Off-Label Ketamine and Treatment-Resistant Depression
How Ketamine Lifted Me From the Depths of Treatment-Resistant Depression
One Woman’s Journey to Mental Wellness Through Ketamine Infusions
In the Beginning…
I don’t quite recall how I got here. Sometime in 2016, my outlook on life began making a slow descent from sky-high to what I’ve been calling The Eternal Abyss. I went from a happy-go-lucky twenty-something to a curmudgeonly, intolerable sandbag. My personality whithered, I drank too much, and for the first time in my life, I didn’t feel any hope for the future. Even more distressing was the fact that I could not find one single reason for my emotional downturn, and thus felt helpless to “fix” it; by all accounts, the picture looked perfect from the outside.
Now, I have been seeing the same psychiatrist for more than a decade. I’ve always had issues with anxiety and panic disorder, but never experienced a truly depressive state that lasted more than a few fleeting minutes. The panic I can handle: I have all the coping tools in my bag for that. But depression? Complete hopelessness? I wasn’t ready. My psychiatrist adjusted my antidepressants and tried different combinations of medications and, while my anxiety was well-controlled, my depression was left almost untouched.
My depression stuck around like the cloud from the original Zoloft commercials. It followed me through earning my master’s degree, building my first house, receiving two promotions at work, and being accepted into law school. It was there for the bad, too: quitting that job where I’d earned those promotions and withdrawing from law school after my dad’s terminal cancer diagnosis really fed that little cloud. No matter what I did, it was there.
At the End of My Rope
As 2020 drew near, I had reached a new level of despair. I was sleeping excessively, had gained 100 pounds since The Eternal Abyss began consuming me, and was setting myself for career failure through a mix of absenteeism and a lingering brain fog that hindered my ability to produce high-level, error-free work without putting in what seemed like an absurd amount of effort. In fact, everything seemed so strenuous that things like brushing my teeth were put on the backburner.
I spent a lot of time desperately searching the internet for some kind of medication I hadn’t tried, or a type of therapy I hadn’t been in, or frankly anything that held the promise of relief. I came across an article discussing the FDA’s approval of a ketamine-derived nasal spray called Sprovato (esketamine) for depression that has not responded to other treatments. Esketamine is the (S)-enantiomer of ketamine, whereas ketamine itself contains both the (S)-enantiomer and (R)-enantiomer. Unlike traditional anti-depressants, esketamine can provide relief from depression in hours instead of several weeks.
Naturally, I began looking for a provider, as my psychiatrist does not prescribe esketamine (though I had her blessing to try it).
Nasal Sprays, Lozenges, and Infusions — Oh, My!
I decided to find a provider in my area. I discovered a variety of delivery methods outside of the Sprovato nasal spray. There are also compounded nasal sprays that contain ketamine (not just Sprovato’s (s)-enantiomer), oral lozenges, intramuscular injections, and intravenous infusions. I found two clinics within an hour of my home offering intravenous ketamine infusions, chose the one with the best reviews, and jumped in feet-first.
The Experience
After undergoing a rigorous screening process which included a full workup of blood tests and documentation from my psychiatrist showing a clear history of treatment-resistant depression, I was approved for infusions. The clinic I chose only provides infusions. My clinic does six infusions over the course of three weeks for the initial treatment, ramping up the dose for each infusion as tolerated. “Booster” infusions after the initial round are available as-needed.
As someone with limited experience with psychedelics, I was actually pretty excited for my first infusion. At the advice of therapeutic ketamine patients on Reddit, I brought headphones for music, a blanket, and a sleeping mask. I was trying to really enjoy the ride.
My first infusion was nothing special; in fact, I felt worse for the next 36 hours or so. The owner of the clinic called to check up on me and told me some patients do have a negative reaction, especially to the first one to two infusions. I didn’t even get to “trip,” I just felt like I was in a state of semi-wakefulness.
The remaining treatments were much more interesting, though the experience is difficult to describe. As my dose went up, I went further into the dark places in my mind with each treatment. Most notably, I was able to think about complex, emotionally traumatic events without assigning negative emotions to the thoughts. For example, I was able to visualize my father’s funeral (who is still living, but with terminal cancer) without experiencing any of the negative emotions I would normally feel such as panic and despair.
By the fourth treatment, I was having more intense visuals. These came as vivid displays of my inner dialogue as opposed to actual hallucinations. If you’ve ever had a lucid dream, it was much like that: I knew I was in control and in a safe place to explore thoughts I would otherwise find deeply disturbing.
These “trips” are actually considered a side-effect of ketamine’s dissociative properties. Ketamine’s hypothesized mechanism of action is through blocking N-methyl-d-aspartate (NMDA) receptors in the brain and allowing glutamate, a neurotransmitter, to activate AMPA receptors. Both of these actions together are thought to improve communication between neurons in the brain and build new neural pathways.
The Results (So Far)
Ketamine infusions have changed my life and given me a renewed hope for the future. As you can see from my MoodMonitor chart, which uses questionnaires to check in on my mental health, I’ve experienced ups-and-downs. The first dot is before my first treatment, and the last dot is after my second booster.
As I noticed the downward trends at the end of March and the middle of May, I requested booster treatments. Immediately after each booster, my mood has improved dramatically.
Unfortunately, the effects of ketamine on depression do not appear to last indefinitely. The clinician where I receive treatment told me most patients return every 6 weeks or so for a booster, and many of them can go much longer after a few boosters. However, the lasting-effects of ketamine infusions for depression are highly personal and there is limited research regarding long-term effectiveness.
What’s Next
Thanks to the infusions, I’ve been able to implement positive changes in my life. For me, it hasn’t been a miracle cure-all, but it has given me the spirit to improve myself and work toward a better me. I have started focusing on my physical health in addition to my mental health. I’ve resolved my absenteeism issues at work and have an overall better outlook on life. I still take the medications prescribed by my psychiatrist, but ketamine is now something I can use if and when the tides turn again.
