A laptop on a woman's lap while she sits cross legged and uses the trackpad

Ketamine for Depression: Misconceptions, Stigma, and Prejudice Online

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.

Abstract landscape with orange trees and blue sky with lines of movement
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:

youtube comments about the effectiveness of ketamine treatment for depression against suicide

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 of the 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.

Youtube comment with two upvotes stating looks like dude just made himself a k addict
He literally just turned into a fiend....
text comment saying thats how you make drug addicts I suppose
text comment saying kyle is a drug user
Text comment discussing ketamine for depression

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.

lilypads-on-blue-water-with-reflected-clouds

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??)
text comment saying how can k treat anything its crazy stuff

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:

Text comment discussing ketamine infusion and animal tranquilizer
text comment reading ketamine is also used to euthanize animals too isn't it
A youtube comment discussing depression, ketamine, and ssri antidepressants

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:

A youtube comment describing misinformation about the risks of ketamine for depression as including tooth loss and itchy skin

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.

woman face in profile with eyes closed against dark background
@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.

A youtube comment saying That's what I'm thinking as well - people need to deal with their problems head on not just get high for awhile as pleasant as that sounds
text comment reading This guy just wanted to get high - what bs
A youtube comment arguing that ketamine infusions are a temporary escape no different than a street drug user
text comment reading Just drink a bottle of nyquil and lie on the couch - same thing
text comment reading This is just taking drugs man - but somehow legal

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.

text comment reading Yes-thanks for doing this-ketamine completely changed my life-thanks kyle
Youtube comment reading-gave me my life back-didn't realize I had lost the joy of life-saved a friend from committing suicide-love yourself enough and just do it
(I’m not encouraging anyone to do it without careful consideration. Just a positive comment I liked.)
text comment reading-k infusions saved my life-simple as that
text comment written by a ketamine infusion patient describing the positive outcome they had from ketamine

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.

scrabble tiles reading Mental Health with sprig of greenery on side

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.

If you’d like to read more about my experience with ketamine for depression, start from the beginning of The Ketamine Chronicles or visit the archives. Click here for mobile-optimized archives of The Ketamine Chronicles.

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A Strange Effect: The Ketamine Chronicles (Part 35)

The last time I had a ketamine infusion, my experience was dramatically bizarre. I have reached the upper limit of what is comfortable for me, so the infusion itself was intensely immersive. More unusual, though, were the days following the infusion. In hindsight, they were a touch disturbing.

Possible Mania After My August Ketamine Infusion

For a few days after the infusion, I frequently felt detached from myself, as if I were simply occupying another person’s body. Looking at myself in the mirror was unsettling, as my reflection was subtly unfamiliar to me. I slept very little – just a few short hours each night – and yet felt perfectly energetic and motivated. I busied myself with tasks that would otherwise have quickly lost my interest. Being still resulted in a pronounced worsening of my tremor and a building pressure to move. Similar reactions had been happening after ketamine ever since I started taking Emsam, an MAOI antidepressant. They started out mild and became more intense with subsequent infusions, especially after I increased my dose of Emsam. Thus, the last infusion felt far more impactful than its predecessors.

There were small black dots that began in the periphery of my vision but soon moved of their own accord across the space in front of me. They traveled incredibly quickly and in a manner not unlike insects – a creepy scuttling that startled me every time. It felt a little like the kind of jumpy sleep deprivation that results in a tense awareness of your surroundings, except instead of momentary startle reactions, it progressed into actual visual hallucinations. I somehow felt alert and productive, while also experiencing an odd disorientation that made time and recent memories disappear out of reach.

The silhouette of a person standing in a field in a thick fog.
Dimitar Donovski, Unsplash

If you’re considering ketamine infusions or are already getting them, I should stress that my odd reaction to the last infusion was mysterious and apparently unrecognized as a side effect. None of the mental health professionals I see had ever heard of it happening. For me, that means an unanswered question that makes me feel uneasy. For others, I hope that the rarity of what I’ve described is comforting.

