Ketamine Infusions

Wanna take a ride?

S.R. Hadden (John Hurt)
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As always, this is not medical advice and any specific information should be double-checked with your doctor.

What is Ketamine?

Ketamine is an anesthetic created in the 1960s as a replacement for and derived from phencyclidine(aka PCP aka Angel Dust). It is hallucinogenic and dissociative, almost like PCP but doesn’t come with the violent effects that PCP is famous for causing. Besides surgery, it is used for acute pain, seizures, and mental health issues.

What are Ketamine infusions?

These are sessions where the ketamine is pushed into you via IV. The nasal spray sessions I talk about below are somewhat similar.

It starts out with two sessions a week for three weeks and then goes to once every 7-10 days. The more treatments, the longer the positive effects last. The initial goal is to get to 4-6 weeks symptom-free and then work to once every 6 to 12 months. I have finished eight sessions and the anxiety and depression come back in about 5 days so I am getting there.

Ideally, you are set up on a comfortable, reclining couch. I am wrapped in a blanket and surrounded by pillows. The room should be dark and there should be no sounds from outside the treatment room. Once, the IV got kinked up and a light alarm went off and that was very distressing. My clinic has put a lot of thought into keeping it dark and quiet. The infusion rooms have no windows. Only one patient is in the room and once treatment starts the nurse leaves - they can monitor vitals from outside the room. Ideally, once they are set up, you don’t see them until the end.

There should be music playing, with headphones available. They should also have a ceiling projector and aromatherapy. These add to the enjoyment of the sessions. I can take or leave the aromatherapy, but the other two are very important to me. It is hard to explain.

What is it used to treat?

Technically, it is just eskatamine(a right-hand mirror image of the ketamine molecule), called Spravato) that is approved but only for treatment-resistant depression. Which is ridiculous. It is great for anxiety and headaches also. It is used for all sorts of MH diagnoses. IMO, it should be a first-line treatment. Toward the end, I will talk about the personal benefits of ketamine infusions that I have experienced.

Spravato is a nasal spray that has to be used in a clinical setting just like infusions.

Infusions vs Nasal Spray

Infusions are 100% bioavailable and they can precisely manage dosage before and during treatment. Spravato cannot. If you get too much, you are either stuck or are getting an injection of Klonopin.

The infusions are so much better because they can turn off the machine and in a minute or two, you are back into reality. When you recover they can turn it back on at a lower setting so the appointment isn’t wasted as much. The dissociation is merely a side effect and is sadly temporary because I think that it adds to the therapeutic effect. The doctor who runs the clinic says I should treat them as dreams. Sometimes they mean something, but are mostly just dreams. The goal is to get as much ketamine as I can tolerate each session - which increases as I get used to it.

I have never had the nasal spray so I can’t comment specifically. I can’t imagine enjoying it as much as the infusions. While enjoying the effects is not really the goal of these treatments, I think it adds a lot during and after because I am in a very sensitive state.

Is it painless and what is the dissociative effect like?

The Spravato is pretty painless, it is just a nasal spray. The only pain with the infusions is getting poked with a needle. The clinic I go to uses the smallest possible needle because it is only used to place a tube in my veins. The needle is immediately removed.

I have had one bad session where I dropped too deep into a black hole(called a K-hole) but it did not hurt or cause panic. I am very calm during the session even if bad things pop up in front of me.

It is hard to describe it. I wish I could record what I am seeing and feeling. Even if I could describe it, I imagine your experience would be very different.

I tried to explain to my therapist and he said, “That sounds like what it was like when I ate mushrooms with psilocybin”.

Mostly, it feels like I am floating through space, which is likely because of the projector in the room that puts stars and clouds on the ceiling and walls. The picture of a forested hill with clouds also adds to the peaceful effect. There is very calm music playing. My clinic has playlists you can use or bring in your own. It is supposed to not have vocals. I wonder if Nine Inch Nails’s many instrumentals would be good? Too late for me. I think things would go bad if it changed.

