Ketamine therapy… is it working? What next if not
June 4, 2024 9:26 PM Subscribe
I recently completed 6 sessions with an online ketamine therapy provider. The results were minimal. I’m now two sessions in to IV ketamine treatment, and I don’t feel like it’s going well. Looking for others’ personal experiences or recommendations.
Background: I’ve had treatment resistant depression for 30 years, tried countless medications, and rTMS (repetitive transcranial magnetic stimulation), all to no avail. At the recommendation of friends and based on a lot of my own research, I decided to give ketamine treatments a go.
I started with a popular online ketamine provider, and their course of six sessions did (ultimately) nothing for me. The sessions themselves used oral ketamine administered sublingually. Despite testimonials, I experienced little more during sessions than a warm fuzzy feeling. The “integration” period—48-72 hours after treatment—seemed promising from the first two sessions, and I definitely felt relief. The remaining four sessions continued to be underwhelming, and the periods after I felt like I was back at pre-treatment distress, pain, hopelessness, and SI (suicidal ideation).
Knowing that I do not respond well to other drugs orally administered, I signed up for IV treatments. These sessions actually do feel like trips, best described as compressing a three-tab 6hr LSD experience into 40 minutes. It’s grueling and highly uncomfortable, but at least I can feel *something* is happening. However, I’ve felt no lift or any positive changes post these two treatments. (Well, for whatever reason, it’s cured my alcoholism and weed dependence, so I got that going for me, which is nice.) Of course the provider toes the party line of “you just have to get through all the sessions.”
All my research prior to doing this says ketamine is remarkably effective at reducing SI after one or two treatments. But I continue to feel the same distress, pain, SI, etc that I did prior to any treatment or post oral-series, with not even temporary relief. (A confounding factor is I do not have a current therapist, and that process could take months.) I wish I had a more specific question, but I am grasping now, and looking for any other personal experiences where things did not go according to plan, or typical to most articles and testimonials I can find online. If you’ve tried ketamine therapy, what was your experience like, was it ultimately helpful? If not, what did you do next? Really, I will take anything you got, because I am at a loss here, disappointed and hopeless. Thank you.
Background: I’ve had treatment resistant depression for 30 years, tried countless medications, and rTMS (repetitive transcranial magnetic stimulation), all to no avail. At the recommendation of friends and based on a lot of my own research, I decided to give ketamine treatments a go.
I started with a popular online ketamine provider, and their course of six sessions did (ultimately) nothing for me. The sessions themselves used oral ketamine administered sublingually. Despite testimonials, I experienced little more during sessions than a warm fuzzy feeling. The “integration” period—48-72 hours after treatment—seemed promising from the first two sessions, and I definitely felt relief. The remaining four sessions continued to be underwhelming, and the periods after I felt like I was back at pre-treatment distress, pain, hopelessness, and SI (suicidal ideation).
Knowing that I do not respond well to other drugs orally administered, I signed up for IV treatments. These sessions actually do feel like trips, best described as compressing a three-tab 6hr LSD experience into 40 minutes. It’s grueling and highly uncomfortable, but at least I can feel *something* is happening. However, I’ve felt no lift or any positive changes post these two treatments. (Well, for whatever reason, it’s cured my alcoholism and weed dependence, so I got that going for me, which is nice.) Of course the provider toes the party line of “you just have to get through all the sessions.”
All my research prior to doing this says ketamine is remarkably effective at reducing SI after one or two treatments. But I continue to feel the same distress, pain, SI, etc that I did prior to any treatment or post oral-series, with not even temporary relief. (A confounding factor is I do not have a current therapist, and that process could take months.) I wish I had a more specific question, but I am grasping now, and looking for any other personal experiences where things did not go according to plan, or typical to most articles and testimonials I can find online. If you’ve tried ketamine therapy, what was your experience like, was it ultimately helpful? If not, what did you do next? Really, I will take anything you got, because I am at a loss here, disappointed and hopeless. Thank you.
You mention that these treatments have “cured your alcoholism and weed dependence”. First off - congratulations! Those are huge fucking achievements. I stopped drinking a few years ago in part because it made my own depression and anxiety significantly worse. Not-drinking isn’t a miracle cure, but it has made a HUGE difference for me (many decades of depressive episodes and a handful that got very dark).