The Following Days

When I came out of the strange state of what my therapist called “miniature mania,” I was initially unbothered by what had happened. But as I considered it in the following week, I became slightly disturbed by it. In the moment, I was uncomfortable due to the jittery, giddy feeling I had, but I felt otherwise like myself. Looking back, I’m not sure why I didn’t reach out to my doctor. It felt like I was in a fog that I didn’t know was there.

After a few days, the energy that the infusion gave me ended abruptly and I could feel myself sinking rapidly back into depression. My doctor isn’t sure why that was the case; even though the feeling of being impaired by the ketamine high was somewhat uncomfortable, it seems logical that its extension into the following days should have boosted my mood, not caused it to worsen. In any case, we decided that the combination of Emsam and ketamine was likely the factor to blame for the sudden decline of my mental health. Yesterday’s infusion was adjusted to a lower dose of ketamine and a planned reduction of my Emsam dose. We hoped that they had just been too much when combined at the levels of the last ketamine infusion.

Recollections of a Ketamine Infusion

The infusion itself was more comfortable this time, although it still pushed my limit. During ketamine infusions, my hearing becomes so sensitive that even the lowest volume of my music is too loud. The pump next to me chugs away, adding to the ambient noise in the room. Without thinking about it, I often turn the volume down on my phone, not realizing that I actually muted it until some time later when I start searching for the music that isn’t there. I haven’t been able to remember my infusions for the past couple of months, which, while not the goal of the treatment, was frustrating and unsettling. This time, I have much clearer memories of what I saw and felt during my infusion.

Familiar Water

A sunny landscape with a large blue lake, green vegetation, mountains, and a blue sky with fluffy white clouds
Photographs are my own unless otherwise attributed

Once again, I was visited by deep water. I started out by observing a landscape from above. There were trees and grasses waving in the breeze and woodland creatures going about their daily lives. I soon noticed, however, that I was not looking at a terrestrial scene, but rather an underwater ecosystem that bustled with aquatic activity. Fish darted around swaying seaweed and hid among rocky crevices. I watched for a few moments (or maybe much longer – who’s to say?) and then moved on to a different scene.

The other images of water are jumbled in my memory, but I remember being next to a tall building, looking up to the top. Water flowed over me and covered me up so that my view of the building was distorted by light and water. It carried a calm peace because it was a relief to stop straining to see the top. There was another, similar scene in which I was slowly submerged in water while looking up at the sky. I have another fuzzy recollection of being buffeted by waves until they overtook me and I was deep underwater, pressed on by the water on all sides of me.

A blue lake with mountains in the background and a dark sky at night

Stretching and Tangling

My other memories of what I saw and felt were centered around layers of earth-toned colors that I understood to represent landscapes. The layers stretched out like bubble gum, getting thinner and thinner while I felt the pulling as well, as if I were connected to the layers myself. At other times, I was tangled up in green vines, hopelessly lost in their confusing loops and knots.

Two natural pillars of red rock at Garden of the Gods in Colorado Springs, Colorado

Layers of Abstraction

In between these scenes, I found myself being sucked into abstract, moving visions of colors and shapes. I felt completely absent at times, as if my body had completely disappeared. During ketamine infusions, I occasionally realize how strange it is to lose my attachment to reality. This time, I frequently forgot what was going on and would reach the end of a song or a scene in my mind and begin to wonder how long I had been immersed in my own imagination to the exclusion of all else. It was like a whirlpool, pulling me in after I got just a split second of clarity.

Tethering Myself to Reality

I experimented this time with the addition of a worry stone. I held it in my right hand so that I could move my thumb in circles around the center. I found it helpful in bringing myself back to the room for a brief moment, which offsets the overwhelming feeling of drifting away into the bizarre soup of my internal universe, never to be seen again.

A beautiful red and grey worry stone with a concave shape

Although I typically dislike not being in control of myself, the all-encompassing embrace of ketamine is hard to shrug off. I’m constantly in conflict with myself because on one hand, I’m uneasy about letting go of the threads that connect me to the real world. On the other hand, I feel so far away from the boundary between my mind and the tangible world that it seems too late to fight my way out. In those moments, I’m fairly content to never come back.

