Entering the K-Hole: Trying ketamine injections for depression

My husband and I recently watched the movie The Professor and the Madman, based on the true story of the making of the first comprehensive English dictionary. The “madman” in the story is the physician William Chester Minor who is taken over by schizophrenia, who, while he’s confined to Broadmoor psychiatric hospital, makes some major contributions to the original Oxford English Dictionary.

At least as depicted by the movie, Dr. Minor received humane, helpful care at Broadmoor. Still, his schizophrenia overtakes him with delusions and self-harm. His psychiatrist seems to be progressive and up to date on the current research, and there’s a scene with Dr. Minor willingly undergoing a “treatment” suggested and lead by his psychiatrist, where someone forces their fingers down Dr. Minor’s throat repeatedly to make him vomit over and over.

The scene first made me think about how wayward historical treatments for mental illness have been, with practices like this as well as phrenology, ice baths, and ice pick lobotomies.

But then, I had a sobering second thought. Like I mentioned, Dr. Minor was a willing participant in the treatment. It reminded me how my own mental health struggles have lead me to be a willing participant in some intensive, invasive therapies—like electroconvulsive therapy (ECT), where you go under general anesthesia to have a seizure induced, and transcranial magnetic stimulation (TMS), where you have a giant magnet fire against your skull with loud clicks and face twitches.

These therapies have been helpful, but after my first semester in PA school, I found myself intensely depressed again, and desperate to find another therapy that could possibly help. I was doing TMS again, medications and talk therapy, and still struggling.

This is what lead me to ketamine injections.

I had read about psychedelic therapy in the book How to Change Your Mind by Michael Pollan. I was curious about the mechanism of these treatments, and learned that the dramatic positive results for using psychedelics to treat different mental illnesses is largely a function of the psychedelic experience. This is why I chose to pursue ketamine injections rather than the more ubiquitous ketamine infusion therapy—because the injections are supposed to provide that kind of experience.

Like I said, I’ve felt desperate after my first semester of PA school being so difficult mood-wise. I’ve done a lot of different treatments, but I hadn’t tried ketamine. So, trying ketamine is what I did. I recently finished the fourth of a recommended six of these sessions, and I wanted to share my experience so far.

Finding a psychedelic

Ketamine is a legal psychedelic, and supervised injections as mental health treatments are available in my home state of Utah. Psilocybin was the major focus of my reading on psychedelics for depression, but it just isn’t available to me (though Oregon legalized it in the last election cycle, and I hope treatments with psilocybin will be widely available there soon).

But ketamine is available.

I went to my first appointment feeling cautiously hopeful. According to what I had read and researched, psychedelics have the potential to completely change your life. At the same time, I’ve tried a lot of things for depression that haven’t worked, and I knew there was the possibility that this wouldn’t either.

I think the clinic I found is pretty new. It’s just open on Tuesdays and Thursdays. It’s in a little office building in the Salt Lake area. When I walked in for my first appointment, I was the only client there. I met with the neuropsychologist, Dr. G., and nurse practitioner who seem to make up the entire staff of the clinic. They introduced themselves, and the neuropsychologist asked me about my diagnoses and my mental health history.

The injections

Then they told me a bit about ketamine injections. They told me how it “protects the airway,” which, I know from my one semester of PA school, is worth mentioning because other sedatives depress your airway, making you breathe slower and slower the more of the substance you use. They said they haven’t had any adverse events among their patients, and that ketamine is quite safe. Then, the neuropsychologist told me: Remember you’re safe, and just go with it. If you see a door, open it. If you see a stairway, climb it. If you see a monster, talk to it.

After that, they lead me to a private room with a recliner. I had brought my phone and headphones to listen to, and Dr. G. showed me a playlist on Spotify to listen to. I declined the eye shades they offered because I was afraid other people had used them and they were infected with COVID, as well as the blankets for the same reason (I just used by big winter coat that I had with me anyway).

The nurse practitioner injected 60 mg of ketamine into my deltoid. It burned going in, like the anesthetic each time I’ve had an ECT treatment. They inject that via an IV, though. I read something last semester that said intermuscular injections (like how I received the ketamine) generally take about as long to work as swallowing something—20-30 minutes. So it surprised me how quickly I felt the ketamine. It hits you after just a few minutes, maybe five. I checked my watch as it did, and settled in.

After reading about psychedelics for depression, and after hearing the neuropsychologist instruct me to welcome doors and stairways and monsters, I expected to experience visions on ketamine. I thought that it could be a life-changing experience, the kind Michale Pollan describes in his book. At the same time, because of how I haven’t responded to a lot of things for depression, I thought maybe nothing exciting would happen. I tried to tell myself to also expect that that would be a possibility.

So, what did happen surprised me.