So: if you’re not drinking now but were drinking regularly/heavily in the recent past (including during periods of intense and treatment-resistant depression and SI), could alcohol withdrawal be playing a role in your current symptoms? Feeling like shit in the morning and during the day when you’re drinking is a little withdrawal, as is feeling like shit for a few months into not-drinking - it’s not just the DTs. There might be a hill to climb over as you dry out that makes any positive effects of the ketamine treatment harder to discern. Quitting drinking can be ROUGH, emotionally as well as physically and neurochemically, and it often takes a long time not least because of how shitty withdrawal makes you feel.
I know therapy isn’t easily accessible for you right now, but there’s lots of support for folks quitting drinking that might step in to help with some of what you’re going through - I’m not a fan of AA, but it’s everywhere, and there are online resources like Tempest and Hello Sunday Morning, in-person and online SMART Recovery meetings (based on CBT, I think), and others I’m sure. People in those spaces know what it feels like to go through hell, and you might find peer support that could help you get to your next step.
posted by rrrrrrrrrt at 11:10 PM on June 4 [16 favorites]
So: if you’re not drinking now but were drinking regularly/heavily in the recent past (including during periods of intense and treatment-resistant depression and SI), could alcohol withdrawal be playing a role in your current symptoms? Feeling like shit in the morning and during the day when you’re drinking is a little withdrawal, as is feeling like shit for a few months into not-drinking - it’s not just the DTs. There might be a hill to climb over as you dry out that makes any positive effects of the ketamine treatment harder to discern. Quitting drinking can be ROUGH, emotionally as well as physically and neurochemically, and it often takes a long time not least because of how shitty withdrawal makes you feel.
I know therapy isn’t easily accessible for you right now, but there’s lots of support for folks quitting drinking that might step in to help with some of what you’re going through - I’m not a fan of AA, but it’s everywhere, and there are online resources like Tempest and Hello Sunday Morning, in-person and online SMART Recovery meetings (based on CBT, I think), and others I’m sure. People in those spaces know what it feels like to go through hell, and you might find peer support that could help you get to your next step.
posted by rrrrrrrrrt at 11:10 PM on June 4 [16 favorites]
I'm not sure from reading your post over how long a period these treatments occurred, but keep in mind that working your way out of this kind of difficult hole can take a pretty long time -- potentially years, even with drug assistance (often without drug assistance the time duration just becomes "never", of course). And that it's quite possible that what you went through just wasn't enough to help you scale the walls of the hole. This could be a problem of the dose, or a problem of the approach, or both.
But at the same time, it sounds like you really did actually make quite a lot of progress, just not quite in all the ways you hoped. Getting past drug dependence is a huge deal and probably is a major step on your journey; you're just not all the way there, is all. Keep in mind that these are steps some people literally don't manage to reach in their entire life, and you already reached them. That's a pretty big deal!
My suggestion would be to consider trying different psychedelic therapy modalities (e.g. MDMA or psilocybin as mentioned earlier). MDMA in particular might be a good idea because it can help give you a direct preview of "what life could be like", like a window into "how you could be without depression". Having that window can be both very motivating and also give you a little bit of direction in a way that not much else can, to know where to go looking next, so to speak, on a metaphorical level.
But in addition to that, a core thing that also seems to be missing from your description is a tripsitter to help you with integration. While depression often feels like fundamentally an internal problem, getting out of that hole often depends on our connections with other people, being able to process those feelings with help from those around us. While it's not strictly required, having someone to help you along here can be a very powerful tool, one that I would strongly recommend if at all possible.
posted by etealuear_crushue at 11:52 PM on June 4 [3 favorites]
But at the same time, it sounds like you really did actually make quite a lot of progress, just not quite in all the ways you hoped. Getting past drug dependence is a huge deal and probably is a major step on your journey; you're just not all the way there, is all. Keep in mind that these are steps some people literally don't manage to reach in their entire life, and you already reached them. That's a pretty big deal!
