Sniff-click. Sniff-click.

One shot in each nostril, and here…we…go.

A while ago, I started Ketamine therapy for depression. I didn’t finish - I changed jobs, which switched insurances, which messed everything up - but I was doing it for two and half weeks (five doses) before then, and had good results with it.

(For those of you who read about my experiences with TMS, I tried Ketamine first, and did the TMS after I couldn't get back on the Ketamine with my new insurance.)

Background

The TL;DR is that a while back, someone figured out that giving humans a low-dose horse tranquilizer cured depression (temporarily).

I don’t know (and I don’t want to know) how they figured that out, because the story in my head is funnier than anything real life could come up with.

Now we’ve got an FDA-approved treatment for depression using a nasal spray (called Spravato) with a ketamine-adjacent molecule called esketamine, and boy howdy does it get the job done.

If you want details about the science or plausibility, look here or do your own research. This post isn’t about that. It’s about the experience I’ve have doing the ketamine therapy, including some of the boring details along with the fun part of what the trip is like.

The Boring Bits

Signing Up For The Treatment

If you’ve got treatment-resistant depression and want a nuclear option, this is it. The good news is that, so far as I know, ketamine works on almost everybody. Unlike every antidepressant I’ve ever taken, it also works within a day or two.

The bad news is that The Bureaucracy Must Be Appeased.

After bringing up Ketamine to my psychiatrist and getting the go-ahead, I looked up local clinics that did the treatment and got in touch with one of them.

They though I’d be a great candidate, and they were happy to help! There were just a few bazillion forms I had to fill out, an app I had to install, an account I had to create, and so on.

I’ll forever enjoy the irony of someone going, “Yes, we can help you with your depression, absolutely! But first you’re going to have to jump through dozens of small pointless hoops made of paperwork and boredom, because accomplishing numerous small tasks isn’t something people with depression struggle with at all, no-sirree.”

Granted, no one actually said that, but I think it captures the zeitgeist of the experience pretty well.

Some of the things I had to do:

• install an app for communication with the clinic
• sign/initial (what felt like) dozens of forms
• contact the pharmacy with the drug (not my normal pharmacy), multiple times, to register my credit card so I could pay for the drug itself
• sign/initial other forms, for some reason
• set up an account with the service provider
• sign/initial more forms, because hell is real and it demands suffering
• arrange transportation to and from the clinic twice a week for four weeks, because you ain’t driving after the happy happy fun times in the chair
• sign more forms, because the trees are already dead so why not
• sacrifice a goat on the altar of Yog-Sothoth, Who Is The Gate And The Key

That last one may have been a dream.

The Schedule

Normal Ketamine therapy is a total of twelve doses. Twice a week for four weeks, then once a week for four weeks, for a total of eight weeks of treatment. As I mentioned above, I only got halfway through the third week.

Additionally, you can’t schedule the treatment for two days in a row during the first four weeks, i.e. Monday and Tuesday; you have to have at least one day in between.

The Treatment Itself

I can only speak for the clinic that I went to, but it goes something like this:

1. Arrive. Thank the person who drove you, and hope you can get them to leave without actually telling them to leave, because that would be rude, but you don’t want them to see you when you’re high, so they kind of need to not be there.
2. Get set up in the nice chair with a blanket. The clinic I went to had zero-gravity chairs, which are awesome, if less physics-breaking than I would like.
3. The person/doctor/nurse/ritualist/shaman attending you takes your blood pressure, makes sure it’s in whatever range it needs to be in.
4. For the first time, you get to practice doing The Snort. The esketamine is taken nasally, so there’s this sprayer thing with a plunger that it comes in. My clinic had a practice version, which was helpful, as I didn’t have any experience sticking a plunger-thingy up my nose and inhaling really hard while pressing the plunger until it clicks. I imagine it’s a similar skill set to doing cocaine, just without the rolled-up dollar bill, bathroom sink, or hooker sex worker.
5. Take the treatment. Each plunger-thing is the same dose, so for the first week you take two plunger-things (one fifteen minutes after the other) and then after that it’s three, all fifteen minutes apart.
6. Happy happy fun times.
7. Get up and leave. I didn’t have too much trouble with this, although I would recommend caution. You will not be walking in a straight line afterwards.
8. Feel a bit tired and groggy until you go to sleep. I don’t recommend going to work or doing anything important. By my fifth treatment it would have been manageable; before that it wouldn’t have been.
9. Wake up the next day and think, so this is what it’s like to not be depressed. Neat.

