Ketamine, a.k.a. Special K, the hallucinogenic raver staple appreciated for its tranquilizing, dissociative high, has made a bit of a splash in the media recently, due in part to its promising potential as an antidepressant.
The World Health Organization lists ketamine among its tally of "essential medicines" thanks to the drug's broad use as an analgesic (painkiller). This allows doctors to prescribe the substance "off-label" for mental disorders like clinical depression. The results are extremely promising.
Allegedly showing results in hours rather than weeks, ketamine affects the levels of the neurotransmitter glutamate, whereas traditional antidepressants like Prozac instead focus on serotonin receptors. Administering ketamine by IV has been shown to rapidly increase levels of these synaptic proteins, with significant effects observed after a mere two hours.
Brent Miles, 41, a songwriter and journalist from Phoenix, Arizona, regularly got ketamine IV treatments at a clinic in North Scottsdale in 2013. I sat down with him to hear his firsthand experience of what this treatment is like, and this is what he told me:
In 2013, I heard a story on NPR about these studies with using ketamine to treat depression. They said there were only a few places in the country allowed to do this and one was in Arizona. I lived in Arizona and I'd tried fucking everything, so I was like, you know, I'll try this.
I was diagnosed bipolar when I was 21, so 20 years ago. I tried every medication under the sun. Some of them work, but they have really bad side effects. Some don't work at all. I'm not an expert in pharmaceuticals, but it just seems like the strategy is just to throw different medicines at the wall and see what sticks.
I've been on Prozac, Wellbutrin, Zoloft, Paxil, Geodon, Zyprexa, Effexor, just about all of them. In my 20s, doctors would treat my anxiety with Valium, Xanax, and other addictive benzodiazepines. I was failing all of my classes in college because I couldn't concentrate, so my doctor diagnosed me with ADD as well and prescribed Ritalin for it.
Of course, Ritalin is an amphetamine and therefore highly addictive. Some doctors would recklessly prescribe me copious amounts of benzos and amphetamines. They were highly effective for treating my disorders—but almost too good. Medications like those make you feel really fucking good. So I would start taking more and more, because you build up a tolerance. The downside was after years of taking these highly addictive medications, I began taking them just to be numb and high. Then you realize you're a full-blown drug addict, which obviously just adds more complications and setbacks to trying to treat a mental illness.
And I know this is a widespread problem, because I've known other people who went through the exact same experience. The treatment becomes a curse.
So I saw the ketamine thing and said, Well, I'll try it. As far as the trials were going and the success rate, it looked promising, and the science behind it made sense too. I wanted to try it because I'd been trying everything for years to control being bipolar.
This wasn't a research-based trial or anything like that. Because ketamine is legal to use as an anesthetic, this clinic didn't have to select me. I just scheduled an appointment. I paid for this out of pocket. I believe I paid $1,500 for six treatments, and they let me pay in four installments.
First you go in and they talk to you, just to make sure you're not insane or something. There are 300 questions to answer on a computer, like about your mood, where you're at with your condition, and if ketamine treatment would even work for you.
They have a psychiatrist on site who consults with you too. They don't just let anybody in there. They seemed to be weeding people out who were probably going just to get their hands on ketamine.
It's about a two-hour process. You can't drive afterwards, obviously. They have a nurse go through what's going to happen to you. Like, "If you start feeling something, say something, because some people can't handle it." The nurse takes your blood pressure, your pulse, monitors all that. Then they prep you for the IV, put the needle in, and tape it so they can hook it up to the IV machine.
They have big plasma TVs with Netflix so you can watch movies. They want you awake the whole time. The nurse guy was like, "You can't fall asleep. You can listen to music, you can watch TV, but don't listen to Slayer, because that wouldn't be good for the experience." It was funny how he put it. It wouldn't feel the same with death metal. They want you just relaxed. I never got sleepy, just calm. Once in a while, the nurse's assistant will talk to you, just to make sure you're cognizant.
I was excited just because I was hoping this would be the one that worked—because of all the studies they did, and the proof that backed it up. I was excited to think that this might be the answer.
