Ketamine Treatment: Treatment Day 9 — Esketamine, Self-Love, and the Vulnerability of Being Seen

Tapping.* (see AD-AD-AD-ADDENDUM) I need to see the research. Sounds too woowoo.

Do I actually —deep down— want to be fat as some bizarre safety mechanism? Is that why I can cut my calorie intake drastically and still not lose weight? What the hell is up with that?

I am loved. Why does it feel so stupid to say that. Even to think that? To fight with the idea that someone could actually love what I loathe so much. Is that their flaw or mine?

Three thoughts.

Buzzing in my mind this week like a saw snarling and rattling in the yard.

Today is the first day of my once-a-week esketamine treatment schedule.

Yesterday was pretty rough: a general sense of overwhelm and hopelessness.

I also had my Somatic Therapy session *(see ADDENDUM) yesterday, so I guess the timing was good. Sometimes the universe gets its scheduling right. Or maybe my therapist does. I should probably give credit where credit is due.

My somatic therapist suggested that I try the “I Am Loved” macrodose meditation from the Limitless Journey app.

Unfortunately, the actual title is I Am Love.

There is a difference.

“I am loved” means that people do, in fact, love me. “I am love” means that I am the embodiment of love itself.

One of these feels like a potentially useful reminder. The other sounds like something Stuart Smalley might say while gazing into a mirror on Saturday Night Live.

“I'm good enough, I'm smart enough, and doggone it, people like me.”

Nope. Still not comfortable.

But perhaps that discomfort is worth examining, eh?

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Esketamine Treatment Day 9: When Self-Love Gets Uncomfortable

First off, today's esketamine treatment session was great.

Second, there is a vulnerability here that I do not like.

Okay, let's back up.

I talked with my nurse, Abby, about the Limitless Journey “I Am Love” Macrodose Journey. I explained my concern that it sounded like it might be a bit more woo-woo than I was comfortable with. I'm not opposed to the occasional woo-woo experience, mind you. I'm just not particularly interested in being asked to swallow a spiritual affirmation that my brain immediately regurgitates with extreme prejudice.

Abby, my nurse explained that, from what she had heard, the meditation was really about deserving love and learning to love yourself.

Bingo.

That was the part that hooked into today's session.

And it was phenomenal.

I mean, I have no idea whether it worked in any measurable clinical sense. I'm not about to declare myself cured because I had an emotional experience while listening to a guided meditation. But the wisps of memory I have from the session speak strongly to me.

While I was in the midst of the esketamine whirl, the idea that I deserved love—including my own love—became something I could actually feel rather than merely think about.

The message was essentially this:

It is okay to love yourself.

You deserve that love.

And if you don't know how to do it, that's okay, too. You can learn how to.

Yeah.

That was a pretty emotional moment.

I recognize it as an important one.

Not necessarily because it proves anything about the effectiveness of esketamine, or because I suddenly understand how to love myself, ‘cause…yeah, that’s going to take a while.

But because, for a moment, the possibility of treating myself with kindness didn't seem quite so ridiculous.

That is something worth paying attention to.

The Research: Self-Compassion and Depression

I’m sure it comes as no surprise that there is an ever-growing body of research suggesting that self-compassion can be a useful part of managing depression, anxiety, and stress.

A 2023 meta-analysis by Areum Han and Tae Hui Kim, called “Effects of Self-Compassion Interventions on Reducing Depressive Symptoms, Anxiety, and Stress: A Meta-Analysis,” examined 56 randomized controlled trials involving self-compassion-focused interventions. The researchers found small-to-moderate reductions in depressive symptoms, anxiety, and stress immediately after the interventions, although some effects were smaller at follow-up. The authors also cautioned that the overall risk of bias was high and that more rigorous research is needed.

In other words, learning to treat yourself with kindness may help. Or not.

At least in 2023.

Now, a newer analysis, “The protective role of self-compassion in trauma recovery and its moderating impact on post traumatic symptoms and post traumatic growth,” * (see ADLEDENDUM) by Adonis, Loucaides, Sullman, and Lajunen, finds that “Self-compassion significantly moderated the relationship between PTS and PTG. Higher levels of self-compassion strengthened and enhanced positive PTG, even among individuals experiencing elevated levels of PTS.”

