I had a challenging 2022. 

For years, I've kept a tenuous hold on my bipolar disorder symptoms. But at the start of the year, my grip slipped. In March, I spent a month living at a residential treatment facility, and two more months attending outpatient therapy. This led to several months of relative calm, but in October I found myself sliding into depression again. 

I did everything right. I took my meds, I went to individual and group therapy, I exercised, I got eight hours of sleep, I didn't use alcohol or substances, and I meditated. But I wasn't getting better.

Then, a therapist suggested I look into ketamine therapy.

In the past decade, ketamine has gained popularity as a medicine to fight treatment-resistant depression and other mental health conditions. Whereas conventional antidepressants like Prozac impact serotonin levels, ketamine is thought to work on a neurotransmitter called glutamate, which is linked to mood regulation. 

Ketamine's first widespread use came during the Vietnam War, where it was used to quickly anesthetize wounded soldiers on the battlefield. It is a dissociative that causes hallucinogenic effects and detachment from one's sense of self, which is probably why it gained popularity as a recreational drug in the 1970s counterculture scene, and later as the club drug Special K.

Ketamine is thought to temporarily increase neuroplasticity in the brain. For a short period after each treatment, you might see things differently and forge new neural connections — the implication being that you can find your way out of depression. To maximize results, it's recommended that you work with a therapist to process whatever comes up during each session. 

Many ketamine patients report an immediate lift in their mood and an end to suicidal thoughts. How long that lift lasts, and how to get the most out of your brain's neuroplasticity, is still up for debate. The evidence I could find points to medicinal benefits lasting for an average of two to four weeks, and hopefully longer with added therapy. 

I decided to give it a try.

Packing for the journey

I started researching ketamine providers and administration methods. In the process, I learned that only a specific nasal spray version of ketamine called Spravato is FDA-approved for depression. Other forms of ketamine such as lozenges, shots, and intravenous drips must be prescribed off-label. 

Off-label prescriptions are common in the U.S., with more than one in five prescriptions filled as such. The downside is that insurance companies may deny off-label prescriptions and providers, potentially putting ketamine patients on the hook for thousands of dollars.

One provider I talked to seemed to treat the experience as a sterile administration of medicine via an IV drip and not much else. I considered Mindbloom, which mails you lozenges and conducts therapy sessions over video. After reading Mindbloom testimonies on Reddit questioning the effectiveness of the lozenges, I passed. 

I ended up finding a clinic just minutes from my house, where the therapist used shots to deliver the medicine. After an initial get-to-know-you screening to determine that I was a good fit, we agreed upon six sessions, with dose strength gradually increasing until we maxed out on the fifth and sixth sessions. We scheduled the sessions as close together as our schedules would allow. It took a month to do all six.

My sessions took place in a cozy room with soft lighting. An oil diffuser gave the air a scented heaviness. My therapist sat in a big armchair while I got comfy on a low bed piled with pillows and blankets. 

Each session lasted up to three hours:

• Hour one was for general psychotherapy. We discussed things that came up between sessions, and things I wanted to have at the front of my mind during my impending journey.

• Hour two was for ketamine. My therapist started by giving me two shots spaced ten minutes apart. (We later spread the dose out to three shots, because my genetic reports show that I’m an ultrarapid metabolizer.) I wore an eye mask to keep my focus inward, and more practically to keep the room from spinning. My therapist played low, lyric-free, psychedelic music. She stayed silent except to occasionally ask how I was doing. Sometimes I talked to her from the ketamine space, and we'd have a short conversation. She took notes on everything I said and gave them to me afterwards.

• Hour three was for recovery. About an hour after the first injection, the hallucinogenic effects of the ketamine had mostly worn off, allowing my brain to drift back into the real world. Sometimes I would peek out from my eye mask, only to realize that the world was still blurry and spinning, and settle back into the blankets. Eventually I felt normal enough to sit up, and we'd chat about the things I saw. I'd drink some water, get my blood pressure taken, and stand up once I felt stable. You can't drive after a session, so I texted my wife to come and pick me up.

