Ketamine Treatment: Treatment Day 7— Some Days Are Just Bad Days

NOTE: This blog post mentions "suicidal ideation."

Today has been difficult.

By far the most down day since treatment.

So much so that I am trying to squeeze in this brief pre-treatment statement in the room waiting for treatment.

And, of course, this gets the cycle of failure running—the feelings of failure and uselessness— followed by the inevitable judgment about having those feelings in the first place.

It’s a remarkably efficient little machine, the cycle of failure.

I’m interested in seeing how this mindset affects—if it affects—today’s ketamine treatment session.

Because right now, I am absolutely fatigued.

All I want to do is go home and sleep.

The pull toward sleep is forceful.

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This Was Not a Great Esketamine Session

I am absolutely fatigued.

All I want to do is go home and sleep.

Yet, I am still about 25 minutes from my pick-up time, and I am still clearly feeling the effects of the esketamine.

I’m a little floaty and slow right now.

I have managed to walk to and from the coffee station without stumbling (to) or spilling the coffee (from). So I have some control.

Wow! The pull to sleep is forceful.

This was not a great session.

Perhaps that means it was working?

I don’t know.

That’s one of the maddening things about documenting ketamine treatment for depression in real time. I don't have the luxury of looking back six months from now and knowing which days mattered. Right now, I just have the day I’m having.

Right now, I would say that, emotionally, I’m not in a great place.

The future feels bleak and holds little interest for me.

I am feeling powerful failure-vibes in pretty much every category:

Financially, Professionally, Personally, Privately, Creatively, Domestically.

Apparently, failure is an all-inclusive resort.

And then there is the darker part.

I wouldn’t say there is no suicidal ideation.

But the thought of nothingness—oblivion—seems like a warm, gray-cloudy blanket that I could gratefully pull over my eyes and simply nod off beneath.

Silence.

Even the ever-present hum of the electrical grid finally disappearing.

Me disappearing.

There is something seductive about the idea of simply not having to participate anymore.

But then there’s the other side of that thought.

It would be incredibly selfish and self-indulgent. I would be leaving the people I love to deal with life and to clean up whatever mess I had made of it.

So that’s not really an option for me.

That doesn’t make the feeling disappear.

It just means I have reasons to keep moving through it.

And maybe, sometimes, that’s what treatment is supposed to help with: not magically transforming a terrible day into a wonderful one, but helping create enough distance between the feeling and the action that you can make it through the day.

I went into this esketamine treatment expecting there would probably be ups and downs.

I was just rather hoping today’s session would bring me out of today’s funk.

It has not.

At least not yet.

The Weird Reality of Life After Ketamine Treatment

Part of the understanding they set down for you before treatment is that you aren’t supposed to do work, sign anything important, or drive until after you’ve had a good night’s sleep.

Having done a few of these esketamine treatments now, that makes sense.

Esketamine can cause sedation, dissociation, dizziness, impaired attention, slowed reaction time, and changes in judgment and motor skills.

Which, if you know me, isn’t far from the normal me.

Well, change “dizziness” to “ditziness.”

The FDA requires patients receiving Spravato to be monitored for at least two hours after administration, and the prescribing information says not to drive or operate machinery until the next day after a restful sleep.

But Life Is Life.

After my friend drives me home, my job will be to pretend there is nothing wrong.

I have voiceovers to do.

Future projects to discuss.

A group to work with on all of the social-media concerns of the week.

In other words, I get to project that positive, can-do-attitude, my here’s-a-joke, and fun-observation-here persona.

Work that personality that I apparently need to present to survive with some modicum of self-esteem intact.

And the strange thing is that those interactions —especially with those people I love— are also what keep me going.

The voiceover.

The work.

The people.

The jokes.

The ridiculous observations.

The conversations about future projects.

And then…

Good god! The most important performances?

The one for my kids.

My boys.*(see ADDENDUM)

All of those things can feel like performances when I’m this far down.

But they are also connections.

And sometimes the things that feel like performances are actually the threads keeping you attached to the rest of your life.

It’s important to remember that.

Because some days just getting out of bed is a big win.

It’s such a convoluted and confusing existence sometimes.

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What Does the Research Say About Esketamine Treatment?

This is one of the reasons I find documenting my ketamine treatment experience publicly so interesting.

