Ketamine

I’ve taken ketamine many times in my life. Once was recreationally. I snorted several lines of powdered material off of my cousin’s coffee table and rapidly lost all sense of myself, the remnants of my identity dissolving into a vast space that included everything, excluded nothing, in which I knew that some part of conscious observation would remain for eternity. During the brief moments of this experience when I could open my eyes, I felt as though there was powerful energy surrounding me, energy that I could hold in my hands and manipulate to my great delight. Afterwards, I was forced to balance a profound sense of well-being with a nausea inducing headache. I also had a deep appreciation for why it was considered a rave drug, though I have never been to a rave. 

The other times I have taken Ketamine it was administered by infusion in a clinical setting. On these occasions, I took it with the intent of mitigating treatment resistant depression, a condition that I have contested through a variety of measures both wise and foolish for the entirety of my adult life. Following on research that shows Ketamine’s efficacy at addressing depressive symptoms the medical administration of the drug has become an industry unto itself. There are a growing number of these clinics where you can be given a series of IV infusions of the drug at significant cost. 

This is an unsurprising development. While major depression is a troubled term with no biological means of diagnosis, the cluster of symptoms that typify it comprise one of the keynote maladies of contemporary life. Estimates vary, but in a given year around 7% of the American population suffers from what clinicians would call major depressive disorder. Selective serotonin reuptake inhibitors, the treatment of choice for a number of common forms of suffering, depression included, have a poor rate of success, improving symptoms in only a third to a half of people who take them. They also come with a host of unpleasant side effects and can be profoundly difficult to stop taking after long periods of use. With this being the case, any alternative that offers relief is bound to generate interest and lots of revenue. 

For myself, I decided to make an effort at divorcing myself from SSRIs after twelve years of use- twelve years in which I experienced little to no relief and in which my life has fallen apart completely a handful of times. While going off of SSRIs- which I have made several efforts at- I experienced horrible withdrawal effects. It is increasingly well-documented that withdrawal symptoms are both more common, more severe, and longer-lasting than is generally acknowledged by American psychiatrists, and this was true for me. I dealt with obsessive, panic-inducing thoughts for weeks, followed by a period of anhedonia in which it became impossible to engage in the basic tasks of life. This plateaued after a time, but in this most recent effort, three months out, I contend with a near constant state of bodily anxiety that makes it hard to work and sleep. I struggle to engage in basic activities- when one can’t watch television, the low bar for conscious experience, there is evidence of a real problem. 

In my years of navigating the contours of depression, I have heard at many junctures about the possible benefits that can be derived from a myriad of psychedelic drugs, Ketamine being just one of them. Psilocybin, LSD and DMT have all been investigated in clinical trials in recent years and have shown promising results. The problem that arises is that for those of us who have engaged in treatment with conventional antidepressants, the therapeutic effects of these substances become difficult to access. SSRIs cause a superabundance of serotonin to build up in the brain with a corresponding decrease in the number of receptor sites over time. 

These receptor sites are the keyholes in one’s brain that psychedelics unlock to occasion mystical experiences, and for the depressed and medicated there is the significant hurdle of withdrawal to overcome before one can access the benefits of psychedelic therapy. In my years of SSRI use I have made heroic efforts to overcome this unfortunate side-effect to no avail. My most recent attempt involved ten grams of mushrooms and two tabs of acid with no discernible effect. Imagine my frustration. 

Ketamine gets around this problem. It is not a classical serotonergic psychedelic, instead acting on the glutamate system. Its benefits, as explained to me by a psychiatrist with an unnerving capacity to type while speaking, lie in its stimulation of the production of brain derived neurotrophic factor (BDNF), which prompts neurogenesis. Apparently there is quite a bit of synaptic pruning that occurs for those of us with severe depression, reducing the connectivity between regions of the brain, literally isolating the ego and hard-wiring a ruminative, self-hating and anxious state of mind. The stimulation of the production of BDNF occasioned by repeated infusions of Ketamine (and also prompted by psilocybin, LSD, and DMT) is thought to stimulate the development of synaptic connections, turning a one way street of a brain into a thoroughfare that is hopefully less obsessed with itself and more interested in the rest of the world.  