But I was a little scared, too, just because I'd never done ketamine or anything. You start to think this is kind of crazy. If I ever have surgery with anesthesia, all I can think about is, What if I don't wake up? Because sometimes people don't. It knocks them out. But see, that's the problem—I think about this shit.
On your first treatment, they start with a really low dose to see how you're going to react. If you're OK with that dose, they'll go higher on your next treatment. If you're OK with that, they increase it. I did five over a six-month period in 2013.
IV ketamine is actually a way lower dose than if you bought ketamine off the street. That's really strong. When they're doing the IV, it's a lower dose because they don't want you going psycho. I've actually never taken ketamine bought on the street, so I don't know what it's like, but it seems like people tend to lose their shit on it.
With the IV treatment, you start disassociating with everything, like you're observing, not participating in anything. It's really weird. I don't know how to explain it. As far as the mind goes, you start going through these weird levels, kind of like Inception or The Matrix, where you don't know what's real.
You start thinking about all kinds of stuff. Whatever races through your mind—and usually when you're depressed it's negative shit—when you're on ketamine it's just like, Well, nothing I can do about that. You feel like, I'm not in control, and that's fine; you're going to die someday and that's just life. You kind of learn to just accept it, I guess.
So it slowly comes on and then it gets kind of intense, at least for me, because of the thoughts and stuff, a lot of stuff was just flashing by, like random memories, but I can't do anything about it.
I tried to watch Pulp Fiction, but they wouldn't let me. But the TV had a screensaver—nature scenes and animals in the wild, with really soothing music—so during all of my treatments, I just watched that the whole time. It was weird because seeing nature got me thinking, Well, my problems aren't important. There's all this stuff going on, and my problems aren't the end of the world. You get bombarded with life, with existence. What's weird is you're not doing it actively—you're not trying to work on stuff—it's just happening.
That was my first experience with a dissociative drug. However, I did a lot of LSD in high school, and I've done ecstasy a couple times and powdered MDMA. While it feels great, the day after I can just feel all the serotonin in my brain got sucked out. The next day, I'm just depressed and a day after that, I'm back to normal. So that kind of sucks.
But I never felt any withdrawals or addiction to the ketamine. In therapeutic doses, there were no problems with withdrawals or addiction. After five treatments, it wasn't like I felt the need to go out on the street to illegally obtain some K, unlike what happened with my other psychiatric medicines.
You've got to get successive treatments, though. With some people it takes two; with some people it takes ten. But it helps. After my first treatment, I felt good for a week. Not the kind of bipolar "good" where I'd be manic. I just felt pleasant, and not crazy or compulsive. I felt normal for the first time in a long time.
But this was the first treatment, a low dose, and it kind of wears off. It's not like you crash or anything. During the next treatment, they boost up the level that you're given, so it would start working successively, staggering. After that, I started feeling better.
The thing is, treatments are really fucking expensive. And in my case, I would probably have needed more treatments to get to a place where I could work on things healthily. I wish I could afford a few more treatments, because I felt like I was getting there. It helped, but it's not like it wore off, like I'm not back to where I was before that. I am a little better.
You'd think they'd have some therapy to go along with the ketamine. The way I experienced it, sometimes it felt like you could go either way, like you could have a bad trip.
But it did help. Once it got to a point where I could afford it, I started going to a psychiatrist and a therapist once a week. So that combined, I'm definitely in a way better place than I was.
It's actually kind of hard to tell because I was actually doing things right this time. I don't know if it's like that with a lot of bipolar people, but when you start feeling good, you stop taking your medication because, Oh, I'm feeling fine. But it's because you're taking the medication.
I didn't tell my psychiatrist about the ketamine. I just have a feeling they won't know enough about it. I was kind of afraid to mention that in case they disapprove. It's a weird thing. It's so new a lot of psychiatrists just don't know anything about it.
I would definitely recommend it. If somebody could afford it, I would definitely say try it. I'd love to go back.
As told to Troy Farah.