My ears perked up in recent months when I began to hear the buzz about ketamine, the anesthetic and hallucinogenic drug that has found a new market as an antidepressant. Numerous credible studies have documented benefits, including that it is fast-acting, with patients sometimes showing improvement within a couple of days. And social and other media have featured doctors and patients describing it as “life changing,” with one user commenting that “I felt like a completely new person.”
For someone suffering from depression, that’s a tantalizing promise.
I’m 65 and for much of my life I’ve suffered from clinical depression, with two periods of suicidal ideation. Since 2002 I’ve taken a selective serotonin reuptake inhibitor, a type of antidepressant that has helped combat the day-to-day symptoms of this illness. Ditto the talk therapy I’ve participated in. But in the past year the medication’s impact seemed to be waning and my other efforts — exercise, meditation, socializing — didn’t seem to be helping as they once had. Having been down this road before, I recognized the dangers as the storm clouds gathered in my head.
As I read the buoyant reports of ketamine successes I decided it was time for me to try it — under the supervision of a professional therapist. With a referral from my therapist, soon enough I found myself on a new psychiatrist’s couch, a doctor specifically trained to administer the drug. The Food and Drug Administration approved the use of a nasal-spray form of ketamine for use in treatment-resistant, unipolar major depression. But the drug may be prescribed “off-label” for other depression and mental health conditions — though not for recreational use.
“At the dosage level administered to you, you are likely to experience mild anesthetic, anxiolytic [anti-anxiety], antidepressant and, potentially, psychedelic effects.”
— Consent form
After determining that I was a medically healthy and otherwise eligible candidate, the psychiatrist — who trained at Yale’s School of Medicine, where much of the early ketamine research originated — briefed me in detail on all the possible side effects, short-term spikes in blood pressure, headache, nausea and vomiting. The nine-page consent form also included this sentence: “At the dosage level administered to you, you are likely to experience mild anesthetic, anxiolytic [anti-anxiety], antidepressant and, potentially, psychedelic effects.” The form also included commonly reported side effects such as “loss of sense of self, changes in the perception of time, dreamlike visions ... and feelings of connection, joy and peace.”
In looking back I realize I didn’t fully appreciate what all that meant. And so I went ahead and made an appointment for my first treatment session — together we would determine how many I’d need or want — remembering the importance of “set and setting,” which refers to a healthy mind-set and a relatively safe environment. (You would not want to take it, for example, if you were suicidal, or standing on a rooftop.)
Two weeks after the consultation I found myself in the doctor’s office, with late-afternoon sun shining through the office windows — and a blackout mask nearby. As soft music played in the background I took the first of two 100-milligram ketamine lozenges. I did what’s called the “swish and hold” for 10 minutes until it dissolved; then I swallowed.
Within 15 minutes, as I wrote in my journal the next day: “I experienced disequilibrium. Imbalance. Unable to find my place. Somewhere between scary and terrified.” Then came the blackness where I felt untethered, floating further and further away from any kind of anchor. I assumed I’d somehow put on the blackout mask — but I hadn’t.
According to the doctor’s notes (which he kept up with in real time during my journey), I told him, “Not sure I like this, feeling afraid of something I can’t see.”
I quickly became terrified of losing contact with him, talking incessantly to maintain the connection. When he switched from one chair to another, I panicked for a moment thinking he’d left me alone. (He had not.) He suggested I do what’s known as 4-7-8 breathing to curb my anxiety; it did. Completely engulfed by an unyielding darkness, I asked him, “Am I failing the experience?” And, “Where are the teal and fuchsia moments” that I had heard others speak of, or the peace and joy from the consent form? I kept talking: “Maybe I came in with unsaid expectations — that this would be a transformative experience. But wherever I go, there I am.”
His notes reveal we talked about “anticipatory grief,” as I began to weep about the prospect of my younger sister Julie possibly dying. (She has Stage 4 ovarian cancer.)
After about an hour I started to come down, regaining my equilibrium and opening my eyes to the darkness that had settled in around me and that I had glimpsed inside me.
Not long after the doctor asked me if I wanted to take a second lozenge, explaining that a second experience would likely be very different from the first. Exhausted and scared, I surprised myself when I said “yes.” I think I knew that if I didn’t try it again then, I never would.
Soon enough I was telling him, according to his notes, “Completely different with this lozenge — sad but not scared, feeling more tethered.” I talked more about losing Julie and the doctor suggested, “You will miss her wisdom and guidance.” Again I wept, asking, “Why do we have to feel?” because it was just too much. I thought back to the time when I had cancer myself, and how I’d been incapacitated by a different emotion: fear.
Once again I returned to the present, exhausted and somewhat nauseated. A friend came to drive me home, which is required because it takes several hours to fully recover. I’d made some mac ’n cheese ahead of time. I scarfed a bowl and fell asleep watching a silly Christmas movie.
The next morning I felt deflated. I’d expected a euphoric kind of experience based on what several friends had said. Trey Weaver, for example, told me he’d been treated almost a dozen times and his experience “feels like a reset from the physical tension and mental fatigue and hardship I endure from dealing with chronic pain.” That’s not at all what I experienced.
