My experience with ketamine therapy (part 1)

Ketamine treatment has been a godsend for my depression, but it's not a day at the spa

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It was December 2019. Brandon and I had been dating for two years, but he wasn’t yet living with me, and it had been days since I had seen him. I kept telling him to stay home, I wasn’t up for spending the night together. (In fact, one day I told him I didn’t even want to text, and we’d try again tomorrow.) I wasn’t seeing friends, I was struggling to focus at work, and I didn’t want to go to the gym. My seasonal depression was back, and every year, it was getting worse, dragging me down deeper and holding me down longer.

I’m no stranger to depression; I’d been battling it since leaving rehab in 2000. I was on Prozac for a few years, then came off it, not liking the side effects. It was the worst in November or December, coming in fast, hovering like a dark cloud for a few weeks, then disappearing on its own. But the last few years, depression felt much closer, darker, and heavier all the time.

Still, normally I’m a functioning depressed person. I work, I show up at the gym, I take showers, and I eat. I don’t socialize, I distance myself from family, and I spend all my free time on the couch or in bed, but I at least function. This time, in 2019, I couldn’t. I had slowly withdrawn more and more, taking no pleasure in anything (not even the gym or hiking). I isolated, I stayed inside, I slept a lot, and I could not kick myself out of it.

One of Brandon’s friends had recently shared his ketamine experience, thinking it may be of interest for Brandon (who has also struggled with depression). Brandon gently mentioned it to me as a potential option.

Ketamine therapy

I had been researching therapeutic psychedelics for the last year, in part for a panel on which I spoke the prior summer, but also because the subject interested me. Ketamine seemed the most accessible treatment—it was legal, administered in a healthcare environment, and had been studied widely, showing great promise for the treatment of depression (including Major Depressive Disorder), PTSD, and suicidal ideation.

How it works: Ketamine creates a dissociative experience (a “trip”), but that’s not the treatment. Mechanistically, ketamine can restore synaptic connections in the brain, and help the nerves responsible for neurotransmitters (mood) communicate more effectively. Regrowing and reactivating synapses helps the brain’s ability to change, which may help it shift out of depression in a way that antidepressants or psychotherapy can’t.

The idea terrified me, though. I had done ketamine recreationally when I was a drug addict. I wrestled with whether using it again (even therapeutically) would somehow “break” my recovery. I was scared I’d like it, and the urge to use would return. And I was equally afraid it wouldn’t work, and I’d be stuck in this dark hole forever.

I was desperate. I was exhausted. My life was starting to fall apart. So with the blessing of my therapist, I set up an appointment at a local medical clinic, run by an MD.

The experience

I spent the first hour of my visit in an onboarding session, filling out forms, doing a physical exam, and watching a video about the benefits and very real risks of ketamine therapy. (Brandon came with me for moral support, and to drive me home.) They leaned heavy on the fact that not everyone has a pleasant experience, but I was confident if that happened, I’d know how to handle it. (I remember what it feels like to trip, and had one really bad trip that lasted a full 12 hours. If I was comfortable, felt safe, and rolled with it, I knew I’d be okay.)

Off-label

The form of ketamine approved by the FDA in March 2019 is a nasal spray—which is not the treatment I did. (Mine involved a series of shots in my shoulder.) Other treatment options include intravenous administration or oral administration (often in the form of lozenges). This is all considered off-label use, but it’s not illegal. It’s like injectors using Botox to relax your jaw muscles as a TMJ treatment; “off-label” means the drug is being used for something not listed in the official FDA approval. Still, you should be aware of the difference, and research the risks accordingly.

They moved me into a private room that was clinical with a nod to comfort. (There were oversized bean bag chairs, blankets, and a plant, but also a heart rate monitor, an IV pole, a blood pressure cuff, and a walker.) They placed the heart rate monitor on my finger, showed me where the puke bucket was (a common side effect), and gave me the first injection. I warned Brandon that I would be out of it and not to try to talk to me. I especially warned him not to ask me if I was okay, because on a trip, this question can send you spiraling. I threw on a chill playlist, sat back in my giant bean bag chair, and let it happen.

This was 2019; there weren’t many stories of people’s ketamine experiences online. Still, I’d read a few articles; people described it as feeling like they were in “outer space” or on a “spiritual journey.” Let me be clear—I tripped my balls off, and it was neither pleasant nor spiritual. I was grateful I knew how to trip, because I spent a lot of time believing I had died. (In fact, every time I do ketamine therapy, I think I’ve died. That’s common, I’ve heard, and can be scary.) It’s a truly dissociative experience; you can’t move, you can’t speak, and you have little control over your thoughts. You’re just gone—the music stretches out in disturbing warped waves (I can still hear the sound, and it makes me feel sick), your eyes aren’t interpreting anything normally, and time loses all meaning.

The trip itself hit me hard and took about 30 minutes, but it felt like hours. The nurse came in a few times to check on me, which I was only vaguely aware of. And just as I was starting to come back to myself, sitting up and starting to talk to Brandon, they came in with another shot at an even higher dose, and injected me again. (Note, every clinic has their own dosage practices, but this one/two shot punch is common, and of course I knew it was coming.) The second trip was worse—deeper, longer (but it wasn’t, it just felt like it) far more intense, and way more dead.

