IV KETAMINE; what is it all about and can it help me?
Route of Administration: Critical to Achieving Relief
There are many different ways to put a medication into the body. You can swallow it, inject it, rub it onto the skin, inhale it, insert it as a suppository, etc. This is called the Route of Administration, which we’ll abbreviate here as ROA.
Intravenous (IV) infusion is by far the most common and most studied ketamine ROA for depression. If you tallied all the volunteers from all the ketamine studies to date, probably 98% of them received infusions.
The ROA makes all the difference in the world. You expect cough syrup to work if you swallow it, but what if you rub it on your skin? You expect a first-aid cream to relieve pain from a cut if you put it on the wound, but what if you snort it? Ketamine for depression is no different: it works best when it is administered with a particular ROA.
The ketamine recipe that works on depression is simple: 100% ketamine and nothing else. When you deliver ketamine to the brain via IV, you are providing exactly the right ingredients. The ketamine travels from the IV directly into your bloodstream, then directly to the brain, without making any stops along the way. But if you swallow an oral dose of ketamine, first-pass metabolism breaks it down into other chemicals as it travels through the intestinal tract and liver before it reaches the brain. You’ve just changed the recipe by reducing the available amount of the critical ingredient, and by adding a large quantity of extra ingredients (metabolites).You might not think of your depression/bipolar/PSTD as a collection of symptoms. To you it might simply feel like the way you interact with the universe, like it’s part of your very identity. But how many of these typical symptoms apply to you?
feelings of sadness, emptiness
insomnia, or excessive sleep
difficulty concentrating and making decisions
feelings of guilt or worthlessness
thoughts of suicide
If those symptoms were relieved, would you still be depressed?
In the simplest terms, ketamine relieves symptoms. It doesn’t add something new to your personality that causes instant happiness. It just takes away some horrible symptoms.
You think you’d notice immediately when these symptoms vanish. Not always. The sensation can be incredibly subtle. There is no jolt of giddiness that instantly courses through your system. The sensation is deeper than that, and gentler.
When symptoms are relieved, patients can quickly gain new abilities that were previously impossible. Like casually picking up the phone to call a friend. Or suddenly breaking out of persistent negative thought loops or behaviors. Or simply being able to get out of bed and stay productive throughout the day.
Let’s go a little deeper…
Mood vs. Function
When we talk about ketamine relief, keep in mind the difference between your mood versus your function. It’s important.
Most of us think of depression/bipolar/PTSD as something that makes us feel horrible, where our mood is bleak. But the impact is in how it prevents us from functioning normally. It impairs us so we can just barely socialize, work, take care of ourselves, maintain relationships, keep our lives organized or our homes clean, etc. – and sometimes not at all. Our lack of function makes our mood even worse, which creates a vicious cycle.
Most patients go into ketamine therapy focused on their mood. Understandably, they are desperate to feel better. They hope to be overwhelmed with an obvious, electrifying sense of relief. They’ve heard that ketamine can create a miraculous feel-good sensation. One prospective patient said “I imagine the doctor pouring a quart of happiness into my veins, and I’ll be able to feel it coursing through my body afterward.”
It doesn’t work that way. Most successful patients do not get an instant, obvious, smack-you-in-the-face sense of total recovery. Relief usually comes without the jolt. Sometimes it takes multiple infusions and several days (which is still incredibly fast, after years of suffering). Instead of an instant smack in the face, relief usually reveals itself in a different way – more subtle, yet still profound.
But what do we mean by “improved function?” Here are some examples given by actual ketamine patients:
Being able to genuinely feel positive emotions, without faking it
Being able to socialize with friends and family, and truly enjoy it
Stresses and obstacles roll off your back instead of reducing you to the fetal position
Finding it easy to sleep right, shower every day, and take care of yourself
Having enough physical energy to get through the day without constant exhaustion
Finally finishing projects that have dragged on for months or years, like home repairs, housekeeping, organizing finances, etc.
Interacting comfortably in big groups, or with strangers, without social anxiety
Criticism and unkind words become things you can simply shake off, instead of causing deep wounds that won’t heal
No more energy spent trying to block out certain memories or traumas; they’re just not terrifying anymore
No longer intimidated by authority figures, bosses, etc.
Suddenly “getting” what your therapist has been saying for years
It seems like any of those improvements would hit you like a ton of bricks, and you’d recognize it immediately. But fellow patients will tell you these changes can be incredibly subtle at first. They can sneak up on you. It’s counter-intuitive, but it’s just simply a fact of ketamine therapy. A couple of actual patient quotes summarize it nicely:
Getting The Most Out Of Treatment
If you’re going to spend serious money and pin your hopes on being a ketamine responder, you should do everything in your power to get the most out of the treatment. There are things you can do before, during, and after treatment to maximize your chances of a good outcome. Keep in mind that some patients do not respond to ketamine, and here we are only talking about those who do.
Try to be well-rested before the infusion.
We realize this is easier said than done for some patients, but try to be in a relaxed state before the infusion starts.
Ask If Your Current Meds Will Interfere
Make sure your ketamine provider is aware of every drug you are currently taking, whether it’s a psychotropic med, heart medication, cough syrup, an illegal substance, etc. Some substances can interact with ketamine or interfere with its action in the brain.
Bipolar Manic State
There is a lot of research showing ketamine’s efficacy for bipolar patients. But some researchers say bipolar patients get good results only when their infusion happens during a depressed state, not manic.
Tell Your Loved Ones to Hold Their Questions
Ask your friends and family not to bombard you with questions after the treatment. They will naturally want to ask “Did it work?” or “Do you feel better?” But the effects can be extremely subtle at first and many patients have trouble putting the experience into words. You may need time to process it.
Don’t Stress Out Waiting for a “Blast” of Relief – Remember Function Often Improves Before Mood
Don’t forget that successful patients often begin functioning better before they feel better. We’re serious: do NOT forget this fact while you wait for relief to reveal itself.
Put Your Improved Function to Use – Right Now!
If you respond to ketamine, you will be able to function better than before. Put that ability to use! Don’t wait, even for a minute. If you’re able to socialize, go do it right now, instead of just patting yourself on the back for feeling able. If you’re able to clean your house or organize your finances, do it right now, instead of feeling satisfied that you could do it. The more you exercise your improved function, the more your mood will lift.
Successful ketamine therapy gives you the ability to build new “muscle” in the form of better function, improved habits, etc. – and the improved mood that comes with those things. This combination can give you an entirely new power: resilience. If your depressive symptoms return, your new strength and resilience can help you withstand those symptoms better than ever before. Most responders do not sink all the way back to their old baseline.
Build on Your Relief to Make Lasting Emotional Gains
Take advantage of this state and find a competent therapist who can help solidify your benefits into lasting emotional gains. Many patients find these improvements persist even if their symptoms return, giving them a resilience they never had before.