Ketamine therapy to treat depression and anxiety

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Medicaid will cover the nasally-inhaled Spravato-brand "esketamine" analog, but not IV infusions or sublingual treatments, as far as I know.

Google "Ketamine clinic" plus your town to locate one

In your experience, would a 25mg sublingual troche cause any noticeable dissociative effect? Or any feeling of being out of it or dreamy or anything of the sort? Or any other feeling that might make one feel vulnerable, or perturbed?

If there is any risk of that effect, I would not be able to bring myself to take it.

Is it advisable to take it alone, at any dosage? Wouldn't it be better to have a trusted person there in case one becomes weirded out in any way?

My sublingual troche dose is 800mg (I weigh about 205 pounds, at the moment), so my guess is that you'll feel very little if any dissociative effect at only 25mg.

A "trip sitter" is always advisable for someone's first hallucinogenic / entheogenic / dissociative experience.
Both for health safety aspects and for emotional support, if things go awry.

My guess, though, is that at 25mg, you'd likely not have any significant chance of a "bad trip"

I take my 800mng doses when alone, but I've had plenty of experiences with mid-altering substances, and am prepared for the weirdness that can accompany such experiences...

Darron

I will be participating in some scientific research at the National Institutes of Health in Bethesda, Maryland, from mid-March, 2024 through mid-April.

The research involves a 5-week in-patient stay at the campus there.

I will be undergoing multiple functional MRI scans of my brain, IV Ketamine infusions, sleep studies, and interviews. The goal of the study is to help determine if there are differences in currently-measurable brain activity in people like me who have had suicidal ideation within a year, and also how and if Ketamine can affect such brain activity.

I may be offered the chance to participate in further fMRI trials, involving Ketamine (in other ways), TMS (Transcranial Magnetic Stimulation) and also sub-seizure-level Electro Convulsive Therapy (ECT). And perhaps other studies, too.

The researchers are aware of my ASD Level 1 diagnosis, and my suspected ADHD diagnosis, too.

Thanks for your response. I have to give it some thought, even though the dose I was prescribed is very low.

I'm also a bit concerned about the possible effect of being able to see things more clearly. I've been going through a very rough patch with the love of my life leaving me and I worry that seeing my situation more clearly will lead to greater rather than lesser despair. I tend to only feel okay when I am distracted, and to cry when I am alone with my thoughts.

In my experience, Ketamine allows me to "witness" my memories and emotions, in a detached way. So I can experience them without "living" them. This has allowed me, on many occasions, to form important new connections and move forward with healing and self-understanding.

What is that? I’ve heard of a therapy where you take an ice bath.

Can you elaborate? I'm not sure I understand the question.

For months, I’ve been meaning to write something descriptive here, to the limited degree that this is possible, describing what a Ketamine session is like. I haven’t been up to it, but the other night, my younger brother texted me, mentioning that his youngest daughter might be starting ketamine therapy soon.

He asked:

“Is it the best treatment you experienced in your life?”

My initial response:

“By FAR, yes”.

What follows is a slightly edited version of what I followed up with, very “stream of consciousness style”, at a little before midnight. So, it’s more than a little rambling, and includes some technical data, similar to what I wrote earlier in this thread, so bear with me…

I was in a VERY deep hole for years when I started on Ketamine. I would wake up pretty much each day thinking "f**k! Consciousness!".

A couple weeks into the treatments, I ended up in pretty much full remission, even though I was deeply mired, mentally, in my very rocky long-term relationship that has since ended.

Ketamine has also proven to be remarkably effective in quelling suicidal ideation, both for me, anecdotally, and clinically.

None of the other MANY psych meds I tried did much more than MAYBE slightly even out the highs and lows.

A VERY possible exception is Psilocybin (shrooms).
During the early years of my LTR, when we did them on occasion (maybe every 6 months to a year in between), I was somewhat more functional, I think, and was doing quite a lot more of the many projects she wanted me to do.

I was at that point still completely stuck in the idea of being bipolar, which I now know to be totally wrong.

I didn't even know I experienced anxiety back then, and didn't understand this until recent years.

And I certainly didn't recognize how directly my experiences affected my mood, instead always blaming the VERY rapid mood shifts on "random chemical imbalances in my brain", and hoped that the various psych meds would help, but they didn't.

When I got into full remission with the Ketamine, I would wake up each day (alone, in a separate house) and think "woohoo! what can I learn today?!". There were the inevitable issues when I had to interact with my now-ex, but even those were MUCH less troublesome (to ME).

