A note to new readers: I have recently applied to be included in a Health-Canada-approved study into the use of psilocybin in the management of treatment-resistant depression (TRD). I have survived the first few stages of the screening process and I really hope to be admitted to the study. How I got to this point will be the subject of this series of blog posts. By the time I’ve written a few of them, I should have learned whether or not I am admitted to the study. If I am, I intend to share the experience with interested readers here.
Ketamine? I’ll Pass
A drug called “ketamine” (street names include “Special K” and “Kit Kat”) has shown almost instant reported benefits in as many as 70% of patients suffering from depression and PTSD. Clinics offering ketamine as a treatment for these disorders are popping up all over North America. The dosing (often by intravenous infusion, although oral options are now available) is typically administered several times over a period of weeks, interspersed with intensive sessions of psychotherapy.
Many of these treatment clinics, and the media that cover them, have given the impression that ketamine is a psychedelic substance – containing properties like those contained in psilocybin (found in “magic” mushrooms) or LSD (a chemical compound that has similar effects to psilocybin). When I first heard about ketamine treatments, I was keen to try them, because the psychedelics I was actually more interested in trying are currently illegal in most (not all) places, even in clinical settings. However, after reading a few articles about the use of ketamine for depression and PTSD, I decided that this was not the route for me, and I withdrew from a treatment program into which I had applied and been accepted.
I’m sharing here what I discovered about ketamine that made me decide against it.
My Interest Is Piqued
By the time I watched a CTV W5 program Psychedelic Healing, which was broadcast in October of 2021 and is embedded at the end of this post, I had already started serious investigation into the effects of psychedelic substances in the treatment of addiction, chronic depression, end-of-life depression and PTSD. As was the case with cannabis before its legalization in Canada, despite their (il)legal status, lots of people are finding ways to obtain psychedelic mushrooms, and are experimenting with “micro-dosing” and even full-scale “tripping” on their own, so there are plenty of anecdotal reports. However, psilocybin is not legally available for therapeutic use in most of Canada or the U.S., with some exceptions in certain states and now in at least one province.
Late last year I started noticing an avalanche of media interest in a drug named “ketamine” for treating depression and PTSD – not only was it covered exensively in the W5 program, but suddenly there were mentions of it everywhere (e.g., this article in the New York Times). I had heard of ketamine as a recreational drug (not for nothing had I watched Russian Doll) but this was the first time I became aware of its use as a therapeutic.
Ketamine is a “dissociative anaesthetic,” and veterinarians have been sedating animals with it for years. Unlike psilocybin mushrooms and LSD, therapists in North America have been able to use it to treat depression and PTSD for quite some time and, from all reports, the immediate results have been amazing.
Much as I have always known to mistrust “silver bullets,” it is in my nature to still hope that one exists out there that will perfectly address my specific problem – and then to think that I’ve just happened to come across it. And so of course I immediately found myself a ketamine treatment program right here in Toronto – one that looked solid (i.e., employed accredited medical practitioners and psychotherapists; offered an extensive therapy program to complement the dosing; had been in business for a while; etc.). After attending one of their webinars and reading their website carefully, I applied, and was accepted. I looked forward with great interest and hope to the day of my first session.
In the meantime, I started investigating ketamine.
Ketamine Is Not a True Psychedelic
From my initial cursory reading and watching, I had received the impression that ketamine was a psychedelic. Although it seemed like a lot of the promotional materials for ketamine clinics, and media coverage of them, made little or no distinction between the psychedelic properties of psilocybins/ LSD and those of ketamine, I did wonder why Michael Pollan didn’t even mention it in his book How to Change your Mind (which I am currently reading and will review in a future post). So I kept digging.
I soon became aware that ketamine is not considered to be a true “psychedelic,” although the two types of mind-altering substances do share certain neurobiological effects. For one thing, since ketamine is a “dissociative anaesthetic,” if the drug is not properly administered and professionally supervised, it is possible to overdose on it, and ketamine can also be addictive. (Psilocybins and LSD are almost impossible to overdose on, and almost never lead to addiction.)
