I wrote in my last post that my ill-advised attempt to get off my medications is not going well. Not much of a surprise, I suppose. My psychiatrist suggested I try an oral formulation of ketamine, known as troches (pronounced “tro-keys”). These are dissolvable tablets that you take home and administer to yourself on a schedule. I’m doing it twice a week for two weeks.
One of the main drawbacks of troches is that the ketamine is less bioavailable compared to IV ketamine, which makes precise dosing a challenge. The risk of addiction can be minimized by carefully monitoring patients’ responses and prescribing ketamine troches in small batches with limited or no refills. An Osmind article written by a physician notes that the ketamine doses that are commonly prescribed are much lower than typical recreational doses but that doctors should have carefully outlined plans for restricting use and halting patients’ access to ketamine troches if necessary.
I got ketamine infusions fairly regularly for two years and then stopped with no problem, so I’m not very concerned about my own risk of becoming addicted. However, a cautious approach seems prudent.
An article on RX Insider describes ketamine troches quite positively, saying that they are a more affordable option than infusions and that they offer relief for patients who may not have access to other forms of ketamine due to logistical constraints or COVID-19 safety concerns.
Even with the experience I have from ketamine infusions under my belt, I was nervous about trying troches. In general, I’m uncomfortable with the idea of not being in control of myself. I managed to let that go when I did ketamine infusions, but the medical monitoring involved in that alleviated some of my anxiety. The uncertainty about what to expect when taking ketamine at home put me on edge, but it has turned out to be fine so far.
What Do Ketamine Troches Feel Like?
I’ve tried two ketamine troches and had very different results each time. Having some idea of what to expect based on my experience with ketamine infusions, I tried to set myself up for a smooth ride. The dog had been walked, my curtains were closed, and I had no obligations waiting for me. I wore comfortable clothes, arranged my weighted blanket on my lap, and chose some gentle-but-compelling instrumental music to listen to.
The first time, I put the troche under my tongue, waited until it dissolved (about 10 minutes), and then waited about 5 more minutes before spitting it out. I may have felt something, but it passed quickly, and I felt completely normal about 5 minutes later. It was so mild that I wasn’t even sure whether I felt it because I expected to or because the ketamine actually had some effect on me. I’d been advised to spit the ketamine out to minimize nausea, but when I reported feeling pretty much nothing, my psychiatrist told me to wait ten minutes after it dissolved the next time and, if I still didn’t feel anything, I could try swallowing it the following time.
A few days later, I tried it for a second time and waited longer than recommended. I think the ketamine that was absorbed under my tongue gave me a very mild dissociative feeling, but it again passed very quickly. This time, I took notes on my phone so I could keep track of the timing. I started at 2:45 and didn’t feel anything until 3:04. I felt a very low level of spatial wobbliness – a lot like how I feel when I’m a little overwhelmed in a busy grocery store. It felt like things were getting a bit hard to track with my eyes, and I felt ever so slightly floaty. By 3:15, it seemed like the effect had already peaked in a mild way and worn off. I felt pretty normal, so I swallowed the ketamine, and a second wave came a few minutes later.
At 3:30, I noted that my fingers felt a little numb and that I was going to close my eyes. Seven minutes later, I wrote, “Music too intense. Felt like being carried on a river of sound.” What does that mean? I no longer know. You might think that I was completely zonked, based on that tidbit, but only one minute later, I held a brief conversation with my mom and managed to seem totally coherent. Compared to ketamine infusions, troches seemed to create a more fragile dissociative state. I was much more able to pull myself out of it when under the influence of troches than I was when I got infusions.
I think my anxiety about what would happen had me coming back to the room frequently, which resulted in a very fragmented experience. I would get sucked into a song for a couple minutes and then reorient myself and write a quick note on my phone about what was happening.
When I closed my eyes, my sense of where my body was and where certain parts of my body were in relation to each other was distorted. It’s a feeling I also tend to experience when I’m on the edge of sleep or when I sit still for too long. Sometimes, it’s only a small discrepancy, such as the difference between whether my hands are resting on my lap or next to me.
The sensation is cranked up on ketamine. This time, it resulted in me feeling like my head was somehow directly connected to my knees. I experienced this kind of bodily confusion frequently during ketamine infusions, so I knew it was nothing to be concerned about. I tried to let go of my desire to organize my body in a certain way and just float along in whatever form I had taken.
Every time I checked back in to the real world, I was surprised to find that only a few minutes had passed. It felt more like 20 or 30.
What I was seeing and feeling during those few minutes was nothing so detailed or bizarre as what ketamine infusions created, but I have the sense that if the experience had not been so fractured, I might have approached a similar level of immersion.
I remember one song evoking an image of the night sky as viewed from a very dark place, with the vast swath of the milky way stretching out overhead. Another song made me feel as though I were standing in my old house as it burned down, sparks and ashes falling around me. The wind had begun to howl outside in earnest, which makes me nervous these days.
At 3:48, Stella decided to sit on the window seat. She found the break in the curtains and pushed her way through, light streaming in behind her. The light held my attention for a few minutes, but by 3:53, I wrote that I was feeling more normal but also rather sad. I had a bit of a cry, noticed that time was jumping ahead in small increments, and then got up to go to the bathroom at 4:10. Looking in the mirror was an unsettling experience, but I expected that, so it wasn’t too disturbing.
By 4:22, I felt like I was completely past the effects of the ketamine. So, all told, the entire process took about an hour and a half from the time I first noticed the ketamine affecting me.
I haven’t noticed any improvement from the ketamine, but I have two more to do before the end of my two weeks. In the meantime, I’ve decided to get back on lithium. It seems obvious that stopping it was a bad idea and that I’ve clung to the hope that I could make it work without it for too long. I’m trying to keep the perspective that my experiment was informative, and it’s good that lithium helps me. But to be honest, I just feel defeated. The better I feel, the easier I am on myself for needing medication, so hopefully, this ultra-critical side of myself will quiet down when the lithium starts working.
