I Tried Ketamine Therapy for Depression. Here’s What I Learned.
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Chronic depression has loomed in the background of my entire adult life. My first depressive episode occurred during my senior year of high school, characterized by a constant ache of paralyzing emotions. Tears started and wouldn’t stop until I cried myself to sleep. The next day, I’d white-knuckle it through classes — quieter, flatter, and sadder than my usually bubbly, extroverted self — then, I’d sob alone in my room that evening.
Almost 30 years later, my depression looks similar. I continue to feel crippling emotions that register physically in my solar plexus (the energetic chakra located above the navel, described in ayurveda), along with frightening, sinking sensations in my gut. Crying remains my constant companion, and at my lowest, tears fall as soon as I wake up. Quite simply: Everything hurts.
I’ve been off and on antidepressants (SSRIs) since my early thirties, starting with Lexapro, then Prozac, then a cocktail of Prozac plus Wellbutrin. I’ve found they all help stabilize my mood at first. Then, slowly, the effects wear off and I’m back to feeling anxious and depressed.
According to the National Bureau of Economic Research (NBER), middle age is a notoriously unhappy time for many people, and my situational depressive episodes are prompted by stressful events. Between the end of my marriage in 2018 and COVID-19 lockdown in 2020, I had a rough couple of years, to say the least — my episodes started to multiply and appear closer together. Whereas before I would have one major episode every one to two years, I began to have them every five to six months.
As a freelance writer, I find it’s nearly impossible to create during a major depressive episode — my brain is unable to focus or think critically. So my depression had become a financial and professional liability on top of the acute pain and utter exhaustion it caused.
Then, I decided to try ketamine-assisted therapy.
The Origins of Ketamine as a Treatment for Major Depression
First synthesized in 1962, ketamine was approved by the U.S. Food and Drug Administration (FDA) in 1970 for use as an anesthetic, according to a research article. But when doctors noticed that some depressed patients who had been given ketamine as anesthesia for routine procedures experienced relief from their symptoms, study of its cognitive effects on animals, and, eventually, humans, began.
John Krystal, MD, a psychiatrist at Yale School of Medicine, is credited with spearheading research into ketamine as a treatment for depression in 2000, when he and his team led the first randomized trial on depressed patients.
When Dr. Krystal began studying the drug, he thought its effects on cognition and behavior seemed profound. “When we observed the antidepressant effects of ketamine, we were shocked by the rapidity and magnitude of its antidepressant effects,” Krystal says. “The more we studied ketamine, the deeper we seemed to go in learning about fundamental aspects of brain function, the biology of psychiatric disorders and addictions, and the treatment of these conditions.”
By 2010, some psychiatrists were using ketamine as an off-label medication for treatment-resistant depression. But ketamine-assisted therapy gained mainstream traction in 2019 when the FDA approved a nasal spray medication called esketamine (Spravato), a form of ketamine, to be used with an oral antidepressant for people with major depressive disorder (MDD).
Though not a classic plant-derived psychedelic like psilocybin (magic mushrooms), peyote, or ayahuasca, ketamine has been classified as a “hallucinogenic agent” or nonclassic psychedelic. And the latest research on the mechanisms of ketamine, as well as other recent studies published in JAMA Psychiatry and the American Journal of Psychiatry, show positive effects on people with treatment-resistant depression.
One hallmark of ketamine therapy is the feeling of dissociation it may engender — a feeling of disconnection from the physical body, thoughts, or emotions. This altered state may then help people suffering from depression and other mental health disorders to examine traumatic memories, painful emotions, or stuck patterns from a fresh perspective, under the guidance of a licensed therapist, notes research.
Why I Decided to Try Ketamine-Assisted Therapy
Given the above, ketamine began to sound like a miracle cure for my chronic depression. But I also had a personal connection to psychedelic therapy approaches for mental illness: my dad.
Ironically (or not), my father is a psychiatrist. My brother, cousins, and I spent our childhoods running around the psychiatric clinic in downtown Indianapolis that my dad had opened with my uncle, who was also a psychiatrist. I sang holiday carols for the inpatients at the hospital while I was in middle school, and I later helped out during summers when my dad ran a day program for people with schizophrenia. My dad was the first person to recommend antidepressants to me in college, which I adamantly refused. This was the mid-’90s, and despite being raised in a mental-health-friendly environment, I thought being “medicated” would stigmatize me. In my mind because of mental health stigma, drugs were for suicidal cases and those suffering from psychosis.
That said, my dad and uncle also raised us with stories about the psychedelic research in the ’70s that brought them to the mountains of Oaxaca, Mexico. There, they participated in a psilocybin journey led by Maria Sabina, a shaman and poet known as the “Priestess of Mushrooms.” They then went to Mexico City, where my dad took a heroic dose — a colloquial term for a macrodose of psychedelics that induces a visionary state or out-of-body experience, per Harvard Law — of psilocybin, plus ketamine and peyote (note that Everyday Health does not encourage trying this combination). My uncle observed as my dad’s heroic dose was administered by the psychiatrist Salvador Roquet, and the experience was meant to foster ego death and ultimately psycho-spiritual rebirth.