The Trip

It’s never easy to describe an altered state of consciousness. There’s no way to do it but to rely on metaphor and simile, because that’s about it for a language’s capacity to translate an entirely subjective experience from one brain to another.

That being said, there are some relatively objective things I can say.

During the trip, there are three physical sensations I notice. First is that my extremities - hands and feet - get cold. This might be a blood pressure thing, I don’t know. Second, there’s a heaviness and dissociation from the body that we’ll get into more later. Third, there’s a reliable visual effect that I don’t think is a hallucination.

The Visual Effect

When you unfocus your eyes, you get double vision on things close to you. I used to play with this as a child, opening and closing one eye at a time to make objects appear to move back and forth. The thing about double vision, though, is that the objects remain parallel to one another, i.e. straight lines remain parallel, just displaced each other.

If there’s a square in front of you and you unfocus your eyes, you might see two squares overlapping like so:

If you tilt your head, the squares will be displaced in both the x and y directions:

But during the esketamine trip, my double vision is angled, like this:

I have no idea why, but it’s happened every time. During some of the trips I’ve watched movies with the subtitles on, and it’s weird to see one line of subtitles angled into the screen.

The Bodily Dissociation

People might describe the sensation as ‘floating’. I think it’s a general sense of distance from one’s body. Signals that would normally travel from the fingertips to the brain instantaneously take longer: sensations take longer to reach the brain, and commands to move take longer to reach the fingertips. There was a dull sense that my body was some kind of extremity, a robot I controlled through a long-distance phone call.

As far as I understand, this is perfectly normal, and it went away after an hour or two.

The Rest of the Trip

I don’t have enough experience to know when a trip ‘ends’, so I’ll just describe the experience as I had it.

Out of the two hours spent in the chair in the clinic, the first 40 or so minutes after taking the Ketamine were spent in a haze. It was extraordinarily pleasant, and time seemed to just fly by.

After that, the comedown seemed to start, involving a gradual return to myself over the course of ~75 minutes. In the clinic I attended, there was a TV with Netflix, so a movie was generally on, and the good mood produced by the treatment made comedies very enjoyable. (The best trip was when I watched Talladega Nights.)

By the time the two hours were up, I had more or less sobered up, although my equilibrium was still a bit challenged.

The Effect

Ketamine therapy worked for me. I walked out of the first session with a powerful sense of disorientation in response to how vivid everything felt. The sunlight coming through the trees looked like a scene from a movie, brighter and purer than such things were in real life. I remember feeling the wind on my skin on the car ride back, marveling at how strong the sensations were.

In my percentage scale, one week (two doses) of treatment took me from ~15% to ~80%. It was almost hard to believe the difference it made.

But the Ketamine giveth, and the Ketamine taketh away.

I didn’t finish the full recommended treatment. Maybe things would be different if I had (although I suspect not).

But almost two weeks to the day after my final (fifth) treatment, I crashed from 80% back down to 15%. It was a horrifying sensation, as if all personality and agency and initiative and life was sucked out of me, poured down a drain in a little whirlpool, and I was the empty husk that was left.

It was a miracle in reverse, and it sucked.

Conclusion

I think that Ketamine Therapy is a powerful option for people with severe depression, but my own (admittedly limited) experience was that it functioned as a temporary fix rather than a cure. It’s a large time commitment: two-hour sessions twice a week for a month that someone else has to chauffeur you to and from, and you likely aren’t doing a whole lot in the day after the treatment.

That being said, it provided me with a lot of valuable personal data. I got a firm baseline for what I looked like when I wasn’t depressed, and a greater understanding of how my own mind worked.

I also got to get high on Ketamine, which was a great deal of fun (note: I took a legal, FDA-approved treatment; I am not speaking to anything else).

There are many available treatments for depression now, and this is one of the most effective (if, for me, temporary) I’ve ever had. And that glimpse at what my life could be like, unencumbered by my own brain’s malfunctioning, was absolutely worth it, for all that it ended too soon. It gave me hope, it gave me faith in myself, and it gave me the motivation to continue pursuing treatment options, until I could finally have the life that I wanted.