It’s not ayahuasca

Some psychedelic experiences unlock hidden parts of your brain and show you the universe in a whole new way. You may speak to your ancestors, see God, or heal childhood wounds. This is not that. I’ve never experienced anything concrete during a ketamine trip. I’ll get flashes (my mom, my trauma, an experience I haven’t thought about in decades) but nothing sticks, and it’s nothing I can use in therapy. For me, it’s too chaotic and I’m far too gone for anything to be memorable. I’m mostly just trying to hang on until I can return to my body.

The after-effects

The ironically good news was that I hated every second of these trips. HATED IT. It wasn’t even a little bit fun; it felt awful, and in no way was I excited (or even neutral) about doing it again. This felt hugely reassuring for my recovery; this wasn’t going to send me spiraling into cravings or worse.

Coming out of the trip, I was groggy, tired, and nauseous as hell. That part was the worst—I never felt pukey during the treatment, but for two hours after, I stayed close to the toilet. (I never threw up, though I wish I had.) But my mental health felt better immediately. It was like the heavy cloak had begun to lift, and I could breathe a little easier.

By the next day, I felt 80% like myself again—no more dark hole. I was still tired and shaky, but my mood was dramatically different, and it was evident to Brandon too. It felt like a miracle; nothing had ever kicked me out of such a dark depression so effectively or so fast. I was so incredibly grateful.

The clinic (and most protocols I’ve seen) recommended a series of six treatments, about two weeks apart. They explained stacking them would give me benefits that lasted—for a year or more, in many cases. But as I’ve explained, I hated the experience so much that I didn’t want to go back if I didn’t have to, so I told them I’d wait and see how this treatment went.

I got six months of benefits from this one treatment—which they told me was astounding. But eventually, the depression started to creep back in, and none of my efforts to bounce back on my own (therapy, meditation, movement, nature) were working. I scheduled another treatment, and had the same experience—two trips I hated, wondering if I was dead, feeling groggy and nauseous, then immediately coming out of my depressive hole. I got a whole year out of this one.

Cost

My sessions were $600 apiece (or I could get a series of six for $3,000). It’s not cheap, and insurance doesn’t cover it. You may be able to get your doctor to prescribe the nasal spray, and that may be covered, but I can’t speak to the efficacy or cost there. I’ve also seen oral treatments offered for less money. In general, prices vary widely based on location, but you aren’t necessarily looking for the bargain here—it’s far more important to visit a medical clinic with professional administration (like, actual doctors) and close monitoring.

It’s not a facial

I’ve done three (or four?) more treatments since then; the last of which was October 2022. The effects have stuck! On my way home from the last appointment, though, I cried, telling Brandon, “I cannot do that again.” Every treatment just seems to hit harder—the trips are more uncomfortable, the nausea more intense. And yet, the effect of the treatment can’t be denied—that’s the catch. I hate the experience so much, the idea of going back makes me shake and want to throw up—and yet I would, because the negative impact my depression has on my health, work, friendships, and especially my husband and son is even worse.

The reason I’m finally writing about is two-fold: First, people keep asking me about it, and I’m always happy to share my experience if it helps someone else. (Sharing it first in this private platform also feels like the right move. It’s not easy putting all of this out there—my mental health issues, the intersection of ketamine therapy with my recovery, using the treatment off-label…. people have opinions.)

Second, I read this Harper’s Bazaar article shared by

Rina Raphael

earlier this year, and it’s stuck with me, to the point where I needed to share my reality with the drug. Ketamine clinics are now being branded as “wellness,” marketing their cozy rooms, plush blankets, and puffy eye coverings. And while yes, there is something to “set and setting” when doing psychedelics, as Raphael writes, “Psychedelics are not on par with a facial. And by putting such a treatment in a more entertaining or soothing setting, you run the risk of distorting its purpose and effects.”

A millennial wellness aesthetic should not be what sells you on a ketamine clinic—you want a doctor with credentials, and a healthcare team to supervise your experience, and medical equipment on hand in case things go sideways. Sure, sometimes the two can co-exist, but look for THIS before you look for THAT.

I also went back and forth about whether or not to share how “miraculous” it felt for me, but since that was my honest experience, I left it in. Still, I will not let you leave here thinking it’s a quick-fix, a guarantee, or the same as getting a vitamin shot or sitting in an infrared sauna.

Ketamine can be a hugely intense and uncomfortable experience with very real risks—and that should not be taken lightly. It’s also not a quick fix—I needed multiple treatments on top of the weekly therapy sessions and regular self-care practices (meditation, journaling, I was already doing. And thought it felt debilitating, my depression was still just garden variety; those with MDD, PTSD, or suicidal ideation may have a different experience.

In summary, do your research, have a trusted friend or family member with you, choose your clinic carefully, and have the blessing of your therapist, who can help you integrate your experience into the work you’re already doing. But also—if you’ve been considering it, it’s worth trying, because for me, the impact is undeniable. (And maybe you’ll enjoy it more than I did! But you’ll still probably think you’re dead.)

Have you done ketamine? Would you share your experience here, so others can learn more? Feel free to ask any questions in the comments, too, like “Hey, what are your best tips for tripping your balls off?” It turns out, I’m still very good at that.

XO MU