I rationalized (and continue to assume) that one of the major reasons for taking ketamine in a therapeutic setting – with a knowledgeable guide nearby and a psychotherapist on board – would be to mitigate such risks. But there was another issue with ketamine that concerned me even more.
Ketamine Benefits Don’t Last
Studies to date indicate that in most cases the positive effects of a ketamine dose wear off within a month or less. This was a huge stumbling block for me.
Recent initiatives in clinics such as the one where I’d registered include investigating such related issues as: 1) whether repeated doses of ketamine are more effective in the long term than just one; 2) whether combining ketamine with psychotherapy is more effective in extending the effect than using ketamine alone; and 3) whether taking ketamine orally has a longer-term benefit than intravenous infusions. As yet there is no proof (or even any real indication) that any of these measures will improve the situation.
A peer-reviewed meta study conducted at U Exeter and released in late December 2021 indicates that “Symptoms were reduced as swiftly as one to four hours after a single treatment, and lasted up to two weeks. Some evidence suggested that repeated treatment may prolong the effects, however more high-quality research is needed to determine by how long.” This reflects the findings of other studies I have read.
This means to me (Please note: I am not a doctor, I am not a pharmacist, and I am not a psychotherapist. In fact, I am a fiction writer. So beware of taking anything I say as actual advice) that a ketamine treatment makes sense for those who are so depressed or stressed that they cannot even get any “talk” therapy underway: they are in the absolute pits of despair, desperate, and possibly even suicidal. For such individuals, to get even a few weeks of respite would be an astonishing relief: they might find themselves grounded enough to talk constructively with a therapist and to begin the necessary long-term work on their recovery. The possibility of an immediate release for those mired in PTSD or a drug or alcohol addiction is almost beyond comprehension. But for someone like me who is looking for a long-term treatment for a life-long depression, a two- to three-month period of relief is not the silver bullet I was looking for.
Some, also like me, might decide that to attain a state of mind that is freed from PTSD or deep depression is worth the investment, even if it means getting another job, digging every dime out from the couch cushions, and stretching the limits of the credit card. But if you were going to spend that much money, you’d want the effects to improve things on a somewhat permanent basis. Ketamine, at least on its own, does not appear to do that. (See the Comments section for the story of someone who did find a ketamine treatment program that was worth the money.)
Ketamine Treatments Are Expensive
Aside from an actual funded research setting such as the one at St. Michael’s Hospital, ketamine treatments are not cheap. Ketamine itself is not expensive. It is the therapeutic context that costs money.
Since most clinics offering this therapy strive to maximize the positive benefits by combining doses of the drug with ongoing “talk therapy,” a patient in such a program normally has several one-on-one sessions with a licensed therapist both before and after each dosing session. During these face-to-face sessions (conducted virtually in the Covid era), the issues the patient is hoping to resolve are identified, and expectations for the outcomes are set, modified and monitored.
Each dosing session (done in person, needless to say, usually with the patient reclining, wearing headphones and a eye mask) is approximately two hours long, and each one of those plus the several hours of talk therapy associated with each dose can cost $800 to $1000. (This is according to my cursory survey on the Internet. I have since learned that in some places it may be cheaper, so look around if you are interested in investigating this option.) It is anticipated that patients will need four to six doses over a period of weeks or months, bringing the total cost to $4000 to $6000 or even more. While some health insurance programs may help to defray the costs of the psychotherapy part, the expense is still beyond the budgets of many.
|Note: I posted a link to this post on Reddit (in the Psychedelic Therapy subreddit) and a person who has really benefited from ketamine – and obtained this treatment at a very reasonable price at a location in the US – posted an extended response there. I asked if they would add it as a comment to my blog post, and I am so grateful that they agreed to do so. It is a comprehensive and useful response, and I have adjusted a couple of points in this blog post to reflect the new information I gained from it. Thanks Nicky! (BTW: There is an interesting discussion about depression on that thread, and in many other places, on Reddit.)|
Psychedelic Therapists in Training?