Oh my God! Write for normal humans!

Okay…what that means is that there is proof that being kind to yourself, being more positive about who and where you are, can actually help you grow and heal better after suffering trauma.

PTS is Post Traumatic Stress and PTG is Post Traumatic Growth.

They noted that self-compassion is a sort of protective emotional buffer by actually reducing self-criticism. It helped people stop avoiding emotional discomfort because they were able to emotionally regulate better. They were less afraid of emotional discomfort.

That heightened emotional regulation allowed them to process their trauma better, often finding a greater personal meaning in surviving that event.

This interests me because self-criticism can become a particularly vicious companion when you're dealing with depression.

You feel bad. Then you criticize yourself for feeling bad. Then you feel bad about criticizing yourself. Before long, you're trapped in a mental feedback loop that would make a malfunctioning smoke detector seem emotionally well-adjusted.

All I know is that in my “loop,” the idea of being kind to myself feels unnatural, undeserved, and bizarrely embarrassing.

But research on self-compassion distinguishes it from self-indulgence or pretending that everything is wonderful. It involves recognizing your difficulties without responding to them with relentless judgment. You can acknowledge that you have made mistakes, that things are hard, and that you have work to do without deciding that you are fundamentally defective.

That distinction matters.

Self-compassion doesn't require me to believe that I'm wonderful at everything. It might simply require me to stop treating every shortcoming as evidence in a criminal trial against myself.

I'm not sure I'm there yet.

I know that my work with IFS (Internal Family Systems)—which I discussed in earlier posts— is helping with that.

And today, at least, I caught a glimpse of the possibility.

Ketamine Treatment, Emotional Processing, and the Woo-Woo Question

There is another interesting question here: What role, if any, does the subjective experience of ketamine or esketamine treatment play in its antidepressant effects?

Look, esketamine is not simply a medication that makes you feel good while you're taking it.

It has established clinical uses for certain forms of depression, including treatment-resistant depression, and its effects involve brain systems different from those targeted by many “conventional” antidepressants.

Researchers are investigating how ketamine may affect neuroplasticity—the brain's ability to change and adapt—and how those changes might relate to improvements in mood.

“Neuro” has sort of become the prefix du jour: neurodivergent, neuroplasticity, neurojerk.

But I digress.

A 2022 …. * (see ADDITIONDENDUM)

A 2022 systematic review of research on ketamine's rapid antidepressant effects found evidence linking ketamine-related changes in molecular pathways associated with neuroplasticity to improvements in depressive symptoms.

Blah blah blah.

Okay, this is what that means—and, trust me, this did not come easy to me.

Imagine that our brain is the state of Iowa.

We have a network of roads all connected together in various ways.

These roads help different parts of our brains communicate with each other.

I guess that makes Des Moines the thalamus: the section of the brain that filters, prioritizes, and routes data to the correct parts of the brain to keep you functioning. The central hub.

Stay with me.

When someone has depression, some of those roads get a lot of potholes. Some of those roads become totally impassable. Some might even just disappear, crumbling into a faint tractor trail.

Other roads? Nearly absolute gridlock. The traffic is so bad, so tied up, that too many cars are trying to get to too many places.

Example: You used to love to drive to the Effigy Mounds. It was relaxing, contemplative, rejuvenating. It made you feel good and gave you great memories. Depression has not only made the road to Effigy Mounds a one-lane dirt track, it has closed it for most of the year.

While US-20W to Ft. Dodge is so packed with cars, Ft. Dodge is thinking of building a high-volume convention center just for you. If you get, you get it.

Ketamine and esketamine treatment has shown to open up construction season and fix many of those roads.

It might repave the road to Effigy Mounds.

It might divert half that traffic going to Ft. Dodge toward Ft. Madison instead—spend some time looking at those lovely bridges and relaxing.

I don’t know if that helped or if was just fun for me.

