K Hole

K Hole

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Elizabeth Hartney, BSc, MSc, MA, PhD is a psychologist, professor, and Director of the Centre for Health Leadership and Research at Royal Roads University, Canada.

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Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

A "k-hole" is how it feels when you take a high enough dose of ketamine that both your environmental awareness and bodily control become very impaired. When someone has "fallen into a k-hole" (the slang term for this ketamine effect), they are temporarily unable to interact with others or the world around them.

Ketamine is a dissociative drug , which means that it can make users feel detached from reality and themselves. It was originally used as an anesthetic, but has also been found effective for treating major depression and bipolar disorder—under medical supervsion. 1

Learn what a k-hole is and what it feels like to be in one, or k-hole symptoms. This article also discusses other ketamine effects, as well as signs of a ketamine overdose and how to get help.

A k-hole is when high doses of ketamine lead to intense feelings of dissociation . This can cause feelings of being disconnected from or unable to control one's own body, also sometimes affecting the ability to speak and move around easily.

One way to think about a k-hole is as a state between intoxication and coma. Some people refer to a k-hole as an out-of-body or near-death experience.

As the consciousness of the real world diminishes, alterations in the senses during a k-hole may lead to illusions and hallucinations . While usually temporary, some people have shown ongoing dissociative and psychotic symptoms with long-term ketamine misuse. 2

This video has been medically reviewed by John C. Umhau, MD, MPH, CPE .

A k-hole can be frightening and induce strong feelings of powerlessness. This may be especially intense if your ability to speak is affected. When in a k-hole, it can be frustrating if someone is trying to communicate with you and you can't respond.

To others, someone in a k-hole may simply look immobile and intoxicated , although their eyes may move around. 3 This is an effect known as nystagmus . Other k-hole symptoms include marked confusion, unexplainable experiences, floating sensations, and mind/body dissociation.

One of the risks of falling into a k-hole is difficulty coming out of the dissociative state. Some people continue to feel disconnected from the world around them (and from their life), and may even develop ongoing symptoms of psychosis . 4

Ketamine can have effects on the brain, heart, and more. Short-term side effects of taking ketamine can include: 5

Long-term side effects of taking ketamine frequently and/or at high doses include: 6

It can be hard to understand why someone would voluntarily take a drug with k-hole effects. But when taken in lower doses, ketamine can produce feelings of euphoria , 8 making the person taking it feel "at one with the universe."

This ketamine effect is sometimes referred to as being in "k-land." It can be particularly attractive to people who have difficulty coping with life and social situations, or those who are troubled by a distressing past.

Another motivation for taking ketamine is peer pressure. People may want to try this drug because their friends are doing it. Others do not willingly take ketamine but have it slipped into a drink as a date rape drug. 9

Some people, such as those who use drugs to cope with depression, seek out feelings of disconnection and dissociation. In these cases, people feel that ketamine can help them control their uncomfortable feelings; a k-hole is a kind of oblivion that gives them a temporary escape from the world.

A review of several studies found that ketamine is a fast-acting antidepressant, often reaching maximum efficacy at 24 hours. 10 This can appeal to people with depressive symptoms, especially when many antidepressants take weeks to months before any changes are noticed.

Research has shown that people who use ketamine more heavily tend to be more depressed than occasional users. 11 It's not clear whether the depression is caused by ketamine use and its impacts on people's lives, or if people who are already depressed are more vulnerable to ketamine misuse as a form of self-medication.

Treating depression with ketamine should only be done under the supervision of a trained healthcare professional and with a valid prescription. If you have been trying to escape negative feelings through taking drugs like ketamine, consider talking to your healthcare provider about other ways of treating depression.

Taking too much ketamine can cause an overdose . Signs of a ketamine overdose include dangerously slow breathing and loss of consciousness. 5 If an overdose is suspected, get immediate medical attention.

There are many effective and much safer ways of treating depression than seeking out a k-hole. If you have been through significant trauma, such as physical, sexual, or emotional abuse, or if you are struggling with feelings of guilt or emptiness, there are various therapies that can help you.

A mental health professional can help find the best treatment options for you. This might include psychotherapy , medications, or both. These treatments can help you feel better without having to experience a k-hole or other negative ketamine effects.

