Doctors Are Using Ketamine to Alter Our Sense of Time and Self

CALL OUT: Ketamine has been getting a lot of buzz recently. In March of 2019, the FDA approved Johnson & Johnson’s nasal spray, Spravato, for treatment-resistant depression. Spravato is technically esketamine, which is, molecularly-speaking, almost identical to Ketamine but three times as potent and can be given at a lower dose.

Maybe you know it as a horse or a cat anesthetic, or maybe you’ve heard of a K-hole. You could have also read the absolutely amazing Twitter thread where Irish writer Seamus O’Reilly slowly tells the story of doing Ketamine shortly before realizing he was scheduled to work, and it was the night the President of Ireland, Mary McAleese, was touring the venue.

Of the experience he writes, “By now, having been alone with my thoughts for the entire Cretaceous period, I am no longer mildly weird but deeply, extravagantly deranged. As the President of Ireland walks in, with my boss’s boss’s boss’s boss, my first impulse is to greet them like I own the place. It would be rude, surely, to not acknowledge their presence? Out of order even. Best thing to do would obviously be to say, ‘ello guys.’, like it’s my home and I live there, in this big white room, where I stand in the corner, alone, holding a tray of drinks, like you do at home.”

Though this seems, and is, a ridiculous anecdote, it does speak to Ketamine’s ability to completely alter one’s sense of time and self. As it turns out, it’s much more than a party and veterinary drug. It was approved as an anesthetic by the FDA in 1970. Since Ketamine does not slow breathing or stunt the gag reflex, it’s often considered a safer option than other anesthetics. The World Health Organization has consistently listed Ketamine as one of its “essential medicines” and it was widely used during the Vietnam War to immediately quell the pain of wounded soldiers.

I spent a late April afternoon speaking with Angela Ward BSN, RNC-Ob/EFM, CPTR and Clinic Nurse Lead at the Advanced Integrative Medical Science (AIMS) Institute in Seattle to get a professional opinion and insight into how Ketamine is used to help treat depression. “A lot of the things we’re seeing in the world, you may have heard them called ‘diseases of despair.’ There’s an epidemic right now of middle aged men suiciding,” Wards tells me. “People are really struggling, and a huge part of it is that we’re so disconnected. That’s why I was like, ‘let’s meet in person!’”

Ward takes me on a brief tour of the AIMS institute, which looks more like an expansive yet cozy mid-century modern home than a clinic. A delicate chandelier made from paper flowers casts a shadow above a framed picture of a dandelion. The shadow and the image combined make it look like dandelion petals are blowing across the white wall.“I could see myself getting high here,” I think, sinking further into the West Elm. Maybe I’m missing the point.

“Wine?” Ward asks, and I agree wholeheartedly. We take a short walk through the Eastlake neighborhood of Seattle to a quiet restaurant overlooking the water. Ward comes from a medical background in labor and delivery, so it’s not without a deep medical knowledge that she tells me, “It’s really fucking hard to do shit by yourself.” I laugh, then sensing, I think, that I may write this statement off as light humor, she adds, “There is something about being energetically in each other’s field, and able to breathe together, and I know that sounds hippie and woo-woo, but that’s how we’re wired.” With that, we toast our juice glasses filled with wine.

Ward continues by sharing with me a bit about her history, which includes the loss of her infant daughter. “I had a psychedelic experience within the safe and sacred container of a plant-medicine ceremony that was profoundly healing in response to the grief from losing my infant daughter.”

It was after this experience, she realized she wished to share this knowledge and experience with other people. “One of the things that ketamine does is it allows people to have an experience where they’re able to step away a bit from an emotional trigger. Let’s say any time you think about a particular person you immediately are angry. [Ketamine] takes it from this immediate experience and then puts it over here, like a concept. It gives you some space to experience something as a concept without the emotional flair.”

