What a Ketamine "Trip" for Depression Is Really Like
Leaving the house before the pandemic was hard enough, thanks to my social anxiety and depression. But once lockdown started? Forget about it. Being in quarantine exacerbated my symptoms until, one day, I realized that I was practically bed-bound. From eating and working to binge-watching and texting, I did it all in my bed.
I was on antidepressants, and my depression was worse than ever.
While I'd heard good things about ketamine therapy, I figured it was too pricey, and the idea of going to an actual brick-and-mortar clinic was beyond me in my depressed state. But Google was onto me: I was served an ad for Mindbloom, an at-home ketamine treatment company.
When I looked it up, the cost was considerably less than I had expected (even though the company doesn't take insurance), and I read that dedicated "guides" would be there via video chat to help me along the way and process my experiences. So, after some more research, I signed up. What did I have to lose?
As it turned out, a lot. Over the past 12 weeks and 12 treatments, I've lost that heaviness that kept me stuck in bed like gravity. I lost that ever-present sense of impending doom. Plus, I found a little bit of clarity and a lot of hope. Things aren't perfect — I still have good days and bad — but I feel like I'm at the beginning of a season of change, full of possibilities.
I'm not alone. More and more depression sufferers who haven't found adequate relief via conventional methods are turning to ketamine therapy, and treatment clinics are popping up across the country. To explain what exactly the drug does to your brain and its potential for treating mental illness, I turned to two experts in the field for their input.
What is ketamine, exactly?
Although it was first discovered in 1956 and used as an anesthetic for animals, ketamine was cleared by the FDA in the 1970s as a human anesthetic. Since then, it's been used extensively to sedate patients for surgery, including soldiers injured in the line of duty during the Vietnam War.
In addition to sedation, the trance-like state ketamine produces comprises pain relief; amnesia; and a sense of dissociation, like you're outside of your body. Taking a high dose of ketamine may lead to a psychedelic experience known as a k-hole, involving severe dissociation, intense visual hallucinations, and feelings of unreality.
How does ketamine help treat depression?
So, when and why did researchers first begin testing ketamine as a treatment for depression? Well, at the start of the 21st century, ketamine was found to have potent and rapid antidepressant properties at sub-anesthetic doses, explains Ryan Yermus, M.D., co-founder and chief clinical officer of Field Trip Health, which provides ketamine therapy for depression. "While the most commonly used medicines, selective serotonin reuptake inhibitors (SSRIs), generally require weeks of continual dosing to achieve a response (and even then approximately one-third of patients will not respond after two or more courses of treatments), ketamine provides a safe, more rapid-acting treatment for depressive conditions," he says.
Although more research needs to be done on what exactly ketamine does to the brain, Gerard Sanacora, M.D., Ph.D., a Yale Medicine psychiatrist and a professor at the Yale School of Medicine, says that evidence suggests the drug alters the brain's adaptive capabilities — almost like rewiring it. The brain's ability to change both structure and function throughout one's life is called neuroplasticity.
"The synapses, the connections between cells in the brain, appear to be changing more rapidly shortly after treatment with ketamine," Dr. Sanacora says. "We believe this can influence a person's ability to change thought and behavior patterns that are associated with depression."
That's why ketamine treatment doesn't just hinge on the drug itself. It typically involves therapy and integration work, too: putting the mental and emotional revelations you experience during treatments to practical use in your daily life (e.g., starting a new meditation practice, creating a daily exercise ritual, etc.) during a time when your brain is in this state of change.
How significant of a development is ketamine as a treatment for depression?
"The discovery and development of ketamine for the treatment of depression has dramatically altered the way we think about depression treatment," says Dr. Sanacora.
On top of providing hope for those with treatment-resistant depression, the use of a drug not previously intended for psychiatric treatment has had a profound effect in the field of mental illness treatment. "This has led to a whole new wave of exploration in attempts to develop new and improved treatments for depression and other related neuropsychiatric disorders," Dr. Sanacora says.
So, is it legal?
Yes, but the law is not so cut and dry. Currently, ketamine is approved for clinical use as an anesthetic, explains Dr. Yermus. When a drug is prescribed for uses other than its original intended function, it's being used off-label.
"Using medicine off-label is very common in practice as doctors learn that safe medicines can be effective for other purposes, and the use of ketamine in mental health is just one of many examples," he says. So, if a doctor prescribes you ketamine for the treatment of depression or anxiety off-label, it is legal and safe.
However, in 2019, the FDA approved one form of ketamine, a nasal spray called esketamine (brand name Spravato), to treat depression — a promising step forward in this field of medicine.
But ketamine is still a controlled substance, so it's illegal to possess without a prescription.
What are the different ways you can take ketamine?
For therapeutic purposes, ketamine can be taken via intramuscular (IM) injection, intravenous (IV) infusion, orally (as a tablet), or nasally (as a spray). More research is needed to determine which method is the most effective. Generally, only the tablet, like the kind I take, is self-administered (i.e., taken at home), and the rest are administered by professionals in a clinical setting.
What does a ketamine treatment session feel like?
While everyone's ketamine treatment session will differ, many describe the experience as a euphoric, dreamlike state in which the world around them seems to fade away, everyday cares dissipate, unusual thoughts emerge, and vivid memories come to the surface. Some mild visual hallucinations are possible.
The psychedelic experience is intended to be gentle, not scary. Depending on the dosage, the length of the treatment will vary, but most sessions take anywhere from 40 minutes to two hours.
