Can ketamine therapy help depression? I experienced it to find out
I was a rocket blasting through dark tunnels of abstraction
I: MEETING WITH THE THERAPIST
I didn’t know much about ketamine when I entered the psychotherapist’s office to have it injected into my body. I knew it induced an altered state that’s been shown to work wonders healing treatment-resistant depression. And I knew it often sent people to a place called “the K-hole.”
I’d heard people mention the K-hole with a sense of dread, saying it brought on numbness and possibly sheer horror. It didn’t sound like a place I wanted to go.
As my psychotherapist took my blood pressure, I asked, “So when people talk about the K-hole, that’s at a much bigger dose, right?”
He replied, “With your dose, you’ll be in a K-hole in four to six minutes.”
I thought, Oh shit.
But wait. Those reports about traumatic K-holes had come from — who? Total strangers? The doctor now preparing this syringe was a professional, a compassionate man I trusted tremendously. He was no sadist; he was a healer.
“Any advice?” I asked, relaxing into the cushioned recliner.
With a thoughtful pause, he said, “My best advice is to surrender, and go for the ride.”
I pulled down my eyeshades, popped on my headphones, and felt the needle enter my shoulder. It was time to see what ketamine was all about.
II: WHAT IS KETAMINE?
Many describe ketamine as a horse tranquilizer. Others call it a psychedelic. In reality, it’s neither. It’s a dissociative anesthetic, meaning it distorts perception and induces feelings of detachment from the physical world.
Many think of it exclusively as a club drug that sends people into debilitating K-holes. In reality, it was once used to anesthetize wounded soldiers during the Vietnam War, not long after it was developed in ’62. To this day, it’s considered both safe and beneficial by the World Health Organization, sitting comfortably on their List of Essential Medicines.
Nowadays, psychotherapists across the country are administering ketamine — off-label, but legally — to treat patients suffering from anxiety disorders, PTSD, addiction, and, most popularly, treatment-resistant depression.
I don’t suffer from treatment-resistant depression. My depression’s been diagnosed as mild. But it’s a bitch sometimes, that old monkey mind repeating how worthless and shitty I am on an endless loop. Years back, I sought a fix. Explaining feelings to psychologists took too long, so I saw a psychiatrist and left with a Zoloft script.
I felt a little better, but the shitty feelings weren’t gone. The psychiatrist prescribed me Xanax. The combo — far from uncommon — left me feeling dull, uncreative, and impotent. Each pill was a bandaid on a wound that kept bleeding.
Ketamine-assisted psychotherapy aims to cure depression. It also advertises instantaneous relief, whereas SSRIs take weeks to kick in. Not a great option for someone with a knife to the wrist.
I got off those meds, but the I’m-shitty-at-my-core thoughts still come back. Coincidentally, they came on powerfully the week before my ketamine session.
I figured I’d get a low dose and talk to my psychotherapist about my mental struggles, the buzz giving me distance from those struggles’ grip. That would have happened, had I been given ketamine lozenges, a low-dose treatment model. Instead, I got the intramuscular (IM) treatment — 63 mg, to be precise. A high dose, as it turned out. A K-hole dose.
III: LEAVING MY BODY
Within minutes, my mouth was numb. My hands and feet felt far away. I rapidly lost sense of the physical world. Still, I was conscious, and my consciousness was traveling in rhythm with the mellow beats playing through the headphones.
High doses of psilocybin and LSD often bring visions of colorful fractals and churning mandalas. Ketamine brought a sense of voidness.
Body immobilized, my consciousness traveled through formless space with increasing momentum. I wasn’t controlling it. I was a passenger on a cosmic thrill ride. Synthesized overtones arose over the beats, and suddenly I felt myself descending, stretching across a wormhole, and dropping into an envelope of darkness.
I was entering the K-hole.
At a rave or a party, I might’ve freaked out. But even as I lost sense of who I was, I recalled I was seated in my psychotherapist’s office. I envisioned him beside me, and I recalled his advice. “Go with it.” I surrendered, letting the K-hole take me where it may.
IV: PERSPECTIVES ON THE K-HOLE
These fragments of an Urban Dictionary definition reflect my preconceived notions of the K-hole: “… the user becomes trapped in a state of detachment from their physical presence… as if stuck in a hole peering out.”
Key words: trapped, stuck.
I hadn’t considered this next definition, which boasts a higher like-to-unlike ratio: “Only noobs think that k holing is overdosing on ketamine when in actual fact, people with experience know that it’s the best bit.”
Colorado-based psychotherapist Jason Sienknecht, a humble, friendly man who recently introduced ketamine lozenges into his 18-year practice, doesn’t like the term “K-hole.”