I say that because once, I was put in a different room with a radically different picture(it is a chaotic modern art piece) and projector, and it ruined the experience - even with the same music. Which is a very odd thing, but the lady who sets me up says it is common. The coat hook is also visible so my coat turns into some creature that looms over me. Perhaps if I started in that room it would feel better? They will try to keep me out of that room, but if I am ever in it again, I am definitely using an eye mask.

The playlist I use is this. The first song is perfect for the “drop” into ketamine and the fourth song is perfect to float along to. I have been toying with the idea of playing the first one and then looping the fourth, but the entire playlist has become the soundtrack of my journey. It guides me through it. The music is not substantial but becomes very powerful during treatment.

Time slows way down. The session is almost an hour long. After the first treatment, I asked if they had forgotten about me because it felt like days had passed. After several appointments, it feels like half a day.

Nothing feels real outside of what I am currently seeing. Even if I think about a person I know, they don’t seem real. It is both weird and nice.

What are the requirements?

Technically, it requires a treatment-resistant depression diagnosis. But it is used off-label for any type of depression, anxiety, and even PTSD and bipolar. Active psychotic symptoms are a no-go, for obvious reasons. It is probably very effective for other MH issues as well. I don’t want to paint it as a miracle drug, but after decades and dozens of failed trials, I will say that it is remarkable.

I got the impression that the doctor that runs my clinic would accept anyone struggling that didn’t have any of the contraindications.

Speaking of, this is the list of issues that make ketamine dangerous.

• Uncontrolled hypertension.

• Unstable heart disease or congestive heart failure.

• Untreated hyper-thyroid disease.

• Renal insufficiency.

• Brain tumor or acute brain injury.

• Severe liver disease.

• Pregnancy or breast-feeding.

• Active psychotic symptoms.

What to look for in a clinic

As hinted at above, you want a clinic that will cater to the best experience possible. Quiet, darkness, and aids like music, projectors, and aromatherapy are signs of a quality clinic.

A comfortable reclining chair is a must.

If the room isn’t a room, and just has curtains around an examination table, run! If the room has windows that aren’t 100% blocked, run! If the clinic is naturally noisy, you guessed it, run!

Beyond that, a clinic whose staff puts you in complete control is a must. You dictate the dosage. Suggestions are good but if they don’t listen to you or try to push you into something you are uncomfortable with, it is a bad clinic.

Initially, they will start you out on a low-ish dose and after that, you can tell if you can take a big jump in dosage or not. You do get accustomed to ketamine so more is needed over time. There are two dosages in ketamine infusions. The “drop” and the maintenance through the session. I have learned that the drop can make or break a session. If it starts too hard, it goes bad quickly. You don’t need a drop, but I use a small one. Everyone is different. My nurse said that some people want a big hard hit to start out with and some don’t want any drop.

Comfort and communication are the keys to a good clinic. The people in mine are so kind and loving, they really do care about the experience and it makes all the difference.

What are the downsides?

Yes, there are always downsides. The main side effects are nausea and dizziness. I am pretty dizzy after a few hours. They put an anti-nausea med in the IV at the start which typically helps. If I am still queasy during or after, they will inject more. They told me if the dizziness is bad or lasts days, they can prescribe scopolamine. I use OTC motion sickness pills if it is bad and that works. It hasn’t been long-lasting for me.

It can wreck your bladder lining, but it is extremely rare when it is not being abused. It is something to keep in mind and talk about.

Ketamine has a short half-life - about three hours - so the side effects are transient, unlike a daily pill.

You do need a driver to take you home. Don’t drive for the rest of the day. In fact, I have to sign a paper promising that I won’t drive for 24 hours, or do anything dangerous, including making big financial decisions. I don’t want to completely dismiss the side effects, but they are not nearly as bad as normal psych meds, which is one reason I think it should be a first-line option.

Alternatives

A related alternative is Spravato. It is the best option if your insurance doesn’t cover infusions and you can’t afford them out of pocket. It is not 100% available and is not as controllable as infusion treatments, but better than nothing.