Going Within My Consciousness

Part of why these ketamine infusions are so intense is because there seems to be no space between my sense of self and what I’m experiencing. I watch it happen while being combined with it, my own essence bleeding into the experience. The visions exist in a realistic way in my mind, and I feel that not only am I observing it, I also am it. I don’t necessarily feel like I’ve traveled somewhere else during a ketamine infusion but rather descended into the very center of my being. Thus, the images seem to have always existed, with me now sinking inside them. It seems that I’m nearly undistinguishable from them.

An abstract swirl of blue and green paint
Joel Philipe, Unsplash

Insomnia Again

So far, I feel somewhat normal, except for a few remaining symptoms, including the unbeatable insomnia. I fell asleep after taking my nightly Trazodone, but even that couldn’t overpower the alertness for long. I woke up around 1:30 AM, made some tea, and sat down to document my memories of yesterday’s ketamine infusion. I managed to get a few more hours of sleep after staying up for a while. This morning, I do feel an inkling of the uncomfortable giddiness which flips back and forth with anxiety and dominates my memory of the days following the previous infusion. I also keep forgetting what I set out to do, becoming easily distracted with other tasks. It’s still a bit difficult to move my arms and hands without conscious thought; they get rather stuck if I leave them alone for too long, and my attempts to do some fine motor movements take a couple of seconds to recalibrate. Overall, the reaction seems to be more mild than the last time, which is reassuring. Hopefully, this one will have more of a positive effect on my mood than the last one did. Fingers crossed.

If you’d like to read more about my experience with ketamine for depression, start from the beginning of The Ketamine Chronicles or visit the archives. Click here for mobile-optimized archives of The Ketamine Chronicles.

Abstract orange, red, and yellow paint bubbles on a black background

An Overdue Ketamine Infusion Report: The Ketamine Chronicles (Part 34)

It’s been a while since I’ve posted anything about my ketamine infusions. My dose of ketamine is high enough now that, combined with the rather sedating anti-nausea medications, I don’t tend to remember much. I have still been getting infusions, though, and I hope that despite the lack of fantastical details, my experience can still be informative.

A Recent Ketamine Infusion

My most recent ketamine infusion was a slightly lower dose than it has been lately. I requested it because the upper limit of what we’ve tried makes me feel like my insides are getting too big for my skin. It creates an unpleasant feeling of high pressure that suggests an impending explosion. We’ll all just be sitting there, listening to the beeps and whirring sounds of the equipment around us, and then BAM – insides suddenly outside. I don’t think there’s a pre-infusion form for that.

The slightly lower dose, while still intense, was much more comfortable. I’ve noticed that, for me, the most prominent experience with higher doses tends to be the physical disorientation. I’m very preoccupied with whether I’m upside down or right side up, whether my eyes are open or closed, or whether I’m still in possession of any of my limbs. The about-to-explode sensation starts out something like how having restless legs feels, which is interesting because sometimes it’s difficult to sleep when I go home. I lie down and feel like I have restless… body. It’s like my muscles are on an automatic movement setting, and holding them still is deeply uncomfortable.

Ketamine’s Dissociative Qualities

In general, at higher doses of ketamine it feels like I leave my body behind but am periodically compelled to figure out where it is. I find myself much less aware of what’s happening, and because it’s hard for me to just let go, that confusion is somewhat uncomfortable. I’ll get all immersed in some spinning whirlpool in my mind and then realize that I have no idea what’s going on, what time it is, or where I am. I used to be able to move in and out of my ketamine dreams and the real world with relative ease. I could pull myself out of it and remember in an instant what was happening. At higher doses, the information is there, but it’s slow to come to me and I have to sort of fight my way over to it in order to remember where I am.

An abstract blue whirlpool of concentric circles
Photo by Derek Thompson on Unsplash

This is where the preoccupation with my physical location comes in. When I’m unsure of what’s happening, it seems prudent to first sort out whether I’m as backwards and upside down as I feel. There is, however, no way to verify that when you’re still under the influence of ketamine. So I just keep trying to reality test my experience with no satisfying answer. “I think my eyes are open. They feel open, but something tells me they’re not. Wait. What am I looking at? Is this what I would be seeing if my eyes were open? I don’t remember. Where am I?” It’s like I know where I am and that there’s nothing to worry about, but the answer is just barely out of reach and I’m slogging through knee-deep molasses to get there. It’s also interesting to note that my ability to think in words in my mind is significantly reduced at higher doses of ketamine. I might think the words, “Where am I?” in my head, but the rest of it is more a kind of conceptual thought that is hard to explain.