Unfortunately, ketamine is not helping me much anymore. The infusion before last gave me a small boost, and I remember feeling good for about five days following my appointment. Some of the other benefits I get from ketamine, including improved appetite, fewer thoughts about self-harm and suicide, and more energy, still seemed to extend for a week or so post-infusion. On the whole, though, I wasn’t feeling encouraged.
My most recent ketamine infusion came just a few days before I started transcranial magnetic stimulation (TMS) treatments. I have almost no memory of that infusion. The day after the infusion did seem better, and I had the sense that things around me seemed a bit brighter or more colorful. I hate to say it, but aside from that mild improvement on that particular day, I don’t think the infusion did much of anything for me.
So, I’ve decided to stop getting ketamine infusions for the foreseeable future. It’s unclear why they stopped helping me, so I’m not opposed to keeping the option of restarting them in my back pocket. Right now, though, I don’t think that continuing them is providing much, if any, benefit to me.
Lithium and My Poor Kidneys
I’m disappointed that I’ve come to this conclusion about ketamine, but I’m also in a slightly delicate spot, and something needs to change.
Image by chenspec on Pixabay
I increased my lithium dose in March because my mental health was deteriorating. Lithium is probably the medication that I have the most conflicted relationship with. Taking such a high dose is effective at reducing my suicidal thoughts, but it’s not ideal for my poor kidneys. And when my kidneys can’t keep up, my lithium levels begin to inch toward toxic.
My lithium level as of a few weeks ago was slightly above the upper limit of “therapeutic.” It’s back in range now because I’ve been working on doing that human thing where you drink water, but I’d still rather not take this dose of lithium for very long.
Deciding to Try TMS
It’s the combination of ketamine’s waning efficacy and lithium’s waxing toxicity that led me to TMS. I’m not in a good place, and I need a different solution. TMS is mostly covered by my insurance, there’s a clinic I like close to where I live, and the downsides of trying it are very few.
Initially, I considered continuing ketamine while doing TMS, as one could receive both treatments concurrently. I’ve opted to do TMS alone because ketamine is not offering me relief and no longer seems worth the expense. However, it’s possible that ketamine is helping me more than I realize, and stopping infusions might worsen my depression. I’ll just have to see how it goes.
I also considered ECT because of how severe my depression was before I increased my lithium dose, but I think it makes sense to try TMS first.
I’ve done a few TMS treatments so far, and they were strange and interesting experiences, but I think I’ll save my descriptions for another post.
Setting Ketamine Infusions Aside
It makes me rather sad to think that this part of my life is over. I’ll miss the wonderful people at my ketamine clinic, and I’ll miss writing about my experiences there. I’m glad I documented my ketamine dreams, which I will remember with equal measures bemusement and fascination.
I’m also upset that I’ve “failed” yet another treatment. It’s a discouraging development that leads me down well-worn paths of self-criticism and frustration.
That said, I’m incredibly grateful for the improvements I gained from ketamine. There was a while there where it was really turning my life around. I started volunteering, I was happier, I felt excited about life, and then the pandemic hit, and a series of stressors undid all the positive progress I’d made. (My therapist would remind me that not all of my progress was lost. That’s just my brain lying to me again.)
Although I won’t be getting infusions, I would love to keep up with the research and continue sharing information about ketamine. I would especially like to see what data exists on the long-term efficacy of ketamine and whether my experience of it is represented in the literature. A quick search shows tons of studies published in 2021 and 2022, so there’s certainly new information out there. My brain power is lacking, though, so I’ll have to save that for another time as well.
Photo by Brad Christian on Unsplash (@y_barron)
I still believe that it’s important to raise awareness of ketamine treatment for depression and reduce the stigma associated with it. It may not be working for me right now, but it’s still a valuable option that people with treatment-resistant depression should be aware of.
So, I’ll leave the door open for further posts in The Ketamine Chronicles. I still want the series to be a resource for people who are considering IV ketamine infusions and find first-person accounts helpful or reassuring. I hope I’ve accomplished that to some degree in this phase of the series. If you’ve been reading for a while or just started, thank you for clicking and scrolling and reading about my bizarre, profound, and nonsensical ketamine dreams.
I have found that my most vivid experiences with ketamine treatments for depression happen when I’m listening to classical music. At my appointment this week, I popped both earbuds into my ears and started listening to a classical playlist while the infusion pump started to whir. The piano in the first song was soothing, and I settled back, holding my phone in my left hand and a worry stone in my right.
Music During Ketamine Infusions for Depression
The next song was heavy on the cello, and while I love cello music, this song gave me a decidedly creepy feeling. It brought to mind lots of puffy, white items in creamy white rooms that made me feel suffocated. It reminded me of a funeral home. I thought about changing the song, but that would have required control over more muscles than just my fingers, so I just waited it out, circling my thumb around the stone in my right hand.
The Worry Stone and a Mild K-Hole
The worry stone has proven to be a useful addition to my IV ketamine treatments. Even though it’s just my thumb that I can feel, that one little point of contact helps anchor me to the real world when I start to dissolve into nothingness.
During my previous ketamine infusion, in which I did not have my stone, I had found myself unable to move. I was probably experiencing what people call a “K-hole.” At times, I was aware enough to know that I only had one earbud in and wanted to grab the other one from my lap. I just could not force my arm and hand to move toward it. I’d try for some undetermined amount of time before giving up and being whisked away from my body once again, only to repeat the whole thing a little while later.
It wasn’t scary so much as it was frustrating. There was something I wanted, and not only could I not do it myself, but I was incapable of communicating my request in any way. We lowered the dose a little for this infusion, and I think that combined with the itty bitty scrap of control I maintained through the worry stone made for a much more comfortable ketamine infusion.