I have read about people getting prescriptions for ketamine and getting them filled at compounding pharmacies. IMO, this is dicey because compounding pharmacies are often problematic, and the personal reports that I have read say that each lozenge has varying amounts of ketamine. It can range from very little to too much. It works for some people as a cheaper option, but I like the predictability of infusions and having someone nearby in case I need help in that state. It is also easier to abuse and that is never good.

Ketamine treatments are an alternative to electric convulsive therapy(ECT) something I cannot try due to being epileptic. It has helped people but it scares me and I dislike the memory loss side effect. During Ketamine, I am wide awake and alert enough. There is no memory loss of things before or after treatment.

There is also rTMS, which is a much less intense alternative to ECT. It uses a magnetic field instead of putting electricity through your brain. I tried to get this last summer but didn’t qualify due to epilepsy. A downside is that it requires 35 or so daily treatments so you have to go in 5 days a week for nearly two months.

Does insurance accept ketamine claims?

Despite being the superior option, infusions are off-label so your insurance might not cover them. For people without insurance, my clinic charges $450 a session. The VA does pay for it. There are few clinics inside the VA, so they send out referrals to the community.

Most insurance will cover Spravato.

Few will pay for compounded, at-home treatments as far as I know.

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A typical session

At the beginning of the session is the time for clear-headed questions. Talk about any problems or questions that might pop up.

It is difficult to have a coherent discussion right after the session.

After that, they will ask a few questions and take your blood pressure.

Then it is time to talk about dosage. It is measured in milligrams per kilogram of body weight(mg/kg). The typical starting dose is 0.5 mg per kg of body weight. I step up 0.1 mg, but not always each week. It depends on how the last session went and how I am feeling about it. My last session was 0.9 kg, but the week before I stepped down a little because the previous appointment went bad. So I went up 0.4 mg over 8 sessions. There are no hard and fast rules. I am going to try 1 mg this week.

They hook you up to the IV and use a finger blood pressure cuff and blood oxygen monitor. They also put the call button around your neck.

They wrap me in a blanket, give me two pillows, recline the chair all the way back put headphones on me, and start the playlist. They start the IV machine, turn off the lights, and say “Have a good journey” and they leave.

Then the trip starts. Each one has had a lot of similarities, but many differences. A lot of thoughts are things that are currently causing stress but what I see is very random.

I dress very comfortably. I wear a loose-fitting, soft long-sleeved T-shirt. Loose-fitting sweatpants with my winter fishing base layer and thick wool socks. I take my shoes off because it adds weirdness. One time I wore a black and white Seahawks t-shirt and the print really bothered me.

When there are about 5 minutes left, they re-enter to turn off the IV, and they leave again and let me slowly come out of it. Then they come back, unhook me, ask how it was or if there are any problems and then I can rest as long as I want before stumbling out to go home.

It is a very peaceful time.

Is it working?

I think so. I am having a difficult time believing it, but the symptoms are noticeably reduced. They are still temporary reductions but the time without them is expanding with each session.

Is it a cure?

I wouldn’t go that far. Even if a person gets down to an annual treatment, that means you still have symptoms.

It is helpful and has been life-changing for many.

Is it better than daily psych meds and how does it affect me?

A million times better. Most of the listed side effects are transitory and the serious and long-term effects almost never show up unless you are abusing it.

For me, the dissociative effects are difficult sometimes. That is odd because I dissociate somewhat often without medication. I think it has to do with epilepsy. Losing control of my mind is very frightening to me so as long as I can somewhat control the dissociation, I am okay. Even in the few instances, it was too much, it was never as bad as a seizure.

It dilates the respiratory tract and I have sleep apnea, so it has a temporary effect on apnea events. It lowers them to almost zero. My tension and migraine headaches are reduced for a few days after as is anxiety. It is truly remarkable.

During the treatment, nothing feels real, not even myself. I remember thinking during the treatments that I could live happily like this forever.

While I am dissociating, I try to think about things that cause my anxiety to spike. That has helped those anxious thoughts to disappear.

Is it worth trying?

Just a few months ago, things looked very bleak. I am still on the path to peace but it feels less urgent so have seem to have pushed back the date. I just might have found another fork in the road.

To answer the question, yes, yes, and yes.