I did my most recent sublingual Ketamine treatment on my 55th birthday, on Thursday.
It had been about two weeks since my last treatment, and I needed to do it again.
The sublingual version I'm doing usually doesn't last that long, but I’ve been in a very good overall mindset, recently, due to being in a truly amazing new relationship, so the benefit lingered longer.

I'd say I had a maximum of somewhere between one and two+ months of close to full remission, back when I was doing the IV infusions.

I don't think I've ever gotten to full remission with the sublingual, even recently when I've been in a very good "set and setting" here in Florida.

And being in the total mental and physical s**thole that was my life in northern Nevada, living in an RV since January often meant the effect from a sublingual K treatment was very short lived.
But it still gave me something to look forward to, as IN the experience (inconsistent and usually less intense as it can be with sublingual) I am completely disconnected from my bad emotional state, and can "observe" my thoughts, memories and the bizarre "world" that I'm immersed in, in the K-Hole, from a very detached, therapeutic way.

And if in a good set and setting, the "neuroplasticity" phase of the Ketamine treatment, which involves literally growing and creating new neural connections, can be very useful to lock in positive ways of thinking and acting.

Neuroplasticity occurs in the hours and days after a treatment.

I was told that during the initial IV infusions that a very strongly positive response in the first treatment was statistically correlated with a less-effective longer-term response.

My initial positive response was mild, and I ended up doing the whole initial course of closely spaced treatments, with excellent result in the weeks after.

As to the experience itself, my first IV infusion was with no "bolus", just a regulated feed at a starting rate, so it took quite a long time to "get there", but once fully in the experience, it was mind-blowingly intense, for me.

My 2nd and all later treatments started with 30mg of the total 150mg of K being blasted in as a "bolus".

This makes me really start to feel it in seconds, but I get to the very deep part in maybe 20-30 minutes?

In initial sessions, I kept having the feed rate upped until I was at the highest level I tried, and stayed at (1 milligram per kilogram of body weight, per hour of feed)

When the full 150mg has been injected, and the feed shut off, it takes about 20 minutes to drop out of the hole enough to be able to get up and walk to where the nurse pulls the IV.

Maybe another 20 minutes later, and I'm walking to the car (carefully).

About 3 hours after the feed is turned off, I'm back to "normal", as to the side effects of the drug, but often doing quite well, mentally, and sometimes VERY talkative.
The next morning is often a very "chatty" time, too, though there was a time or two on the day after an IV infusion where I felt a bit of a temporary "dip" in mood.

Memories like that are tempered by the fact that I was in the last year of a long-failing, very intense relationship, so any bad effects can be at least partially assigned to an "unknown" cause, given the daily stress that I was under.

There are a series of plateaus as you get deeper into the experience, where you're kind of cruising along at a certain intensity for a while, then all of a sudden, you find yourself in a very different, deeper pool in moments, then you restabilize at that level.

From what the anesthetic nurse told me, many patients don't see much beyond some faint, swirly, muted colors.

At the deepest levels, and at higher feed rates, I get such mind-blowingly detailed visualizations that I can't describe them with any meaning, in just words. 8K full-motion cinematics of such detail, pseudo realism and intensely bizarre look and feel. An entire new Universe, each session, and endlessly morphing throughout each session.

These visualizations are always quite "dark", as if the “backlight” of the scene is turned way down, but because I always (now) use an eye mask, the detail is always there to be noticed. The character, animation and detail of what I see ratchets up with the plateaus, but at the final "drop", the effect is often of being in a peaceful room with somewhat familiar objects and scenery, with little or no motion of the "camera".

Earlier on, the camera is ALWAYS panning, with the "frame rate" early on being very staccato, and eventually, buttery smooth 100+ FPS.

Resolution just keeps going up and up, and being that it's ALL in your visual cortex, there are NO optical or retinal limits to the detail that you "see".

I sometimes start to focus on something that looks immensely detailed, then the experience just kind of says "Yeah, you think THAT'S impressive?" Have a look at THIS!! !, then a crash zoom into fractal detail that never ends…

And all that isn't even mentioning the "feeling" of it all.

Memories from my whole lifetime play out, not visually, but experientially. Many of them are things (and people) I haven't thought of for many decades.

Some of my almost-always "takeaways" from these sessions:

"everything, everyone and all of time" is connected.

"everything happens for a reason".

"i am destined for better things, or a defined purpose"
This could easily be defined as grandiosity, a common side-effect of Ketamine, but it feels way more "external" than that.