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.
For more mental health resources, see our National Helpline Database .
Gao M, Rejaei D, Liu H. Ketamine use in current clinical practice . Acta Pharmacologica Sinica . 2016;37:865-872. doi:10.1038/aps.2016.5
Strous J, Weeland C, van der Draai F, et al. Brain changes associated with long-term ketamine abuse, a systematic review . Front Neuroanat . 2022;16:795231. doi:10.3389/fnana.2022.795231
Zanos P, Moaddel R, Morris PJ, et al. Ketamine and ketamine metabolite pharmacology: Insights into therapeutic mechanisms . Pharmacol Rev . 2018;70(3):621-660. doi:10.1124/pr.117.015198
Zuccoli ML, Muscella A, Fucile C, et al. Paliperidone for the treatment of ketamine-induced psychosis: a case report . Int J Psychiatry Med . 2014;48(2):103-8. doi:10.2190/PM.48.2.c
Drug Enforcement Administration. Drug fact sheet: ketamine .
Bell RF, Kalso EA. Ketamine for pain management . Pain Rep . 2018;3(5):e674. doi:10.1097/PR9.0000000000000674
Pahlamar JJ, Rutherford C, Keyes KM. Trends in ketamine use, exposures, and seizures in the United States up to 2019 . Am J Public Health . 2021;111(11):2046-2049. doi:10.2105/AJPH.2021.306486
Ho R, Zhang M. Ketamine as a rapid antidepressant: the debate and implications . BJPsych Advances . 2016;22(4):222-233. doi:10.1192/apt.bp.114.014274
Corriger A, Pickering G. Ketamine and depression: a narrative review . Drug Des Devel Ther . 2019;13:3051-3067. doi:10.2147/DDDT.S221437
Fan N, Xu K, Ning Y, et al. Profiling the psychotic, depressive and anxiety symptoms in chronic ketamine users . Psychiatry Res . 2016;237:311-5. doi:10.1016/j.psychres.2016.01.023

By Elizabeth Hartney, BSc, MSc, MA, PhD

Elizabeth Hartney, BSc, MSc, MA, PhD is a psychologist, professor, and Director of the Centre for Health Leadership and Research at Royal Roads University, Canada.

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Large doses of ketamine can cause a person to become completely detached from reality and slip into a dissociative state commonly known as a k-hole. The potentially terrifying feeling is often compared to an out-of-body or near-death experience.

Author: Amy Keller, RN, BSN

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Last Updated: 2/27/20

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People who use ketamine recreationally often enjoy the tranquilizing and hallucinogenic effects of the powerful dissociative drug. At lower doses, ketamine can make a person feel relaxed, numb and
trippy. Floating sensations are common, and some people become giggly.
But at high doses, ketamine can cause people to completely lose awareness of the world around them and fall into a psychedelic abyss known as a k-hole.
Ketamine can be smoked, snorted or mixed in drinks, but many people experience a k-hole after injecting the drug.
Falling into a k-hole is often described as an intense out-of-body or near-death experience.
People in a k-hole will feel completely detached from their body and surroundings. They are unable to move or speak. Drooling is common, and they appear to be in a catatonic or zombie-like state.
But the mind is far from quiet. During a k-hole, an individual typically experiences vivid, dream-like hallucinations and distortions of time and space.
While some people find the psychedelic experience enjoyable, others find it terrifying. In fact, going into a k-hole is often compared to a bad LSD trip.
Ketamine’s k-hole effect stems from the drug’s unique ability to completely shut off communication between the brain and body, blocking awareness of pain and other physical sensations.
But the same properties that have made ketamine a useful drug in the operating room make it dangerous for the people who use the drug recreationally.
Because ketamine causes paralysis, a k-hole can leave a person more prone to injury.
As a k-hole takes hold, a person may stumble and fall. Ketamine can cause nausea and vomiting, and immobilized people could potentially choke on their vomit. People have also been slipped the drug unwittingly in drinks and assaulted or raped.
While rare, fatal ketamine overdoses have occurred.
High doses of the drug, particularly when injected directly into veins, can suppress breathing. Mixing ketamine with other central nervous system depressants, such as alcohol, heroin, valium or GHB, is extremely dangerous and can increase the risk of overdose .
Frequent use of the ketamine can lead to long-term mental problems.
A 2014 article in the British Journal of Clinical Pharmacology describes the k-hole effect, noting its schizophrenia-like symptoms.
The article also states that chronic ketamine abuse can cause memory probl
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