Controlling My Thoughts During a Ketamine Infusion
When the next song came on, I decided that I did not like all of the white imagery I was seeing, so I changed it to a more tan color and was immediately more comfortable. I don’t think that I’ve ever been able to just decide to change something about my experience of IV ketamine, so this was an interesting development.
I’ve contemplated the connection that happens between my recent experiences and IV ketamine that occurs in the form of bizarre, distorted versions of real-life items or events. I often start to see things during a ketamine infusion that I remember having a passing thought about a couple hours earlier. For instance, the oceans of corn I witnessed after briefly thinking about movie theater popcorn before one of my early ketamine infusions.
I’ve been mostly unsuccessful in doing this on purpose by seeding my mind with ideas. I had thought that my brain simply has its own agenda, but if I can change details like color while the infusion is happening, maybe I could learn to guide myself more reliably over time.
Machinery Noises
The infusion pump next to me whirred and chugged away, and although sometimes it faded into the background, at other times, it was extremely loud and menacing. It started to sound like a deep growl, and I felt as though I were trapped in a small space with a sinister beast and a red glow all around me. This occurred for only a few seconds, as I quickly tried to ground myself using the worry stone in my right hand. I remember thinking to myself, “This isn’t real. You’re sitting upright. You can feel the stone in your hand. This isn’t real.”
Photo by JR Korpa on Unsplash
Forcing myself back to the room felt like dragging myself up, up, up through a dark corridor to the surface. I turned up my music to drown out the sound of the pump and found myself floating into another feeling entirely.
What Am I?
At times during this ketamine infusion, I felt like I was a thin layer of ice spreading across a pane of glass. I watched the methodical movement of tiny ice crystals marching across the pane, like an army moving to claim new territory.
Photo by Sydney Rae on Unsplash
I watched it and I felt like I was it. It’s difficult to explain how disconnected I feel from my own body during a ketamine infusion. In fact, it’s difficult for me to fully comprehend after the fact, despite having experienced it many times. I still feel like myself, I’m just lacking a physical body. I’m free to move around as what feels like my pure essence, observing and sometimes participating in events that sound nonsensical to my rational mind. Although I seem not to have much control over what I see or become, it’s a somewhat pleasant experience to not feel constrained by my human identity.
Real-World Distortions
I rebelliously opened my eyes once to see the room coated in a gently moving, gauzy film. The walls seemed to shift as the film moved, creating odd, geometric patterns over everything. The photo on the wall suddenly had an ornate frame that stood out to me as being different than the understated one that had existed before.
My mom sat in the corner, typing quietly on her laptop. I tried to focus my eyes on her, but ketamine messes with my depth perception and I couldn’t even manage to keep my gaze on her face without my eyes jumping around the room and then back again. Finding the effort of this to be tiring, I closed my eyes again.
As usual, I was underwater for a time, but I don’t remember any specifics. I don’t know if it was the ocean, a lake, a river, or a stream. All I remember is that it felt somewhat healing.
Going Home After IV Ketamine for Depression
I have vague memories of getting home from my ketamine appointment and walking Stella through the park. I must have hung up my laundry at some point. I definitely remember lamenting my poor timing before leaving them to sit in the washing machine during my ketamine infusion, but now they’re on the drying rack. I may also have filled up the dishwasher, but again – it’s a blur. Maybe I should save some truly unpleasant task for post-ketamine productivity time. That way, I wouldn’t have to remember actually doing it!
I napped from 5:30 to 7:00 PM, then ate dinner and promptly went back to bed. I woke up later on at 11:00 PM and had a snack before getting back into bed. My face felt strange – like there was something weighty resting on my cheekbone and the right side of my scalp.
My tremor was bad the next day, and I struggled for minutes on end just trying to clasp a necklace around my neck. I felt spacey for two days following my infusion, and time had an odd quality to it. I tend to sleep poorly for a few days after a ketamine treatment, but mostly because I have a burst of energy that leaves me wanting to accomplish things instead of going to bed. Forcing myself to get in bed before I’m really ready results in extreme restlessness – it’s difficult to stop moving and I have to constantly remind myself that there is no reason whatsoever why I should be tensing every muscle in my body. Besides, I spend so much time sleeping when I’m depressed that finding myself actually wanting to do things is a refreshing change.
The side effects of ketamine typically go away very quickly after an infusion, but I have the added factors of multiple anti-nausea medicines and the MAOI antidepressant I take, Emsam. In my experience, the combination of all this makes for a more intense experience of IV ketamine and slower recovery from its acute effects.
My previous ketamine infusion felt more effective than recent ones felt. I didn’t start napping again until a few days before this infusion, I’ve been fairly motivated, and my general level of hopelessness hasn’t been too bad. Hopefully, this one will have the same effect on my depression.
I just watched a video that Kyle Kittleson of the MedCircle YouTube channel posted about IV ketamine. It’s called, “What It’s Like to Do Ketamine Treatment for Depression.” The video itself was great; I love that Kyle and his producer, Brigid, were so open about sharing their first ketamine treatment experiences with over 950,000 subscribers. I think their courage will have a big impact on the public’s understanding of why and how professionals administer ketamine for depression.
Online Discussions about Ketamine for Depression
Building awareness about ketamine in mental health treatment is good because we have a LONG way to go. Scrolling through the comments on Kyle’s ketamine infusion video was a rollercoaster of feelings. I have a ketamine infusion about every 4 weeks. I write about ketamine on my blog, and if someone were to ask me about it in public, I would happily talk about it. But I don’t tell just anyone that I use this treatment. I thought that I was being overly cautious, but frankly, after reading the comments I’m about to present to you, I’m not so sure. The judgment, condescension, flippant jokes, and dangerous misinformation were hard for me to read. I could imagine people reading those comments and losing hope in a potentially lifesaving treatment.
