.14–16 However, little is known regarding how ketamine compares to other drugs in association with depressive symptoms outside of clinical settings, especially among adolescents, in whom the prevalence of depression continues to rise.1 The present study addresses these limitations in the existing literature by using national data to determine the extent to which recreational ketamine use, relative to other drugs, is related to the current experience of depressive symptoms among adolescents.
METHODS
Procedure
Data were analyzed from Monitoring the Future (MTF), a nationally representative annual cross-sectional survey of high school seniors in the US. A new sample is surveyed each year in approximately 130 public and private schools throughout the 48 contiguous US states using multi-stage random sampling.11 Six different survey forms are randomly distributed to seniors each year, but only Forms 5 and 6 contain items asking about depressive symptoms so these analyses were limited to data collected on these forms. We aggregated data from the four most recent cohorts (2016–2019, N = 15,673) in order to increase sample size due to reported use of some drugs of interest being relatively rare. This secondary data analysis was exempt from review at the New York University Langone Medical Center Institutional Review Board.
Measures
Students were asked their agreement with the following four statements: (1) “Life is often meaningless,” (2) “The future often seems hopeless,” (3) “I enjoy life as much as anyone,” and (4) “It feels good to be alive.” Response options were disagree, mostly disagree, neither, mostly agree, and agree, and we reverse-coded the last two items to ensure that higher ratings aligned with the higher severity of depression. These items were derived from the depression scale of the Bentler Medical and Psychological Functioning Inventory.17 This scale has been used as a measure of depression in multiple national studies,18–21 and it has been shown to have good reliability and predictive validity.19 We computed a mean composite measure for these items (Cronbach’s α = .79), and similar to a recent study using this measure,18 we only computed the composite if students answered at least three items, and among those only answering three items we replaced the missing item with the mean value of the other three items. Given that this composite measure is positively skewed, similar to other studies,18 we created a binary variable indicating a high level of depression, which was defined as students in the top 25 percentile of average reported symptoms (a mean score of 3 or higher).
With respect to drug use, on both survey forms, students were asked how often they had engaged in past-year use of alcohol, cannabis, cocaine, ketamine, and heroin, and how often they engaged in nonmedical use of prescription amphetamine, opioids, sedatives, and tranquilizers. Nonmedical use was defined as using without a doctor recommending use. Answer options for each drug were: (1) 0 occasions, (2) 1–2 occasions, (3) 3–5 occasions, (4) 6–9 occasions, (5) 10–19 occasions, (6) 20–39 occasions, and (7) 40 or more. We dichotomized responses to indicate whether any use was reported, and we also collapsed some response options to indicate use (1) 0 times, (2) 1–2 times, (3) 3–9 times, and (4) ≥10 times. Collapsing some categories was necessary as more frequent use of some drugs was relatively rare. We also created a variable indicating the level of polydrug use, which was coded into the following categories: 0 drugs, 1–2 drugs, 3–4 drugs, and ≥5 drugs.
With regard to demographic characteristics, students were asked to indicate their age (pre-coded by MTF as <18 vs. ≥18 years), sex (i.e., male, female), and race/ethnicity (i.e., White, Black, Hispanic). Students were also asked about the educational attainment of each parent and a variable was coded indicating the highest level of education attained by either parent. Students were also asked how many evenings per week they go out for fun or recreation.
Statistical analyses
First, we estimated prevalence for all independent and dependent variables included in this analysis. We also determined whether there were log-linear trends in depression (those in the top 25th percentile of depression symptoms) and ketamine use over time (between 2016 and 2019). This was done using logistic regression models to estimate odds as a linear function of time as a continuous predictor. Next, we compared the estimated prevalence of depression symptoms according to self-reported past-year use of each drug using Rao-Scott chi-square tests. After conducting these bivariable tests, we fit each past-year drug use indicator into a multivariable generalized linear model using Poisson and log link with the binary depression variable as the dependent variable. Based on past research, we controlled for survey year, age, sex, race/ethnicity, parent education, and the number of evenings a student goes out per week.22 This model generated adjusted prevalence ratios (aPRs) for each independent variable. We then repeated bivariable and multivariable models, examining the frequency of use of each drug as independent variables and the associations of polydrug use with depression. In our polydrug use models, we repeated such models with our polydrug use variable as the main independent variable in three separate samples: (1) the full sample, (2) among those not reporting ketamine use, and (3) among those reporting ketamine use.
