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I am going to die in this dentist’s chair.
My eyes are closed, but I can still see skulls outlined with white against a black background. I have an epiphany: God is death. I’m in the midst of a real-life version of the hallucinogenic ride in Willy Wonka and the Chocolate Factory, all in my own mind.
A monitor emits a steady beep, and for a second, I think I’m flatlining. But no: I’ve just completed my first infusion of ketamine, a veterinary anesthetic (often used on cats and horses) sometimes used illegally as a club drug called Special K.
I am here because I cannot stop thinking about suicide. I’ve been in therapy on and off for more than 30 years, since I was 5, and on depression medication for more than a decade. Nothing seemed to work. I couldn’t stop imagining killing myself in increasingly vivid daydreams.
As a journalist who covers health and medicine, I had read about the success of experimental trials that used ketamine to treat depression. My therapists had recommended extreme treatments like electroshock therapy, a procedure that frightened me due to reports of memory loss from those who had undergone it, but had never mentioned this. But I was getting desperate for a serious intervention.
After some research, I concluded that ketamine was not only more affordable but just as effective as sending electrical pulses through my brain. (About 70 to 85 percent of patients with severe depression who try ketamine treatment say it’s effective, compared with 58 to 70 percent of ECT patients.) I told my doctor I wanted to try it.
It wasn’t my goal to be on the vanguard, just to get better, but I am an early adopter of a treatment that could one day help millions of people with chronic depression. After a full treatment cycle, my suicidal thoughts went away. And depression isn’t the only psychiatric illness the drug may combat. Studies are being conducted on ketamine’s efficacy on anxiety, bipolar disorder, post-traumatic stress disorder, and even obsessive-compulsive disorder.
That’s how I wound up glued to that dentist-style chair at a clinic in Houston envisioning skulls, as an IV drip steadily infused me with a drug I’d thought was reserved for rave-goers.
An anesthetic that triggers happiness
Most people familiar with ketamine know it as either a veterinary medicine or an illegal street drug. But it’s been approved by the Food and Drug Administration for anesthetic use for humans since 1970. Its rise as a treatment for depression, a legal but off-label usage not yet approved by the FDA, is even more recent.
Ketamine’s antidepressant effects were revealed in a Yale study in 2000. Over the next decade, researchers continued to explore its potential as a treatment for major depressive disorder. Asim Shah, a professor and executive vice chair at Baylor College of Medicine who co-led several of these studies, told me that doctors have long been curious about the euphoric effects of ketamine. A lot of people given ketamine as an anesthetic “would start smiling or laughing,” he says. “That’s the reason that many people before have said, ‘Oh, maybe it can be used for depression.’”
As of now, selective serotonin reuptake inhibitors (SSRIs) like Prozac and multiple-receptor antidepressants such as trazodone are among the most commonly prescribed drugs to treat depression. Yet studies show that only around 37 percent of people who use these drugs experience full remission. The number drops past the first year of use.
Ketamine is an NMDA (N-methyl-D-aspartate) receptor antagonist, which means that it targets glutamate absorption in the nerve cells, unlike traditional antidepressants, which raise serotonin levels by blocking the reabsorption of the neurotransmitter. Glutamate is associated with excitability — among many other brain functions such as memory. Researchers like Shah believe that as the brain metabolizes the ketamine, new neural pathways are created that help restore function obliterated by depression. It’s this effect, not the experience of hallucinations or dissociation, that can help treat depression.
Despite its association with the platform sneakers and vinyl pants of the 1990s club scene, ketamine abuse began in the ’80s. People who take ketamine recreationally do so for its fast-acting high, which is typically a floating or out-of-body experience coupled with euphoria. But it’s not the kind of party drug that will bump up your social skills. After all, it is an anesthetic: Users retreat into their minds and experience hallucinations, sometimes reporting religious experiences or even a feeling some compare to rebirth. Drawbacks of recreational use of the drug include risk of overdose, dependence, and high blood pressure.
But for someone experiencing intense depression, that “rebirthing” can be therapeutic.