Overview
I recently went through ketamine infusion therapy for depression and want to share my experience. (Buckle up, this is a long post.) Overall, it was very, very positive. If you’re not familiar, the therapy consists of getting hooked up to some equipment (IV pump, blood pressure cuff, pulse oximeter) and sitting in a dark room for 40-120 minutes at a time. The pump pushes a steady dose of ketamine (and a little antiemetic to control nausea) into your veins throughout the infusion. Medical staff check your vitals periodically. Eventually they come in, say you’re done, unhook you from the machines, and you can spend a few minutes getting your bearings before leaving. The clinic I went to recommends six 40-minute infusion sessions within a 15-day period with the option of another one or two sessions in the 3-6 weeks following that period.
I won’t try to explain what happens neurochemically, but basically the thinking is that this treatment increases neuroplasticity in the days and weeks that follow. As I understand it, repeated exposure to the drug “loosens up” rigid patterns of thought, freeing your brain to form new, healthier patterns. And this helps treat depression and anxiety. (Subjectively, I feel like it might grant perspective that makes it easier to find your way out of these dysfunctional loops.)
Ketamine, especially in these doses, is profoundly disorienting and nausea is a common effect. They tell you to fast for 8 hours before the infusion and limit liquids in the last 2 hours. (I once tried fasting for only 3 hours after a light lunch and that was the only time I had noticeable nausea afterwards. Fasting the full 8 hours is a good idea.) You also shouldn’t drive or make important decisions for 24 hours following each infusion.
The clinic I used strongly recommends being under the care of a mental health provider prior to and during infusion therapy. I think that’s a very good idea.
Details
This table shows how my sessions were scheduled, the ketamine dose for each session (expressed as milligrams per kilogram of bodyweight), and what I listened to.
For anyone considering this therapy, I’d recommend spacing the infusions with at least one day between them if possible, rather than having them back-to-back like I did due to schedule limitations.
Audio
Also, regarding music: The provider I worked with recommended calm, gentle music without lyrics and I think that’s excellent advice. Your thoughts can go strange places while in that dissociative state and I strongly suspect lyrics would encourage unhelpful diversion. The disassociation isn’t just a byproduct, it’s the therapeutic payload. Tempo and mood make a difference too; for my second infusion, I listened to Zelda & Chill II and, though I enjoy that album in other contexts, found it to be a poor choice for these infusions. It had a dark, mechanical “marching” vibe that made me feel like I should doing. That’s apt for video games, but wrong for this experience.
The albums that worked best for me during the infusions were Sailing through Rainbows of Sound, meowcraft, and The Angler’s Dream. Earbuds with active noise cancellation are a good idea.
Play-by-Play
Because it’s something I would want to know, I’ll describe in detail what happens during each infusion visit. Bear in mind that: (1) these were preceded by a consultation appointment where I discussed my complete medical history with the provider and got to ask lots of questions, and (2) protocols differ and this only represents my perception of how one clinic does things. That said, here’s how it goes:
The patient arrives. Since they won’t be driving after, they were probably brought there by someone they trust. They identify themselves to the reception team and pay the fee. Reception then escorts them to a small room just large enough for a sink, some cabinets, a power recliner, a stool, and a chair. The care provider comes in and talks with the patient for a couple minutes. Meanwhile, a nurse enters and starts getting things ready. The provider gives the nurse some instructions which might include information like dose, use of an initial bolus, and additional medications (perhaps to control blood pressure or nausea). They tell the patient the nurse will check on them about ten minutes into the therapy and the patient should try to give a thumbs-up if everything is going well.
The provider leaves and the nurse preps the patient for IV catheterization (helps choose the site, swabs the skin, gives a small subcutaneous lidocaine shot to numb the spot). The nurse places the IV, then connects the blood pressure cuff and pulse ox finger clip. The nurse records patient vitals and starts the IV pump. Before the nurse leaves, they switch off the lights and turn on a projector that covers the ceiling in slow, swirling green and blue shapes. The patient reclines the seat and stares at the ceiling.