In short, my dad believed in the potential of psychedelics to treat many psychiatric illnesses, like depression, PTSD, and schizophrenia. So, when all other treatments failed for me, I talked to him about ketamine-assisted therapy for depression, and he encouraged me to try this path to healing.
How I Found a Ketamine-Therapy Provider
I live in Colorado, one of the first U.S. states to legalize recreational marijuana, in 2010, and most recently to decriminalize and legalize psilocybin, in 2022. So, it wasn’t surprising to me that ketamine-assisted therapy seemed easier to find here than in other places. (The Psychedelic Research and Training Institute has a directory, too.) But most insurance companies don’t cover this treatment, and out-of-pocket prices can be prohibitively expensive.
Luckily, friends introduced me to a few practitioners in Fort Collins at the Wholeness Center, an independent integrative mental health clinic and one of the first U.S. healthcare providers to offer ketamine-assisted therapy, starting in 2015, as an off-label treatment for depression and PTSD.
The center was just about to host its first weeklong immersive ketamine retreat in Costa Rica in November 2022. It required evaluation and clearance by a psychiatric mental health nurse practitioner (PMHNP) to attend, and included therapeutic preparation, three ketamine sessions, group therapy, and integration, as well as room and board in the small, scenic beach town of Playa Negra. The price tag? $2,000 (equal to the cost of one ketamine IV infusion at some U.S. clinics, per KetamineClinicsDirectory.com).
I applied for a number of reasons. Personally, I liked the idea of taking time away from my regular environment to focus on my health, in a beautiful setting, for seven dedicated days. Also, after years of individual psychotherapy, I was interested in the group therapy and communal support this retreat offered. Major depression can isolate you, brutalize your self-esteem, and make you feel alone and worthless, per StatPearls. So, I wondered: What would it be like to gather with others who understood similar pain to try ketamine therapy? Would this be the reset my brain ached for?
“We’ve seen that when people get stuck or have transitional [life] events, it can be really difficult for them to move through it,” says Mary Rondeau, ND, a cofounder of the Wholeness Center. “We really get concentrated time with someone in a retreat setting and build in therapies that allow for breakthroughs and new perspectives on their lives. Ketamine may help with that along with incorporating group work together with individual work,” explains Dr. Rondeau.
So when my PMHNP cleared me, I committed to the experience.
Warning: I’m not encouraging just anyone to travel to a ketamine retreat on foreign soil. This was my choice and preference based on my own unique health needs and discussions with my medical providers. Always talk to your healthcare providers before pursuing any form of psychedelic therapy, as there are risks and complications depending on each individual.
Quick Overview of How Ketamine May Work for Depression
Depression is shown to decrease the brain’s neuroplasticity, which can keep people stuck in negative thought patterns and habits, notes research. And while no one knows definitively how ketamine may work for depression, or how long it lasts, there are theories.
Briefly, ketamine itself is thought to bind to the NMDA (N-methyl-D-aspartate) receptors in the brain, which play a role in our synaptic plasticity. This may allow neurons to create novel pathways in the brain that help patients with severe depression, per the aforementioned research review.
That same review found evidence that those who take one dose of ketamine may experience a euphoric, antidepressant effect that lasts up to a week. Follow-up doses may last longer, from 18 to 19 days. (A separate meta-analysis concluded that ketamine’s antidepressant effects may last longer — up to six weeks following treatment.)
“[For some patients, ketamine] enhances neuroplasticity in a profound way,” says Scott Shannon, MD, a psychiatrist and another cofounder of the Wholeness Center, of his clinical experience. “It appears to clean the chalkboard and allows [some] to start all over again. It [may be] a refresh for the brain.”
Although many media outlets and mental health clinics claim that ketamine has the ability to rewire the brain, Krystal finds this description too simplistic. “When people use the phrase ‘rewire the brain,’ it appears to suggest that a new pathway is created,” Krystal says. “I do not think that there is any evidence to support that idea. Instead, research in stressed animals and depressed patients suggests that these conditions are associated with impairments in the communication between nerve cells in brain circuits associated with mood regulation, reward processing, decision-making, and other functions that underlie human resilience.”
In other words, ketamine may potentially “regrow lost synaptic connections between nerve cells,” Krystal explains. “It also seems to reduce depression-related changes in the communication between brain structures,” he says.
Because ketamine’s effects aren’t permanent, it may be more effective for people with depression when paired with other mental health approaches. In order to shift out of depression, “people need to change their thinking and behavior,” Dr. Shannon says. “Ketamine provides a temporary boost, and then fades. Psychotherapy and integration make all the difference in the long run. Because, without that, people tend to go back to the way they were,” he explains.
With this drug-therapy combination under the guidance of a licensed practitioner, the dissociative effects of ketamine may be a gateway to self-discovery, and many patients report experiencing profound realizations about themselves and their lives, per a recent systematic review and a narrative review.