My suggestion would be to consider trying different psychedelic therapy modalities (e.g. MDMA or psilocybin as mentioned earlier). MDMA in particular might be a good idea because it can help give you a direct preview of "what life could be like", like a window into "how you could be without depression". Having that window can be both very motivating and also give you a little bit of direction in a way that not much else can, to know where to go looking next, so to speak, on a metaphorical level.
But in addition to that, a core thing that also seems to be missing from your description is a tripsitter to help you with integration. While depression often feels like fundamentally an internal problem, getting out of that hole often depends on our connections with other people, being able to process those feelings with help from those around us. While it's not strictly required, having someone to help you along here can be a very powerful tool, one that I would strongly recommend if at all possible.
posted by etealuear_crushue at 11:52 PM on June 4 [3 favorites]
To add, keep in mind that drug therapy, while powerful, is just one component of the healing process. "Integration" is a long process that involves many things, not just therapy. Put one way, psychedelic therapy makes your brain dramatically more plastic and able to reform itself in different ways, but if you spend all that time subject to the same routine and pressures as before, you're likely not benefitting quite so much from that plasticity (again, this is part of why an outside influence can help: it can help you avoid falling back into the same ruts as before).
It might sound cliche, but this is why after tripsitting someone I often bring them out on a long walk outside during the come-down period. Contact with the outside world and nature makes a huge difference when your brain is highly plastic and can really help pull you in a positive direction, even if it might superficially sound meaningless.
posted by etealuear_crushue at 12:14 AM on June 5 [1 favorite]
It might sound cliche, but this is why after tripsitting someone I often bring them out on a long walk outside during the come-down period. Contact with the outside world and nature makes a huge difference when your brain is highly plastic and can really help pull you in a positive direction, even if it might superficially sound meaningless.
posted by etealuear_crushue at 12:14 AM on June 5 [1 favorite]
tl;dr: Don't look for a silver bullet.
Yes, I want to build on etealuear_crushue's point. The battle with depression happens on many fronts and you should fight on all of them that you can.
I have MDD and PDD diagnoses and decades of history dealing with them, and I have also been thru both ket and TMS treatments in the last 6 months. For me, these were helpful, but not a silver bullet (and it's worth noting that ketamine therapy has proven only to be a short- or medium-term relief for those it actually helps.) Neither was the enormous volume of talk therapy, self-therapy and self-help reading I did (although these were helpful too) over the past two years, which have been spent mostly recovering from the hardest and most painful years of my adult life, mental health-wise.
Even the rigorous routines of exercise, nutrition, intentional light exposure and quitting vaping and spending time outdoors that I've habituated since July '22 to replace the daily drinking and cocaine use that had become my habit over the previous few years--even getting into the best physical condition of my life has not been enough to resolve depression for me, though it's helped as well.
Finally, after nearly two years on the healing path, one of the best therapists I've ever seen agreed that the above would not be enough to fully resolve symptoms of depression on their own. I've done everything else to heal, but some vital things are still missing from my life, without which we think some level of depression is inevitable. That's meant work rebuild and maintain community, to hopefully find my way to a career path that isn't terrible and a partner that isn't abusive... My point is that having things like these missing from your life might hinder your recovery, too.
You might like the latest Ten Percent Happier episode, in which Bruce Perry observes that you could see the best therapist in Manhattan and get nothing from it without community around you. Mia Birdsong was on the episode just before that and made similar points.
Therapy is good, psychopharmacology is good... all the things I mentioned doing for myself to heal have helped, but these interventions, even the heavy guns like TMS and ketamine, are for naught without community and momentum, which are two pillars of trauma recovery.
If I could offer just a single recommendation for you, it would be to make an intentional practice of healing. Do three things every day that to heal, and write them down. They could just be very small, modest things.
I wish you all the healing you deserve.
posted by tovarisch at 2:29 AM on June 5 [7 favorites]
Yes, I want to build on etealuear_crushue's point. The battle with depression happens on many fronts and you should fight on all of them that you can.
