“I don’t want to die, but I can’t shake these suicidal thoughts and imagery,” I told Dr. Glen Brooks, Chief Medical Director of NY Ketamine Infusions. Through my own research and my psychiatrist’s help, when traditional SSRI antidepressants weren’t putting a dent into my depression, I was ready for something new.
Science shows that ketamine infusions help treatment-resistant depression—and quickly. While medications such as SSRIs take up to six weeks to work (I was already on them; they weren’t doing much), ketamine infusions begin providing relief hours after the treatment.
“The real work that ketamine does doesn’t even begin until 10 hours after you leave here, and then quite quietly in the middle of the night, you’ll be unaware of it. Ketamine is all about is restoring structure and anatomy,” Dr. Brooks told me during my intake session, which he let me record.
Why Did I Seek Out Ketamine IV Treatment?
In 2013, after a sexual assault and a series of unfortunate events, I found myself deep in a depression. That is when I sought out my psychiatrist, who referred me to Dr. Brooks. While it wasn’t legal yet (now you can get a medical cannabis card for PTSD in New York), I found that cannabis was one of the few substances that made me feel like myself again. It put my flashbacks on hold and eased the social anxiety that kept me holed up in my apartment, wanting to die, as the city I lusted after my entire life kept its lights on.
Five years later, while I knew that I was still a complicated and creative person prone to anxiety and depression, I thought I had treated and outgrown the type of depression that keeps you in bed, wakes you up with nightmares, and plays suicidal films of your own death even if you don’t want it to happen. It came back. In my defense, 2018 was a shit show of a summer.
While visiting my hometown, the Virgin Islands, for an assignment on the effect of the hurricanes on reproductive health care, I found myself down on the floor of a pub during a shooting. Then my grandmother, who I was extremely close with, died. Three days after her death, on a day meant for mourning, my partner dumped me. And then at my grandmother’s funeral, someone groped me. Someone else groped me when I was back in New York at a bar.
All the side effects of PTSD from the previous sexual assault came back—the nightmares, the self-loathing, the ruminating thoughts of suicidal imagery. I found myself back in bed, spending the 4th of July alone with earplugs in because any sound of a firework reminded me of gunshots.
I was no longer 25—I was 30. And I had an unfolding career for which I’d worked my ass off. I didn’t want to stay in bed, and I didn’t want to think about suicide. I did not want to die. I wanted help. I wanted to live and get a book deal. I wanted something that would get me better, and my current medication wasn’t cutting it. That determination lead me to Dr. Brooks’ office, where I began a course of ketamine IV infusions which just might have saved my life.
What is Ketamine?
Ketamine is a dissociative anesthetic. They give it to kids before surgery, and even animals—my cat got ketamine recently for a dental procedure.
It’s also a club drug, but oddly I’ve never tried it for that purpose.
“I’m an anesthesiologist; I’ve been administering ketamine since 1974,” Dr. Brooks told me. “It is on the world health organization’s list of Top 10 essential drugs. But very different than its use as an anesthetic is that it’s found a new role in treating post-traumatic stress disorder.”
One study, on ketamine IV for PTSD, which is published in the JAMA psychiatry journal, concluded that: “Ketamine infusion was associated with significant and rapid reduction in PTSD symptom severity…Ketamine was also associated with reduction in comorbid depressive symptoms and with improvement in overall clinical presentation. Ketamine was generally well tolerated without clinically significant persistent dissociative symptoms.”
What Else is Ketamine Used to Treat?
Ketamine IVs are used for mental health off-label, meaning that while it’s approved for anesthesia, the FDA still needs to approve it for mental health concerns. You likely read recently that the FDA approved a ketamine nasal spray for depression, which is news that unfortunately isn’t as life-changing as it sounds (more on that to come).
Ketamine IV infusions are used to alleviate treatment-resistant depression, suicidal ideation, bipolar depression, obsessive-compulsive disorder, post-traumatic stress disorder, major depressive disorder, extreme anxiety, postpartum depression, and chronic pain, particularly neuropathic pain, says Zinia Thomas, M.D., a psychiatrist certified in IV Nutrient Therapy of Radiance Float + Wellness in St. Louis.
“After decades of conventional psychiatric practice seeing rates of chronic and childhood disease climb, seeing a multitude of pharmaceuticals flood the market providing a ‘pill for every ill,’ yet marginal improvements in core symptoms with loads of side effects, I knew I needed to find a change,” Dr. Thomas says. “My patients were demanding it.”
How Does Ketamine Work?
For some people, a mental health diagnosis is welcome. Someone finally identified the issue, and now you can treat yourself properly. I felt such relief when I learned about PTSD, but before that, when I was searching for the right psychiatrist many years ago, I just felt like a crazy girl.
One doctor said I had generalized anxiety disorder. Those ruminating thoughts? Another one said they’re because I have OCD. Trouble getting out of bed and focusing? It must be ADD. I knew I was depressed, but as it turns out, all those other side effects are just part of the PTSD umbrella.
“For the last 50 years psychiatrists have been separating out the symptoms: anxiety, depression, OCD, rumination, eating disorders, rage and anger, and treating them individually as if each represents some sort of a chemical imbalance. So that’s why over the years you’ve been given drugs that increase serotonin, or dopamine, or norepinephrine, or in some cases lithium,” Dr. Brooks told me.
