The part of ketamine treatment people seem to find most interesting (though it’s actually irrelevant to the treatment’s efficacy) is the experience of receiving the infusion–the “trip,” if you will. For those of you who have experimented with psychedelic drugs (Hi, Mom!), you probably have a rough idea of what this might feel like. For all you boring squares, I’ll try to break it down using bizarre, confusing descriptions and obscure pop culture references. Helpful, right?
Ketamine has somewhat of a negative reputation (undeservedly so), with its most common associations being horse tranquilizers and 90s club kids. (Maybe it should have an adorable mascot like that Zoloft bean, or bubble, or whatever the hell it is—all I know is that it’s a great way to make antidepressants appealing to small children!) But Ketamine is actually one of the “core” medicines on the World Health Organization’s Essential Drug List, and is most often used as an anesthetic. It is an incredibly safe drug when administered properly, particularly at the sub-anesthetic doses used in treating depression. While the medical community may be slow on the uptake when it comes to espousing the brilliant, anti-depressant effects of ketamine, there are hordes of patients out there who will gladly testify to its magical, life-saving abilities with all the zeal of a gospel choir on Sunday morning.
The most effective ketamine treatment for depression is administered intravenously at a rate of .5 – 1 milligram per kilogram of body weight, over the course of 45 minutes to an hour. The initial treatment consists of six infusions spread out over two weeks to provide a rapid anti-depressant effect. From there, booster infusions are given as needed, usually every four to six weeks. It normally takes between one and three infusions for the effects to kick in. It took four for me and you better believe that I spent that weekend between infusions three and four agonizing over whether to keep throwing money at a problem that evidently couldn’t be solved, and cursing the universe for its clear and malevolent bias. (Because obviously I’m so important that the universe would have a personal vendetta against me.) But after that fourth infusion, to quote David Bowie, “Wham, bam, thank you , ma’am!” I was up and at ‘em like never before and ready to grab life by the horns and… well… admittedly, I wasn’t really sure what to do with it, yet. It takes time to get used to the whole “living” thing after decades of merely existing. Mostly I cleaned a lot. But it felt great!
Okay, enough boring (super important!) facts. Down the K-hole we go…
That first infusion was at a slightly lower dose to acclimate my body to the drug. I think the most apt comparison would be a pleasant, buzzy intoxication on par with a couple of drinks (or more–I happen to be a lightweight. At least I am these days, post the infamous frat year of 2013. Xanax is one hell of a drug….) It was enjoyable, certainly, but nothing to write home about. Then they brought in the big guns. Rounds two through six were a transcendent swirl of strange and wondrous energies and the occasional bout of time travel, like dropping your brain into a blender with a pinch of nostalgia, a dash of euphoria, and perhaps a universal secret or two.
Curiously, the most thrilling aspect of the trip for me was time travel. As someone who has gone a lifetime trying to avoid any time spent trapped within the confines of my own mind, you would think a stroll down memory lane is something I would avoid at all costs. In fact, my mom has a favorite quote of mine that goes, “Don’t get nostalgic–it never ends well.” This still rings true, but ketamine is a game-changer on that front. Tripping on ketamine is like sinking through the pages of a photo album, each picture a portal to a different time or place. It allows you to inhabit various moments in your life in a pleasantly detached manner, wondering at your ability to reconnect with loved ones who have died, relive old family vacations, and drift through your childhood home like a benevolent specter. A strange, temporal dissonance occurs which caused me to marvel at having moved out of my parents’ house–I wasn’t old enough to live on my own! I couldn’t possibly have my own apartment. Who would have allowed that? Rationally, I knew I had moved out nearly a decade ago, but it felt unreal from my current post in the world of teenage Zoe, spending quality drug-induced fantasy time with her dearly departed pets. I also traveled forward, the atoms in my body melding with those of the universe, traipsing over large swathes of time and space with ease. I was whisked away on planned, but as-of-yet untaken trips to the desert, and weeks early for family gatherings that hadn’t occurred. I even dropped in on Hogwarts, a place as deeply seeded in my memory as any of those less fictitious destinations.
This brings me to the aforementioned pop culture references that will likely be lost on those of you who aren’t sci-fi nerds like myself. (Except Harry Potter—there’s no excuse for not getting a Harry Potter reference, so let’s start there.) One of the metaphors I’ve used in an attempt to describe my experience to others is that of the pensieve in Harry Potter, a mystical basin of swirling thoughts and memories that can be perused like some sort of fucked-up Tivo, even allowing you to step into the memories and experience them as an impartial observer, unable to effect real change. Another great example is the TARDIS, the Doctor’s time-traveling police box that whisks riders away through space and time in a riotous swirl of cosmic matter. But the most evocative comparison for me is Eternal Sunshine of the Spotless Mind.
There’s a sequence in the film where the lead character, Joel, is having his ex-girlfriend, Clementine, erased from his mind in a futuristic, wholly unadvisable, procedure. In the midst of the procedure, trapped in his own mind and unable to communicate with the waking world, Joel realizes he’s not ready to say goodbye, and attempts to shield his recollections of Clementine by secreting her away to memories where she doesn’t belong. He flees, with Clementine in tow, through a parade of these memories both meaningful and mundane, childhood traumas and unremarkable rainy days. Each memory is a fully realized world, but a world that, despite its familiarity, is slightly askew–the dimensions off and the scenery shifting in a disorienting manner. Maybe it’s because I happened to be listening to the movie’s soundtrack during my infusion, but I always identify that bit of the movie with a ketamine trip. I like to imagine someone involved in the film was no stranger to the K-hole, themselves.
Lastly, the come down. Waking from this bizarro mind-meld with the Ghost of Christmas Past leaves you feeling raw and somewhat melancholic, like your brain has been soaked in meat tenderizer and wrung out to dry. It’s like waking from a dream before you’re ready, or, to quote the musical number in Buffy (you didn’t think I’d let you go without a Buffy reference, did you?), when she reveals that she hasn’t, in fact, been languishing in a hell dimension for the past few months, “There was no pain, no fear, no doubt, till they pulled me out of heaven…I think I was in heaven.” But fear not, that feeling soon abates, replaced by an all-encompassing exhaustion and, at last, after a good rest, life begins.
Ketamine isn’t physically addictive and you don’t crave the high between infusions, but the chemical alteration lives on in your sense of well-being, your ability to be a productive, contributing member of society, and your newfound gratitude for all that life has to offer. Those first infusions seemed to unify all the disparate parts of me that had broken apart over the years and taken to rattling around in my head like loose change, so that I emerged not unmarred, but whole, with each piece of me–weird and wonderful, glorious, and ungainly–joined in harmony. (A well-adjusted Frankenstein, if you will.)
(Important disclaimer: Ketamine should not and cannot be administered in a safe and effective manner by anyone other than a licensed physician. Seriously, if you’re off by even a little you won’t so much “trip” as fall down the hole and die.)