Due to a high level of missingness among independent variables, we imputed missing data for the multivariable models. However, since MTF does not provide race/ethnicity data on students not identifying as White, Black, or Hispanic, we included a missing data indicator for this variable rather than imputing as most of such race/ethnicity data were not truly missing, but instead not available. We implemented multiple imputations via chained equations to handle missingness due to nonresponse. Predictors included all variables in the analysis. We imputed 10 datasets, on which we computed the multivariable model and combined results using Rubin’s Rules.23 All analyses were design-based for survey data and utilized survey sample weights provided by MTF. Stata 17 SE software (StataCorp.) was used for analyses.
RESULTS
The majority of the sample identified as being age ≥18 (57.5%), female (51.1%), and white (60.4%; among those with race/ethnicity data), with 14.3% identifying as black, and 25.4% identifying as Hispanic. With regard to parent education, 10.9% had less than a high school diploma, 18.4% had a high school diploma, 20.1% had some college, 31.3% had a college degree, and 19.4% had attended graduate school. Regarding the number of nights students go out per week for recreation, 38.9% on average go out 0–1 nights, 46.2% go out 2–3 nights, and 14.9% go out 4-7 nights. Over half of students used alcohol in the past year (52.7%), 35.9% used cannabis, 5.8% used amphetamine (nonmedically), 4.3% used tranquilizers (nonmedically), 3.6% used opioids (nonmedically), 2.9% used sedatives (nonmedically), 2.3% used cocaine, 0.9% used ketamine, and 0.4% used heroin. With respect to trends, between 2016 and 2019, depression increased from 20.8% to 29.0% (p < .001) and ketamine use decreased from 1.2% to 0.6% (p = .005).
Table 1 presents results from models examining past-year drug use in relation to students reporting relatively high depression symptomology. Compared to those not reporting use, those reporting past-year use of each drug other than alcohol were more likely to report a high level of depressive symptoms in bivariable tests (ps < .01). With all else being equal, results from the multivariable model suggest that ketamine was associated with the highest risk for reporting a high level of depression (aPR = 1.55, 95% CI: 1.24–1.94), followed by use of cannabis (1.29, 95% CI: 1.19–1.39), and nonmedical use of tranquilizers (aPR = 1.22, 95% CI: 1.04–1.44) and amphetamine (aPR = 1.17, 95% CI: 1.01–1.34). Alcohol use was associated with decreased risk (aPR = 0.92, 95% CI: 0.85–0.99). A graphical presentation of these results is also presented in Figure 1.
TABLE 1.
