My experience with ketamine infusions

This is from personal experience, what I have read, and from discussions with the ketamine clinic staff. This is not medical advice.

What is Ketamine?

Ketamine is an anesthetic(NMDA receptor antagonist) created in the 1960s as a replacement for and derived from phencyclidine(aka PCP aka Angel Dust). It is hallucinogenic and dissociative, almost like PCP but doesn’t come with the violent effects that PCP is famous for causing. Besides surgery, it is used for acute pain, seizures, and treatment-resistant depression.

Supposedly, it helps to create new neural pathways which help a variety of MH issues.


What are Ketamine infusions?

These are sessions where the ketamine is pushed into you via IV.

It starts with two sessions a week for three weeks and then goes to once every 7-10 days. The more treatments, the longer the positive effects last. The initial goal is to get to 4-6 weeks symptom-free and then work up to once every 6 to 12 months. I have finished ten sessions and the anxiety and depression come back in about 5 days so I am getting there.

What is it used to treat?

Technically, it is just eskatamine(a right-hand mirror image of the ketamine molecule), called Spravato that is approved but only for treatment-resistant depression. That is ridiculous. It is great for anxiety, from personal experience. It is used for all sorts of MH diagnoses. IMO, it should be a first-line treatment. I think outcomes will be better and people will be more receptive to this treatment over traditional psych meds.

Spravato is a nasal spray that must be used in a clinical setting like infusions.

Infusions vs Nasal Spray

Infusions are 100% bioavailable and the staff can precisely manage dosage before and during treatment. Spravato cannot. If you get too much, you are either stuck or are getting an injection of Klonopin.

The infusions are so much better because they can turn off the machine and you are back into reality in a minute or two. When you recover they can turn it back on at a lower setting so the appointment isn’t wasted as much. The dissociation is a side effect but it seems to add to the therapeutic effect. The goal is to get as much ketamine as one can tolerate each session - which increases as the patient gets used to it - but the experience adds to its value.

Is it painless and what is the dissociative effect like?

The Spravato is pretty painless, it is just a nasal spray. The only pain with the infusions is getting poked with a needle. The clinic I go to uses the smallest possible needle because it is only used to place a tube in my veins. The needle is immediately removed.

I have had one bad session where I dropped too deep into a black hole but it did not hurt or cause panic That did seem to reset my improvements but it quickly got back on track with the next infusion.

It is hard to describe it. I wish I could record what I am seeing and feeling. Even if I could describe it, I imagine your experience would be very different.
I tried to explain to my therapist and he said, “That sounds like what it was like when I used to eat mushrooms with psilocybin”.

Time slows way down. The session is almost an hour long. After the first treatment, I asked if they had forgotten about me because it felt like days had passed. After several appointments, it feels like half a day.

Nothing feels real outside of what I am currently seeing. It is beyond me to explain it.

YMMV

What are the requirements?
To use this treatment, a diagnosis of treatment-resistant depression is technically required. However, it is often prescribed off-label for conditions such as depression, anxiety, PTSD, and bipolar disorder. It's important to note that individuals experiencing active psychotic symptoms should not use it.
While it may also be effective for other mental health issues, I don’t want to characterize it as a miracle drug. After decades of trials and many failures, I can say that it is quite remarkable.

I got the impression that the doctor who runs my clinic would accept anyone struggling who didn’t have any of the contraindications:

• Uncontrolled hypertension.
• Unstable heart disease or congestive heart failure.
• Untreated hyperthyroid disease.
• Renal insufficiency.
• Brain tumor or acute brain injury.
• Severe liver disease.
• Pregnancy or breastfeeding.
• Active psychotic symptoms.

What to look for in a clinic

As hinted at above, you want a clinic that will cater to the best experience possible. Quiet, darkness, and aids like music, ceiling projectors, and aromatherapy are signs of a quality clinic.

I cannot overstate the value of the music, picture, and projector during the treatment. Personally, aromatherapy isn't an important part of my session, but people I talked to love it.

A comfortable reclining chair is a must.

If the room isn’t private or has curtains around an examination table, run! If the room has windows that aren’t 100% blocked, run! If the clinic is naturally noisy, you guessed it, run!

I cannot overstate how important the experience is.

Beyond that, a clinic whose staff puts you in complete control is critical. You dictate the dosage. Suggestions are good but if they don’t listen to you or try to push you into something you are uncomfortable with, it is a bad clinic.
Initially, they will start you out on a low-ish dose and after that, you can tell if you can take a big jump in dosage or not. You do get accustomed to ketamine so more is needed over time. There are two dosages in ketamine infusions. The “drop” and the maintenance through the session. I have learned that the drop can make or break a session. If it starts too hard, it goes bad quickly. You don’t need a drop, but I use a small one. Everyone is different. My nurse said that some people want a big hard hit to begin and some don’t want any drop.

Comfort and communication are the keys to a good clinic. The people where I go are so kind and loving, they do care about the experience and it makes all the difference.

What are the downsides?

The main side effects are nausea and dizziness. I am somewhat dizzy for a few hours. They put an anti-nausea med in the IV at the start which typically helps. If I am still queasy during or after, they will inject more. They told me if the dizziness is bad or lasts days, they can prescribe scopolamine. I use OTC motion sickness pills if it is bad and that works. It hasn’t been long-lasting for me.

