It bothers me periodically that I’ve lost interest in my hobbies. I used to enjoy going to the library, but I don’t read anymore. I try every once in a while to draw something or start an embroidery project, but I usually just end up staring at the materials for a while and then giving up. Art has always been something I do sporadically. I have periods of inspiration and periods in which I set it aside, but I always cycle back through. Not lately. I feel like I’ve lost all motivation to create anything – even in writing. My drive to write on my blog has been exceptionally low, even though I maintain a desire to keep up with it. It’s a frustrating space to be in.
Part of my problem with visual art is that I get too caught up in making it match my mental image. It leads me to give up or not start at all. It occurred to me that it might be easier to get started if I tried to make something after taking a ketamine troche. I have tried writing while dissociating on ketamine, but something about articulating my thoughts in full sentences proves to be very difficult, and I usually abandon it.
Turns out, painting is entirely different. I sketched out a landscape based on a photo and pulled out my watercolors before taking a troche.
I found the process of putting colors on the paper to be engrossing, and I think that since I was curious to see how it turned out, I wasn’t so worried about it looking “bad.”
By the time the ketamine had worn off, I had made it to this point:
It was unfinished, so the next day, I went back to it with all of my faculties and spruced it up. I still don’t love how it turned out, but I can label it a ketamine experiment and be content with that.
Other hobbies I’m attempting to resume include running, drawing, and volunteering. Each of them is in the tiny beginning stages, but I have to start somewhere.
My experiences with ketamine troches have been varied. Sometimes it hits me, and I decide that being horizontal is better than attempting to sit up, so I get in bed. I’ve definitely noticed that remaining still makes me less likely to get nauseated, but it also makes it harder to perceive the dissociative effects of ketamine. I frequently think that I’m past the dissociation and get up, intending to go walk the dog or clean the kitchen, only to realize upon standing that I most definitely am not ready to practice such advanced life skills.
Then again, sometimes it seems like nothing happens when I take a troche. This is somewhat disappointing, given how much mental preparation goes into overcoming the revolting medicinal flavor. I could just swallow the troche without letting it dissolve, except the edges of it are sharp. Believe me – I’ve tried. It’s painful. The best way I’ve found to take ketamine troches is to sip lukewarm tea while it’s dissolving in my mouth. It helps with the flavor, and the liquid speeds up the dissolving process.
My first few troches were more intense than subsequent ones, and overall, I’ve found that they produce much less absurdity in my mental images than ketamine infusions did. Troches tend to lead me down memory lane or explorations of personal questions rather than bizarre, imaginative storylines.
I think that because taking prescription ketamine at home still seems strange to me, I often ponder the question, “How did I get here?” My experience with mental illness started early, so naturally, my childhood comes to mind when I pose that question to myself. Sometimes, when the ketamine kicks in, I begin to review my life as if I were watching a movie, skipping ahead and replaying certain parts. It either leads to me feeling like perseverance is my path or just feeling utterly lost. When I separate from myself a little, it often just adds to my pre-existing sense of confusion and nonbelonging.
More often than not, I cry when the ketamine kicks in. I don’t know if that’s common or expected, but it’s definitely a pattern for me. And it’s interesting because I don’t cry with much regularity in my everyday life. I’m not sure why dissociating would make me feel my emotions more, but it seems to me like it does.
I do feel a bit better, but I’m not sure whether I should attribute that to being back on lithium, the ketamine, or the new medication I’m taking, Mirapex. Historically, lithium has been very helpful in tamping down my suicidal thoughts and allowing me to be more functional. It doesn’t usually do much about the anhedonia, which leaves me feeling the need to accomplish things but not getting much satisfaction from it.
I also started taking Mirapex a few weeks ago. It’s a dopamine agonist used for Parkinson’s disease, restless leg syndrome, and – off-label – depression. I’m in the middle of increasing the dose, and so far, I’m not sure whether it’s helping. It certainly could be part of the combination.
Listening to music during ketamine infusions usually helped me generate a flow of images connected by associations that were often mysterious to me when the infusion was over. Sometimes, I would be faced with settings or items that had made recent appearances in my life, and other times, the things I saw seemed entirely random. It was always different.
However, there was one commonality between many of my infusions. I often felt as though I were sinking in deep water. It was peaceful but also evoked a feeling of hopelessness, which is what I wrote in my posts at the time. Some of those infusions gave me the sense that water held some significance to my subconscious. I tried to draw some meaning from it – to spin it in a positive way or discern some kind of symbolism. I could only guess that the unsteadiness the ketamine made me feel was connected to the sensation of being underwater, and that my day-to-day sense of hopelessness was intruding on me during my infusions. It made me feel like I was drifting down through a vast body of water, and there was nothing I could do about it.
At some point, the water-based visions stopped, only to be replaced by a similar experience in which I was buried in sand at the bottom of an empty well. I concluded at that time that “my perception of depression [was] manifesting itself as unbeatable natural forces in my ketamine infusions. In my visual experience of ketamine, depression feelslike 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.” I don’t know for sure why I had so many experiences like those, but I felt the comparison was apt; depression was pulling me down, and it would be easier to not resist.
I found myself in a similar place when I took the ketamine troche the other day. Deciding which playlist to start proved to be difficult, so I removed my earbuds for the first half and just listened to the sounds of the room around me. Allowing my thoughts to wander on their own without the influence of music might not be the best option for me. Although my mind touched on dark topics during infusions, the progression of one song to the next helped keep my thoughts moving, and frankly, the intensity of the ketamine made controlling my thoughts difficult. They floated from one image to the next automatically. With nothing to pull me along and just enough mental control of myself to not get distracted by random stimuli when I took the troche, I became stuck. Eventually, I found some music to listen to, but my mind was already trapped in a negative space and it seemed to be too late to change it.
I’m planning to find a guided meditation or an audiobook to listen to next time. Perhaps if I begin with a positive intention and impose a framework of some kind, I can herd my thoughts toward something more helpful.
So far, the dissociative effects of ketamine have been limited to a roughly one to two-hour window. Thankfully, it seems that the extended visual and auditory hallucinations that I experienced after a few infusions (notably, this one and this one) were due to the combination of ketamine and Emsam, which I’m no longer taking. I haven’t noticed any giddiness or restlessness after taking the troches, either, which troubled me toward the end of my time getting infusions. That may have also been because of Emsam.
The plan is to increase the dose and continue taking them twice a week. Hopefully I’ll start to notice something positive.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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!
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 