Ketamine Treatment: Treatment Day 6— I Am Enough
I’m looking forward to today’s treatment.
That sentence is worth noting because, up until now, I have been a little nervous about going in for the esketamine (SPRAVATO) treatments.
And while my last treatment certainly wasn’t as “profound” as the previous one, I have spent the last day and a half feeling pretty good…
Even when things—foreign and domestic—have delivered negative blows to my emotions, plans, or general desire to participate in civilization.
So I would call that a win.
Temporarily, at least.
Esketamine Treatment and the Weirdness of Feeling Better
Unfortunately, even with ketamine therapy, improvement doesn’t smash cut like some sudden cinematic moment where the clouds part, angels sing, and I suddenly become the person who remembers where he put his keys.
Improvement is almost always much quieter.
Sometimes it’s simply realizing that something happened that would normally send my emotional state careening downhill, and —this time— it didn’t.
Remembering that seems important.
There have been several publications and clinical data releases on the efficacy and timing of ketamine and esketamine treatment for Treatment-Resistant Depression (TRD)…
… although individual responses vary considerably.
The 2026 French ESKALE Study showed a 7-point reduction in depressive symptoms within the first week of beginning treatment.
Okay, like most “facts” these days, that statement is 72% more meaningless without knowing what “7-points” means. So, see my Addendum.
The point is that within the first week, patients felt—based upon the MADR scale—11% better.
By the end of the induction phase (4 weeks), they felt a 13.5-point reduction or 22% better.
Although individual responses vary considerably.
The 2026 Biological Psychiatry Monotherapy Study, ECHO Real-World Cohort Study, and ESCAPE-LTE Long-Term Study also revealed similar findings.
That doesn’t mean every treatment session is going to feel transformative, because…
… individual responses vary considerably.
Apparently, my brain is working on “individual variability.”
I Am Enough
My IFS/EMDR therapist has suggested I listen to a guided IFS meditation by Dr. Richard Schwartz while doing the esketamine treatment.
IFS (Internal Family Systems) and EMDR (Eye Movement Desensitization and Reprocessing) are forms of psychotherapy that purportedly help people “deal with stuff.”
And, while I have gotten to know The Critic, The Editor, The Homicidal Child with the Pillow, and the Fat Lady with an Empty Pint of Häagen-Dazs Double Belgian Chocolate Chip, I am not ready to bring them along to my hour of relief twice a week.
If that was confusing, see Addendumb.
I will not—at least yet—work IFS while enjoying the ketamine treatment.
I think I’m, however, ready to deal with the Limitless Journey Macrodose entitled “I am Enough.”
I.
Hate.
That phrase.
I told my Somatic therapist (yes, I have one of those, too) that it makes me feel so Stuart Smalley.
For those who don't remember Saturday Night Live in the 1990s, Stuart Smalley was the relentlessly positive character whose mantra was essentially that he was good enough, smart enough, and—dammit—people liked him.
I have apparently spent enough time in therapy to develop an allergic reaction to the concept.
I also don’t like the use of the word “Triggered” because of its flagrant overuse of the past decade, but that phrase triggers me.
The idea that I could feel like I am enough for anyone or anything is so far outside my current reality that it feels like a comical fool’s mission.
I told my therapist that my concern is that if anyone actually felt “enough,” how would they maintain the drive to improve themselves? How would they create new things? How would they push themselves to become better?
Naturally, my therapist stared at me for about five seconds.
Then she began writing feverishly in her notebook.
Which, frankly, is never comforting.
But today I am feeling different.
Today, I am feeling a little more open to the idea that perhaps I can be enough.
Which I suppose is kind of a big thing.
We'll see what today brings.
Treatment Day 6: Tired, Emotional, and Trying to Stay Grounded
It was tough to stay awake during today’s treatment.
I began the treatment tired.
I suppose that is an always thing, though.
Today I swung between—I don't know—relief…
And some strange combination of sadness and hope?
A little happiness?
No joy.
No euphoria.
Today actually felt like I was working.
Working to stay centered.
Working to stay grounded.
Working to stay focused on her voice; the “I Am Enough” Macrodose.
And maybe that is worth mentioning because there can be a strange expectation surrounding ketamine and esketamine treatment that every session should produce some kind of profound psychedelic revelation.
That certainly hasn't been my experience.
Sometimes the work is much less exciting.
It is just lying in a treatment room, listening to someone's voice, trying to remain present, and noticing what happens inside your own head.
Today was one of those days.
The Post-Treatment Exhaustion
I am still in my room, and I am very tired.
I began treatment about an hour and forty-five minutes ago.
I would very much like to take a nap and give in to the exhaustion.
Unfortunately, I am supposed to stay awake for a bit.
Nap later.
Sleep well tonight.
That is what they say is the best way to work with the treatment.
Sedation and somnolence are recognized effects of SPRAVATO. The FDA prescribing information requires patients to be monitored for at least two hours after administration because of risks including sedation, dissociation, and respiratory depression.
During the first hour after the Spravato huffing, the nurse comes in a couple of times to check on me. They take my blood pressure and my blood oxygen levels.
Within about an hour and ten minutes, the “debilitative” effects wear off. That’s when I open up my computer and start writing this section of the blog.
They’ll come in to check my stats again before I can leave.
My desire to curl up and hibernate is apparently not evidence that I have suddenly become a very lazy woodland creature, though I am partial to becoming a marmot.
The fatigue is a known part of the treatment experience.
Maybe a capybara instead.
