I took the two enormous pink pills and held them in my mouth, allowing them to dissolve and forcing myself not to swallow, as instructed by my guide. They had a terribly bitter, medicinal taste, but I waited for the prescribed seven minutes before spitting them out, then rinsing my mouth with water. Then I placed a shade over my eyes, laid back on the couch, and listened to the music piping through my headphones. Gradually, my body began to tingle and fall away, and soon, it felt as if I was moving through space.
This was the beginning stage of my experiment with ketamine therapy, which I was taking via the Mindbloom home program. It was a decidedly strange experience, and having gone through the entire program, I can see why using ketamine for depression has emerged as such a popular treatment option. It’s completely unlike other forms of psychedelic therapy.
What is ketamine?
Ketamine began its journey in the 1960s as a tool for anesthesia, first for animals, then for humans — particularly soldiers wounded while fighting in the Vietnam War. Its dissociative qualities — i.e., its ability to force a person’s consciousness to “leave” their body — made it the perfect tool for performing surgery under battle conditions.
Later, during the 1980s and ’90s, ketamine was taken up by the rave scene. Soon after, it was criminalized due to public hysteria about the much-hyped “K-hole” that detractors claimed was a catatonic state from which users might never emerge. While the K-hole was very real — in fact, it’s a key part of the therapy — the urban myth around its dangers was almost entirely fabricated.
In the early 2000s, research began to indicate the drug’s antidepressive qualities. The results were so conclusive and drove such high rates of recovery from treatment-resistant depression and other related mental health issues that ketamine was declared a “breakthrough” therapy by the FDA, which fast-tracked studies and set it on the path to legalization.
Today, ketamine is legal for use via “off-label prescription,” meaning a doctor or therapist can prescribe the drug for purposes other than its typical anesthetic use. This is why programs like Mindbloom are able to prescribe and send ketamine tablets to patients by mail.
What is ketamine therapy?
Ketamine therapy is performed via one of two methods. Ketamine infusion therapy, in which a patient goes into a clinic and receives the drug through an IV, is the most studied and easiest to control, as the dosage is adjusted in person, instantly. The at-home, pill-administered variety rose to prominence during the pandemic lockdowns. While it’s more convenient, its results are less studied, and its administration is more difficult to control and fine-tune.
While I chose to try ketamine therapy via Mindbloom’s at-home program, the process is more or less comparable to the infusion therapy method. Here’s how it went.
To start, I met virtually with a Mindbloom psychiatric nurse practitioner named Samantha Guijarro (MSN, ARNP, PMHNP-BC). She walked me through the ketamine treatment and explained how she was drawn to ketamine therapy by the profound results it was delivering. Studies had shown that patients who had otherwise been untreatable were having their lives transformed.
She started by delivering a straightforward questionnaire to determine whether I fit the parameters of the program. This accomplished, she walked me through the process:
- I would receive my first dose in the mail. After my first session, we would meet again to discuss the results and whether the dosage needed to be raised or lowered. In my case, it turned out, the dosage needed to be slightly increased.
- After this first round, I would also meet with a guide who would help me “integrate” my experience. More on that in a moment.
- I would go through four more rounds, punctuated by two more integration sessions.
The whole process was straightforward, and I found everyone involved to be highly compassionate. I got the sense that these were people who were excited by the potential offered by ketamine, and that they were truly there to help.
What is ketamine therapy like?
Now for the meat and potatoes of the thing: What is the ketamine experience itself like?
I went into it somewhat nervously. Even though I have plenty of experience with psychedelics, the fact that they required that I have a “trip sitter” on hand for my first session made me think that perhaps this was going to be a dramatic undertaking of some kind. Would I have the much-feared “bad trip”?
It turned out that I had nothing to worry about. The entire experience was downright pleasant. In fact, the images that stand out to me most involve the sense that I was floating through space upon gently rolling waves. It was exceedingly relaxing. I came away with the impression that my mind had been polished by a rock tumbler.
While other forms of psychedelic therapy — psilocybin therapy, for example — tend to be extremely active processes in which you do a lot of pondering of big ideas, ketamine therapy is much subtler. While I did think about specific issues, it primarily felt as if my mind left my body while repairs were being performed “under the hood,” so to speak. It seemed like a physical process rather than a mental one.
According to ketamine researcher Dr. Paul Glue, professor of psychiatry at the University of Otago New Zealand, it is a physical process by which the drug helps to boost the brain’s neuroplasticity.
“Neuroplasticity is a broad term that relates to the brain’s capacity to change — both in function and structure — in response to life experience, or over time (e.g. developmentally),” Dr. Glue explained via email. “Ketamine and serotonergic psychedelics (e.g. psilocybin, MDMA) have common effects on cellular processes that promote new connections to be made between nerve cells. In people who are depressed or anxious, brain networks associated with mood will be firing abnormally (some areas overactive, some underactive), and drug-induced increase in connections will normalize network activity.”
In other words, ketamine therapy helps to fix the crossed connections in your brain.
Punctuating the therapy are the aforementioned “integration” sessions, during which you discuss your experience with a guide or counselor and explore methods of “integrating” the lessons you’ve learned into your daily life via reflection, journaling, creating art, and whatnot. From my experience, the integration is less essential than it is with more powerful psychedelics like mushrooms or LSD, which tend to deliver powerful realizations that can be difficult to comprehend. Ketamine operates further under the radar, or at least that’s the impression I gleaned from it.
In the end, the transformative power of ketamine is different from other psychedelic therapies in that rather than delivering some sort of life-changing realization, it helps to fix the parts of the brain that have been damaged by trauma. That’s exactly what the experience felt like to me. I didn’t face my demons or anything dramatic like that; rather, I had the rough edges of my mind smoothed out.
If that sounds nice, well — it is.
What are the risks of ketamine?
Most of the risks associated with ketamine are best known under recreational conditions where it’s abused or mixed with other drugs, which can result in cognitive impairment, dependence, hallucinations, mood disorders, and even death.
Under nonabusive, therapeutic conditions, however, negative side effects tend to be minimized. Typically, they involve temporary afflictions, such as nausea, increased blood pressure or heart rate, headache, or anxiety. Some patients have, however, experienced more severe or longer-lasting effects like hallucinations, mood changes, and liver or bladder damage.
The decision to pursue ketamine therapy should not be taken lightly, and you should consult your physician before doing so.