Photo by Jr Korpa on Unsplash
Ketamine has many uses as an anesthetic in human and veterinary medicine, and yes, as a recreational drug. It works as a powerful treatment for suicidal thoughts, depression, PTSD, and more. When I get a ketamine infusion, I’m using a legal treatment that helps my brain repair itself. Then, I go home and resume the rest of my regular mental health practices – therapy, medication, being outside, confronting painful issues – the whole nine yards.
I was so excited to see that many comments on the MedCircle video were positive, ranging from support to curiosity to stories of success with ketamine treatments for depression.
Other comments featured honest questions about addiction, cost, what it feels like, and how to get a referral.
And then there were THOSE comments. The ones that spread misinformation, jumped to conclusions, and judged others for their choices. The ones that doubted Kyle’s depression, saying, “He looks fine to me.” And the ones that declared ketamine a dangerous street drug and the people who use it for depression irresponsible high-chasers who can’t face their problems.
Let’s visit some of these comments. I’ve covered the names, but these are real comments from the comments section of Kyle’s ketamine infusion video I linked above. My intent is not to harass anyone with this post. I only want to point out misinformation and address some damaging attitudes about ketamine infusions.
The “this is just a high” comments:
I haven’t found a source for the 99% statistic, but there are many studies demonstrating the rapid improvement of suicidal thoughts in a majority of patients following a single ketamine infusion. Assuming you share the moral conviction that people deserve to live, that is a wonderful thing. So to respond with a flippant question is insensitive, and that particular question is such an oversimplification that it misses the point entirely.
To be clear: the way in which ketamine leads to improvements in mood is not simply through the perceptual experience of being high, although it’s possible that contributes to the benefits. The biochemical effects of ketamine in the brain, which happen as a consequence ofthe part where you’re high, can improve depression for weeks or months at a time.
The “not even once” comments:
Here, we get into just a few of the many, many comments about Kyle’s interest in experiencing a ketamine infusion again. In the brief interview immediately following his treatment, he emphatically expressed a sense of amazement and wonder. He said that he wanted to go back to “where [he] got it.” He wanted to be back “in that space.” Lots of comments labeled Kyle’s enthusiasm a “red flag” for addiction.
I have to wonder if those commenters are reading into Kyle’s words a little too much. I don’t know Kyle, so I can’t say whether he really is in danger of abusing ketamine, but he and Brigid were screened and each consulted their psychiatrists. It’s not something that anyone can go into lightly. I didn’t become a candidate for ketamine infusions until I had spoken to my psychiatric nurse practitioner, my therapist, and the doctor at my ketamine clinic. I explained my lengthy history with antidepressants, consistent psychotherapy, and my hospitalization for suicidal ideation. The doctor then spoke to my psych NP, I filled out a whole lot of forms and then had an initial appointment, in which I asked questions and he explained the process, its risks, and what to expect. I take a pregnancy test before every infusion, I’m still in therapy once a week, and I still take my oral medications. I couldn’t have just rocked up to the ketamine clinic and demanded they accept me as a patient. If I had indicated that I’d had a history of addiction, I’m sure the screening process would have been altered to address that.
Starting treatment with ketamine for depression was a fascinating experience for me, and it still is. I think it’s reasonable to expect a bit of wonder and excitement about the experience. Without knowing Kyle Kittleson personally, I don’t think anyone can determine whether those feelings indicate anything more than innocent fascination for him.
Exploring the way my mind works on ketamine is sometimes bizarre, sometimes soothing, and sometimes it gives me new ways to think about my depression. And yes, when I’m severely depressed, it’s nice to escape for 45 minutes in a dim room with a blanket and people I trust. That doesn’t mean I’m going to “chase down” ketamine and become addicted. I have absolutely no desire to seek out illegal sources of ketamine, nor would I know how.
While I’m glad that last commenter is content to live their life sober, I’m also glad that I have access to medically supervised ketamine infusions. I didn’t start ketamine infusions so that every day can be “sunshine and lollipops, cherries and all that stuff.” I did it so I could stay alive. So that I wouldn’t spend every waking moment in crushing depression anymore. Let’s not minimize the suffering that people with treatment-resistant depression endure.
A Drug By Any Other Name…Would Act the Same
There is a subset of comments that argue that using ketamine for depression is dangerous. Many of those comments revolve around the fact that it has other uses. The comments were full of references to each of ketamine’s names as a party drug. Those who disagree with ketamine treatments for depression seemed split between people who worry that patients will become addicted and people who look down on its history as a recreational drug.
(Why leave a comment if you haven’t watched the video yet??)
Ketamine was developed in the 1970s and was quickly adopted as a battlefield anesthetic. It now has uses in elective and emergency surgery and chronic care settings. And yet, the applications for ketamine that everyone seems to focus on as reason not to use it are its uses in veterinary medicine:
SSRIs are commonly prescribed for depression, and they work great for some people. This person’s claim that THE chemical cause for depression is about serotonin is not accurate. Many other neurotransmitters are involved in depression – possibly even more than we know about yet. Not to mention, the antidepressant effect of ketamine involves, among other neurotransmitters, serotonin.
Chemicals are everywhere. They are everything. The combinations and amounts of them are what make them behave differently in different environments. Ketamine is used to anesthetize animals, whether they have four legs or two. Things that can be deadly in large amounts can also be safe and therapeutic in small amounts.
The “say it with conviction and people will believe you” comments:
Good God, my teeth will fall out?! How horrifying and comically inaccurate. Barring accidental facial trauma due to intoxication, the only way you’ll lose teeth on ketamine is if a dentist is removing them while you’re anesthetized. Memory loss and anxiety can be associated with a ketamine high, but the half-life of ketamine is short and, as these researchers found, “ketamine-induced long-term cognitive deficits were confined almost exclusively to frequent users.” There is a big difference between using ketamine for legitimate medical purposes and abusing it.