I have MDD and PDD diagnoses and decades of history dealing with them, and I have also been thru both ket and TMS treatments in the last 6 months. For me, these were helpful, but not a silver bullet (and it's worth noting that ketamine therapy has proven only to be a short- or medium-term relief for those it actually helps.) Neither was the enormous volume of talk therapy, self-therapy and self-help reading I did (although these were helpful too) over the past two years, which have been spent mostly recovering from the hardest and most painful years of my adult life, mental health-wise.
Even the rigorous routines of exercise, nutrition, intentional light exposure and quitting vaping and spending time outdoors that I've habituated since July '22 to replace the daily drinking and cocaine use that had become my habit over the previous few years--even getting into the best physical condition of my life has not been enough to resolve depression for me, though it's helped as well.
Finally, after nearly two years on the healing path, one of the best therapists I've ever seen agreed that the above would not be enough to fully resolve symptoms of depression on their own. I've done everything else to heal, but some vital things are still missing from my life, without which we think some level of depression is inevitable. That's meant work rebuild and maintain community, to hopefully find my way to a career path that isn't terrible and a partner that isn't abusive... My point is that having things like these missing from your life might hinder your recovery, too.
You might like the latest Ten Percent Happier episode, in which Bruce Perry observes that you could see the best therapist in Manhattan and get nothing from it without community around you. Mia Birdsong was on the episode just before that and made similar points.
Therapy is good, psychopharmacology is good... all the things I mentioned doing for myself to heal have helped, but these interventions, even the heavy guns like TMS and ketamine, are for naught without community and momentum, which are two pillars of trauma recovery.
If I could offer just a single recommendation for you, it would be to make an intentional practice of healing. Do three things every day that to heal, and write them down. They could just be very small, modest things.
I wish you all the healing you deserve.
posted by tovarisch at 2:29 AM on June 5 [7 favorites]
I agree with @rrrrrrrrrt. The fact that you are no longer using alcohol and marijuana is a huge step forward, but I wouldn't expect significant relief from depression in the short term. Just give it more time for your body and brain to adjust to living without the mind-altering substances.
posted by akk2014 at 4:50 AM on June 5 [3 favorites]
posted by akk2014 at 4:50 AM on June 5 [3 favorites]
First off, please make sure you are detoxing/ceasing alcohol use safely. I know you don't have a therapist, but do you have or can you talk to a physician about this? Cessation with support is much safer and more likely to stick.
That aside, I really hate that ketamine treatment is implied to be an instant fix, although
it’s cured my alcoholism and weed dependence
is HUGE HUGE HUGE and you might need to coast on that for six months or so while your body heals.
I have seen and heard of this before, that some kind of deliberate or accidental mind-altering chemical resets the addiction switch literally in a day. I've seen it happen in a family member after general anesthesia for very routine day surgery (stopped drinking so abruptly we had to get medical intervention), after mescaline or acid, and I have a (teetotal, incidentally) friend who quit smoking cigarettes cold turkey after their first marijuana experience (without switching to weed as a substitute, they just got high once and woke up the next day disgusted by cigarettes and quit like it was no big deal). But just because one switch flipped instantly doesn't mean the associated health problems - including depression - heal instantly.
In general, you have to give your body time. Ketamine may flip switches but it cannot change your serotonin levels significantly in a few weeks, and if your gut is damaged from alcohol it needs time to heal regrow what it can and repair your microbiome to return to some kind of baseline serotonin production (and that's not the only neurochemical produced in the gut - there's all kinds of endocrine symbiosis there). Your liver needs time before it's going to be doing its best work again. If you were smoking or vaping, your lungs need time.
And in such a vulnerable place right now, you might - again - talk to a doctor for support. There's some good evidence backing carefully-selected antidepressant support as part of the overall treatment plan alongside K to address things like obsessive or intrusive thoughts, addiction or substance abuse cessation. And you really should be tracking your liver numbers and checking for vitamin and endocrine issues, because it would really suck if the K was working absolutely as well as it could but your thyroid or acute vitamin deficiency as a result of alcohol abuse was the limiting factor.
All my research prior to doing this says ketamine is remarkably effective at reducing SI after one or two treatments.