Another frequent (always?) theme upon entry into that very odd other state of being is a vague sense of being communicated to that "Oh, you're back! We've got work to do! Let's get on it!"
NOTHING like literal words coming through, much more of a feeling.

When I'm "in there", I just can NOT come to terms with the idea that it's "all in my head".

It seems vastly more complex than anything my stupid, degrading, weird old brain can do on its own. It seems much more like a connection to something external, and is a VERY "digital" experience, though this could be explained by my affinity for, interest in and knowledge of the way digital communication and mediums work.

I no longer latch onto my previous mental bedrock of being just an isolated, discrete electrochemical computer in a slowly dying meat suit.

I'm not giving my experience a name, because it doesn't have one.

It does seem, though, from experience, that intentions can manifest in what we like to think of as "reality", and I'm gradually learning just how powerful this daft idea may be…

Experience of time passing can be very dramatically altered, and a high-feed-rate, 90+ minute IV session can feel like weeks.

Being fully disassociated from BOTH your body and your sense of "self" is a fascinating part of it all, too.

If I feel like I'm getting too far away, I can "check in" with my body, often by just squeezing the armrest of the recliner I'm in, though this feels like someone else doing it, and describing it to me, rather than my own hands doing so.
When the doc comes in to check on me, and maybe ask me if I want a rate adjustment, up goes the eyemask, and I'm back in my body and (mostly) my "self", though with bizarrely distorted vision and sound, and making the effort required to speak a few words is immense.

Down goes the eyemask, and in moments I'm back "in", though now in a totally different place.

Each and EVERY IV session, though very consistent in the "shape" of the intensity of the experience, is vastly different in visualizations, memories and thoughts.
I've never recognized more than a few very slight consistent "through lines" to the various experiences, with each being a massive series of surprises and tone, but with none of them ever being distressing, despite being run through the wringer of the Universe in many directions, in 6 dimensions, and at different speeds.

Music is VERY important, but not really WHAT music, as long as there are no, or VERY few vocals.

Almost any soundtrack will sync PERFECTLY with what is seen and felt, and the spaces between tracks are often a source of an incredible feeling of impending surprise at what's about to crash into your attention.

The distorted sound at higher feeds is amazing, and I find something new to hear in the same tracks each time. Even the order and placement of the tracks in the "movie" seems "guided", though I almost always just let random play take charge.
I sometimes hear a silence before the next track, and anticipate the "perfect" next one, and there it is…

In short, for the right person, Ketamine is a life-altering experience, and one that will likely destroy any illusions of complacency about one's place in life, and erase the feeling of being just a bunch of elements from the Periodic Table, flying in close formation for a little while.

Ketamine gets me unstuck, unblocked and deeply connected to other people in ways that I never imagined were possible.

Ketamine killed Matthew Perry.

Not necessarily an accurate way to state what happened. Perry had Ketamine in his system when he died by drowning, and he had physical comorbidity, as well:

We watched that last night.
I have physical comorbidities too.
Many people do, and they're often undetected until it's too late.

There is, unfortunately, no medication that has zero risk involved. It's always a risk to benefit consideration.

From the headline, it seems that he was found to have a dose in his system of the same magnitude that would be found in someone who was under full anesthesia in an operating room, which would be around 4 times higher than the highest feed rate I ever experienced, and that was in a clinic, while being monitored by medical people. Why he was by tubs/pools while THAT seriously dosed is the question, as he would be absolutely unable to save himself if immersed in water while so seriously affected by an anesthetic.

I'm going to come back and read this again when I'm better able to absorb it. I'm scatterbrained this week and not retaining information for sh**.

The fwb I have now, he's been looking into doing ketamine treatment. He'd be doing it outpatient. I'd like to have him read what you wrote. I think he'd dig it.

The first time I heard about Ketamine was on the Joe Rogan podcast. They talked about it being a really strong psychedelic experience, and I didn't want that for myself. I didn't feel like it was safe to use, and I stuck to regular anti-anxiety pills. I also do the guided meditation. The effect might not be as fast as when you take Ketamine, but if you do it long enough you will reach that zen state. Meditation is a popular thing now, a lot of people do it, but also a lot of them aren't doing it the right way. You can use YouTube to learn how to do it, but I'm more for a personal approach which is why I use the Calmer app. With it, I never forget about my meditation because it reminds me of it. It also gives me other exercises that I can incorporate into my medication and get better at it all the time. I know that Psychedelic drugs like Ketamine gained popularity recently because you can hear about them on podcasts, but that doesn't mean it's the best solution out there.