Anyhoo…

What about the experience itself? The imagery, the emotional moments, the unexpected connections, the feeling that something has shifted?

Those are harder questions.

Research into ketamine-assisted psychotherapy suggests that changes in perspective, emotional learning, and the integration of experiences may be relevant to treatment outcomes. But the evidence is still developing, and we cannot assume that a particularly profound or emotional session necessarily produces a better or longer-lasting antidepressant response.

Bummer.

That's an important distinction for me.

I can acknowledge that something felt meaningful without claiming to know exactly why it happened or what it will mean tomorrow.

Perhaps the esketamine helped me approach an idea that I usually resist. Perhaps it gave that idea a form I could engage with. Perhaps the combination of the esketamine and my ongoing therapy helped me experience something differently.

Or perhaps I had an unusually good session.

I don't know.

But I am interested in what happened, and I'm interested in what I might do with it.

My Body Had Other Ideas: Tai Chi, Humming, and Golden Light

At some point during the session, I found myself involuntarily—or at least, it seemed involuntary—doing lounge chair Tai Chi again.

This has happened before.

Flowing from “Pushing the Mountain” to “Hugging the Tree,” I began pushing the self-deprecating thoughts down into the tether-tube that grounds me, then pulling golden light and fresh air into me.

I know. I know.

That's pretty woo-woo.

I am aware that I sound like I'm about three minutes away from opening a crystal shop.

But it was symbolic, if nothing else. I was taking the thoughts that hurt me and moving them away from the center of my experience. In their place, I was drawing in something that felt restorative.

I wasn't arguing with every negative thought. I wasn't trying to prove that the thoughts were wrong. I was physically representing the possibility that I didn't have to hold on to them.

And then there was my low vibratory hum.

It felt good.

I was moving my body, humming, and Stevie-Wondering my head around in a way that seemed perfectly reasonable and productive at the time.

Which brings us to the vulnerability problem.

The Vulnerability of Being Seen During Esketamine Treatment

As I was doing my Tai Chi movements, humming, and generally conducting what must have looked like an experimental one-person production of Night at the Orgasmatron, the nurse came in to check my blood pressure.

Again, blood pressure monitoring is a routine part of supervised esketamine treatment. The medication can temporarily increase blood pressure, and the FDA-approved prescribing information calls for monitoring before treatment and for at least two hours afterward.

So the nurse wasn't interrupting my private interpretive dance because she was concerned about my artistic choices. She was doing her job.

Still.

I was humming, moving my head around, and engaging in what I can only describe as an embodied exploration of my inner emotional landscape.

And there she was.

Did I know it?

Yup.

Did I care?

Nope.

And that was kind of huge, too.

What If I Don't Have to Be Embarrassed?

One of the things I struggle with is vulnerability: letting myself be seen when I'm not controlling how I appear to other people.

It's one thing to write about depression. It's another to let someone see you in the middle of an experience you can't entirely explain, particularly when you're doing something that would look more than a little odd from the outside.

I can intellectualize an awful lot of things. I can analyze my feelings, explain my reactions, and make a joke before anyone else gets the chance.

Humor is useful. It can help me approach difficult subjects without getting overwhelmed by them.

It can also be a pretty effective disguise.

If I make the experience funny enough, perhaps I won't have to sit with the uncomfortable part.

Maybe I won't have to admit that something matters to me.

Perchance I won't have to let anyone see how much I want to believe that I deserve love.

Yuck. Hated writing that, though “perchance” did help.

But during today's session, I was doing something that felt good, and the nurse walked in, and I didn't care.

I wasn't monitoring myself through someone else's imagined eyes. I wasn't stopping to consider how ridiculous I might look. I was simply having the experience.

For a little while, being seen wasn't a problem.

I don't know whether that feeling will stick around. I don't know whether it will translate into anything meaningful outside the treatment room. I certainly don't know whether it will make me any better at dealing with the ordinary, frustrating, and occasionally infuriating business of being a human being.

But I recognize that moment as important.