With this said, the profusion of articles that have appeared in recent years touting the benefits of Ketamine administration for treatment resistant depression convinced me to try it, while the high cost convinced me to put it off indefinitely. Ketamine is ‘off-label’ for the treatment of depression, meaning it has not been through clinical trials to assess its efficacy. The problem lies in Ketamine’s ‘age’- it is in the public domain, so to speak, having been approved for use in the United States since the 1970’s. With drug companies lacking a financial incentive to invest in extensive trials the FDA will not approve it as a treatment. This creates a situation in which only those with disposable income can afford the relief that it (hopefully) provides. 

With a recent death releasing some liquidity into the family coffers, I was able to move forward with the treatment. It was surprisingly easy to become a patient of the clinic I chose. I just called, filled out an online questionnaire, and was scheduled within days. After an initial consultation with the psychiatrist in which I went over the sad details of my sad life, an experience that I have frequently and that is never pleasant, I was declared a good candidate for the treatment and was placed in a recliner and dosed. 

This was a very different experience than my self-administered experimentation in my cousin’s livingroom. Likely this has to do with the accepted effect of set and setting on any psychedelic experience. In my cousin’s apartment, I had someone else to exchange exclamations with, someone to giggle “I’m so fucking high” to. There was art on the walls to lose myself in, and no clinician to tell me what to expect, merely the thrill of a new drug that was taking me to a place in my internal world to which I’d never been. 

 In the clinic on the other hand, there was dim light, a businesslike nurse inserting a needle in my arm, and a desire on my part to be left alone while I went through whatever it was that was about to occur. There was no large space in which I lost myself ( although lose myself I did) and little desire to move my body. Ketamine, at least in this context, was far different than other psychedelics with which I am familiar. It had little of the narrative making and storytelling faculty of DMT or psilocybin or LSD. Even at high doses of these drugs, there is at least an awareness that you are a person who has a conception of oneself, however much the substance might convince you that this conception is misguided. 

On Ketamine, there was no me to be reoriented in the trip, and instead a distinct absence of any self- who I am, who I was, who I might be were erased completely. When I was able to summon some sense of self, there was a profound alienation from that person, a disbelief that the thinking subject on the drug could possibly have anything to do with anyone.  There is also little about the trip that is visual- instead of strange landscapes, playful entities or shifting patterns,  there are simply torrents of strange and muted light that press upon the mind’s eye, and an odd sensation of being shifted and rotated. When you come up, you come up relatively quickly. You’re offered crackers and water (I declined) and are left alone to put yourself together.

In the immediate aftermath of the clinical experience, you feel distinctly as though you should not be up and walking around, but this is exactly what you do, against all odds scrawling your signature on a release stating that not only will you not drive for the remainder of the day, but that you will refrain from going out alone or from making any important life decisions. Then you toddle into the world, and whoever your kind-hearted driver happens to be takes you home. 

All in all, I liked snorting it with a friend better than I liked having it pumped into my vein by a psychiatrist, but I suppose the important question is whether it did anything to alleviate my depression, and the answer is yes, with caveats. I can state unequivocally that I felt not only a diminishment but a complete cessation of my depressive symptoms in the hours following administration, which was wonderful and for which I am grateful. With that being said, it barely affected the anxiety I experience, and in the days that followed each administration depression slowly crept back, although the length of time this took varied, and after the sixth infusion there seems to be a lingering effect.

This is my great fear, and sadly a fear that is likely to be realized- That after all these strange, sometimes unpleasant clinical experiences, the misery will creep back into my life, perhaps stronger and darker than before, and it is a bitter pill to swallow. I have been told that should this happen I can return for a ‘booster’ infusion, but this is honestly something that I’d prefer to avoid. As I imagine most people with depression feel (we’re not a social bunch, so I haven’t asked around) I want to get on with my life, for this to be a chapter that concludes rather than a running narrative. Unfortunately, when one reads between the lines, this is not the story of depression, Ketamine or no. Depression haunts you, sometimes actively, sometimes merely by dogging your memories and lingering in your awareness. 

In conclusion, if you have the money and you’re desperate, this is an option that has the ancillary benefit of being a really strange experience. It feels like an industry, and it is, but so are the majority of other avenues we use to treat emotional distress. Of course, there are a host of other substances that offer similar benefits for a lower price, however they happen to be illegal and, depending on your predilections and risk tolerance, don’t have the benefit of taking place in a medically supervised setting. 

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