Ketamine treatments for the regular depressed?
June 13, 2022 8:52 AM   Subscribe

I've been seeing a new therapist who recommends I try ketamine treatments but I thought that was only for folks who are treatment resistant or severely depressed. My therapist thinks I'm in a spot where I'd benefit. I called the treatment center and there really isn't a criteria. Feeling a mix of shame and confusion around seeking this kind of treatment.

I've been anxious my whole life, and it wasn't until a year or so ago that the anxiety manifested into very bad depression that pushed me to finally try medications. It seemed to work, but killed my libido, so I stopped it after 6 months or so when I felt that I was in a better place (under the supervision of my psych.)

Fast forward to now and I feel like I'm in the same spot, but not as bad. I started to see a new therapist after transitioning out from my past therapist of 5 years, as I wanted to find someone with more shared identities and specialization in [thing that is specific to me.] After their assessment, they basically said straight up "Woah, sounds like you're really suffering. Have you thought of Ketamine treatments?"

And I was so thrown off! It took me 5eva to get on Prozac because my family and culture is SO against medications for mental health, that I had to fight my own stigma and secrecy of being on it. So when I heard ketamine, I was like huh?? I'm functioning well enough, am I in a worse place than I thought? I don't really deserve that kind of treatment because I'm not in as terrible of a place as many other folks I know. She said to call the treatment center and talk to them. Basically, the treatment center said there's no criteria (in fact, people with Long COVID are using ketamine to treat brain fog) and that because it's more accessible to people nowadays, it might be able to be used in situations that are not as severe. My insurance covers the treatment.

I have so many questions about it though. Most things I google have results for people with severe and enduring depression, which I don't think I relate to. If I do the treatment, will it fundamentally change me? Do I keep up with it forever and if I don't, will I crash back into a worse depression? Some of these things I think can be answered by the med staff on hand, but I don't know anyone who has done ketamine treatment in my personal network, as opposed to a bunch of friends who are on Prozac and can give me their perspective. I feel a mix of scared and hopeful and also a layer of stigma for seeking it (both from the "just go take a walk and be social -- you don't need medicine!" family side and the "you're not sick enough to get this treatment, wait until it gets worse and then you'll deserve it" side with a mixture of "it's scary to try a new medication.")

Looking for some reassurance if I do decide to seek treatment this way, but also more stories on if you or you know someone who has sought ketamine treatment and what their experience was like. Is there anything I should try before considering treatment (i.e., get a SAD lamp or try a new medication, etc.)? tia.
posted by buttonedup to Health & Fitness (13 answers total) 10 users marked this as a favorite
> I don't really deserve that kind of treatment because I'm not in as terrible of a place ...

You do; really, you do. A mental health professional has recommended it for you and your insurance covers it. This hits my 100% deserving test.

Anyone telling a person experiencing depression to "just go take a walk and be social ..." is being exceptionally heartless. "Just" is such a nasty word: it's so easy for them to say it, and so lacking in compassion. If I could have "just" not been lazy and "just" paid attention in school and "just" applied myself without the intervention of a mental health professional and appropriate medication, I could have "just" made my ADHD go away.
posted by scruss at 9:47 AM on June 13, 2022 [13 favorites]

Someone I know does ketamine treatments and credits it with saving their life. I have seen them morph from someone with debilitating anxiety and depression to someone who is able to exist without nearly as much pain and suffering.

I get the shame around medication--I struggle with it myself every time I switch dosages or medications. But I've personally never regretted my psychiatrist-recommended increase in dosage. I look back and am grateful for trusting them. But I still struggle with the shame every time. Shame is a shitty byproduct of our dumb society--it's not you. You're doing great.
posted by sugarbomb at 9:57 AM on June 13, 2022 [5 favorites]

This is a relatively new area of research and less formal experimentation with few studies having been completed and those studies having been done under a limited range of conditions. Like many drugs in early stages of research, the initial human studies emphasize very severe cases, in part because the risk/benefit calculation feels more 'worth it'. Someone with severe, life threatening depression is at great harm by doing nothing, so worth trying a drug with potential negative effects. In future, one could expect more studies on people with depression more similar to yours. But given the limited state of research on this drug, the real answer to this question is we just don't know.

Existing studies show promising outcomes for severe depression. Given that ketamine is widely used in emergency medical settings and taken recreationally by many, we know enough to feel fairly confident that is fairly safe to take in supervised settings. Your therapist seems to have an interest in this modality so if you are attracted to trying it and feel confident in your therapists ability to for example seek emergency medical care in the very unlikely case that something goes wrong, I don't see a harm in you trying it.

If on the other hand Ketamine just doesn't appeal to you, or scares you in a way you don't want to push against, then don't try it. Another option is just sitting with the idea for a few months, maybe doing more of what you're doing now and talking to folks who have tried it, then considering in the future.
posted by latkes at 10:08 AM on June 13, 2022 [4 favorites]

If I do the treatment, will it fundamentally change me?