I noticed that many of the comments expressing shock, derision, or confident predictions about Kyle’s ketamine infusion came from people who identified themselves as having experience with addiction in one way or another. I can see how learning that people are using ketamine to treat depression could be initially disturbing, especially if you have a background with addiction. What I don’t understand is that people left comments like this when the video very clearly states that there is research to back it up, people are carefully screened beforehand, and it’s administered by a licensed anesthesiologist. This isn’t the guy down the street telling vulnerable people he can cure their depression with some special k. This is science.
@gabrielizalo on Unsplash
Understanding the Risks of Ketamine for Depression
The bottom line with many of these comments is that they argue against the use of ketamine treatment for depression because it has risks. Everything has risks. NOT using ketamine to treat depression has risks. When the alternative is death and you’ve tried the other options already, it’s ok to take a calculated risk. Ketamine may not be safe for people who are prone to addiction – it’s a very individualized decision that should be made with communication between every mental health professional who treats you.
Although a StatPearls overview of ketamine toxicity argues that, “…patients…should [be] risk-stratified similar to those under consideration for chronic opioid therapy,” we see a significant difference of opinion from practitioners and strong evidence that ketamine can be used to treat addictions of many kinds, including alcohol, cocaine, and opioid use disorders.
What About Overdose?
It’s difficult to find statistics on ketamine-related deaths, possibly because there are so few that major trend-monitoring bodies don’t seem to report them in their own category. Instead, I can only guess that, if there are any deaths at all, they might be included under broad diagnosis codes that encompass several other substances. When researchers use death certificate data, they sometimes attribute the deaths to ketamine use when, confusingly, multiple drugs were involved or physical accidents were the direct cause of death. This strikes me as extremely misleading; actual ketamine overdoses are rare.
One review, stated to be the most comprehensive review of ketamine-related deaths published to date, found that there were 283 ketamine-related deaths in England and Wales between 1997 and 2020. The majority of these deaths involved the use of other drugs. Only 32 involved just ketamine, and only 23 were attributed strictly to the drug as opposed to accidents resulting from its use.
Mysteriously, the authors go on to say, “[This review] should dispel the myth that ketamine-related deaths are rare events.” On the contrary: while tragic, 23 deaths over the course of 23 years indicates that ketamine-only-related deaths are quite rare, as are ketamine-related deaths in general.
As for the StatPearls quote about risk stratification, there were 2,263 opiate-related deaths in England and Wales in 2020 alone. In 2019, there were 49,862 fatal opiate overdoses in the US. I can’t find a single mention of ketamine-related deaths in 2019 from US statistics providers, either because the few cases are hidden among various ICD codes or because there are zero. (I have also heard the latter from experienced professionals who may have access to data that I don’t.) Regardless, the fact is that ketamine is implicated in far, far fewer deaths than opiates are. Its use in surgery can reduce postoperative opioid consumption and, as previously mentioned, it can be a valuable tool for treating addiction.
Ketamine in medical contexts is highly controlled, constantly monitored, and the patient should always be active in therapy while undergoing ketamine treatments for depression. No, this isn’t foolproof, and not every clinic provides adequate support for their patients. On the whole, though, ketamine is very safe. I hope that as ketamine becomes more widely accepted for this use, our understanding of the entire picture will improve. Discouraging all people from getting a lifesaving treatment because “drugs are bad” and, as some of these commenters want you to think, risks inevitably become reality, is a dangerous attitude to take when it comes to treating mental illness.
The “stop avoiding your problems by getting high” comments
This comment is like saying, “They have the ability to help people without TMS. It’s just zapping magnets on your head.” It dismisses a complex treatment without considering the actual mechanism by which it works.
I’ll speak for myself when I say that all of these commenters seem to think that by being in therapy once a week for several years straight, revealing extremely painful, personal details about myself, digging into my thought patterns and history and beliefs, spending time in a psychiatric hospital, patiently titrating up and down on numerous medications, and working every day to improve my treatment-resistant depression through behavioral change, I’m simply avoiding my problems now by getting high on ketamine.
It’s also important to note that some of these types of comments are problematic in more than one way. People getting ketamine treatment for depression shouldn’t be shamed, and neither should people suffering from addiction. The stigma of having ketamine treatments relies in part on the stigma of drug abuse and addiction, and ultimately, I think it creates more division and fewer solutions.
A reputable clinic will not allow you to start ketamine infusions for depression unless you’ve demonstrated a clear need for it. It’s a tool like any other. It does help people “get to the root of it” and ketamine patients often use their experience to change their mindsets and heal from trauma.
I agree with the overarching message of this comment. It is hard work to treat depression, and it does take more than one strategy. However, I dislike the implication that people who turn to ketamine for depression are trying to avoid doing that work. Ketamine infusions should not be used in isolation. In my experience, it’s less like a band aid on a cyst and more like a life raft on the ocean. I still have to deal with the waves, but at least I’m floating.
(Band-Aid on a Cyst is going to be my new punk rock band name. I called it first.)
Ketamine for Depression Saves Lives
Ultimately, I’m disappointed but not surprised that so many people left ignorance, insensitivity, and moral judgments in the comments of the MedCircle ketamine video. Kyle took a chance and shared something he likely knew would be controversial. I don’t want to gloss over the fact that there were lots of comments supporting him and Brigid, as well as ones expressing excitement and interest in this emerging treatment. I loved seeing other people refuting misinformation and sharing their own stories of healing with ketamine for depression. There was a significant portion of the comments section that was bursting with positivity.
(I’m not encouraging anyone to do it without careful consideration. Just a positive comment I liked.)
And those were just a few. ❤
More Research is Always Needed
It’s absolutely true that more research is needed on the long-term effects of ketamine treatments for depression, chronic pain, and PTSD. Ketamine has been in use for over 50 years, but we still need to understand more about its effects in order to more accurately predict its efficacy in each patient and its risk of addiction when used for depression in this way. I just wish that we could all respect each others’ mental healthcare decisions and keep an open mind about a promising treatment.