“There can be flashes of insight that may not have been accessible before,” says Shannon. “It [may give some] a [new] experience of consciousness … the ability to look at things creatively.”
My Jungle ‘Trip’: Life Lessons I Learned From Ketamine
I embarked on my retreat to Costa Rica depressed and anxious. As usual, even though I live in sunny Colorado, daylight saving time had sent me into a downward spiral.
There was a group of 13 of us, ranging in age from 19 to late sixties, including one couple, a father-daughter pair, and solo seekers like me. All of us were suffering from depression, grief, or PTSD. Our licensed facilitators — two psychotherapists, a naturopathic doctor, and a psychiatric nurse practitioner — quickly fostered trust within our group. We freely shared our stories, hopes, and fears in preparation sessions, and developed community poolside and at meals. It felt healing to be in a relaxing environment with others who understood emotional pain and yearned to feel better.
I had never taken psychedelics, so I was incredibly nervous about the ketamine experience itself. Our first ketamine session happened on day two. We gathered in the screened yoga studio surrounded by tall, shady guanacaste trees, and took our places on mats topped with supportive bolsters and eye masks, circled up in small groups of four or five. Our heads lay in the center, our bodies fanned outward.
Under the guidance of our practitioners, we selected our individual doses of ketamine, provided in the form of sublingual lozenges, ranging from 100 to 300 milligrams (mg). Because everyone reacts to medication differently, our practitioners advised first-timers to start with smaller doses. As a novice, I opted for 150 mg.
After settling into the space and hearing an inspirational reading from one of the therapists, we were invited to set an intention for our journeys. I chose self-compassion. One of the most painful symptoms of my depression is a constant stream of negative self-talk, where I berate myself for being lazy or unable to cope with the stress of everyday life like a normal person.
We all then took the lozenges at the same time, and per instructions, allowed them to dissolve in our mouths. They tasted bitter and unpleasant. Then, we swished the medicine around for 10 minutes so it could enter the bloodstream via the skin in our cheeks. Peaceful music played in the background, and after about eight minutes, I started to feel relaxed and woozy. I swallowed, leaned back, put my eye mask on, and surrendered to the experience.
Dose 1: Change Doesn’t Occur Overnight
My first journey was mellow. I felt relaxed and at peace, as if I were sinking into the floor. The only visualizations I had were the words “open heart” and “slow change” in my mind’s eye.
“Slow change” felt frustrating because I had pursued this treatment to accelerate change. An hour and a half later, when the ketamine wore off, we journaled about our experience and then divided into small discussion groups. I was a little disappointed by my journey. Not much happened. Was this worth all the money?
Dose 2: Curiosity Is Critical to Healing
Two days later, after dedicated integration work, we embarked on our second journey. This time, I took a larger dose — 250 mg. This time, I hoped for a more revealing experience.
I lay next to the youngest participant, a 19-year-old woman, and after I dissolved and swished the lozenge, I really felt it. I turned my head toward her and said, “I am high as f***.” Then, we held hands and began to laugh.
I felt like I began to levitate up into the sky, chest first, until I was floating in space. This time, I experienced intense visuals. I saw a staircase leading up to a door, slightly ajar. I walked toward it and noticed it led to the entire universe. Various characters floated in space from fiction movies of my past, and my observing or conscious mind wondered how this could possibly help my depression. But, I maintained an attitude of curiosity and openness to the experience. I witnessed images typically perceived as creepy, like clown faces melting into doll faces. However, the dissociative effects of ketamine allowed me to observe something potentially frightening without fear. It was then that I realized objects and memories could be neutral. It was the stories I told about them that created fear.
Ketamine drove me to embody realizations like this, which translated to my experiences of depression. Intellectually, I understood that the stories I told myself about my history or future were just that — stories, not facts. Once I felt and embodied this insight, I found it possible to access this truth over and over, even months later (more on that in a minute).
As a person who experiences overwhelming anxiety, ketamine helped me to feel the antithesis — complete fearlessness — momentarily and by abandoning concern for the future. In essence, the mindset I felt with ketamine liberated me from old, unhelpful patterns temporarily and brought me into the present.
Dose 3: Transformation Takes Time; Slowing Down Helps
At my third session, I took the full dose: 300 mg. I chose to let go and fully relax, refraining from self-judgment. I actively welcomed every hallucination and asked what it had to teach me. This time, I visualized the natural world. I started off as soil, and I looked up to the sky above, then transformed into a seed that rapidly grew into a magnificent guanacaste tree, from roots to leaves. From there, I became honey, a healer in many traditional cultures. My journey ended with the phrase: “You are the medicine.”
Insights from my final journey were less straightforward. Once again though, I felt the essence of transformation, which I knew then would take time. I realized I couldn’t change everything, especially my depression, in one go — that slowing down and being gentle with myself might just be the bridge to expansion that I needed.
The Importance of Psychedelic Integration for Me
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