It takes a little while for the drug’s effects to become noticeable, maybe two or three minutes. The first thing I notice is that my tongue and fingertips start feeling “fuzzy.” The disassociation comes on gradually. I would begin feeling very comfortable, but not sleepy. The state itself is hard to describe. You don’t think in the ways you normally do. Maybe imagination deepens. Time seems to move at a different rate. The nurse checks in, a thumbs-up is given, they leave.
Thirty minutes later, the nurse comes in and makes sure the patient has some awareness. They remove the sensors and IV, then bandage the insertion site. They leave the lights off and tell the patient to take as long as they need to get their bearings. Once the patient feels well enough to walk, they go outside and meet their ride.
Thoughts, Mind-Wandering
Here are some things that passed through my mind during the infusions. These were mostly like vivid daydreams, or possibly pseudohallucinations.
During the first infusion, I briefly forgot where I was and felt like I was in a place outside the world. Another time, I felt like I was capable of perceiving everything anywhere and my entire life to that point had just been a tiny, arbitrary sliver of this greater continuum of experience.
For a while I considered the vast amounts of human labor it took to produce the room I was sitting in; the construction of the building, the manufacturing of the tools to do that construction, the development of technologies to produce materials, laying all the roads to bring them there, the training of the staff (and the training of the trainers), and all these recursive origins for the people, objects, and knowledge that went into creating this little room for this simple (in a way) treatment.
Once, I was in something, part of it. I couldn’t move or breathe, but there was no sense of confinement because I was getting everything I needed to live. I knew that the things surrounding me were having the same experience and we had some awareness of each other. I had a moment of panic, thinking, “Oh no, what am I supposed to be doing?” And then a surge of relief realizing that I was already fulfilling all my obligations by just existing in this state. I think I was a cell in the body of a larger organism.
Something that felt like an epiphany and stuck with me for a long time after: There’s no escape from existence. Once you have presence, the feeling of being, you will always have it. Death might change it, or erase memories, but “you” (as in, the thing that feels) still exist and experience something. If you were looking forward to some “final rest” forget about it! The only feasible response is acceptance because the alternative is discomfort and longing without end. Learn to love existing. (I admit some cognitive dissonance about this. It’s impossible for me to know it without evidence, but it feels true and I think the belief is functionally useful.)
Cost
I understood the cost per infusion, without insurance, to be $350. Fortunately, my insurance covered it and the Explanation of Benefits forms showed an “amount billed” of $407 per infusion. My personal costs were $200 for each of the first five visits, at which point I hit my deductible so visits six and seven were only $100 each. My total out-of-pocket cost with insurance was $1,200.
Effects
The short-term effects are apparent and somewhat negative. Immediately following an infusion I would only want to lie down and watch TV. I’d have no appetite. But this went away after 4-5 hours and I was back to feeling fully normal by the middle of the next day, aside from a temporary reduction in physical stamina. The reduced stamina lasted, at most, 2-3 days. During that time I also felt sharper while doing complex tasks, sort of like the opposite of brain fog.
The longer-term effects are more subtle. My mood improved massively, though not immediately. For me, it took a couple weeks. And even then I wasn’t sure about the cause since there’s some natural variation and an uptick in early summer is typical. But now that I have more data I feel confident in attributing most of the improvement to the ketamine infusion therapy. Here’s a chart from a daily mood tracking app I use:
Other longer-term changes I’ve noticed include a small increase in libido and shortened recovery from events that would usually worsen my mood for hours or days after.
Overall, I’m extremely satisfied with the therapy. The provider at the clinic says I can come in for booster infusions in the future and I can imagine myself benefiting from those. Maybe in 3-6 months or a year, we’ll see. I don’t regret my 7th infusion but it felt like the returns had diminished substantially.