Any of these results are going to be individually varied, though. That's not the quick fix you got here, but you have really convincing evidence that your brain is responding to treatment. I mean, I am absolutely sympathetic to your disappointment and fear here because intrusive thoughts are a form of torture, but I do think you would be better served here by trusting the process a little bit and leaving room in your expectations that the SI's days are numbered because Things Are Happening all through your neuro-bio system.
And these clinics...they have some investment in you thinking it hasn't worked "enough" to keep coming back until you run out of money. They design their entire experience to imply without ever saying so that this is like chemo, that you keep taking the treatments until the Bad Thing is squashed, but I'd liken it more to having surgery to fix a badly-broken bone: you don't get up from the operating table and dance the tango on that freshly-pinned ankle! The tango doesn't come until you've gone home and carefully managed inflammation and weight-bearing for weeks if not months, gone to physical therapy AND done the assigned exercises and other caretaking as instructed, let it heal, strengthen back everything that got damaged originally and atrophied while it was immobilized. There are a whole bunch of little victories along the way - walking around the block, hitting your range-of-motion milestones, being able to wear halfway-cute shoes again, and it's those little things that accumulate until ba-dum-dum-DUM(dramatic face), tango time!
Anecdata: I accidentally ended a very severe 18-month depressive episode with mescaline, one dose, a long time ago. It was years before I actually figured that out because I didn't wake up the next day with the ability to function in the world. But it must have force-rebooted my pituitary gland, because I started sleeping again like a normal person after two years of increasingly fucked-up insomnia, and that DID happen fast. I even mentioned to a friend I'd been with that night (it had been quite a ride, and we kinda accidentally went for a multi-mile walk) that I must have finally truly gotten SO tired that I'd had an amazing week of sleep. It snowballed from there: after weeks of decent sleep I started actually getting shit done sometimes, I had energy to do a little bit more than drag myself to school and work, I started taking interest in things again.
You still have to climb out of the hole, there is no treatment that's going to spring-eject you out of it. I can hear how desperate you are for some relief and so to you this is not good news, but slow progress on most fronts plus remarkable progress on a few is the right way and the safe way because they are the sustainable way.
I just want you to believe that it is possible for the treatment to still be working even though you're not in the "window" they imply is the only progress you can possibly make. I feel like if you can't believe it, you will miss opportunities for momentum.
posted by Lyn Never at 8:17 AM on June 5 [6 favorites]
That aside, I really hate that ketamine treatment is implied to be an instant fix, although
it’s cured my alcoholism and weed dependence
is HUGE HUGE HUGE and you might need to coast on that for six months or so while your body heals.
I have seen and heard of this before, that some kind of deliberate or accidental mind-altering chemical resets the addiction switch literally in a day. I've seen it happen in a family member after general anesthesia for very routine day surgery (stopped drinking so abruptly we had to get medical intervention), after mescaline or acid, and I have a (teetotal, incidentally) friend who quit smoking cigarettes cold turkey after their first marijuana experience (without switching to weed as a substitute, they just got high once and woke up the next day disgusted by cigarettes and quit like it was no big deal). But just because one switch flipped instantly doesn't mean the associated health problems - including depression - heal instantly.
In general, you have to give your body time. Ketamine may flip switches but it cannot change your serotonin levels significantly in a few weeks, and if your gut is damaged from alcohol it needs time to heal regrow what it can and repair your microbiome to return to some kind of baseline serotonin production (and that's not the only neurochemical produced in the gut - there's all kinds of endocrine symbiosis there). Your liver needs time before it's going to be doing its best work again. If you were smoking or vaping, your lungs need time.
And in such a vulnerable place right now, you might - again - talk to a doctor for support. There's some good evidence backing carefully-selected antidepressant support as part of the overall treatment plan alongside K to address things like obsessive or intrusive thoughts, addiction or substance abuse cessation. And you really should be tracking your liver numbers and checking for vitamin and endocrine issues, because it would really suck if the K was working absolutely as well as it could but your thyroid or acute vitamin deficiency as a result of alcohol abuse was the limiting factor.
All my research prior to doing this says ketamine is remarkably effective at reducing SI after one or two treatments.