Past-year drug use in relation to depression
| Sample characteristics | High depression (top 25th percentile) | Multivariable model | ||
|---|---|---|---|---|
|
|
||||
| Weighted % | No, weighted % | Yes, weighted % | aPR (95% CI) | |
| Alcohol | ||||
| No | 47.3 | 74.4 | 25.6 | 1.00 |
| Yes | 52.7 | 75.0 | 25.0 | 0.92 (0.85–0.99) * |
| Marijuana | ||||
| No | 64.1 | 76.8 | 23.2 ** | 1.00 |
| Yes | 35.9 | 71.1 | 28.9 | 1.29 (1.19–1.39) ** |
| Amphetamine (nonmedical) | ||||
| No | 94.2 | 74.9 | 25.1 ** | 1.00 |
| Yes | 5.8 | 65.4 | 34.6 | 1.17 (1.01–1.34) * |
| Tranquilizers (nonmedical) | ||||
| No | 95.7 | 74.9 | 25.1 ** | 1.00 |
| Yes | 4.3 | 61.5 | 38.5 | 1.22 (1.04–1.44) * |
| Opioids (nonmedical) | ||||
| No | 96.4 | 74.8 | 25.2 ** | 1.00 |
| Yes | 3.6 | 65.1 | 34.9 | 0.98 (0.81–1.19) |
| Sedatives (nonmedical) | ||||
| No | 97.1 | 74.8 | 25.2 ** | 1.00 |
| Yes | 2.9 | 59.3 | 40.7 | 1.19 (0.99–1.44) |
| Cocaine | ||||
| No | 97.7 | 74.6 | 25.4 ** | 1.00 |
| Yes | 2.3 | 62.2 | 37.8 | 1.02 (0.83–1.26) |
| Ketamine | ||||
| No | 99.1 | 74.7 | 25.3 ** | 1.00 |
| Yes | 0.9 | 46.4 | 53.6 | 1.55 (1.24–1.94) ** |
| Heroin | ||||
| No | 99.6 | 74.5 | 25.5 ** | 1.00 |
| Yes | 0.4 | 36.4 | 63.6 | 1.14 (0.84–1.56) |
Note: Use of LSD, other psychedelics, and ecstasy were not presented because these were not surveyed on both survey forms. The sample characteristics column presents column percentages and row percentages are presented for bivariable comparisons. We controlled for demographic characteristics and survey year in the multivariable model. Significant findings are bolded.
Abbreviations: aPR, adjusted prevalence ratio; CI, confidence interval.
p < .05
p < .001.
FIGURE 1.
Past-year drug use in relation to depression
Table 2 presents results from models examining the frequency of past-year drug use in relation to reporting relatively high depression symptomology. Prevalence of depression differed significantly according to the frequency of use of each drug examined (ps < .05), and the prevalence of high-level depression tended to be higher as the frequency of use increased. With all else being equal, results from the multivariable model suggest that compared to those not using cannabis in the past year, those using 3–9 times (aPR = 1.36, 95% CI: 1.22–1.51) or ≥10 times (aPR = 1.40, 95% CI: 1.26–1.55) were at higher risk for high-level depression. A similar but more extensive dose-response-like relationship was detected regarding ketamine use. Specifically, compared to those reporting no past-year use, those using 1–2 times (aPR = 1.37, 95% CI: 1.01–1.86), 3–9 times (aPR = 1.65, 95% CI: 1.18–2.32), and ≥10 times (aPR = 1.70, 95% CI: 1.20–2.41) were at increasingly higher risk for reporting a high level of depression. Compared to those reporting no past-year alcohol use, those reporting use on 3–9 occasions were estimated to be at lower risk for reporting depression (aPR = 0.85, 95% CI: 0.77–0.94).
TABLE 2.
