Mariah King (not her real name) first remembers feeling anxious in kindergarten, and by the age of 16, she was suicidal. King has been hospitalized multiple times throughout her adult life, partly because it was a safe environment for her to transition from one medication to another. "I consider myself a professional," King says, "but my real career has been staying alive."
King is now in her late 40s and has tried all the psych meds, but nothing has worked for her. Her team of psychiatric professionals more or less ran out of ideas, plus, in her early 40s, King had a new stressor in her life—motherhood—which made it more challenging to try new meds and deal with the horrible side effects that included escalating suicidal ideation. "I realized I couldn't go to the hospital for a month or two and leave my son," she recalls, "and then I read an article about ketamine in the New York Times."
King lives in Saugerties and considered Woodstock Healing Arts, but she wanted intravenous infusions, which they don't do, and she decided it was worth the trek to Albany Ketamine Infusions. Ketamine isn't covered by insurance, though the therapy sessions before and after may be. King paid a $100 copay for each of her ketamine sessions, though most people pay more in the range of $400. In addition to the monetary expense, ketamine requires an investment of time. Patients meet with their therapist before starting ketamine to get clear on their intentions, there's the dosing session, plus integration sessions after each dose. It's also a gamble—about 30 percent of the population doesn't respond to ketamine treatments.
The standard ketamine protocol is two sessions per week for two weeks, then one session per week for two more weeks, though some patients do more and some less. There's also the travel to and from the clinic, which requires a ride because you can't drive afterward, and taking a day off of work. Desperate to avoid another hospitalization, King took a month-long leave from work to devote to her healing and to give ketamine the best shot at helping her.
"I didn't feel much after the third dose and still had suicidal ideations, so the doctor upped my dosage," King recalls. "But after that, it was like an unearthing, and I started going places I didn't normally go." King felt the biggest shift around the fifth dose, when she noticed her nervousness was gone and she felt peaceful. "You start to learn what the journey is and how to leverage it," she explains. "Anxiety was knocking at the door, but it wasn't coming in."
About midway through the process, King realized she was still depressed—which doesn't sound great—but the win came when she realized she was no longer planning her suicide. King and her medical team decided she should do more than the standard six sessions, so they added a few more, and she completed her 10-session series in June 2022. A year later, King is still free of suicidal ideation.
Ketamine Calms Everything Down
David Nidorf, MD, medical director at Wellness Embodied, a New Paltz psychotherapy clinic that offers ketamine-assisted psychotherapy (KAP), is also an emergency medicine physician at Northern Dutchess Hospital. Dr. Nidorf has administered ketamine in the emergency room for 30 years—for everything from setting bones to repairing face lacerations—and he considers it one of the most important medicines in the world.
Ketamine was first synthesized as an anesthetic and pain reliever in 1962 and approved for human use by the US Food and Drug Administration in 1970. It's used worldwide, has almost no side effects, and has been on the World Health Organization's list of essential medicines since 1985. Ketamine gained a reputation as a club drug in the 1970s and is still used recreationally, which makes some people leery of its therapeutic potential, though Dr. Nidorf says it's one of the safest medications we have available, and it's shown remarkable results both for supporting patients during surgery and for treating depression, anxiety, OCD, addiction, eating disorders, and more. "We discovered that people who were getting procedural sedation—and ketamine was a part of that—woke up from surgery and felt better than before then went to sleep, like their depression got lifted a little bit," Dr. Nidorf says.
Researching ketamine as an antidepressant began in the 1990s, when John Krystal, MD, chief psychiatrist at Yale Medicine, and other doctors designed a study where they gave ketamine to depressed patients. On the day of treatment, patients reported feeling a little better, which wasn't too promising, but when the researchers checked in with them the next day, they reported that their depression was gone.
This was a huge shift from selective serotonin reuptake inhibitors (SSRIs), which often relieve the symptoms of depression, but leave patients feeling a bit flat because you can't selectively numb pain, so life as a whole becomes duller. SSRIs work on serotonin uptake, but research shows that serotonin accounts for only 20 percent of neurotransmitters in the brain, and the other 80 percent are GABA and glutamate. Ketamine triggers glutamate production and allows the brain to form new neural connections. What this looks like for patients is an increase in neuroplasticity and an opportunity to rewire the brain.
Like a Street Sweeper in the Brain
Cortney Jefferson was diagnosed with anxiety and depression when she was 17, and over the past 20 years has been on 50 different medications, only two of which were effective. Mostly she's dealt with crippling side effects from medication and very little reprieve. "It's been a guessing game," she says.
Jefferson suffers from treatment-resistant depression, but after six ketamine sessions in 2018, she was able to experience two years of remission from anxiety and depression, and she got to experience life completely off all meds for the first time since she was a teenager. "It was a foreign feeling to feel good," Jefferson says, and although she now takes some medication again, the meds work better than they did before ketamine therapy, and she's been able to navigate life's challenges, which for her have included post-partum depression and divorce. It's been five years since Jefferson's initial ketamine therapy, which she did at Albany Ketamine Infusions, and she's lost track of how many boosters she's had. She describes the treatment as "a street sweeper for the brain."