Any of these results are going to be individually varied, though. That's not the quick fix you got here, but you have really convincing evidence that your brain is responding to treatment. I mean, I am absolutely sympathetic to your disappointment and fear here because intrusive thoughts are a form of torture, but I do think you would be better served here by trusting the process a little bit and leaving room in your expectations that the SI's days are numbered because Things Are Happening all through your neuro-bio system.
And these clinics...they have some investment in you thinking it hasn't worked "enough" to keep coming back until you run out of money. They design their entire experience to imply without ever saying so that this is like chemo, that you keep taking the treatments until the Bad Thing is squashed, but I'd liken it more to having surgery to fix a badly-broken bone: you don't get up from the operating table and dance the tango on that freshly-pinned ankle! The tango doesn't come until you've gone home and carefully managed inflammation and weight-bearing for weeks if not months, gone to physical therapy AND done the assigned exercises and other caretaking as instructed, let it heal, strengthen back everything that got damaged originally and atrophied while it was immobilized. There are a whole bunch of little victories along the way - walking around the block, hitting your range-of-motion milestones, being able to wear halfway-cute shoes again, and it's those little things that accumulate until ba-dum-dum-DUM(dramatic face), tango time!
Anecdata: I accidentally ended a very severe 18-month depressive episode with mescaline, one dose, a long time ago. It was years before I actually figured that out because I didn't wake up the next day with the ability to function in the world. But it must have force-rebooted my pituitary gland, because I started sleeping again like a normal person after two years of increasingly fucked-up insomnia, and that DID happen fast. I even mentioned to a friend I'd been with that night (it had been quite a ride, and we kinda accidentally went for a multi-mile walk) that I must have finally truly gotten SO tired that I'd had an amazing week of sleep. It snowballed from there: after weeks of decent sleep I started actually getting shit done sometimes, I had energy to do a little bit more than drag myself to school and work, I started taking interest in things again.
You still have to climb out of the hole, there is no treatment that's going to spring-eject you out of it. I can hear how desperate you are for some relief and so to you this is not good news, but slow progress on most fronts plus remarkable progress on a few is the right way and the safe way because they are the sustainable way.
I just want you to believe that it is possible for the treatment to still be working even though you're not in the "window" they imply is the only progress you can possibly make. I feel like if you can't believe it, you will miss opportunities for momentum.
posted by Lyn Never at 8:17 AM on June 5 [6 favorites]
You mention "cured my alcoholism" and I want to add that it can take months, even a year after quitting alcohol abuse for you to get back to "normal." I know this from experience. One month booze-free was entirely, completely different than 6 months booze-free. Depending on how badly you abused alcohol and for how long, this can be an enormous factor in what you are going through now.
You didn't mention how long ago you gave up alcohol, but I would urge patience based on this alone. You will be re-setting for months. It took 8 months to a year for me. Alcohol abuse really, really messes with your brain chemistry, but there is hope... with time. I'm 5.5 years sober. It's made a gargantuan difference.
posted by SoberHighland at 8:19 AM on June 5 [2 favorites]
You didn't mention how long ago you gave up alcohol, but I would urge patience based on this alone. You will be re-setting for months. It took 8 months to a year for me. Alcohol abuse really, really messes with your brain chemistry, but there is hope... with time. I'm 5.5 years sober. It's made a gargantuan difference.
posted by SoberHighland at 8:19 AM on June 5 [2 favorites]
In my first attempt at ketamine treatments, it wasn't particularly helpful. I did IM (intramuscular) shots at a ketamine clinic where I was alone in the room during it, then afterwards had a quick check in with the NP where I spoke about my experience (though I think most people do a quick "yup feeling good, yup I have a ride home"). We added Versed to the infusion when I felt some anxiety going into the sessions, and increased the ketamine amount over time as I came back for maintenance sessions.
I can't imagine doing this online as safety is a concern, and having someone check my blood pressure and keep an eye on me (I had a help button and there's a camera in the room) made me feel safer, though it was suggested that being alone may have triggered something about fear of abandonment. Ugh. I also tried sublingual KAP sessions with my therapist twice.
In general, I liked that I was doing something, and I liked the time afterwards where I made myself kind of slow down, do only one thing at once, maybe journal. It had little impact on my major struggles with depression and SI.