Frequency of past-year drug use in relation to depression
| Sample characteristics | High depression (top 25th percentile) | Multivariable models | ||
|---|---|---|---|---|
|
|
||||
| Weighted % | No, weighted % | Yes, weighted % | aPR (95% CI) | |
| Alcohol | ||||
| 0 times | 47.3 | 74.4 | 25.6 * | 1.00 |
| 1–2 times | 16.5 | 75.1 | 24.9 | 0.94 (0.86–1.04) |
| 3–9 times | 20.8 | 77.1 | 22.9 | 0.85 (0.77–0.94) * |
| ≥10 times | 15.5 | 72.2 | 27.8 | 1.00 (0.89–1.12) |
| Marijuana | ||||
| 0 times | 64.1 | 76.8 | 23.2 ** | 1.00 |
| 1–2 times | 10.4 | 75.4 | 24.6 | 1.11 (0.99–1.25) |
| 3–9 times | 9.9 | 70.4 | 29.6 | 1.36 (1.22–1.51) ** |
| ≥10 times | 15.5 | 68.6 | 31.4 | 1.40 (1.26–1.55) ** |
| Amphetamine (nonmedical) | ||||
| 0 times | 94.2 | 74.9 | 25.1 ** | 1.00 |
| 1–2 times | 2.8 | 68.9 | 31.1 | 1.13 (0.95–1.36) |
| 3–9 times | 1.8 | 64.8 | 35.2 | 1.11 (0.89–1.37) |
| ≥10 times | 1.2 | 57.0 | 43.0 | 1.23 (0.96–1.56) |
| Tranquilizers (nonmedical) | ||||
| 0 times | 95.7 | 74.9 | 25.1 ** | 1.00 |
| 1–2 times | 2.3 | 64.4 | 35.6 | 1.20 (0.99–1.44) |
| 3–9 times | 1.4 | 59.4 | 40.6 | 1.16 (0.91–1.47) |
| ≥10 times | 0.6 | 54.6 | 45.4 | 1.05 (0.73–1.52) |
| Opioids (nonmedical) | ||||
| 0 times | 96.4 | 74.8 | 25.2 ** | 1.00 |
| 1–2 times | 1.9 | 69.7 | 30.3 | 0.89 (0.71–1.12) |
| 3–9 times | 1.2 | 62.4 | 37.6 | 1.00 (0.75–1.33) |
| ≥10 times | 0.5 | 52.0 | 48.0 | 1.21 (0.83–1.78) |
| Sedatives (nonmedical) | ||||
| 0 times | 97.1 | 74.8 | 25.2 ** | 1.00 |
| 1–2 times | 1.4 | 62.7 | 37.3 | 1.16 (0.92–1.45) |
| 3–9 times | 1.0 | 54.9 | 45.1 | 1.27 (0.95–1.69) |
| ≥10 times | 0.5 | 58.3 | 41.7 | 1.13 (0.77–1.68) |
| Cocaine | ||||
| 0 times | 97.7 | 74.6 | 25.4 ** | 1.00 |
| 1–2 times | 1.1 | 62.3 | 37.7 | 1.05 (0.83–1.34) |
| 3–9 times | 0.7 | 63.5 | 36.5 | 0.86 (0.61–1.22) |
| ≥10 times | 0.5 | 60.2 | 39.8 | 0.89 (0.58–1.36) |
| Ketamine | ||||
| 0 times | 99.1 | 74.7 | 25.3 ** | 1.00 |
| 1–2 times | 0.3 | 53.8 | 46.2 | 1.37 (1.01–1.86) *** |
| 3–9 times | 0.3 | 40.9 | 59.1 | 1.65 (1.18–2.32) * |
| ≥10 times | 0.2 | 42.7 | 57.3 | 1.70 (1.20–2.41) * |
| Heroin | ||||
| 0 times | 99.6 | 74.5 | 25.5 ** | 1.00 |
| 1–2 times | 0.1 | 34.8 | 65.2 | 1.43 (0.85–2.42) |
| 3–9 times | 0.2 | 25.4 | 74.6 | 1.21 (0.83–1.78) |
| ≥10 times | 0.1 | 54.0 | 46.0 | 0.95 (0.52–1.72) |
Note: Use of LSD, other psychedelics, and ecstasy were not presented because these were not surveyed on both survey forms. The sample characteristics column presents column percentages and row percentages are presented for bivariable comparisons. We controlled for demographic characteristics and survey year in the multivariable model. Significant findings are bolded.
Abbreviations: aPR, adjusted prevalence ratio; CI, confidence interval.
p < .01
p < .001
p < .05.
Polydrug use in relation to depression is presented in Table 3. The number of drugs used in the past year was associated with an increased risk of depression in a dose-response-like manner for the full sample and for the subsample of students who had not used ketamine. However, among the subsample of students who did use ketamine, the level of polydrug use was not significantly related to depression in the bivariable or multivariable model.
TABLE 3.