SPRAVATO Savings and the Cost of Treatment
Today my nurse talked to me about the SPRAVATO withMe Savings Program, which was something I specifically wanted to discuss.
And this is one of those rare occasions when I have something positive to say about the American medical insurance/pharmaceutical-industrial apparatus.
Weird, huh?
Depending on your insurance coverage, the out-of-pocket cost of SPRAVATO can be significant. But the manufacturer currently offers SPRAVATO withMe, which provides several forms of cost and treatment support.
For eligible commercially insured patients, the SPRAVATO withMe Savings Program says patients may pay as little as $10 per treatment for the medication, subject to program limits and eligibility requirements. There is also a separate observation rebate program for eligible patients.
And that's worth investigating.
Importantly, the savings program doesn't necessarily mean your entire treatment is going to cost $10. The program distinguishes between the medication itself and the cost of treatment observation.
Naturally, insurance coverage varies.
So talk to your treatment center and your insurance company.
And check the actual program requirements before assuming anything.
But still…
A pharmaceutical company offering a patient assistance program that can materially reduce some treatment costs?
Forward-thinking.
Patient-centric.
Strange.
And welcomed.
Normally this is where I would spend several paragraphs spitting vitriol at the American system of medical-insuro-pharmoceutical graft and all its ancillary and fetid tendrils of malfeasance and mismanagement.
But today?
I'll give them this one.
Treatment Day 6 Takeaway
Today wasn't euphoric.
It wasn't profound.
There wasn't a giant psychological breakthrough accompanied by a choir of celestial beings.
I was tired.
I was trying not to dissociate.
I worked to stay grounded.
And somewhere in the middle of all of that, I found myself a little more open to an idea that I have spent a considerable amount of time rejecting the idea that:
I am enough.
I'm still not sure I like it.
I mean, I’m still me.
But maybe that's the point.
Maybe “enough” doesn't mean finished.
Maybe it doesn't mean complacent.
Maybe it doesn't mean giving up the desire to grow, change, create, or become better.
Maybe it simply means that I don't have to hate myself into becoming someone I can live with.
Maybe there is another way to grow.
That's a considerably more interesting idea.
I'll have to see where it takes me.
ADDENDUM:
Many of these studies base a person’s level of depression on something called the Montgomery Åsberg Depression Rating Scale (MADRS).
This is a 60-point scale assessing a person’s sadness, stress, sleep, appetite, concentration, ability to feel emotions, pessimism, and suicidal ideation.
It also assesses something called “lassitude,” which has something to do inability to start or finish something but I got a little
Anyhoo…
Here is the scale:
0–6: Recovered / asymptomatic7–19: Mild depression20–34: Moderate depression35–60: Severe depression
There is also a PHQ-9 scale and a Hamilton (HDRS) scale, so…
ADDENDUMB:
IFS, or Internal Family Systems Therapy, is essentially a way of helping someone understand the different “parts” (distinct inner voices) that try to “help us survive, cope, and protect us from pain.”
If you imagine the Human Psyche is a corporation, there are three departments made up of Exiles, Managers, and Firefighters.
Exiles are the parts that carry pain, fear, and trauma. Usually seen as someone of the age at which that trauma occurred, these “parts” are often isolated by a person’s psyche to help “protect” the whole system. One of mine is The Homicidal Child with the Pillow; how’s that for a personal revelation?
Managers are the administrators who handle the daily functioning, working to proactively keep control and prevent the pain from surfacing. I have discovered my Editor and The Critic. These are two very different parts, though they may sound the same.
Firefighters—a term I still have problems with—are highly reactive to “triggers,” often impulsive and intense, stepping in when an Exile’s pain surfaces. They are called “Firefighters” because it is their job to come in and “extinguish” the pain. I’ve got MonkeyMan, who is very interested in the myriad interesting things I don’t need to get done right now, especially if it involves having a “difficult conversation.”
Okay, examples:
EXILES
The Stifled Ecstatic/Artist is the part (often a child but could be older) who was shut down by strict caregivers or peers. They were told to “be quiet” or “grow up” while expressing moments of unbounded joy. Or they were told they couldn’t draw or that “art was for sissies” or artists were “useless.”
The Shamed Self—I have found this little guy, but I don’t know what he looks like because he is always curled in a dark corner—who believes they have little or no worth. They feel “stupid” or “bad” because there made fun of or punished for a mistake or, more likely, showing vulnerability at some point while growing up.
MANAGERS
The Caretaker focuses entirely on other people as a way to avoid personal needs in an effort to keep down feelings of unworthiness.
The Inner Critic—who is my tweed-and-suede-elbow-patched bastard—attempts to motivate you through belittlement and self-judgment. That way, if others attack you because you’re “stupid and worthless,” you already know, so it doesn’t come as a surprise.
FIREFIGHTERS
The Phone Scroller might step in when you are feeling lonely or rejected or useless. They force you to mindlessly consume social media, which helps to numb those negative feelings.
The Soother—this is my Fat Lady with an Empty Pint of Häagen-Dazs Double Belgian Chocolate Chip—usually steps in to deal with stress or shame. They use some type of behavior—overeating, drinking, substance use, obsessive movements—to cover over those negative emotions.
I imagine that IFS is one of those “therapy things” that people who would never go to therapy give as reasons for never going to therapy.
Look, I have spent nearly 30 years now in traditional talk therapy. And, while “getting things off of my chest” is nice and helpful, I’m not sure anything has clarified my inner workings for me as well as IFS.
It feels to me like the ketamine therapy can open me up or clear my clutter so that my IFS makes more sense and gives me the room to better myself.
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