In my investigation of ketamine, I also read some of the transcript of a panel at the Center for the Neuroscience of Psychedelics at Mass General that included Michael Pollan as a guest. They mentioned ketamine as a useful intervention until scientists can start legally investigating actual psychedelics, but suggested that it was not a long-term solution.
I found Franklin King’s words (about 1:13 in the transcript) noteworthy: “Well, I think the other interesting thing about ketamine is that it not only sort of fills the space, but I think it also allows opportunities for clinicians and other people who are interested in working with psychedelics to sort of get their feet wet and get a little bit of experience working with patients in a clinical setting under non ordinary states of consciousness.”
In other words, it sounds like some ketamine clinics are in part therapeutic treatment centres that are gearing up for the time when they can use actual psychedelics.
In the next post, I’ll explain what attributes of psilocybin made it sound like a better fit for me.
P.S. I welcome your comments on this blog! Please note that I have settings that permit me to approve comments before they are posted (I went viral on another blog once, and I don’t really want to re-experience the downsides of that kind of attention again!) so your comments may not appear until the day after you have posted them.
What a fine researcher you are, Mary. I’m following with great interest.
I’m someone who benefited hugely from ketamine infusions. I went for a series of six for CPTSD in May 2020, and I went for integration sessions with a somatic bodyworker a few hours after each infusion. I’d been through years of terrible, excellent, and meh therapy, but I’d never gotten to the point where I could process trauma in therapy. My infusions were full of insights and trauma processing. My CPTSD went into remission after my second infusion. I’ve been going for maintenance infusions about once every five months to process additional trauma, but I don’t feel like I need them to maintain remission.
I’m not trying to talk you or anyone into ketamine, but there’s some inaccurate and incomplete information in your blog. I think it’s a great option for some people. And so are MDMA and psilocybin, and I wish they were accessible. Accessibility is why I went with ketamine. I was also desperate, but I’m really glad I did.
First, ketamine is incredibly safe in much higher doses than a mood disorder dose. That’s why it’s used as a field anesthetic. It’s also what the vet uses to knock out my cats when she cleans their teeth. Every clinic has a crash cart, but the kind of reaction that would warrant one is almost unheard of. The Special K, horse tranquilizer is an old, “war on drugs” stigma that people who recognize the therapeutic benefits of psychedelics shouldn’t be spreading.
Ketamine is not a psychedelic! You are 1000% correct. I wish everyone understood this. People go for treatment expecting a psychedelic experience. Some providers think they can apply MAPS protocols. It doesn’t work the same. Guides and therapists on standby are pretty useless with ketamine. There is still a trip, at the right dose, but it’s not something you can talk through. And because it’s a dissociative anesthesia, more doesn’t really take you deeper. It just makes you less lucid, and that definitely hits a point where it stops being therapeutic.
Ketamine can last, but you have to take advantage of the temporarily increased neuroplasticity. The antidepressant effects are pretty temporary. The trip can provide helpful insights and a safe space to process. But because ketamine temporarily increases your neuroplasticity, you can really take advantage of those two things to create long-term healing. Not everyone knows it, gets it, or does it. And there’s really no research on combining ketamine with therapy, save for one study with CBT, my second least favorite modality.
For IV ketamine, a 40-minute infusion is standard for mood disorders. I have no idea what a four-hour ketamine treatment looks like. That’s a pain dose. Your pricing assumes therapy with infusions, but most people go to a separate provider for much less. For infusions alone, my intake was USD$105 and my infusions were $399 each. It was the best $2500 I ever spent. The program you describe is non-standard. Ketamine is also available in intranasal and oral forms. Oral ketamine is probably the most accessible. It’s much cheaper, and people can take it at home.
Thank you! I am so glad that ketamine has helped you find relief!