Past-year polydrug use in relation to depression
| Sample characteristics | High depression (top 25th percentile) | Multivariable models | ||
|---|---|---|---|---|
|
|
||||
| Weighted % | No, weighted % | Yes, weighted % | aPR (95% CI) | |
| Full sample | ||||
| 0 drugs | 42.0 | 75.1 | 24.9 * | 1.00 |
| 1–2 drugs | 49.7 | 75.2 | 24.8 | 1.10 (1.03–1.19) ** |
| 3–4 drugs | 6.3 | 65.4 | 34.6 | 1.60 (1.42–1.79) * |
| 5–9 drugs | 2.1 | 60.2 | 39.8 | 1.91 (1.63–2.23) * |
| No past-year ketamine use | ||||
| 0 drugs | 42.2 | 75.2 | 24.8 * | 1.00 |
| 1–2 drugs | 50.3 | 75.5 | 24.5 | 1.10 (1.02–1.18) *** |
| 3–4 drugs | 5.8 | 67.2 | 32.8 | 1.51 (1.34–1.72) * |
| 5–9 drugs | 1.7 | 65.8 | 34.2 | 1.71 (1.40–2.08) * |
| Past-year ketamine use | ||||
| 0 drugs | 22.1 | 58.1 | 41.9 | 1.00 |
| 1–2 drugs | 40.8 | 40.3 | 59.7 | 1.32 (0.71–2.47) |
| 3–4 drugs | 15.6 | 54.7 | 45.3 | 1.17 (0.51–2.66) |
| 5–8 drugs | 21.5 | 43.6 | 56.4 | 1.21 (0.65–2.24) |
Note: The sample characteristics column presents column percentages and row percentages are presented for bivariable comparisons. We controlled for demographic characteristics and survey year in the multivariable models. Significant findings are bolded.
Abbreviations: aPR, adjusted prevalence ratio; CI, confidence interval.
p < .001
p < .01
p < .05.
DISCUSSION
Results suggest that in comparison to other substances, recreational ketamine use was associated with the highest risk for reporting a high level of depressive symptoms among US adolescents, with more frequent use associated with increased risk in a dose-response-like manner. These results begin to address the gap that exists in the literature regarding the association between depressive symptoms and nonmedical or recreational ketamine use, but further research needs to be conducted to investigate the temporal associations between depressive symptoms and ketamine use in both the adolescent and adult population.
While ketamine use was found to be independently associated with an increased risk of reporting depression, it is important to keep in mind that the vast majority of students who had used ketamine also used multiple other drugs. While the number of drugs used was associated with increased risk for depression in a dose-response-like manner, among students who used ketamine, the number of additional drugs used did not increase risk. This may further support that while ketamine is indeed often used in polydrug contexts, other drugs, over and above ketamine, do not seem to be associated with as high risk for depression.
Although the prevalence of the major depressive disorder among adolescents continues to rise,1 depression is undertreated in this already vulnerable population.24,25 In a study that examined an administrative claims database of privately insured individuals with depression ages 6–17, it was found that less than 60% of these adolescents were provided treatment for depression, either by medication only or combination treatment including therapy.24 Additionally, because the symptoms and presentation of depression differ from the criteria for adults, depression among adolescents often goes undiagnosed and untreated.24,25 Although recent trials suggest that ketamine administration in clinical settings is efficacious in treating treatment-resistant depression, our study demonstrates that past-year recreational ketamine use is actually a risk factor for reporting current depressive symptoms among adolescents. In the context of increased media attention regarding the clinical use of ketamine for depression, especially among nightclub-goers,26,27 there may be a subgroup of adolescents using ketamine to self-medicate untreated depression. However, our findings could also suggest adolescents using ketamine recreationally (e.g., in social contexts such as parties as a club drug—where most recreational ketamine use occurs) are at high risk for experiencing high depressive symptoms. There could also be indirect pathways regarding such associations. For example, depression may be related to party attendance or access to the drug.