“But none of them have really gotten you better. What the ketamine researchers have been saying for the past two decades is that’s because when you’re dealing with PTSD what you’re really dealing with is not a chemical imbalance, but a structural problem.”
If SSRIs and therapy are the software, he compared ketamine to a hardware fix, which is especially useful for those who experienced trauma, which I have, as a child, which could be everything from a natural disaster, to war, to fighting parents.
BDNF, or brain derived neurotrophic factor, is a protein that allows the mood centers of the brain to communicate. “When you raise brain cortisol levels during those developmental years, it ends up suppressing the production of the brain derived neurotrophic factor. So chances are you were going through your grammar school, and your middle school, and your high school years under reasonable amounts of stress for various reasons, suppressing, BDNF development and mood center development,” Dr. Brooks told me.
Without that connectivity intact he likened the brain to two octopuses trying to communicate without arms. “What ketamine does, unlike the other medications you’ve been on, is turn on, or back on, the brain derived neurotrophic factor that should have been flowing during those developmental years, and it now stimulates the dendritic and the synaptic growth you need to restore connectivity,” Dr. Brooks says.
Scientifically, this is known as a synaptogenic neuroplastic repair, which means that a ketamine IV works on structural repairs of the brain rather than chemical ones. Does this mean it can cure treatment-resistant depression or PTSD? We need more research, but some patients do notice a major difference.
“Now that the depression is more manageable, I just get way fewer episodes. I’m the most even-keeled that I’ve ever been,” says Ilana Masad, another ketamine IV patient.
How is it Administered?
Ketamine can come in pills, which some ketamine IV patients, such as Masad, use for management in between sessions. There is also the nasal spray that made headlines when the FDA recently approved it.
“Spirato, an intranasal ketamine spray, was approved by the FDA for treatment-resistant depression last month. The news coverage and hype is funded with pharmaceutical dollars,” Dr. Thomas says. However, the IV is simply more effective.
“Although Esketamine, also known as Spravato, has been FDA approved as a nasal spray treatment for depression, IV Ketamine Infusion Therapy has been found to be more effective at lifting mood and relieving suicidal thoughts,” says Steven L. Mandel, MD. the founder and president of Ketamine Clinics of Los Angeles. Back in New York, Dr. Brooks agrees.
“We do it by intravenous infusion because it’s the only way to get the right amount of drug in roughly based on your weight. It can’t replicate the bioavailability with nasal sprays or pills,” Dr. Brooks told me before I headed into a nearby room to start my first treatment.
Most people, myself included, do a six-course treatment, with a check-in halfway to see if it’s helping and if it’s worth the cost to continue. Ketamine infusions are not cheap and not often covered by insurance; they can cost upwards of $400 per visit. After you complete the six-course treatment, then patients come back for “booster” visits. Some people come in every three weeks, some once a month, some twice a month. It depends on how much you need and what you can afford.
“Coming in on a regular basis isn’t for the rest of your life,” Dr. Brooks says. “It’s about a year, a year and a half, and then what you’ll notice is that your need to come in just becomes less and less and less and the interval between visits becomes greater and greater.”
What is a Ketamine IV Treatment Like?
Never having tried ketamine before, I wasn’t sure what to expect. Delightfully, they encourage you to listen to upbeat music during the session, so to feel as shiny as possible, I created a glam rock playlist full with Bowie and Queen.
“Most young adults like yourself enjoy the whole experience especially if you have some fun music to listen to,” Dr. Brooks says. They hook you up and then leave you alone for an hour. I felt wonderful. I closed my eyes and let the experience take over me. It’s a dissociative experience, so opening your eyes can feel a little odd sometimes. It’s not insanely out of this world, and while it takes a few minutes or two to get your bearings when it’s over, you come back to Earth when the drip is finished. Exploring music, I discovered that ketamine also really enjoys The Cure.
I liked the first round but knew that my experience in the clinic, while meant to be enjoyable, was not the real medicine. That would come afterward. That first night, two of my close friends came over to record a podcast. I felt…calm. Peaceful. At one point in the night I was confronted by someone unhealthy from my past, and rather than engage, I texted with a woman I met on Twitter who was also curious about ketamine IVs.
Who was this person, letting bygones be bygones and moving forward with healthy relationships?
Over the next two weeks, in which I completed my six rounds, my suicidal thoughts and imagery simply disappeared. It was like they were zapped from my brain. I struggled to recall what it was like to have them. If before beginning ketamine IV treatment, I could mentally drop to a nasty place in which I didn’t matter, in which there was no hope, in which there were upsetting visions, it’s like an elevator came and lifted up my “bottom” to be a pretty well-designed and pleasantly curated floor.
Sure, I can still get sad, or angry, or stressed. I still see a therapist, and I’m still on medication. But I feel those emotions from a calm place in which I can healthily manage them. There is no more catastrophic thinking, suicidal thoughts, or uncontrollable sobbing. There is healthy communication and emotional processing and believing in myself. Not to brag, but not I even have a girlfriend (yes, the ketamine texter) and a book deal and am happy.
Sometimes hard things, unspeakable things even, still arise. I book a ketamine booster visit when this happens, and go back every month or so. What ketamine IVs did for me was yank me out of the dark place and back on solid ground so I could deal with my shit, while magically zapping away suicidal thoughts and imgary, because those were of no use. I hope that the next steps are insurance companies working with ketamine IV patients to make the treatment accessible for everyone who can benefit from it.