“K-hole isn’t a clinical term,” he said. “It’s a street term, so it’s hard to say exactly what it is. But clinically, it’s that transformative level that one can reach on a high dose of ketamine.” He added, “Mystical experiences, out-of-body experiences, near-death experiences, ego dissolution — that all happens in the K-hole.”
When asked if people should fear it, Sienknecht shook his head. “Absolutely not.”
His advice mirrored that of my psychotherapist.
“Surrender to the experience, learn what it has to teach you, and you’re going to come out feeling a lot better.”
V: INSIDE THE K-HOLE
I was a rocket blasting through dark tunnels of abstraction. I was a torpedo speeding through a limitless ocean. I was a ship flying along a metallic river flowing through a galactic forest. I was in motion, a motion of tremendous momentum expanding infinitely across a cosmic vortex. I lost all sense of who or where I was. Still, I was, and releasing my fear filled me with a tremendous sense of joy and exhilaration that guided me across the cosmos and eventually back down to my body, still seated in that cushioned recliner.
VI: DESCRIPTIVE DILEMMAS
A problem with descriptions like these is that while people who’ve experienced ketamine may feel intrigued — perhaps even a sense of recognition — skeptics will reduce it to, “That guy’s on drugs.” Another problem is that these descriptions are, in a sense, totally inaccurate.
The only accurate descriptor of the experience is a word both Sienknecht and my psychotherapist used: ineffable. I can only describe my experience with metaphors. To understand it, you’d have to experience it yourself.
You might not want to. It can be heavy, after all, and possibly frightening.
“It takes courage to do this work,” Sienknecht said. “Sometimes deep trauma will come to the surface, which can be painful to work through. Inevitably, though, when patients come back to their ordinary mind, they know they’ve done good work.”
When I took off my eyeshades and saw my psychotherapist beside me, welcoming me back, I felt elated, but confused. K-holes aside, my confusion revolved around a core question: What the hell did that have to do with depression?
VII: HOW KETAMINE THERAPY WORKS
If you want to learn about the neuroscience, appeal to the experts. I’m interested in the theories, which tend to be explained, once again, in metaphors.
As he helped me process my experience, my psychotherapist likened depression to too many apps running, draining the battery. A high dose of ketamine reboots the system, helping people realize the apps don’t define them. In fact, they have the power to choose which apps to run.
In How To Change Your Mind, Michael Pollan’s recent book about psychedelics, Pollan entertains an analogy that likens the mind to a snowy hill. Thoughts are sleds, setting grooves in the snow, and as time goes on, the sleds follow the set grooves, deepening their impressions each descent. Psychedelics temporarily flatten the snow, allowing the sleds to create new pathways.
Though not a psychedelic, ketamine’s believed to have similar effects. According to Sienknecht, ketamine offers “complete liberation from that obsessive mind that has such a hold over someone deep in depression.” People with crippling depression live in their depression, where self-sabotaging thoughts become indistinguishable from reality. The mind’s entire sense of self runs on repeated phrases of I’m shitty. I’m worthless. My life is pointless. I should just kill myself already.
Talk about being stuck in a hole.
I liken it to the film The Truman Show. Truman lives in a constructed world until his sailboat collides with that world’s borders, where he discovers a door. He realizes the world he’s known has limits, and new ways of perceiving exists outside those limits. If he stays in the construction, he’ll keep feeling empty and unfulfilled. So he steps out to experience this broader world of limitless possibilities.
If the constructed world is depression, ketamine provides the vessel that leads outside the door. What awaits is boundless as the scope of a consciousness unrestricted by physical laws.
“Ketamine lets people access parts of their minds they didn’t have access to before,” Sienknecht continued. “They realize they themselves are an identity separate from their mind or body. That space, freedom, and perspective is healing.”
As Alan Watts once said: “When I see you, I see not just what you define yourself as… I see the primordial energy of the Universe.”
You may feel so depressed that you can’t get out of bed. But you are not your depression. You are far, far more.
You can read that a million times, but it won’t register until you experience it. Ketamine-assisted psychotherapy gives you a way to do that.
Hours after exiting the K-hole, I felt great. The next morning, I felt even better. I wasn’t magically cured forevermore — after all, patients undergo at least six sessions for long-term healing. But if I’d been in that shitty state for months, or years, or my whole life, then feeling genuinely good in body and mind in a way that endured could be all I needed to believe there was a way out. That belief alone can be far more healing than any SSRI.
There’s still so much we don’t know about ketamine. But amidst all this misinformation on K-holes and horse tranquilizers and wild journeys through outer space, one guarantee is that in the depths of a high-dose ketamine experience, you’ll have no choice but to leave your baggage behind, no matter how heavy it is.
Sometimes we just need to get blasted beyond who we think we are to open ourselves to possibilities outside our suffering.
[Originally published on October 17, 2018]