A few days later I had a follow-up appointment with the psychiatrist. Despite the mixed feelings I had about the lozenges, mainly the taste and upset stomach, I made another appointment three weeks hence, hopeful that the transformative experience would now be mine. The consent form had explained that “recent studies suggest the antidepressant response tends to be sustained with repeated use ...” And friends — and the doctor — had told me that it can take several sessions for ketamine to work, although many who suffer from depression realize almost immediate effects. This time the doctor would be injecting 50 milligrams of ketamine intramuscularly.
Three minutes later, more scared than excited, I told the doctor, “I have liftoff.”
In fact, I saw myself strapped to a rocket shooting up into space — again, a deep black space. I very quickly lost track of time, but I also lost almost all sensation in my mouth, a result of ketamine’s analgesic and anesthetic properties. I couldn’t feel my lips and began tapping on my face in search of them. No luck. Panic. Suddenly, my throat disappeared — no feeling when I swallowed. I could only “see” a black hole where it had been. I tried not to swallow, fearful that I’d choke to death on my own saliva. More panic.
According to the psychiatrist’s notes I asked out loud, “Am I okay?” (In my head I recall shouting something more like, “GET ME OUT OF HERE!”)
I soon felt completely immobilized, trapped in my body. I started to recall a magazine story I’d written a long time ago about a woman who lived in what’s known as a “locked-in” state. (According to the Cleveland Clinic, people with locked-in syndrome “have total paralysis but still have consciousness and their normal cognitive abilities.”) I saw myself in a glass coffin looking out into the dark universe, although I’d see flashes of deeply hued magenta and chartreuse from time to time.
According to reputable studies, ketamine can be life-changing for a significant majority — as much as three-quarters — of those who take it for depression. That leaves 25 percent, like me, who are not so fortunate.
The doctor’s notes say I reached out to him with my left hand, a manifestation of my distress. I felt him clasp it. “This is my lifeline,” I thought to myself, holding on to his hand for about 15 minutes as I tried to use Morse code to communicate “SOS.” (Alas, I don’t know Morse code so I’m not sure what I communicated.)
“Was I going to be locked in forever?” I thought to myself, floating through space, untethered to my family, friends and my cocker spaniel at home. The answer appeared to be yes, because with no real sense of time, I began to feel as though months were passing.
I wondered, “What had I done wrong to put myself in such danger?” I had taken all the proper steps before starting this journey, and still somehow I felt something awful had happened to me. I had a “sense of sliding into a death experience.” I was dying, although I wasn’t frightened by that. Eventually I gave in and slid through the tunnel toward the light, accepting my fate.
Forty-five minutes after the injection I started reentry, touching my mouth with my fingers, feeling my throat, hearing myself speak out loud (not necessarily coherently). The doctor reported in his notes that I told him, “Oh my gosh, I died.”
That evening I texted the psychiatrist: “I’m ok. But I feel like today’s journey was too much, too fast, too dark.” He replied quickly, saying he hoped “tomorrow finds your fears less prominent.”
The next handful of days did not prove easier. When I texted the psychiatrist he was responsive and kind, and suggested the timing of our sessions might not have been best, given my worries about my sister.
“Psychedelic experiences can be hard, regardless of set and setting. Integration is important, and so is giving it time to settle,” he texted back.
In the days that followed I still didn’t feel like myself. Detached. Untethered. Scared. In a world of my own. Several friends noticed this difference in me, with one asking me directly if I was at risk of self-harm.
During my next appointment the doctor suggested I increase my daily dose of the antidepressant I take. I could not do it quickly enough. Within several days I began to settle, feel better, more like “me.”
And just the thought of trying ketamine again made me feel anxious.
Where does that leave me? According to reputable studies, ketamine can be life-changing for a significant majority — as much as three-quarters — of those who take it for depression. That leaves 25 percent, like me, who are not so fortunate.
I asked John Krystal, chief of psychiatry and behavioral health at Yale-New Haven Hospital and a leading authority on ketamine use for depression, about my experience. “There is a risk that some patients will have extremely upsetting experiences during treatment [with] ketamine or psychedelics,” he said. “The experience of losing control of the form and content of their thought processes and the altered sensory experiences are, themselves, potentially traumatic experiences.”
I wish I’d understood that better beforehand so that my expectations would have been better aligned with my experience. Still, Krystal continued, “When patients are well prepared for the experiences, supported as they occur, and debriefed afterwards, the risk of lasting negative effects is substantially reduced and the potential for personal growth is enhanced.”
I was glad to hear that the negative feelings would probably dissipate — and they did over a period of six weeks — and I might even discover some delayed benefits to the treatment (still waiting). Perhaps this wasn’t the right time for me to try ketamine. But this was when I felt that I needed it most. And I — like so many others who suffer from debilitating depression — had been willing to grab for a much-talked about lifeline to help me through the storm. It was not, however, a lifesaver for me.