The second time, I worked with a psychiatrist who recommended a combo of ketamine and TMS. This time it was an IV infusion, I wasn't alone in the room, the nurse who was present was much more engaged with what I was experiencing and how I was doing, and I had more intentional support from my therapist. I was also more dedicated to digging into what was really going on in my head. I read "The Body Keeps the Score" and "No Bad Parts," both of which were incredible. I experienced insane lows in the first 3 sessions, which was awful, but I attributed that to doing this full investigation of my experiences and having some harsh, overwhelming realizations. By the end of those 6 sessions (and alongside the daily TMS) I felt like it was a way more meaningful experience with long term impact.
I didn't have major changes after those first 2 sessions either time. I can't believe people really experience that!!!
IANAD. But following a more intentional plan with a more experienced team, better aligning the ketamine treatments with other things I was trying, and taking way more of a vested interest in some of the deeper sources of my mental health issues made a huge difference.
Please feel free to message me if you want to talk more!
posted by violetish at 8:54 AM on June 5 [2 favorites]
I can't imagine doing this online as safety is a concern, and having someone check my blood pressure and keep an eye on me (I had a help button and there's a camera in the room) made me feel safer, though it was suggested that being alone may have triggered something about fear of abandonment. Ugh. I also tried sublingual KAP sessions with my therapist twice.
In general, I liked that I was doing something, and I liked the time afterwards where I made myself kind of slow down, do only one thing at once, maybe journal. It had little impact on my major struggles with depression and SI.
The second time, I worked with a psychiatrist who recommended a combo of ketamine and TMS. This time it was an IV infusion, I wasn't alone in the room, the nurse who was present was much more engaged with what I was experiencing and how I was doing, and I had more intentional support from my therapist. I was also more dedicated to digging into what was really going on in my head. I read "The Body Keeps the Score" and "No Bad Parts," both of which were incredible. I experienced insane lows in the first 3 sessions, which was awful, but I attributed that to doing this full investigation of my experiences and having some harsh, overwhelming realizations. By the end of those 6 sessions (and alongside the daily TMS) I felt like it was a way more meaningful experience with long term impact.
I didn't have major changes after those first 2 sessions either time. I can't believe people really experience that!!!
IANAD. But following a more intentional plan with a more experienced team, better aligning the ketamine treatments with other things I was trying, and taking way more of a vested interest in some of the deeper sources of my mental health issues made a huge difference.
Please feel free to message me if you want to talk more!
posted by violetish at 8:54 AM on June 5 [2 favorites]
I've suffered treatment resistant depression for nearly 50 years. The condition was very nearly fatal more than a few times over the years. I started ketamine therapy a few years ago and the effects were immediate and profound. I did a lot of research as you did and found that ketamine does not work for everyone, and my optimal experience with it may in fact be somewhat rare. It seems you have sunk a lot of good faith effort into ketamine. I am not a health care professional, but I think if it's only had minimal result for you to date you need to drop it and keep searching. That ketamine doesn't work for you doesn't mean there is not a drug therapy that will work for your unique biochemical makeup. Ketamine doesn't help a lot of people. The failure of efficacy in your case is not your fault. Please keep searching until you find what will work for you. As someone who has been fighting this for over half a century, I would advise you to keep looking and to seriously pursue other psychedelic therapies. I would be happy to answer any questions you have privately. I'm not credentialed, nor an expert. I do have a lot of experience with this kind of pain and bottomless sympathy and compassion for anyone in your predicament. Much love.
posted by leonard horner at 9:35 AM on June 5 [1 favorite]
posted by leonard horner at 9:35 AM on June 5 [1 favorite]
I had better results with a higher dose of IV ketamine as well as oral. As you say, the effects are not generally known to be a permanent fix even for people who respond well. I have also done mushrooms a few times but without a guide. I did not have a good immediate experience with shrooms because I was very sad and frightened, but then later I was so relieved it was over I think it made me grateful to not feel that terror any longer, so it was really a matter of perspective. I think having a knowledgeable guide would likely help a lot, and there are a lot of resources out there for finding one. I have used Tam integration as a resource for weekly online group discussion as well as a place to investigate guides. The group discussions have been very helpful and I've met some great people there. I did/do the women's group on Thursday 7 pm Pacific time.