Over the course of our conversation, I begin to notice that when speaking about Ketamine, Ward often mentions that it creates space: space to separate the mind from what it perceives to be true (I will never be happy, for example), space between impulse and action, space between periods of suffering where pain may still be present but the sensation can change, and if it can change it opens the mind to the possibility that it may not be forever. Ward put it this way, “It might not be this wall that’s crushing you for all eternity.”

Ward continued by explaining how some people think the downfall of Ketamine is that it’s not a one-stop shop. Typically people do not go on a Ketamine journey and then never experience depression again.“We’re following the MAPS ( MDMA-assisted Psychotherapy) for PTSD model which says we’re creating the conditions for healing, and we’re awakening your eternal healing wisdom.” She explains to me an analogy first used by Michael Mithoefer of MAPS. ”If you were out riding your bike and you fell on some gravel and you had a cut on your leg, you’d go to the hospital, they clean up the wound, clean out the gravel and stitch the edges together, but they wouldn’t actually make your skin grow back together. Your body knows how to do that if you create the conditions for healing.” Ward continues, “[By using Ketamine] we create the conditions for healing the mind and I’ll say spirit, supporting you in making meaning of what’s happening to you.”

What To Expect

Patients are medically-cleared by their provider for treatment, then a patient meets with Ward or another member of the AIMS team and their medical provider to talk about what to expect. The Ketamine treatment itself consists of three sessions, called deep dives, where a patient is injected with the substance; the dosing is weight-based and typically works out to 1.6 milligrams per kilogram. A bit after the injection, people typically get a wobbly feeling, a feeling of floating not unlike the sensation of having the spins when you’re drunk. Once that feeling takes over, they’re ready to “launch.”

During post-launch behavior, “75 percent of people are very still,” Ward explains, “Some people will report to me what they’re feeling and then they’ll stop talking and then have an outburst of, ‘Wow,’ or ‘Amazing,’ or ‘I’m scared.’ Other people will move their hands, almost like pulling energy blocks off their bodies, big smiles, or sometimes they will cry these big releases. Some people are wild cats. Ketamine makes them move like crazy. They’re working some energetic thing out. [Their] eternal healing wisdom knows you need to undulate your arm this way.”

People on Ketamine lose their ability to trace thoughts, which means the last word that was said is often immediately forgotten. For some people this can be confusing, unsettling, scary even. “This is a huge part of the ego trying to be there,” Ward explains. “That’s okay. This is about trying to soften the ego so it can come back online in a way that’s healthier.”

Ward sits with patients on their deep-dive journey, what many would consider the “tripping” part of the process, which lasts 50-60 minutes. After this portion of the therapy, Ward steps out and the provider steps in, and they begin talk therapy. “We’re billing insurance which is unheard of in the rest of the work around Ketamine.

Following both portions of the therapy, patient care continues, “After about two hours and 15 minutes, the patient usually has to pee. We help them get to the bathroom. They usually keep their sunglasses on or wear an eye mask because Ketamine makes things bright, then they’ll have a snack or some tea, and that helps people come back into their body. We don’t let people drive home.”

I later talked to someone who preferred to remain anonymous that had recently undergone their first Ketamine deep dive at AIMS. I asked if anything about the experience had surprised her, “I think I was pretty prepared, I’ve taken hallucinogens recreationally. The weird thing was closing your eyes and tripping inside of your mind rather than interacting with the world, it’s much more of a journey. It took me a couple days to process. Nothing really popped up as a life-changing moment. It all just felt like a dream.”

This patient seems to have a genuine faith that more will be revealed in the two journeys to come, that the confusion she experienced initially will ultimately lead to an understanding, or at the very least, her experience could help other people experiencing the same things. Ward echoes a similar sentiment, explaining that creating a space of intentional healing with a focus on personal traumas awakens intuitive parts of ourselves. This space also shows others that healing is possible and that a meaningful life is attainable. “That helps people live. That helps people not kill themselves,” Ward emphasized.

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