"The boosters work instantly," Jefferson says, with a mix of reverence and awe, adding that one of her favorite parts of ketamine therapy is the two-week window of neuroplasticity that follows a dosing session. "I take better care of myself all around—I eat better, I exercise, and I surround myself with positive people," Jefferson says, "which is amazing, considering when I'm depressed I can't even figure out how to get myself to the grocery store."
Jefferson has done ketamine through intravenous infusions in Albany and through lozenges at Wellness Embodied. She prefers the infusions because they're fast-acting, you don't have to deal with the taste of the lozenges, and the dose can be stronger. With a higher dose comes the increased possibility of dissociation, which can range from a relaxed, dreamlike state to more intense visions or hallucinations. More isn't always better, and it depends on each patient's particular set of circumstances.
When it comes to trauma, Doree Lipson, LCSW-R, SEP, who is the founder and director of Wellness Embodied, says we can have small-t trauma or capital-T trauma, but how we manage it is more about how it lands in the nervous system than the perceived size of it, and unfortunately, we don't get to choose. "The awareness of what you're carrying can be transformational," Lipson says, "and KAP acts as a little bit of an accelerant."
Ketamine as a standalone can only do so much, and the real emotional work is done by the patient, which is why having a therapist in the room amplifies the benefit more than a higher dose. "Higher doses are not needed for good results," says Susan M. Scharf, MD, a MAPS-trained (Multidisciplinary Association for Psychedelic Studies) physician psychotherapist practicing in New York City and at Woodstock Healing Arts. "Most of my patients successfully use very low doses of ketamine."
Albany Ketamine Infusion encourages patients to have a therapist in the room with them during their ketamine dosing session, but at this time, they don't require it. At Woodstock Healing Arts and Wellness Embodied, having a therapist in the room is a required part of the process. "For ketamine-assisted psychotherapy, as with any psychotherapeutic work or any process to create change, it is important for the individual to be engaged and committed to building insight and awareness about themselves and their issues," Dr. Scharf says. "The goal of ketamine-assisted psychotherapy is to help heal/resolve the underlying issue(s) so that the individual can lead a more fulfilling life and no longer require ketamine."
Unearthing the Thing Under the Thing
Many people struggling with mental health issues have lived much of their lives on mood-stabilizing medications—such as SSRIs and benzodiazepines—that have trained them not to feel, which is the opposite of what ketamine does. "You can't get over something unless you go through it," says Philip Hansen, MD, a board-certified anesthesiologist who is the owner and medical director of Albany Ketamine Infusions.
During a ketamine dosing session, patients may have a dissociative experience that allows them to relive their trauma. For those with PTSD (and others), this can be frightening and is best done with a trained therapist in the room. "Some people talk during their sessions and some don't," says Brook Nam, LCSW, a psychotherapist at Wellness Embodied. For some patients, it's just nice to know someone is there in the room with you holding space.
"We may not have words for things because they're pre-verbal and held in the body," says Julissa Almonte-Perez, LCSW, a psychotherapist and clinical supervisor at Wellness Embodied. Almonte-Perez explains that bodies often move involuntarily during ketamine sessions. "The body is trying to work it out," she says.
Whether it's something a patient has discussed at length during talk therapy or something they've buried, psychological discomfort can be difficult to pinpoint. Successful people can still feel imposter syndrome, for example, and someone who grew up in a stable family can still experience fear and anxiety around abandonment. Almonte-Perez says that often people want to access "the thing under the thing," and ketamine helps them do that.
"There's a difference between doing ketamine to avoid being present as opposed to using it to excavate," Almonte-Perez says. Nam says that one of the biggest indications that a patient will have success with KAP is an openness and willingness to go where the medicine takes them because what will manifest during a session is anybody's guess. "We say, 'Be with whatever happens without a need to control,'" Nam explains.
"We go in with intention, but we don't know what the medicine is going to show you," Almonte-Perez says. "It's either something around the intention, or it's the thing that stands in the way of the intention." The bottom line is an open mind. For people with high anxiety who want to control as much as possible, it can take a while to let go. "You'll experience less if you try to direct the experience," she says, "As opposed to letting it be what it needs to be.
Not a Quick Fix
Psychedelics are trendy these days, but there's no evidence that you can trip your way to happiness and well-being, even with powerful tools like ketamine. That said, ketamine offers hope for people who've been suffering from serious mental illness, especially if they're willing to put in the time, do the work, and set the intention. "Why wouldn't we want to do everything we can to help people get to a place where they can live without unnecessary suffering," says Lipson, who has studied Buddhism in addition to her psychology work since 1996. "If there's a possibility to help people feel better and be better in their communities and for their families without creating more harm, let's do it," she says.