In comparison, lower doses were more visually trippy. I used to watch entire scenes play out like dreams – sometimes nonsensical, sometimes a little disturbing in hindsight, but often beautiful and occasionally profound. Things feel much more disconnected at higher doses. There are images, but I don’t remember much of it being distinct, fully-formed scenes or plots. Some of that seems to be connected to the type of music I listen to; I used to choose slow, gentle, classical music, something with a beginning, middle, and end that lends itself to creating cohesive images. But even that has become too intense with higher doses, so I tend to go with something even more chill, now – meditation music, usually. As far as I can tell, my visual experience these days is more about slowly shifting, spinning, zooming shapes and colors punctuated by bizarrely realistic images of mundane life.

Ketamine Feels Less Novel with More Experience

I suspect that although part of why I don’t remember as much of my ketamine infusions these days is the higher dose, part of it is that I’m more comfortable with it and am paying less attention to my experience. I used to have moments of clarity in my earlier infusions when I’d think to myself, “That was SO weird. I have to remember to tell someone about that.” And then I’d come up with a couple of words to describe the scene (which often became the titles of blog posts in The Ketamine Chronicles) and repeat them a few times in my mind so that I would remember whatever it was whenever I regained sensible thought.

Now, I find myself so apathetic that although I might notice when something really bizarre happens in my mind, exerting the effort to remember it just seems impossible. Instead, I just float along through my ketamine infusions, seemingly going both forwards and backwards in time, and arriving back in the room with half-materialized body parts and very little recollection of what I saw. I’m also less “with it” when we leave the office, which makes it challenging to hold the fading memories of what I saw during the ketamine infusion while also trying to walk to the car.

Abstract landscape with orange trees and blue sky with lines of movement
Photo by Jr Korpa on Unsplash

Is It Still Working?

All in all, ketamine infusions still help my depression, even if I don’t remember as much of them. The value comes from the alterations that ketamine facilitates in the brain. I haven’t been experiencing the sudden improvement on the second day after an infusion that I used to, but I do feel a decline in my mood in the same time frame as always. I’m slightly uneasy about the possibility that that might be the power of suggestion; do I start to feel worse because I’m expecting to? It definitely feels different when it seems like the ketamine is wearing off. Like something changes in my brain and I’m less able to pull myself out of those negative mood states we all have, I lose motivation, and I start sleeping more. I’m still wary of my interpretation of that, but I’m really not sure how to determine what the real cause is. It seems like the improvement from a ketamine infusion is more subtle than it used to be. I’m not sure why that is, although it could be because some of my current problems are less biochemical and more unavoidable life stressors. With the addition of Emsam, I do think that my mood has been more stable, which makes the wearing off of ketamine feel a little less abrupt.

So, that’s everything I can think of to share in this post. Sometimes, it seems less entertaining to write about when I don’t have bizarre tales of fish weddings and oceans of corn to share. Nevertheless, it’s always interesting to compare infusions and ponder the factors that make each one different. As always, if you have any questions about what it’s like to get a ketamine infusion, want to share your own experience, or anything else, feel free to leave a comment!

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Post-Infusion Confusion: The Ketamine Chronicles (Part 32)

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.

If you liked this post, consider starting at the beginning of the Ketamine Chronicles, or visit the archives to find month-by-month posts.

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A Gold Monocle: The Ketamine Chronicles (Part 31)

The warm, vaguely citrusy feeling of ketamine spilled down my back while I tried to get my earbuds in and my music started. I fumbled around for a moment, not sure which earbud was which, but finally settled with the knowledge that I had a 50/50 chance of getting it right. I jammed those puppies in there while the world outside my eyeballs spun around. After some time, I realized that I had left my index finger suspended in the air with the pulse oximeter on it. One of those deep-seated memories, the ones that you wish you could get rid of because they always seem to displace more critical information, rose to the surface. Yes. I remembered that SpongeBob episode in which Patrick teaches SpongeBob that holding your pinky up is fancy, so, “the higher you hold it, the fancier you are.” I kind of wanted to laugh, but was afraid that if I started, I wouldn’t able to stop and I’d just spend the whole infusion cackling over fancy pinkies.