Many studies demonstrate the association between depression and a range of use of various recreational psychoactive substances among adolescents,2,3,5,6,28–30 and our study confirms the positive association of past-year cannabis use and nonmedical use of amphetamine and tranquilizers with high depression symptoms among high school seniors. However, the frequency of ketamine use appears to have the strongest association in a dose-response-like manner to current depressive symptoms compared to other psychoactive substances. Higher frequency cannabis use was also associated with higher risk for depression although not as high risk compared to ketamine use. These results differ from a recent study, which found that while any cannabis use was associated with major depressive episodes, more frequent use was associated with lower risk for such episodes.28 With respect to alcohol, previous research has shown alcohol use to be a risk factor for depression);29,30 however, we found that any alcohol use was associated with decreased risk for depression. Further, with regard to frequency of alcohol use, use 3-9 times was associated with lower risk, suggesting unstable findings and that perhaps more nuanced analysis is needed in the future in this adolescent population. Multivariable associations for cocaine and heroin were null but the use of these drugs were indeed risk factors in bivariable models.
Understanding why ketamine use in particular is a risk factor for reporting current depression than most other drugs among adolescents is imperative to minimize harms and to address the needs of this vulnerable population. The dissociative effects of ketamine may help explain its use relative to high depressive symptoms if the user desires to “escape.” Additionally, as a club drug, ketamine is often initiated after drugs like cocaine and ecstasy;31,32 therefore, in this respect, ketamine use can sometimes indicate more extensive drug repertoires or even higher levels of drug use severity. While ketamine is relatively safe, particularly in medical settings,33 all psychoactive substances have potential risks, and frequent ketamine use may lead to dependence, episodic memory impairments, lower urinary tract dysfunction, and poor impulse control.33,34 These could be a concern among adolescents using ketamine recreationally or nonmedically without medical supervision.
LIMITATIONS
Although this study helps address the gap that exists between the association of depressive symptoms and ketamine use outside of medical settings, there are several limitations to this study. As this is a cross-sectional study, we are unable to investigate the directionality of the association between nonmedical or recreational use and depressive symptoms. Trend analyses suggest that depression has been increasing and ketamine use has been decreasing among high school seniors. As such, the main independent and dependent variables examined in this analysis have been shifting in prevalence, but we did control for survey year in multivariable models in order to help control for such secular trends. We assumed that all or most ketamine use was recreational in nature; however, we do not know for certain that all use was recreational or nonmedical, which is an important distinction to make when determining why adolescents use ketamine outside medical supervision. Further, the depression scale in this study is not as commonly used or validated as other depression measures. Additionally, LSD, ecstasy (MDMA, Molly), and psychedelics other than LSD were only queried on one of two separate survey forms focused on in this analysis, so these drugs were not included in models. However, a separate analysis of these forms determined no significant associations with respect to these drugs (data not presented). Students also reported on what drugs they believe they used, but street drugs are commonly adulterated with other drugs. For example, a recent study found that unknown exposure to other drugs (e.g., as adulterants) is common among people who use ketamine or other drugs.35 Finally, chronically absent students and dropouts were underrepresented in the samples.
CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE
To our knowledge, this is the first nationally representative study that evaluates the extent to which ketamine is used recreationally or nonmedically, relative to other common drugs among adolescents reporting depressive symptoms. Findings indicate that past-year ketamine use is a risk factor for reporting current depression. Given the high prevalence of depression and illegal drug use among adolescents, more research is warranted to understand the temporal associations between recreational ketamine use and high depressive symptoms.
ACKNOWLEDGMENTS
Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Numbers R01 DA044207 (PI: Palamar) and K23DA043651 (PI: Han). The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health.
Funding information
National Institute on Drug Abuse, Grant/Award Numbers: K23DA043651, R01DA044207
Footnotes
CONFLICT OF INTERESTS
Dr. Palamar has consulted for Alkermes, but the authors declare no additional potential conflicts of interest. The authors alone are responsible for the content and writing of this paper.
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