The lived experience can look very different from the clean lines of a clinical trial.

Research gives us averages.

I only get Today.

And my Today currently sucks.

The evidence for esketamine in treatment-resistant depression (TRD) is substantial, but it certainly isn't a magic wand. A 2025 long-term extension study called SUSTAIN-3 followed 1,148 adults receiving esketamine —that’s the nasal spray— alongside an oral antidepressant. Participants had a median depression exposure of nearly four years, and the researchers reported that improvements in depressive symptoms generally persisted among people who remained on maintenance treatment.

That’s a good thing.

The thing for me to key into is the discovery that continuing esketamine can help prevent depressive relapse in people who have already responded to treatment.

Honestly, I was hoping I could give the treatment a year and then go off it.

Now, I don’t know.

The SUSTAIN-1 study * (see NERDENDUM) involving patients with treatment-resistant depression found that, of those patients who had achieved stable remission, 26.7% of those who continued esketamine plus an oral antidepressant relapsed, compared with 45.3% of those who discontinued esketamine and received placebo nasal spray.

What’s that mean?

Looking at the positive: Keeping up with the esketamine treatments has a pretty good percentage of “continually” fighting off depression.

Looking at the negative: Sucks to be in that 26.7%.

Easily put:  Relapsing into depression is substantially more common in those who stop the esketamine treatments.

That’s important.

But it doesn't tell me exactly what will happen to me.

It doesn't tell me whether today's terrible mood means the treatment isn't working.

It doesn't tell me whether tomorrow will be better.

And it certainly doesn't tell me whether this particular session was somehow secretly accomplishing something profound while I was lying there thinking, Well, this seems to be going badly.

Clinical trials measure populations. I experience Todays.

There is also newer evidence from long-term observational research suggesting that people who continue esketamine treatment can maintain improvements over time. Although real-world studies are smaller and have different limitations than randomized clinical trials.

So there is actual evidence behind this treatment.

There are measurable benefits.

There are known risks and side effects.

And there is plenty of uncertainty.

Which, frankly, feels like a pretty accurate description of depression treatment in general.

And that's where this blog comes in.

The research can tell you what happened to hundreds or thousands of people.

It can tell you about response rates, relapse rates, side effects, and averages.

It cannot tell you what it feels like to sit in a treatment room on Day 7, exhausted and dissociated, wondering whether you're getting better or simply becoming better at documenting how badly you feel.

That's what I'm trying to capture here.

Not a success story.

Not a failure story.

At least not yet.

Just the experience of going through esketamine treatment for treatment-resistant depression, one treatment day at a time.

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*ADDENDUM

My boys.

Anxiety with depression as a parent is a real mindfuck.

I’ve always had those issues bubbling around, but the real deal hit me after my parents died (perhaps more on that in following posts).

So, when I was daddy-not-dad, the first seven or so years of my kid’s growing was mostly magical.

And now, that time has mellowed the days and diaper changes and the continual questions and the fear of falling, those were the best days I’ve had.

There are really few things better than watching my boys play.

As my boys have developed and become more complicated and faceted human beings—and my depression took serious hold— parenting often became a Herculean effort.

And I know that I often failed.

I need this ketamine thing to work.

My kids need this thing to work.

* NERDENDUM

I am learning more about research than I ever thought I would.

The SUSTAIN-1, SUSTAIN-2, and SUSTAIN-3 trials are “Phase 3” clinical trials sponsored by Janssen Research & Development, LLC.

They are, of course, a subsidiary of Johnson & Johnson.

The makers of Spravato.

But that’s how this world rolls.

“Phase 3” means the study is a 1 to 4 year study based on a large scale, 300-3000 patients, and compares a “new” treatment against a “standard” treatment or a placebo. And most of them are blinded and/or randomized.

The studies, not the patients.

For this specific study on the Spravato:

SUSTAIN-1 studied “Relapse Prevention and Randomized Withdrawal.” This type of study is used to test if an experimental medicine or treatment keeps “a condition or symptom from returning over the long term.”

SUSTAIN-2 studied “Long-Term Safety and Maintenance.” This one’s pretty self-explanatory.

SUSTAIN-3 studied “Long-Term Open-Label Extension.” This means that participants and researchers all know that everyone is taking the active experimental drug.”

I guess I'm in an Open-Label Blog.