I’ve learned that if I don’t put my head back and try to relax my neck before the ketamine gets started, it takes a herculean effort to do so later on. I find this strange. Like I did when I left my finger pointed up, I can go long stretches of time without even noticing that I’m doing it. One would think that sitting in a reclined position with their neck bent to keep their head aloft would be really uncomfortable. But somehow, it’s just easier to forget about it than to try to move. It reminds me of that locking mechanism that birds do with their feet so that they don’t fall off of telephone wires while they sleep. I just get stuck in whatever position I’m in when the ketamine hits me.

I don’t remember much from this ketamine infusion, although I know that it was one of the most choppy, disconnected visual experiences I’ve had during a ketamine infusion. There was a man dressed in 19th century clothing – ruffled white collar peeking out from a buttoned up, navy tailcoat jacket, with a gold monocle arranged over his left eye. He was leaning over me, large grey beard waggling while he spoke, telling me something about achievement and perfection and getting started before it’s too late.

I don’t think that I’ve ever heard my ketamine dreams make any noise at all, except for one time when I heard some garbled gibberish in the center of my head after an infusion, when I was on my way home. Who knows what that was, though – the radio, people on a crosswalk, etc. But in any case, it was startling to realize that someone imaginary was speaking to me during an active ketamine infusion. I don’t remember exactly what he said, but the advice the man was giving me wasn’t encouraging. It was more like a stern lecture, siphoned from my own inner dialogue about failure, perfectionism, and growth. Quite strange.

Side note: I started writing this when I got home from my infusion. This morning, I opened up my laptop to see that I had written “before it’s two late.” I must have been more impaired than I thought. It’s not as bad as, say, waking up to find that I’d spent all my money on vintage beanie babies or clown figurines, but whoo, boy. What an egregious mistake for an editor to make.

The image of monocle man is what I remember with the most clarity, but I also remember a taxidermized rat with an oblong hole in its neck. A live white rat emerged from the hole, pulling itself free like some kind of disturbing mammalian version of a snake shedding its skin. Seriously creepy. Other than a lot of colorful TV static and a white sand beach, that’s all I remember.

I wish I had a better way to end this post, but that’s all I’ve got. Go look at something heartwarming to get that rat image out of your brain. Bye, for now!

Not Much to Report & Ketamine FAQs: The Ketamine Chronicles (Part 30)

It’s part 30 of the Ketamine Chronicles! Time flies, doesn’t it? My previous ketamine infusion (which I use as part of my treatment-resistant depression treatment), was surprisingly more effective than it has been in the last couple of months. I’ve been enjoying the general lightness and ease with which I can get out of bed. Last Thursday seemed to take a downturn, although it’s always hard to tell which factors explain which results. In any case, my regularly scheduled ketamine appointment was yesterday, so it was good timing, if so.

Whereas the last infusion was extremely trippy, this one seemed more mundane. That might only be because I don’t have much memory of what I experienced, though. At the start of my infusion, my ears began feeling incredibly hot, as if I’d just said something horrifyingly embarrassing. Once I closed my eyes, I remember feeling a tad uncomfortable, like my thoughts were becoming too big for the confines of my head. It seemed like I was seeing darkness for longer than usual, and I think that the lack of engaging visual noise is what made my thinking feel too big. Of course, I don’t remember what I was pondering, just that it was happening.

Photo by: Leni und Tom on Pixabay

Once again, I fell asleep when I got home and then had several disorienting instances upon waking up and not knowing what day or time it was. It felt like I had been sleeping for many hours when my mom poked her head into my room. All that had registered in my brain a moment before was that my phone said 6:30. So, when my mom informed me of the shrimp and rice on the table, I momentarily thought, “why would she make shrimp and rice for breakfast?” It quickly dawned on me that it was, in fact, the same day. I woke up a few more times during the night, still briefly believing that it was the next morning. The pitch black scene outside my window hinted that no, it was not 11:30 AM. It took me a few seconds to reassess.