Shaming People Who are Desperate for Help is Counterproductive
The comments I’ve highlighted here may come from people who have experience with addiction and a strong bias against the use of ketamine. They have a right to their opinions, and I hear their concern. Ketamine is a schedule-III drug that should continue to be handled carefully in medical settings. When people come to a judgment about something without being informed and then leave comments intended to divide through fearmongering, insulting assumptions, and straight-up incorrect information, it moves all of us back in the fight against mental illness stigma.
I struggled immensely with the idea of treating my depression with ketamine. The unknowns of what it would feel like scared the pants off me and I was completely intimidated by the social implications of using a mind-altering substance for any reason. If I had read these comments when I was in the process of deciding to try ketamine infusions, I might have been ashamed enough to reconsider. That might have been catastrophic for me. I was recently past my hospitalization and subsequent partial hospitalization and I had been thinking about suicide every single day for years. Ketamine became my life raft, and I’m so thankful that I have the privilege to access it.
I forgot to put on a scopolamine patch the evening before this ketamine infusion, but other than that, this one was packed with stuff intended on making the ketamine more effective. Cimetidine, magnesium, petocin, some anti-nausea drugs, to be honest, it’s all a blur. It was “the kitchen sink.” Getting infusions of IV ketamine for treatment-resistant depression is kind of a balancing act. It works best as an individualized recipe, and it seems that mine is always changing.
I don’t usually start out my ketamine infusions with chit chat, but this time, I spoke to Sarah for a couple of minutes before closing my eyes. What we talked about, I no longer remember, but it was casual and light. When I did close my eyes, I had the sense that this infusion might be a gentle experience at the surface between lucid and zonked. I was very wrong. I think that focusing on my conversation with Sarah diverted some of the weird sensations of ketamine from overcoming me, but they hit me later.
Sand and some lessons about depression
I remember a lot of sand. I was in a desert near some ancient stone ruins, and the sand was shifting like a river in the sunlight. I was on the ground, watching a snake struggle to squeeze between a crack in the stone building before the sand could drag it down. The snake succeeded, turning into a blooming flower as it rose up from the river of sand.
Photo by @wolfgang_hasselmann on Unsplash
At some point, I was looking down a long tunnel into the ground – like a well – at some people on the other side. But as I strained to see who they were, I realized that I wasn’t looking down, I was looking up from the bottom. The people far above me leaned over the edge to gaze down, and the walls of the well crumbled into sand and buried me in darkness. It was quiet. It was something of a relief.
These experiences of being buried or of drowning are never frightening, but they do evoke a certain hopelessness. I used to have whole infusions dominated by water and the feeling of sinking, but lately, that theme has been absent. This theme of sand is different, but it feels much the same. I wonder if it has to do with the state of my depression at the time. In thinking back to the last few times I had a water-based internal experience, I do remember feeling similarly to how I feel now. I’m treading water, still moving a little in the direction of my goals, but I’m decidedly denser than my surroundings. Sinking would be so much easier than pulling myself upwards.
When I’m drowning or being buried in my ketamine infusions, it feels completely out of my control. The forces of water, sand, or perhaps depression, in this metaphor, are simply overwhelming. I think that my perception of depression is manifesting itself as unbeatable natural forces in my ketamine infusions. Most of the time, it doesn’t seem hopeless to that extreme in my real life, so it’s interesting that that’s how it comes out in my ketamine appointments. But, maybe that’s the only way my mind can conceptualize it in that setting.
In my visual experience of ketamine, depression feels like sinking alone in the dark, open ocean. It feels like being buried in sand at the bottom of a well, while people far away can only watch. But in reality, it’s neither of those things. It’s an illness that, like others, can be treated. Reality is clouded by depression, and it’s easy to forget how turned around I can become in my own mind.
Is the ketamine infusion over? Should I get up now?
At the very beginning of this ketamine infusion, my doctor pointed at the photo on the wall across from me and said, “We’ll just see if this starts moving.”
“I’m not supposed to have my eyes open,” I replied, referring to our frequent conflict in which I open my eyes and stare at various entrancing objects while he patiently reminds me over and over again that I’m supposed to have them closed.
“That was a test. You passed.” He laughed.
And then at some point in the infusion, I proceeded to leave my eyes open for what felt like a really long time.
In my defense, I was confused. I opened my eyes because I thought the infusion was over and that everyone was waiting for me to get it together. Let me tell you, trying to fight ketamine while it’s still infusing into your bloodstream is pretty impossible. I kept thinking that I needed to get up and walk to the car, and that seemed utterly beyond my capabilities.
Photo by Michael Dziedzic @lazycreekimages
I vacillated between anxiously willing myself into wakefulness and resigning myself to living the rest of my life in that very chair. Words can’t describe how disoriented I was. Every time I blinked (which wasn’t often and was probably more like a short time with my eyes closed), the room seemed to change somehow. It was wider than I remembered, then it was taller, then the picture was farther away, and everything was tilting to the side. I couldn’t understand why it was taking me so much longer than usual to regain my faculties.
I distinctly remember thinking, “I wish someone would just tell me what I’m supposed to be doing.” That thought gave me some satisfaction because after all, how could anyone get frustrated with me for being slow when they didn’t even tell me that I was supposed to be speeding up? “That’s *their* problem,” I thought. Having convinced myself that transportation to the parking garage was not my concern, I stared at the wall with the photo of the wolf and the goat and found that there actually were three frogs hidden in there, too. I occasionally thought things like, “What time is it?” or, “When did we start?” or, “Which way is up?” only to realize that the answer would mean nothing to me and there was no point in mustering up the energy to ask.
After some amount of time that may have been five minutes or five hours, I was told to close my eyes and that there were eight minutes left. Oh my God, what a relief. “How long did I just spend thinking I needed to get up?No matter, now.” Somewhere in my mind, I found some wry humor in my ability to carry my anxiety about inconveniencing people into Ketamine Land. I guess it follows me everywhere.