The first injection

First of all, there were no visions, no monsters, no stairways. Not much of anything, really. The new-age music the neuropsychologist had me listened to felt immersive and deep. But visually…it was pretty much like looking at the back of your eyelids as you fall asleep, maybe with pressing on them from time to time. You know how you see some lights and colors and patterns when you push on your eyelids while your eyes are closed? It was pretty much like that. Just a little bit of colors and patterns that would kind of shift and change. Mostly, though, just black. Just staring at the back of my eyelids.

The ketamine also made me feel somewhat dissociated with myself. My hands felt papery. They had given me Zofran as a sweet sublingual tablet for nausea before the injection, and that lingering flavor and my mouth and nose felt especially prominent. And I felt a little like I was light or floating or maybe moving backwards.

At the same time, I never felt like I was losing my faculties. I would feel my fingers, which felt like my fingers. And my mind was still working just fine. I thought during the experience: I came here to be injected with ketamine because I’m hoping it will help with depression. I really, really need help with depression…and this isn’t really what I expected.

Unlike what I had read and been told, there were no visions, no grand thoughts, no connectedness with the universe, nothing spiritual, out-of-body experience. Certainly no doors or stairs or monsters. It was pleasant enough, but certainly not euphoric.

And though my expectations were that either it would be helpful and be a neat experience or it wouldn’t do anything, my outcome wasn’t either of those. As I laid there staring at the back of my eyelids, I thought about how I guess I had been hoping the experience would help with my life. And then the thought process began: This isn’t helping. I’m going to have to come out of this floating feeling, and all the depression will be back. All the problems, the stress of PA school, of life in general, will be back. The ketamine isn’t helping with the depression. It won’t help. Nothing will help. And then, the overarching theme of the experience: The world is a shitty, shitty place. It is for everyone. It always will be.

I checked my watch as I came out of it, and as the nurse practitioner and neuropsychologist appeared again in the little room. It had been an hour. It would be another two hours or so before it all wore off, though. But they seemed to want me to go, even though no one was helping me walk. So I carefully shuffled out to the waiting area on my own to find my husband Chad. I tried to stand straight while they asked me about scheduling the next appointment. And as Chad and I drove home, I looked out the window. I watched buildings, people in their cars and on the street. I told Chad: The world is a shitty, shitty place. And look at all these chumps. They’re just taking it.

Still, I wanted this to help. The last few months had been really difficult, and I was feeling desperate. So I said I’d come back.

The second injection

Disappointed with my first experience, but still hopeful, I decided to start taking matters into my own hands with the second injection. Instead of the generic, new-age music Dr. G. had chosen for me, I made my own playlist the night before. I chose music that had new age elements—some of those calm, complex sounds. I chose stuff that also had very positive lyrics and/or associations for me.

The second appointment was two days later, and, the neuropsychologist, Dr. G., was actually late. The nurse practitioner just got us started on things without much talk. She did ask me how the first injection had gone, and I told her it was actually quite negative. She told me, “Sometimes things get worse before they get better.” She took my blood pressure and injected me in the other arm—I wore better clothes that time to make accessing them easier. She increased the dose to 70 mg. This was to increase the intensity of the experience gradually, but also because apparently people develop tolerance to ketamine really quickly.

Dr. G. came in as I was getting settled, and after being injected. I told him a little about things being negative, and he nodded, and just asked if I’d try the eye shades this time. I had opened my eyes a lot to take a look around the room during the first appointment, kind of to assure myself that things were fine and I was safe. I said yes to the eye shades, hoping that maybe not always looking around would mean a different experience.

I got settled into the armchair with my eye shades and playlist. Again, there wasn’t any kind of vision or hallucination. The music sounded pretty cool. Like I had hoped, the lyrics helped me feel more positive, too. This time, instead of the take-away that everything is horrible, I felt a little bit of connection with the world, like I was worth taking up space and worth attention. I felt more positive. Like the first experience, I also felt a little bit that I wanted to stay in the calm and peaceful floating state rather than come back to reality.

The neuropsychologist and nurse practitioner told me after that “the learning” after the experience is important, and that ketamine “resets the brain.” They encouraged me to listen to Brené Brown’s Netflix special. Dr. G. also pushed me to sign up for and pay for six appointments at this point. They handed me paperwork the first day saying I shouldn’t make major decisions while doing the treatment, but…being still groggy on ketamine and hardly able to stand was apparently fine for charging my credit card with over $1,000.

After leaving the office all groggy, I went home and put on Brené Brown while I made something to eat. I had fasted before the first two appointments, not because they told me to, but because I had read online to do so. That’s why I went home hungry. After these appointments, though, I decided to ditch the fasting as not important. I felt a headache after this one, but other than that, haven’t had any negative side effects, and nothing bad has happened from not fasting.