Start from the beginning of the Ketamine Chronicles! Or, visit the archives for a list of month-by-month posts. Other posts have far more absurdity and detail in my descriptions of what it feels like during an infusion.

Ketamine FAQs

Since this entry in the Ketamine Chronicles is pretty short, I thought I’d share the questions that I asked when I started ketamine therapy. I’m not sure that these are actually frequently asked, but it made the heading nice and concise, and I do love some organization. The answers to these questions are a blending of what my doctor told me, plus what I’ve learned through personal experience. Everyone is different, so the answers may not apply to everyone.

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I love strange stock images. Photo by: Tumisu on Pixabay

1. How do you know when you should get a maintenance infusion? Is it a sudden change, or more gradual?

For me, it’s usually a gradual change that I notice somewhere between two and three weeks after an infusion over the course of three or four days. I know that it’s time to get another infusion when I find myself doing a lot of nothing and feeling apathetic. My motivation disappears and I usually start thinking that acting to counter my symptoms is pointless.

However, it can be more of a sudden change for some people. They may wake up one morning knowing that, because their symptoms have returned quickly, the ketamine has worn off.

2. Do some people eventually manage their depression with just therapy, etc.? Or is the damage that depression causes a continuous process that you have to constantly work against?

Unfortunately, it’s the latter. After your initial series of infusions, you’ll need to periodically get maintenance, or “booster”, infusions. The effects of ketamine wear off at different rates for different people.

I suppose it’s possible that someone could really piggyback on the results of ketamine therapy and launch themselves into better long-term mental health, but as far as I know, the vast majority of people need booster infusions.

Exercise, therapy, social interaction, and other activities that support your mental health can help the effects of ketamine last longer. It’s possible for some people to extend the interval between their infusions. #goals

3. How do people decide whether or not to keep taking their medicine?

This is a uniquely personal decision that you make with your psychiatrist or other prescriber. I was hopeful that the benefits of ketamine would allow me to at least reduce some of my more side-effect prone medicines, but so far, trying it hasn’t worked out for me.

4. Is it possible that for some people, ketamine makes their meds work better because of the brain repair it facilitates?

Yes! As I discovered first-hand, going off some of my medications had pretty abysmal results. It’s clear that for me, the combination of my usual medications and periodic ketamine infusions is what works best. You can even try medications that you’ve taken and discontinued before, as sometimes they work better with ketamine.

5. Is my reaction to the first infusion a good indicator of whether or not it will work?

No. While ketamine works for some people nearly immediately, it takes longer for others to see any benefit. I didn’t feel better until roughly my fifth infusion.

Additionally, the way you do your first infusion is not set in stone. Sometimes, you need to change the dose or add other medications. It’s not a one-size-fits-all treatment.

6. Does ketamine ever “kinda work,” or is it all or nothing?

I apparently didn’t write down my doctor’s answer to this, so this is entirely my own experience.

I find that it can “kinda work” for me, depending on circumstances that I haven’t pinned down yet. Still, even when it’s not amazingly helpful, it’s still worth it for that small benefit. I tend to vacillate between “meh,” and “wow, I feel so much better.” So, much like question #3, it’s probably worth tweaking things if it’s less beneficial than you hoped.

However, for some people, it seems not to work at all. On the other hand, there are people for whom ketamine makes a dramatic difference almost immediately. It seems to be a continuum.

7. Will I do anything embarrassing during a ketamine infusion?

I don’t think I asked my doctor about this, but it was definitely part of my apprehension. I tend to be quiet during my infusions, in part because it feels nearly impossible to carry on a conversation. When asked if I’m doing ok, I usually just sort of nod my bobblehead a little.

I do know that other people are far more chatty than I am and can just talk the whole time. I doubt they divulge any deep, dark secrets without meaning to, though. Even though I can’t muster up the energy to speak, I have contemplated whether or not I should say something. Some of the things I see behind my eyelids are so absurd that I want other people to know about them. But even with that desire to share something funny, I’m still capable of deciding whether or not to say it. I probably would talk more if it weren’t so hard to work around my bubble gum tongue.