Nah. I did 10 (or 11?) ketamine treatments for depression last year. I was in the sad minority for whom they didn't work, but regardless, I don't feel like I'm permanently changed or different for the experience. It was a cool life experience to have and even if they don't work for the depression, ketamine can be a pleasant distraction.

Even for those people that ketamine works for, they usually have to get "topped up" with maintenance sessions monthly or so. It doesn't seem to be a thing that changes you forever, for good or for ill.

I'm happy to answer any more questions you have about the process or the experience. I think you should go for it, since your insurance will cover it. You deserve to feel better and you deserve to try anything you can toward that end.
posted by fiercecupcake at 10:10 AM on June 13, 2022 [2 favorites]

I did ketamine in February. While I was severely depressed and anxious, I am not the type of person to seek something like ketamine out. I only did it because my trusted psychiatrist recommended it, AND someone I knew and trusted had done it themselves to positive results. Even with that information it took months of thinking about it and, frankly, being scared of it and thinking I didn’t deserve it, before I signed up.

Ketamine was a great experience for me. I felt my symptoms lift - almost vanish - after the 4th session. I had six sessions total, spaced over two weeks. I wasn’t working at the time, but it’s a big time commitment and also for someone else, because you can’t drive afterwards. It affects people differently, but I enjoyed the sessions. I felt dreamy, and kinda blissed out. I always knew I was in a chair in a room, but time and space felt different. I had pleasant visions, sometimes memories, but mostly nature-themed. You can get a little dizzy or nauseated; medical staff gave me an anti-nausea med before my infusion each time. I used a weighted blanket because it helped ground my body to feel less woozy. I recommend a good playlist - everyone always says wordless music - but I listened to calm, floaty music that had some words. It definitely enhances the experience. I also had an eye mask, which helped.

Since doing ketamine, I feel much, much better. My anxiety is gone, and my depression has only now started to creep back. I did ketamine in mid-February, so I’ve had four months of symptom lift. In fact, I am going for my first booster Friday. I’m on the fence about needing it now, but I don’t want things to get worse unnecessarily. Which brings me to…

Gently, you don’t need to win the depression Olympics to deserve treatment. Part of treatment’s purpose is to intervene BEFORE things get worse. To not just boost you, but prevent you from slipping further. You deserve to feel better than you do now. If you’ve only tried Prozac, there are other anti-depressants to try, but ketamine has a good success rate, and no side effects past treatment. Ketamine won’t change you.

Finally, ketamine is the Wild West right now; lots of places administering it, low or no bar for entry, lots of money being made. It’s hard to find long-term research on it, and places that administer it have glowing websites about its miraculous properties without a lot of perspective. I would ask your mental health professionals for a specific recommendation if there’s more than one place near you. I also recommend strongly that you talk about your experiences and feelings with your therapist, maybe booking some extra sessions so you can talk in between infusions.

Finally, finally, ketamine is very expensive, and the fact that your insurance covers it makes it a no brainer to me.
posted by missmary6 at 10:20 AM on June 13, 2022 [16 favorites]

Feeling a mix of shame and confusion around seeking this kind of treatment

Yup. That's the depression lying to you. As it does.

It is in no way a moral failing to use whatever treatments are available to you. There is nothing to be ashamed of. You are as deserving of help as anyone.
posted by ook at 11:11 AM on June 13, 2022 [5 favorites]

Ketamine's negative reputation, like LSD's and psilocybin's and MDMA's, is largely based on it having historically seen far more recreational than therapeutic use, with all the associated cultural baggage and moral panic.

If you're working with a mental health care team that you trust, and that team has both experience with some potentially therapeutic substance and good reason to consider it worth your while to experiment with inside a supportive care team context, then I strongly recommend doing your best to put all the Just Say No war-on-drugs propaganda aside when making your decision about whether or not to do so.

The authors of that propaganda do not, in general, have your best interests at heart, and most of what brings recreational substance users undone is uncontrolled doses of those substances taken with unsound intentions in unsafe settings rather than the substances per se.

Yes it's scary to try a new medication. Flip side of that, though, is that living with chronic anxiety makes everything scarier than it probably needs to be. So again, if you've good reason to trust your care team to steer you right, I recommend letting them try. Also, the more solid information you can get from them and from other reliable sources about the option they're proposing before you let them try, the less scary it's going to be.

As to whether ketamine will change you: I'd hope so, given that the way you're presently functioning includes anxiety and depression that nobody benefits from suffering from, especially if there might be some effective way not to. There is nothing noble or desirable about suffering, in and of itself. It doesn't "build character", it's just an embuggerance. If it's distracting you from what you want to do with your life and there's something you can do to get rid of it then that something is, in general, a good idea to do.