Once I got into the Netflix special, Brené Brown started talking about her Ted Talk, so I listened to that, too. Her work talked about being vulnerable in order to connect and be happy. I thought about what she said. I think I could probably use some help in this area, some help with connecting to others and being vulnerable. I had read that “integration” is important with psychedelic therapy. The clinic I’m using offers this, but at $225 for each hour session with Dr. G. (who I don’t really love spending time with), and they don’t take insurance. I spent some time online looking up therapists who do “psychedelic integration therapy” AND who take insurance, but I’ve found that either those therapists have long waiting lists, or that they work at places that want me to do the actual ketamine injections at the same place. Basically, no luck with finding a therapist for integration. So, I’ve been trying to write down my thoughts notes after appointments, and I’ve been reading Marsha Linehan’s memoir and reviewing DBT skills. Basically, I’ve been trying to do some integration on my own.

I believe it was this second appointment that I felt a mood change for the first time: I felt happy for the rest of the day. By the day after, though, that was gone. It was back to depression.

The third appointment

By the second week and my third appointment, I was still feeling quite depressed. But at this point, I had paid for the sessions, and I was really hoping this would help. Still, I was also starting to change my expectations. I wasn’t having incredible experiences, the mechanism for helping depression that I had read about. I started to wonder if just the chemical makeup of ketamine would be the mechanism.

I had tried again to work on my happy playlist before the session, but this time, I was feeling less enthusiastic about it. I had added in more instrumental pieces. Instead, the major change I made this session was trying to actively engage my imagination. I wasn’t seeing anything grand, so what if I tried to just roll with my imagination?

I was up to an 80 mg dose for this session. I could feel the increase. I read something that called a ketamine high the “k-hole,” which I think is a great description. It felt like I was falling or floating backwards, with layer upon layer of black stacking up on me as I fell. It felt like I went deep, but then went deeper. It was at that point I tried to “lean in” to my imagination. The experience was dream-like, and like a dream, I don’t remember a lot of it now. I do remember at one point the sensation that I was walking around inside my body. I remember trying to prompt myself to move into my brain, find the part that’s defective, and dig it out.

I wasn’t able to do it. I wrote down after that, in addition to that idea, there was also the logical thought: It isn’t that simple. Depression isn’t just a spot in my brain.

I also wrote down that this time, there was no dread coming out of it, no dread about returning to the real world.

The fourth appointment

I still wanted more from my experience. For the fourth appointment, I decided I would try adding visuals. Before the appointment, I found a YouTube video described as “trippy” to watch. I knew I would still be wearing my eye shades, and I was kind of nervous about Dr. G. and the nurse practitioner finding me watching my phone when they checked in on me. I decided I’d sneak some glances. But after I got injected (with 90 mg this time), a pretty great set-up came together: I pulled up my pre-selected video, and propped my phone in the folds of my big winter coat that I’ve been using instead of a blanket. I also put on the eye shades, but realized I could open my eyes and look down and see the phone propped on my chest. I don’t know if they would have been perfectly fine with me trying this, but it seemed like I needed to hide it.

The video didn’t end up adding a whole lot. Watching some of the colors and patterns on the still-higher dose was kind of trippy, but didn’t make me think deep thoughts or have dramatic realizations. I had been timing all my sessions, and this one was almost exactly one hour like the other sessions. This one, however, felt faster. It felt like it went by without me being totally aware of everything.

There has actually been a difference since this appointment, though. Again, it isn’t because the ketamine experience has opened my mind to deep thoughts or hallucinations or a sense of connection. There hasn’t been much at all in that arena. For whatever reason, however, since this fourth appointment, I haven’t been feeling depressed. Again, this goes against what I’ve read and researched. I assume whatever is making the change for me is the same mechanism as what could occur just as well with ketamine infusions or nasal spray—that is, whatever is working, it is something chemical.

If it is just chemistry, that makes me a bit concerned. The major one is that I’ve read that ketamine infusions can be very helpful, but that their effect is quite short-lived. And, like ketamine infusions, the ketamine injections I’ve been undergoing are expensive, around $300 each. I’m concerned about needing them frequently to make a difference, and draining my funds in the meantime.

At this point I’ve done four injections in two weeks. My husband and stepdaughters and I took a vacation for a week after that. I’m still feeling good. This coming week, I’ll be doing treatments five and six. The following week, I start my second semester of PA school. I’ll also be starting up TMS treatments again when I’m back at school, and will be able to start talk therapy again. I wrote how my first semester of PA school came with a dramatic return to difficult depression symptoms, and that even though I had good outcomes with TMS at the beginning of 2020, they didn’t seem to help during the semester.

I’m grateful I’m feeling better right now. My hope is that since ketamine finally somehow got me out of depression, going back to TMS and talk therapy will be able to prolong and maybe even enhance those effects (though I’m sure no one has yet done research on that kind of combination of therapies). I know the last two ketamine sessions will also come with increased doses again, and I still have a little bit of a hope that maybe that will finally mean an impactful experience with those injections. If they don’t, though, I feel like they will still help things. My biggest hope is just that I’ll be able to survive the coming semester of PA school—which needs to mean that my mood doesn’t dramatically drop again.

Now…I just need to see if that happens.

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