A long, strange trip

I usually started to feel the effects of the ketamine about 10 minutes after my first shot. The music took on a strange echo, overlain with what sounded like the needle scratch of a record player. Shapes emerged from the darkness behind my eye mask, and what looked like a black void suddenly became a wall with subtle texture. The scene usually changed to some kind of cavernous space that I generally took to be my own brain.

During my first two sessions the space looked something like the inside of an ancient temple. Pallid vines covered walls made of large golden blocks. A dim light illuminated the scene from a far-off entrance. 

My third session was more memorable and intense. I visited the temple again, but suddenly, the vines were all around me, backing me up against a wall. I touched one and it crumbled to ash. Back in the real world, it felt like I was picking at a scab inside my head.

The entire scene began to dissolve. I curled up for protection, but everything around me fell away until there was nothing left. I fell into a darkness that felt like nothingness, but also somehow the entire universe. According to my therapist's notes, I suddenly declared that I had lost my mind. I repeated "Jesus fucking Christ" for about five minutes, with some "holy shit" sprinkled in. I capped it off with a mumbled "let's go flying over Mars or something."

The experience wasn't exactly unpleasant or painful. But it was very intense, like nothing I had ever experienced, and my brain felt scrambled afterwards.

I came to my fourth session steeled for a possible repeat of session three. Instead, it was my most gentle trip yet. I felt like I knew what to expect in the ketamine space and was growing confident in my ability to pilot myself through my own brain. 

For my fifth session, we reached the highest dose. I snuggled up on the bed and tumbled silently through my mind, not really remembering much afterwards. And for my sixth and final trip, I confidently slid around my mind, generally enjoying the experience. 

Integration

A couple of days after my intense third session, I told my regular therapist what had happened. She suggested that the vines might represent my erratic relationship with my own moods.

It has been a challenge to accept my bipolar disorder. I have spent much of my life locked in a struggle with my intense and unpredictable moods. When I'm handed a mood that I don't like, regardless of whether it was caused by illness, the human experience, or some combination of both, my instinct is to respond with anger and self-loathing. 

But living with bipolar disorder means living with strong moods. Getting angry about it, or hating myself over it, only makes things worse.

Something about the crumbling vines suggested a renewal; a clearing out of old ways of thinking. My therapist and I had already been working on acceptance and my relationship with my moods, but hearing her pair that with the vines helped something click. 

When a storm overtakes a ship at sea, the captain doesn't shake their fist at the sky and rage with self-loathing. They can't stop the waves, so they batten down the hatches and steer into the storm to keep the boat from capsizing. 

For the first time, I believed that it was okay to feel my moods, and that the moods handed to me by my illness were not my fault. By accepting my feelings without guilt or resistance, I could more effectively let them go. And then, I could put my brain to work on mitigation. Maybe I could push through the mood. Maybe I needed some exercise. Maybe I needed to play some video games. Maybe I needed a nap.

Prognosis

For some patients, ketamine immediately lifts depression and suicidal thoughts. That certainly wasn't the case for me. In fact, after session two, I had strong suicidal thoughts for the first time in months.

I think the key to potential long-term success is having a good therapist who can help you process things that come up during sessions. This could be the same therapist who administers your medicine, or it could be an outside therapist with whom you are already established. 

There's no question that ketamine therapy lifted my depression and helped me see things differently. I can see the effect, plain as day, in my mood tracking app. After my third session I enjoyed about six weeks of stability. Sometimes it felt like I was driving on an icy mountain road, and whenever my car slid out of control, a guardrail was there to stop me from tumbling into oblivion.

It's common for patients to schedule booster sessions as the effects of the ketamine wear off. The timing is mostly up to each patient; I've seen ranges from monthly to yearly. I'm planning to get a booster shot of my own soon. 

There's so much we don't know about how our brains work. People living with a mental illness often feel like lab rats as our providers experiment with different drugs to see what works. Ketamine could be a promising option that lifts symptoms immediately for some, rather than waiting weeks for traditional medicines to kick in. It isn't a magic fix, but it deserves consideration for a spot in the toolbox.