Here's what my first ketamine "trip" looked like:
Per the instructions, I didn't eat for four hours before my treatment. There's potential for nausea when taking ketamine, so Mindbloom provided me with anti-nausea medication, which I took one hour before I began my treatment.
When it was time to begin, I tucked the ketamine tablet inside my lip to let it dissolve. I swished it around with my saliva to help it absorb into my bloodstream, and then I spit the rest out. I turned on a zen Mindbloom playlist, put on an eye mask, and laid down in bed to let the trip begin.
Mindbloom encourages you to set an intention before each treatment — something that's not quite a goal but perhaps a question you want answered or a topic you want to explore. Mine was finding joy. As the session began, I felt a strong need to connect to something deeper and more powerful than myself, something spiritual (I consider myself an atheist). Then I saw an image of myself as a child. My first instinct was to fold her in my arms and protect her from everything to come in life. It made me weep.
Behind my closed eyes, I saw some mild visuals of swirling shapes and colors. I never felt scared or overwhelmed at any point — simply like I was floating down a river and observing thoughts, feelings, and memories as they passed by. I felt euphoric and slightly detached from my body, which felt somewhat tingly and numb, but I was still aware of the room around me.
Overall, you're supposed to dedicate one hour to your treatment. I found that the ketamine kicked in about 10 to 15 minutes after taking it, and then I would have about 40 minutes or so of the "trip" experience. Directly afterward, Mindbloom encourages patients to journal what they saw, felt, and experienced so they can later process it.
I felt a little groggy after my first session, but generally didn't feel any other side effects from taking the ketamine. My guide told me that this is a very "clean" way of taking the drug in that it produces very few side effects, if any.
How long does it take to work?
Like with most psychiatric medicines, your mileage may vary. While some see improvement in their depression symptoms immediately after the first treatment, it doesn't usually last, Dr. Sanacora says. Research indicates that ketamine therapy has a cumulative effect.
"Most people require a series of treatments in order to improve the chances of sustaining the response," he says. "Many of those people then also require some ongoing maintenance treatments every couple of weeks or monthly to keep the depression at bay." He notes that there are active research studies trying to find ways to extend this response, but there are no clear methods of achieving it at this time.
Dr. Yermus agrees that the timing depends on the person. "The severity of the condition is generally a guide for how many sessions people need — so someone with debilitating, acute depression will likely need more sessions than others with more moderate symptoms," he said. "Clients with mild anxiety and depression who feel stuck and disconnected can sometimes have a profound 'aha' moment after one or two sessions."
Personally, I had some significant revelations during the first couple sessions (e.g., I decided to move closer to family after years of hemming and hawing over it), but I didn't feel relief from my depression symptoms right away. That happened about six weeks in: I started to feel that lighter feeling, and doing everyday tasks wasn't so hard.
Early on in the treatment, my guide, Shannan, an Aussie based in Tulum, Mexico (shoutout to Shannan — she's the best!), helped me process what I experienced during my treatments during online video chats called integration sessions.
One time, I went into a session with the intention/question: Why am I so depressed? I wound up seeing memories of family and didn't think they were relevant to my intention, but she helped me talk it out and make the connections that I had missed — kind of like a therapist does.
Once you get through the first round of treatment (six sessions) at Mindbloom, then it's a little more DIY and there are fewer integration sessions, unless you want to buy them. The idea is that you get the hang of it in your first six sessions and can purchase additional support if needed.
Who is a good candidate for ketamine treatment?
Dr. Yermus says that anyone dealing with depression or anxiety who is in good physical health and has an open mind is a candidate for treatment.
However, the government is a bit more exacting when it comes to prescribing the esketamine nasal spray. The FDA has only provided approval for the treatment of treatment-resistant major depression (meaning depressive episodes associated with major depressive disorder that have not responded to standard forms of oral antidepressants) and major depressive episodes associated with serious suicidal ideation and/or behavior, says Dr. Sanacora.
What does ketamine therapy cost, on average?
Unless you're taking esketamine, which is FDA approved and thus eligible for insurance coverage, you'll be paying about $450 for one IV infusion, on average, per WebMD. At Field Trip Health, one IM injection costs $750, and Mindbloom charges $89 a week for three months ($1,060) for new patients, which includes six ketamine treatments. Returning clients pay $59 per week for three months.
Note that all these companies offer support services before and after treatment, the cost of which is typically included in the aforementioned prices.
What are the risks of taking ketamine?
Dr. Sanacora points out that the long-term effects of taking ketamine for depression remain unknown. During research involving animals, ketamine was shown to cause some toxic effects on the brain as well as behavioral and cardiovascular side effects, he said. While some human studies have also shown evidence of behavioral and brain abnormalities linked to ketamine use, this has generally been in people who use the drug recreationally, he notes.
Also, ketamine — known by its street names Special K, Vitamin K, Kit-Kat, and Super K — has been used recreationally for decades, particularly in the 1980s. So there's a possibility for addiction if dosing isn't professionally monitored. As its Schedule III label indicates, ketamine has "a moderate to low potential for physical and psychological dependence," per the DEA.
Personally, I don't feel that I developed any kind of dependence on the ketamine, but I do feel drawn to the healing nature of the ketamine experience. My Mindbloom guide said that, after doing an initial round of, say, three months of treatments, many clients do a refresher course once a year afterward to keep reaping the benefits of therapy.
That's likely what I intend to do, and I can only hope that — for myself and others — ketamine treatment becomes more widely accessible and affordable in the future.