It can wreck your bladder lining, but it is rare except in abuse cases. It is something to keep in mind and talk about.

Ketamine has a short half-life so the majority of side effects are transient, unlike a daily pill.

You do need a driver to take you home. Don’t drive for the rest of the day. I have to sign a paper promising that I won’t drive for 24 hours, or do anything dangerous, including making big financial decisions.

This might just be me, but dealing with dissociative effects is hard. It was okay at first, but now that I am over twice the starting dose, the treatments are getting even harder. I am super sensitive to psychoactive meds. Other patients have gone far higher in dosage than I have so far.

Does insurance accept ketamine claims?

Despite being the superior option, infusions are off-label so your insurance might not cover them. For people without insurance, my clinic charges $450 a session. The VA does pay for it with approved referrals.

Most insurance will cover Spravato.

Few will pay for compounded, at-home treatments as far as I know.

A typical session for me

At the beginning of the session is the time for clear-headed questions. Talk about any problems or questions that might pop up.

It is difficult to have a coherent discussion right after the session.

They will ask a few questions and take your blood pressure.

Then it is time to talk about dosage. It is measured in milligrams per kilogram of body weight(mg/kg). The typical starting dose is 0.5 mg per kg of body weight. I step up 0.1 mg, but not always each week. It depends on how the last session went and how I feel about it. My last session was 1.1 mg, but three weeks before I stepped down a little because the previous appointment went bad. So I went up 0.6 mg over 10 sessions. There are few hard and fast rules. They can even increase it by hundreds, and not just tenths. For example, 0.95 instead of 0.9 or 1.0. The clinic I go to won't do an initial increase over 0.2 but will allow increases during the session.

They set up the IV and place a finger blood pressure cuff and blood oxygen monitor. They also put a call button around my neck.

They wrap me in a blanket, give me two pillows, recline the chair back put headphones on me, and start the playlist.

They start the IV machine, turn off the lights, and say “Have a good journey” and they leave.

Then the trip starts. Each one has had a lot of similarities, but many differences. A lot of thoughts are things that are currently causing stress but what I see is very random. Since I have hit 1 mg I have periods where I have no thoughts at all. That is strange as I have a chaotic mind.
I try to come up with something to think about before I even get there but it doesn't always stick around.

The psychiatrist that runs the clinic says most of the thoughts are like dreams - usually, but not always meaningless.

I dress very comfortably. I wear a loose-fitting, soft long-sleeved T-shirt. Loose-fitting sweatpants with my winter fishing base layer and thick wool socks. I take my shoes off because it adds weirdness. One time I wore a black and white Seahawks t-shirt and the print bothered me.

The first sensation is my teeth becoming numb, then my mind, and it just slowly goes from there. By the beginning of the fourth song, I am very deep. From that point on I get deeper and then come out of it a bit. It is a cycle.

Over time, I have improved at pulling myself out of dark places and reorienting myself to my surroundings. Often, my perspective shifts to the ceiling, making the scene appear more distant. The best sensory aid, by far, is a projector that displays stars with clouds moving back and forth. If the projector has been rotated, I need to adjust it back to its side-to-side motion.

The strange thing is that I have tried different rooms with different projectors, and it is bad. The disassociation has locked into exact elements, and if anything is even slightly different, it is uncomfortable, at best. They wrote that all appointments going forward will be in room 4.
It is strange, but they said it is common. Again, an office that is committed to the experience is so important.

After 55 minutes or so, they re-enter to turn off the IV, then leave again and let me slowly come out of it. When I push the button, they unhook me, ask how it was or if there are any problems, and then I can rest as long as I want.

Is it working?

I think so, but I do not want to jinx myself.

I find it hard to believe, but my symptoms have noticeably reduced. Although these reductions are still temporary, the duration without symptoms is increasing with each session.

Lately, my annual bout of SAD has been fighting against the treatments.

Therapy is actually progressing. I have never gotten much out of it before and that is changing.

I have success in eliminating anxiety by trying to think of thoughts that cause anxiety since I feel no anxiety during the sessions and it has greatly decreased outside of the treatment room.

I don't have SI nearly as often.

Other benefits are fewer tension and migraine headaches a day or two after a session and it seems to be helping my sleep apnea. My CPAP typically reports far fewer events for a few days after a treatment - Ketamine dilates your airway. My average sleep time has increased from 4.5 hours to almost 7 and it is typically a deeper and more peaceful sleep. I have had poor sleep for decades.

If I could graph my progress it would be an upward slope, but not a smooth one.

Is it better than daily psych meds and how does it affect me?

A million times better. Most of the listed side effects are transitory and the serious and long-term effects rarely show up unless you are abusing it - which is highly unlikely in a clinical setting.

For me, the dissociative effects are difficult sometimes. That is odd because I dissociate somewhat often without medication. I think it has to do with epilepsy. Losing control of my mind is very frightening to me so as long as I can somewhat control the dissociation, I am okay. Even in the few instances, it was too much, it was never as bad as disassociation from seizures.
I never feel anxiety during the treatments, even when I am white-knuckling it.

Is it worth trying?

Yes! I mentioned before that it should be a first-line treatment and I believe it will be sooner or later.

If you are struggling with meds or the side effects, you should seriously consider doing this. It can be life-changing.

Hopefully, this is useful information. It seems like ketamine is an underutilized and fairly unknown treatment.