Ketamine Treatment: D3
The Second Week Begins
So, I’m beginning the second week of treatment.
I’ve had four non-treatment days between.
They have been up and down, which I consider regular days.
There was a pretty significant dip Saturday, which I’m sure was environmental instead of simple chemistry. I’m clearly not doing a great job of being a partner, and I really don’t have any excuse.
I mean, I’ve got the basic mental and emotional stuff I can blame, but the reality is….
Well, I don’t know what the reality is.
Good intentions are like buttholes: everybody has them. (See addendum.)
And that’s probably part of the point of all this.
Ketamine Treatment and the Waiting Game
One of the hardest things about ketamine treatment for depression is that I have absolutely no idea how quickly I’m supposed to notice something.
I’m trying to maintain a general state of positivity about the treatment. That positivity occasionally flags.
It feels a bit like some kind of physics equation:
H − (DT × 2) = ChW
Hope minus twice the time you’ve been depressed equals the chance of the treatment working.
But I hope that’s not true.
The actual research is considerably less tidy than my completely made-up equation.
Studies have found that ketamine can produce relatively rapid reductions in depressive symptoms, sometimes within hours or days. According to an article in EClinicalMedicine (Nikolon, Rodgers, Schwaab, Bahji, Zarate, Vazquez, and Loo), a 2023 systematic review and meta-analysis of 49 randomized controlled trials involving 3,299 participants found evidence of antidepressant effects following ketamine treatment, including during repeated dosing.
That sounds encouraging.
But it also doesn't mean that everyone walks out of treatment feeling transformed.
One of the many interesting things about the research is just how much variation there is in response, timing, treatment type, and duration of benefit. Earlier meta-analyses have found significant effects after a single treatment that can persist for several days, while repeated treatments may help sustain the antidepressant effect.
So, apparently, my brain doesn't have to follow my imaginary—though pretty kickin’—equation.
That’s cool.
Ketamine Treatment Day 3: What I Actually Experienced
Today’s treatment was quite interesting.
I downloaded an application called Limitless, which was recommended to me, and used it during the treatment today.
I am not getting any sponsorship from Limitless, nor do I really know anything about them. I'm simply documenting what I used and what happened.
During the treatment, the application took me through several guided audio exercises involving:
getting centered
getting grounded
setting boundaries
practicing neutrality
It gave me something to focus on. And, when the treatment hit full potency, the Limitless audio really seemed to enhance the positive effects.
That was probably the biggest difference for me today.
Instead of simply experiencing whatever my brain decided to throw at me, I had something to gently focus on.
Getting Centered During Ketamine Therapy
The centering guide was pretty much as expected.
Find your mind's eye.
Notice the space inside your head.
Make that space your own.
Imagine t a video monitor you can see just outside yourself.
I liked that.
Apparently, the thought is that by visualizing this monitor outside yourself, you can place upon it the stressors, the negative images, and self-talk as something external to who you actually are.
By externalizing those negative elements, your brain creates a safe psychological distance to be able to observe triggers of panic or anxiety or self-talk.
This gives you the ability to clear out what you can now see which helps you to reframe how you view triggers, supporting your nervous system regulation.
Heady.
Getting Grounded
The “Getting Grounded” guide was nice.
The guide’s voice is soothing and casual with a fair amount of humor —which is great for me.
There is something to the phrase,
“Laughter is the best medicine.”
That's probably not a clinical requirement.
It should be.
The “Getting Grounded” guide asks you to imagine that there is a rope or pipe or tether of some sort that is extending to ground from the base of your spine.
It connects you to the Earth.
It is unbreakable.
It allows you to float freely, to feel whatever you need to feel, knowing that you are safely tethered to this unbreakable bond to the Earth.
And when you feel stress, that tension, that fear —all those things weighing you down— they just slide down that tether, like water down a drain, and disappear into the earth.
Man, was that revelatory for me. That was gold.
Setting Boundaries Was Surprisingly Difficult
Oddly enough, I had some issue during the setting boundaries section.
Not anything with the guide, but with my reaction…my ability/inability or push back on setting my boundaries.
My reaction to it is surprising.
I suppose I don’t know what my boundaries are.
That's a pretty uncomfortable realization.
But maybe it's also useful.
If ketamine treatment is going to be about more than simply waiting for a medication to change how I feel, then these are probably the kinds of things I need to look at.
The chemistry may be doing its thing.
Now I have to do mine.
The Ketamine Treatment Exercise That Surprised Me: Neutrality
The neutrality section surprised me.
I really like it, and I learned from it.
I will definitely revisit this guide.
The basic idea was that becoming more neutral toward your triggers can give you some observational distance from your immediate reaction.
That concept hit me pretty hard.
Because my default setting isn't always neutral.
Sometimes it's more like:
Something happens → I react → I judge the reaction → I judge myself for reacting → I react to that judgment → congratulations, we're now several layers deep.
It's exhausting.
The visualization of neutrality as a color with volume—mass, not sound—was evocative and seemed to really focus sense of neutral observation taking over knee-jerk subjectivity.
Mass.
Presence.
Something that could occupy space.
I'm not claiming that this visualization is a scientifically established component of ketamine therapy.
I'm saying it worked for me.
And right now, that's what I'm documenting.
When Does Ketamine Treatment Start Working?
One thing they've reiterated to me is that people may not notice significant changes immediately.
And that is often only after their family and friends mention noticing a change in them: a lightness or a new openness.
The research does support the idea that ketamine can act relatively quickly compared with many traditional antidepressant treatments. But the evidence doesn't establish one universal timeline that applies to every person. According to the JAMA (the Journal of the American Medical Association), a recent systematic review and meta-analysis of 26 randomized controlled trials found reductions in depressive symptoms after single infusions at several time points from four hours through one week, while repeated infusions also showed benefits by the end of treatment.
But that was for infusions, not the nasal spray.
Infusions work better and faster.
Medical insurance does NOT pay for the infusions.
I am hoping that I will be able to tell the difference.
I just have to keep paying attention to my moods.
What I'm Learning from Ketamine Treatment So Far
That's probably the biggest lesson from Treatment Day 3.
Pay attention.
Pay attention to the chemistry.
Pay attention to the environment.
Pay attention to my reactions.
Pay attention to my relationships.
Pay attention to the stuff that makes me uncomfortable—YUCK!
And, perhaps most importantly, pay attention without immediately deciding what everything means.
That's harder than it sounds.
I want ketamine treatment to work.
Obviously.
But I also don't want to turn every mood swing, good afternoon, bad morning, argument, insight, or moment of calm into evidence for or against the treatment.
That's probably not particularly helpful.
The research suggests ketamine can have rapid antidepressant effects, but it also makes clear that response varies and that questions remain about long-term effectiveness and safety.
So I'm going to try to give this some room.
I'm going to keep showing up.
I'm going to keep paying attention.
And I'm going to try not to obsessively measure whether it's working every second of the day.
Because I'm only on Ketamine Treatment Day 3.
There's still a lot of sniffs and sour candy ahead.
Here's hoping for the best.
ADDENDUM
Although one of my favorite quotations, it turns out that is not entirely true—the buttholes, not the good intentions.
TANGENT: Anorectal malformation, or imperforate anus, is a thing. It is called a “rare” condition, but around 1 in 5000 are born with the condition. I don’t really see that as rare. It is so not rare that there is a Johns Hopkins Medicine Imperforate Anus Guide. I’ve linked it in case you want to do a little research.
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