Whether or not you find the change to be "fundamental" really comes down to a question of what kind of thing you conceive of yourself as being. Any psychedelic experience has the potential to reveal certain kinds of self-concept as no longer tenable, but then again, so do many non-psychedelic experiences.

I think you can be reasonably confident that experience with unusual states of consciousness will increase, rather than decrease, the amount of information available to you as you work through the lifelong process of finding out what kind of a thing you really are. If you put as high a value on having an accurate and testable internal account of that as I do, then those extra perspectives will be a good thing. Having a demonstrably more accurate and therefore more robust self-model has certainly been a big part of what's reduced my own anxiety to quite tolerable proportions.

I wish you all the best of luck with whichever way you decide to jump.
posted by flabdablet at 11:21 AM on June 13, 2022 [2 favorites]

I've met many people, including several friends, who had great results with ketamine. You do deserve to feel good, and there's nothing inherently bad about ketamine versus another antidepressant - it might be really good to try, and if you don't like it or it doesn't work for you for whatever reason, you can stop.

The worst thing I've heard about it is that if you get the nasal spray instead of an infusion, you end up tasting it a little and it doesn't taste very good. That's the absolute worst thing I've heard, and I could write a giant wall of text about issues I've known people to have with other antidepressants.
posted by bile and syntax at 11:25 AM on June 13, 2022 [1 favorite]

If it's the new-ness of ketamine treatment that worries you, you might also consider ECT, which has been around long enough that it's now well understood and standardized.

ECT has a bad reputation because of how it's portrayed in pop culture, but today it's not at all frightening or painful. I work in a hospital where ECT is given both outpatient and inpatient, for depression and anxiety, and I've been surprised at how straightforward it is.

Like all treatments for mental health issues: ECT works well for most people, for a minority it doesn't really work enough to be worth it, and for an equally small minority its an absolute miracle cure.

The thing about ECT these days, however, is that it is all done under anesthetic and with muscle relaxants, so there aren't really any side effects apart from feeling sleepy for the rest of the morning/day. Our patients who have it in the morning are up and about by the afternoon. (Of note, when articles or doctors talk about 'memory loss' in relation to ECT, this means:you might have trouble remembering the 30 minutes or so around your treatment, although with most people this is also temporary. It's not like people forget whole days any more.)

Whatever you choose, I wish you all the best.
posted by EllaEm at 1:57 PM on June 13, 2022 [1 favorite]

Keep in mind that in drug trials, a significant proportion of people recover with no medication at all. There’s absolutely nothing at all wrong with waiting to see how the next few months go as you work on therapy. Also I think I would want to go to a really good psychiatrist to discuss medication options to explore better known medications that might address the side effects you did not like before with your anti-depressant.
posted by haptic_avenger at 5:36 PM on June 13, 2022 [1 favorite]

You do deserve to feel better, and ketamine isn't just for the severely depressed.

That said, it is far from your only option.

A lot of therapists know very little about psychiatric medication. That's not necessarily a red flag -- knowing about meds just isn't their job. So your therapist may not realize that lots of people get relief from side effects just by switching between conventional meds. It sounds like you've just tried Prozac, yes? So okay, for sexual side effects, you could try a different SSRI other than Prozac, an SNRI, Prozac plus Wellbutrin, or switching to Wellbutrin entirely. None of these is guaranteed to work -- but neither is ketamine. And all are well studied, convenient, easy to get insurance coverage for, and cheap. If I were in your shoes, I'd want to try them first just for the sake of money and time.

My advice is, don't take your therapist's word for it -- find a real psychiatrist and ask their opinion.
posted by nebulawindphone at 4:51 AM on June 14, 2022

My friend's experience with ketamine is that it will not fundamentally change you. It's their favorite drug, and they do it regularly, and do experience something of a small reduction in anxiety and depression for a week or so after using it. I would trust your therapist and not worry overly much about a life-changing bad trip if you're otherwise comfortable with the idea.

And just as a PSA for anyone who finds themselves encouraged to experiment with street ketamine for depression, whether for access or cost reasons, please always test your drugs with fentanyl test strips, which are likely available from your Friendly Neighborhood Harm Reduction Group.
posted by Corinth at 11:43 AM on June 14, 2022

A close friend did this a couple years ago & found it to be a fully positive experience:

If I do the treatment, will it fundamentally change me?
In friend's case, seems like yes, into a happier and less anxious version of himself!

Do I keep up with it forever and if I don't, will I crash back into a worse depression?
In friend's case, no; he did the treatment for a couple months, and the benefits seem to have been permanent (or at least long-term) from a short-term treatment regimen.
posted by anotherthink at 11:46 AM on June 14, 2022

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