Ketamine is highly addictive. If it's a way to save yourself from suicide, that's one thing, but for me it's a problem. I have a history of alcohol use disorder and tend to latch onto "easy" fixes, like drugs. I will say that the ketamine did give me the boost I needed to get to work on therapy daily exercise and building a supportive community. Even small steps in those areas gave me a much better quality of life, even if I still have SI from time to time. I would say in general, I still have a longing for death but I'm willing to experience painful feelings more readily than I used to be, so I get the bonus of good times in between, which I had so very little of before. Internal Family Systems (IFS) work has really helped with this.
One of my anchors is walking 1-2 hrs every day. I make time for it because it really is that helpful. I started doing it as a substitute 60 minute practice to AA meetings, which I truly hated. Two years later I'm still doing it and am so glad I am. I have stayed sober for the most part in large part due to IFS, walking and accepting pain in life, as hard as that can be sometimes. I guess we have no choice in the end, pain cannot be wished away but it can be managed and life can still be wonderful at times.
Congratulations on your sobriety journey, that's a big step.
posted by waving at 11:03 AM on June 5 [2 favorites]
Ketamine is highly addictive. If it's a way to save yourself from suicide, that's one thing, but for me it's a problem. I have a history of alcohol use disorder and tend to latch onto "easy" fixes, like drugs. I will say that the ketamine did give me the boost I needed to get to work on therapy daily exercise and building a supportive community. Even small steps in those areas gave me a much better quality of life, even if I still have SI from time to time. I would say in general, I still have a longing for death but I'm willing to experience painful feelings more readily than I used to be, so I get the bonus of good times in between, which I had so very little of before. Internal Family Systems (IFS) work has really helped with this.
One of my anchors is walking 1-2 hrs every day. I make time for it because it really is that helpful. I started doing it as a substitute 60 minute practice to AA meetings, which I truly hated. Two years later I'm still doing it and am so glad I am. I have stayed sober for the most part in large part due to IFS, walking and accepting pain in life, as hard as that can be sometimes. I guess we have no choice in the end, pain cannot be wished away but it can be managed and life can still be wonderful at times.
Congratulations on your sobriety journey, that's a big step.
posted by waving at 11:03 AM on June 5 [2 favorites]
it’s cured my alcoholism and weed dependence
THIS IS A VERY BIG DEAL. Congratulations! I also think you might be dealing with some side effects of these changes in your life. My understanding from an alcoholic friend and from my therapist is that substance dependence can come about because we are masking our feelings, and giving up these substances can mean we start to experience emotions we had numbed for a long time. I bet there's a lot going on with your body, physically, not just emotionally. Do you have a PCP you can chat with while you wait for a therapist?
posted by bluedaisy at 12:56 PM on June 5 [3 favorites]
THIS IS A VERY BIG DEAL. Congratulations! I also think you might be dealing with some side effects of these changes in your life. My understanding from an alcoholic friend and from my therapist is that substance dependence can come about because we are masking our feelings, and giving up these substances can mean we start to experience emotions we had numbed for a long time. I bet there's a lot going on with your body, physically, not just emotionally. Do you have a PCP you can chat with while you wait for a therapist?
posted by bluedaisy at 12:56 PM on June 5 [3 favorites]
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My psychiatrist (at a major research hospital with one of the first ketamine clinics in the U.S.) said when patients don't respond to a few IV treatments, he increases the dosage pretty dramatically, and that helps some. I don't know if your providers have done this, but if I was in your place I would ask for that.
I get your frustration, as someone who has also spent decades trying everything to stay alive! My next experiment is probably going to be psilocybin or MDMA; anecdotally, some people have told me that these substances helped them more than ketamine did. ECT is also an option if you haven't tried it, I'm passing on that one as my sister had a negative experience with it (memory loss and no improvement of depression), but I know it works for some people.
posted by CancerSucks at 10:28 PM on June 4 [1 favorite]