Maybe the point isn't to become someone who never feels embarrassed. Maybe it's to become someone who can tolerate being seen, even when there's a chance of looking ridiculous.

Maybe it's to let myself experience something good without immediately criticizing it, dismissing it, or explaining it away.

And maybe, just maybe, learning to love myself doesn't have to begin with declaring that “I am love.”

Blech!

Perhaps it can begin with something smaller.

I guess I might deserve kindness.

And if I don't know how to do that yet, maybe I can let someone help me.

For today, that seems like a pretty good place to start.

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A note on this ketamine treatment journal: These entries describe my personal experience with supervised esketamine treatment and should not be taken as medical advice or as a prediction of how another person will respond. My subjective experiences are meaningful to me, but they do not establish treatment effectiveness. Esketamine should be used under appropriate medical supervision, and changes to treatment should be discussed with the prescribing clinician.

* AD-AD-AD-ADDENDUM

Tapping. Okay. Let’s get woowoo.

Tapping Therapy, otherwise known as Emotional Freedom Techniques (EFT) —what a horrible snow-flaky name! I could never get my father to use anything called “Emotional Freedom Technique”!— is getting some pretty good play lately.

According to David Feinstein in “How tapping works: physiological and psychological mechanisms in energy psychology,” “Once dismissed as fringe or implausible, tapping therapies are now at the center of a scientific reckoning as mounting clinical and physiological evidence challenges longstanding skepticism.”

Okay, imagine that your brain has a fire alarm.

Sometimes, due to trauma, that fire alarm gets pretty sensitive and starts going off when there are actual emergencies. This is why people can’t fly, take elevators, go to butterfly parks—long story.

Tapping Therapy allows you to at least turn down the volume of that alarm.

In the 1980s Stanford clinical psychologist, Dr. Roger Callahan, discovered that he could “cure” a patient’s severe water phobia by having them think about water and tapping on the acupressure point underneath their eye. * (don’t ‘see’ anything yet. This is a rabbit hole I may or may not jump down in a following post)

Callahan’s student Gary Craig then simplified and quantified that procedure into a single and universal system, creating what he called—unfortunately—Emotional Freedom Therapy.

* ADDENDUM

Somatic Therapy is a “body-centered” form of therapy usually for those with PTSD. It believes that there is an intrinsic connection between the body and mind and that the body holds tension and creates blockages from traumatic events.

Fight.

Flight.

Freeze.

Fawn.

Those are our options under extreme stress —supposedly.

During trauma, our body does one of those things instantly and unconsciously. Those things create spikes in all kinds of our brain chemicals and sort of shorts out our system for a while.

According to Somatic Therapy theory, our body can still contain that chemical imbalance, which can tighten muscles, shallow breathing, and create fatigue.

In other words, it does a number on your nervous system.

Somatic Therapy uses a combination of talk and physical therapy to  elp you move from a state of chronic fight-flight-freeze-fawn to a more relaxed and controlled sense of well-being.

If you want a deep dive, check out The Body Keeps the Score by Bessel van der Kolk. It’s a hell of a read.

* ADLEDENDUM

Seriously? Do these boffins NOT know what positive work a good title can do. I am looking for the answers these articles are giving me and the titles make me want to NOT read them.

I mean, “The protective role of self-compassion in trauma recovery and its moderating impact on post traumatic symptoms and post traumatic growth?” That could induce an amnesiatic coma.

How about trying on “Good Vibes Kick Trauma to the Curb.”

Or “Love Yourself, Deglove Your Trauma.”

Or even “Self-Compassion is the Mr. Darcy You’ve Been Looking for.”

I mean…come on!

* ADDITIONDENDUM

For some reason 2022 suddenly felt farther away that I think it should. Perhaps it’s because most of the research I’ve been looking at is 2025/26.

I have been thinking about time a lot, though. I’ll get into it in upcoming posts.

 But I just realized that I am now, temporally, as far away from my own high school graduation as my high school graduation was away from the Truman administration…

Pre Korean War.

The year radiocarbon dating was invented. Not ironic…but funny.

Time is a mindfuck.