Feel free to leave questions in the comments. If I have an answer, I’d be happy to share it with you.

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Kaleidoscope: The Ketamine Chronicles (Part 29)

Right away, I could hear my heartbeat in my ears and head, and my face seemed to be pulsating with the rhythm. My ears became surprisingly hot, but all of that faded away after a few minutes. Usually, when I close my eyes I see bizarre images, but they’re mostly distinct and recognizable. This time, there were points in IV ketamine infusion when I felt like I was traveling through a three-dimensional kaleidoscope – just shapes and colors that morphed together as they moved.

A Small Hallucination?

The real world was also especially distorted this time, and once, when I opened my eyes, the wall across from me appeared to be covered in pale yellow cobwebs. There were two tiny silhouetted figures standing among the cobwebs, engaged in what looked like a silent argument. After a minute or so, one of the figures sprouted wings and fluttered away like a moth. I don’t think I’ve ever had my ketamine dreams intrude upon the real world when my eyes are open before. It was really trippy.

I don’t remember much of the internal experience of this ketamine infusion, but I know that there were a ton of lines – straight lines, wavy lines, crosshatched lines, diagonal lines, lines moving away from me, and lines coming closer. Sometimes, I was looking for something among the lines, but it was always hidden out of sight.

If you’ve ever seen those “deep dream” images created by Google’s neural net API, you know roughly what my experience was like this time. Here’s one I just made out of a picture of a sloth.

I had always assumed that trippy pictures like that were just weird approximations of what it would be like to be high. But no, it really looked a lot like that. Just take that image and imagine it moving, and that’s pretty much it.

There were rarely any distinguishable objects in my inner view this time, though. It was mostly just a sea of odd, moving blobs and spirals. When the lines and colors and moving kaleidoscope patterns got to be too much, I’d open my eyes briefly. I’m technically not supposed to do that, but it did serve as an effective break from my brain’s wild mishmash of subconscious vomit.

Physical Sensations of Ketamine Infusions

At some point, I switched my crossed ankles and was immediately struck by the sensation that my legs were melting. My bones seemed rather rubbery, and the weight of my feet extending past the footrest made me feel as though my shins were bending in the middle. I remember thinking that I felt just like a Salvador Dali clock, melting over the edge of the footrest. My whole body threatened to melt, at which point I’d slip off the chair into a puddle on the floor. It occurred to me that it would be difficult to get back to the car that way.

Visual Signals on IV Ketamine

During my moments of open-eyed room viewing, I noticed that the door looked unusually soft. It appeared to be made entirely of clay or putty. The color was the same, but it looked temptingly squishy, like if I went over there and pressed my hand on the edge, it would just mush in on itself. Perception is so interesting. Just 20 minutes earlier, I had interpreted the same visual signals in a completely different way.

Is Interpretation Important for Healing with Ketamine?

Ever since I wrote that post about water in my ketamine dreams, I haven’t had any further peaceful drowning experiences. Maybe it’s a coincidence, but I do think it’s interesting that after contemplating potential meanings of that recurring image, I no longer find myself experiencing it. What does still happen is the spreading darkness. This time, I was trying to look through a bright skylight while inky blackness approached from all around. It closed in until all that was left was a pinprick of light. Whenever that happens, my mind just switches gears and I begin a new dream-like vision.

My next ketamine treatment appointment is three weeks from now. I think I already feel lighter, although still a little spacey. My memory of yesterday is kind of foggy, and conversations I had feel choppy and surreal. I got home mid-afternoon and promptly fell asleep. At 11pm, I awoke suddenly, wondering where I was. I had fallen asleep on top of my blankets, oriented the wrong way with my feet on my pillow. I sometimes nap this way in order to differentiate naptime sleeping from nighttime sleeping, but it was still incredibly disorienting. I managed to do all the usual things I do before bed and then crawled under the covers the right way.

I hope this ketamine infusion works; I’m feeling discouraged about my depression again. I’m tired of being tired and unmotivated. The pandemic set me back a good deal, and I find myself forgetting that I had made some good progress last winter. It just feels like I’ve felt this way forever.

If you liked this post, consider starting from the beginning of The Ketamine Chronicles, or visit the archives for month-by-month posts.