While it’s true that ketamine is used to anesthetize horses and other animals, and also used as a street drug (Special K), it’s now being used to treat depression that doesn’t respond to medication. Prior to ketamine treatment, I’d had electroconvulsive therapy (ECT), which I wrote about here. It wasn’t as successful as my ECT psychiatrist had hoped. Years later, my regular psychiatrist suggested ketamine infusions, so I checked it out. The clinic I went to required a Zoom consultation during which one of their doctors determined I was a good candidate.
The ketamine clinic looked like any clinic, with a reception desk, couches, and chairs in the waiting room where my husband waited during the sessions. Off of that room was a hallway with exam rooms. During my first and subsequent sessions, I was led into one of these rooms that was only big enough to hold a chair, a recliner, and an IV stand from which they hung a bag of fluids. Monitors were set up near it. A camera was suspended above and directly across from the recliner. On the recliner was a blanket and a set of headphones.
After sitting down, a nurse inserted a catheter into a vein in my hand. Moments later, the doctor entered. He went over the procedure, assuring me my vitals would be monitored, and they could see me through the camera in case anything happened. I didn’t ask what, but having done hallucinogenic drugs in high school, I knew it was possible to have a bad trip. He suggested I put on the headphones and listen to the ambient music they piped through it. According to Wikipedia:
Ambient music is a genre of music that emphasizes tone and atmosphere over style and rhythm. It is often ‘peaceful sounding’ and lacks composition, beat, and/or structured melody.
Because my hearing aids are Bluetoothed to my phone, I can listen to my own tunes, which I opted to do. I did take his suggestion and put it on an ambient music channel.
The doctor injected a low dose of ketamine into the IV bag connected to my vein. He dimmed the lights and closed the door. Although I could have been in near-total darkness, I wanted to see my surroundings when I opened my eyes. I was apprehensive but wasn’t completely scared that first time because as I mentioned, I’d used these types of drugs before. So I leaned back in the recliner, covered myself in the blanket, turned on the music, and closed my eyes.
What I saw was almost like looking through a kaleidoscope. Colors changed and interchanged. It wasn’t scary, but it was confusing. One of the things I remember seeing was a toy dog with wheels for paws, the kind you can pull. There was a black one and a white one against a bright yellow background, which turned into a grid filled with these images, almost like those Andy Warhol paintings of soup cans in squares. Because I was listening to music, it was like I was watching a video. When I did open my eyes, I could see the room but through an overlay of these visuals. I accepted it, closed my eyes again, and relaxed.
The ambient music, which was continuous, was a mistake. I’d only ever listened to it while getting a facial. The problem was one song flowed directly into the next with no breaks in between. I felt like I was drowning, and that was scary because I can’t swim. It was hard to breathe. Fortunately, that didn’t last long and I had the presence of mind to decide that next time, I’d listen to classical music. They’d advised me not to listen to music with lyrics, but an entire orchestra was too much for me under those circumstances. Solo classical piano, however, was perfect. The pause from one piece to the next was like coming up for air.
At the end of the hour, I heard a nurse knock lightly on the door. I opened my eyes, and my vision began to clear. I still felt pretty out of it though, confused, and I had trouble walking without my husband’s assistance. He helped me to the end of the hall where the bathroom was, and using it was challenging because I had trouble unbuttoning and buttoning my pants. My fingers felt as thick as a Snickers bar.
We drove home. I was all giggly for no reason, but I felt great. I was gregarious, which I’ve only ever experienced while hypomanic. Normally I’m a little shy. When I got home, I spent a couple of hours sleeping off the effects. It worked great, but only for about six weeks (of going two or three times a week). They offered me compounded ketamine in the form of gum that tasted awful. I chewed it for an hour, but only reached a heightened state (like on a mixture of marijuana and cocaine), but without visuals. The depression fell over me again, and the doctor said that if the ketamine stopped working, it wouldn’t work long-term, which I was sad to hear because I’d been feeling so good.
It was just as well because ketamine infusions aren’t cheap. Insurance doesn’t cover it because it hasn’t been FDA-approved to treat depression. (Though there’s a nasal spray called Spravato (esketamine), which is FDA-approved.) According to the Ketamine Clinics Directory, each infusion costs anywhere “from $300 all the way up to $2,000”. Fortunately, the clinic I went to was on the lower end of the scale.
I don’t regret trying this because it worked if only for a little while. It didn’t have the same effects of losing chunks of my memory and brain fog like I had after ECT. In fact, I don’t recall any side effects other than the lack of coordination for the first hour or so. I’d do it again if it only worked for me.
Fascinating and important writing, beautifully rendered.
What you've had to go through . . . just to be yourself. Fortunately, mine has responded to venlafaxine for 25 years.