After that, I spent some time thinking about oobleck, which is a non-Newtonian fluid often made in middle school science class composed of corn starch and water. It moves like a fluid at rest, but solidifies when you exert sudden force upon it. I felt like I was surrounded by oobleck. Or maybe that I was made of oobleck. Things were flowing like a lazy river when I let go and rested, but when I tried to move, I found myself glued in place.
The eight minutes that were left when I closed my eyes instantly shrunk down to about twenty seconds, and then before I knew it, I was back to searching the inside of my brain for control of my limbs. I got my coat on, missed my face a couple of times trying to put my glasses on, wobbled out the door, and successfully made it to the car.
IV ketamine for depression is different every time
The rest of the day passed uneventfully. I was interested to see if the reintroduction of magnesium into my infusion would result in the wild limb jerking that happened the last time we used it, but thankfully, it didn’t. The bizarre afternoon I had that time has continued to be an isolated event. This time, I slept for most of the day, got up for dinner, then went back to bed. I think. To be honest, I don’t remember the details, but I know that it was fairly mundane.
Every infusion I’ve had has been different, which is why I find it so interesting to write about them. Even my experience once I get home tends to change, and I can’t always pinpoint why. Sometimes, I go about my day – working, writing, walking the dog – and sometimes, I just crash.
It doesn’t even seem like a wackier or more mundane experience correlates with any particular result. At least, as far as I can tell. Maybe there are just too many factors for a clear pattern to emerge.
For the time being, I’m planning some more changes to my medication regime, trying not to nap too much, and carrying on with tiny clams.
My last ketamine infusion was much less trippy than the previous one, so I’m relieved to say that I remember absolutely none of it. Much less fun to describe, but also less persistently, somewhat threateningly bizarre. We skipped the magnesium this time, and I did not have any sudden, limb-jerking spasms. It’s good to know that was likely the culprit. When I can’t remember an infusion, I feel pretty curious about the off-putting gap in my memory. I always think it’s interesting to know what I experienced during a ketamine infusion, and when I can’t, I feel like I’m missing out on something that I just can’t access. Thankfully, the benefits of ketamine for treatment-resistant depression remain even when I can’t remember them.
Eating Food
I’ve been having some problems with nausea and appetite since starting Wellbutrin. They mimic what I feel when I’m really depressed, just amplified. Food is not appealing, neither in my imagination nor my mouth. When it’s time to eat, my goal is to find something that’s least unappetizing. Eating it is a strangely empty experience, as if I can recognize the flavors but can’t assemble them into something I like. The closest analogy I can think of is that it’s like the difference between sound and music. For a few days following a ketamine infusion, that problem is gone. It’s easy to pick something to eat, and not only does it register as, say, a grilled cheese sandwich, but my brain is also willing to exchange it for dopamine. Things taste like how food should taste, and it’s great.
Making Decisions
Ketamine makes the days following an infusion feel remarkably lighter. The difficulty I have with making even small decisions is much improved. I just go about my days without getting stuck at every turn. Speaking of turns, I’ve really been enjoying my morning walks with Stella. When we come to an intersection, I let her choose, and we amble around a ridiculously inefficient route that’s different each day. I am typically a very routine-driven person, so this microscopic spontaneity is a teeny, tiny sign that says “ketamine helped!” If the ketamine wears off or some other factor occurs and my depression gets worse, I tend to become more rigid in the route we take. I’m sure Stella prefers our ketamine-lightened walks, and so do I.
Thinking about the Future
The bigger benefits of ketamine for treatment-resistant depression, for me, are centered around my attitudes about the future. Depression makes me feel hopeless, and ketamine lifts that – sometimes just a little, but sometimes a lot. I’m not sure what determines the degree of helpfulness, but it’s always a welcome effect. It makes it easier to imagine myself making changes and taking big steps.
Other benefits of ketamine for treatment-resistant depression that I notice include:
Sleeping less
Feeling more social
Experiencing something called “fun”
Feeling satisfied about completing a task
Noticing little things that I appreciate or find interesting
Reduced suicidal thoughts (hasn’t been much of a problem recently, but I’ve definitely noticed that in the past)
Lately, I’ve noticed that the most noticeable changes stick around for a few days or a week, then things level off to a pretty neutral place where I’m neither jazzed about life nor am I in the pits of despair. By three weeks, I’m in something like the salt marshes of despondency; not inescapable, but pretty unpleasant.
That is a completely individualized timeline. Everyone is different, and I get the feeling from the forum I’m on that there are a lot of people who go much longer between needing ketamine infusions. I kind of try not to think about it because of what they say about comparison, I guess. (They = various quotes)
Musings about Medication
This was tagged “medication” on Unsplash, and I thought, “that’s a weird swap of the typical ‘pills aren’t candy, kids!’ warning.” (Photo credit: Sharon McCutcheon)
My medications may change again sometime soon, and although I just said that getting ketamine infusions for depression makes making decisions easier for me, I’m setting that choice aside for now. It’s harder to decide soon after an infusion because I feel like I don’t need to change anything. I feel better, therefore, I should keep things the same. But, ketamine wears off at some point, and even though I feel “better,” should I stop at that point? Maybe I only feel a fraction of my potential “better” but it seems like a lot because it’s better than abysmal. These choices are always hard. I don’t want to settle for just ok, but I worry that I’m expecting too much. Maybe this is exactly how happy people feel – they’re just more grateful for it.
But then a couple of weeks pass and I slowly start sliding backwards into napping and apathy and isolation, and I realize that there was no in-between. It was mildly happy and then increasingly depressed. There must be something more than that. I habitually blame myself for depression in the short term. A bad day or week makes me think that I let myself wallow and didn’t try to change things. I think that I’m lazy and burdensome and why can’t I just be cheerful? But when I look at the long-term – the years I’ve spent with depression – I feel kind of robbed. It’s easier to see the trends of it and the forks in the road where I didn’t pick the option the non-depressed me would have chosen. I may try to blame myself for all of that too, but the more reasonable answer is that depression has been in my way. Sometimes, that perspective makes me determined, and all of the other times, it makes me tired.
My last few months have been saturated with medication changes and mood fluctuations. I go up and down, up and down, and I’m thankful for the ups, but there’s something about the downs that feels so much more impactful. Despite the incremental progress I’m making after starting Wellbutrin, I feel completely insecure in that success, like it’s just visiting and will have to leave soon. A large part of me says that would be disastrous and I’ll just have to claw my way forward from here on out because losing ground would be unacceptable. I guess we’ll find out.
My experience of receiving IV ketamine for depression this time around is now almost completely lost in the recesses of my brain. I do remember having an odd, somewhat uncomfortable feeling early on that I recognized from one of my recent ketamine infusions. My best description of this feeling is that my thoughts were physically too large for my head and too fast to really grasp. But what was most interesting about this infusion was what happened afterward.
First of all, I was so incredibly disoriented that when I thought that my mom was driving in the wrong direction, I asked, “Wait. Where are we going?”
“…Home…?” She replied. It then dawned on me that we were leaving my appointment rather than being on our way there. I was so impaired that I didn’t even remember going to the appointment at all.
The second very strange thing that happened post-infusion was that I began having brief, uncontrollable muscle spasms combined with sudden knee buckling that affected my entire body. I was wobbling along, trying not to fall in the parking garage, when it hit me. My arm shot out in front of me, flinging the apple juice I was holding onto the floor, and the rest of me doubled over for a second. It felt sort of like when you fall asleep sitting up and then violently jerk awake. Except, I was walking. For the rest of the afternoon/evening, this happened in varying degrees at least once per hour. At least, that’s my estimate. Then again, maybe we shouldn’t trust the person who couldn’t even remember going to a ketamine infusion.
The muscle spasms are mysterious but may have been due to the magnesium we’ve been adding, which helps some people see better results from ketamine. We plan to skip it next time, as it hasn’t made a dramatic difference for me, mood-wise. While magnesium may not be important for my depression, something was very different about this experience. The infusion itself seemed the same, but the bizarre visual, proprioceptive, and even auditory components extended far past the time when they usually disappear for me. I can only attribute this to the other measures we take in the effort to slow down my metabolism of ketamine, plus the somewhat recent increase in dose, but to be honest, I don’t know why this one was different.
Generally, by the time I’m capable of putting my shoes on to leave the clinic, things look pretty much normal. This time – not so much. Once home, I noticed that a piece of crumpled paper appeared to have cobwebs on it with tiny insects crawling around inside it. At first, I was completely fooled. Fascinated, unsettled, and fooled. I peered at it from a close-but-safe distance, trying to get my eyes to focus on its movement. I tried alternately holding my breath and blowing on it to see if the gentle movement was actually caused by my own proximity; I tried holding my hand above it to feel for a draft, and I tried touching it with another piece of paper. But, no matter what I did, the cobwebs continued to wave slowly back and forth at their own pace, and the small bugs never explored past the cobwebs. My little tests helped me realize that it wasn’t real, but I was so interested in it that I continued to stare.
Eventually, I dragged my eyes away from the paper to look behind me, and when I turned back, the bugs and cobwebs were gone. After the rather large amount of time I spent engrossed in a crumpled piece of brown paper, I suddenly understood via first-person experience why ketamine’s effects make for a useful clinical model of psychosis. The entire event was bizarre and deeply unsettling in a way I can’t quite describe.
My eyesight was frustratingly blurry, to the point that things actually looked clearer without my glasses. I’m not sure exactly how the physics of that works, but wearing my glasses seemed to make it much more difficult to focus my eyes than it was without them. Attempting to lock my gaze on something flat and relatively close to me, like texts on my phone, made the object recede and push forward into subtle 3-dimensionality on repeat.
Perhaps the most persistent phenomenon of this post-ketamine experience was the sound of voices next to me. I’ve been re-watching a show I like lately, and at some point in the afternoon, I realized that I had been “listening in” on the dialogue of several fictional characters off to my right for at least an hour — not sure about that timeline, though. Their voices sounded exactly like the actors’ voices; so much so that I felt I could identify the person speaking at any given time. There seemed to be a choppy plot- not one familiar to me from the actual show. My brain must have created a whole new plot, but I couldn’t tell you what it was. I again reminded myself that I was just not quite past the effects of ketamine, and that it would pass. It wasn’t that I ever thought those fictional people were actually next to me; the voices just wouldn’t stop. It was like listening to a podcast that I couldn’t turn off. I kept trying to distract myself with something else, but I would eventually drift away from it, back to the voices. Then, after what felt like a few minutes, I’d remember that it’s generally not good to be hearing voices and would try to distract myself again. I was moderately creeped out, but mostly exasperated by the fact that I couldn’t reliably corral my thoughts back to reality.
All of this – the experience of seeing and hearing things so long after an infusion is distinctly new to me. There have been times when I thought I heard things post-infusion, but I’m never quite positive that those sounds weren’t real, and they always happened much closer to the infusion. It seems possible that I might have just been thinking about that show and gotten pulled into an imaginary scene, which doesn’t necessarily count as hearing things. But the cobwebs – which I also saw once during an infusion when I left my eyes open for too long – definitely appeared to be taking up space in the real world, and long after I’m usually good to go.
Today, I feel much more like myself, although I’m strangely exhausted despite doing basically nothing all day yesterday. My vision is still a tad blurry, which I think might have been the scopolamine patch I was wearing, which can dilate your pupils. I’m going to make a checklist before the next time of things that I need to do when I come home from a ketamine infusion. It’s difficult to keep things straight when you can’t remember whether you even made it to the infusion in the first place! I’m going to take this weird continuation of my ketamine infusion experience to mean that it might be more effective against my depression this time. Or, maybe it’s a really bad sign and nobody else ever experiences this. When I find out, I’ll let you know.
Love, Your Brain 