Experience with ketamine therapy for depression

[Foreigner]

I’ll be using this thread to talk about my use of low-dose ketamine as a mental health aid, specifically for chronic depression that has never been really cured with conventional treatment.

My inspiration comes partly from Jamshyd’s Ketamine Regimen, but I did not attach my report to his thread because there are going to be some divergences in opinion, plus I just have a lot to say and I’d like to be thorough.

I originally was not going to write a report on this but in reflecting upon my own struggle with trying to get more precise information about how to carry out this regimen, I believe my input would help someone out there who might have already been considering this approach but is going through a similar challenge. Also, I feel there is just not enough first-person reporting on this regimen to coincide with the research findings, and it's a gap I would like to contribute to filling.

Most importantly, this regimen appears to have worked for me, and I believe that seed of truth deserves to shine somewhere.

Index

• DISCLAIMER
• SIDE EFFECTS
• THE SCIENCE
• WHY I CHOSE TO DO THIS
• PREPARATION ADVICE
• TCM PROPERTIES (Traditional Eastern Medicine relevance)
• THE REGIMEN
• EFFECTS OF THIS REGIMEN
• CONCLUSION
• LONG-TERM UPDATE (1 year later) + Please read replies in thread for more information

Other reading:
Ketamine and magnesium

 

[Foreigner]

DISCLAIMER

Although I am trained in the scientific method, this work was not carried out in a professional setting. Please keep in mind that this regimen remains controversial. Although NMDA antagonists offer a wealth of promise for the future treatment of depression and other mental health issues, most sources admit that ketamine is a rather raw and unrefined approach for this purpose, and is being employed until better alternatives can be developed. You should therefore not be considering this regimen unless the conventional approaches have all failed.

Another warning I must give – probably more important than the above – is that this regimen is for those who embody the utmost self-discipline. Ketamine’s euphoric and transcendent properties make it a substance easily abused. Even in a low-dose regimen, the temptation to do “just a little more this dose” can be ever present. Each brief period of euphoria makes you feel as though you are close to a supreme truth, if only you could do just a little more to figure it out. Do not chase this feeling, it is a transient, false lure. If you can avoid the pitfalls by always sticking to the allotted dose, this regimen could very well work for you. For those who lack the discipline, I believe a clinical setting where someone else controls the allotment would be more ideal.

 

[Foreigner]

SIDE EFFECTS

Ketamine is not without its side effects, and this is not a perfect therapy, even for someone like me who is in a state of finely tuned health. (For more details, see the section on "negative effects" below.)

Because I am an eastern medicine practitioner, I am able to pick up on subtle signs of physiological changes more readily than the more obvious western diagnostic signs. From day one there were impacts to the kidneys and urinary system. Urine was darker no matter how much I hydrated, and there was usually floating matter in the urine. There was minor kidney colic as well as spasm of the kidney meridian down the inside of the legs. My kidneys were in a constant state of trying to purge, including at night time when I was awoken repeatedly to urinate. I had minor lower back pain (also a kidney sign).

Liver and gallbladder both took a hit too. The constant bitter taste in my mouth, red and dry eyes, and systemic sluggishness due to processing metabolites, were not major, but still noteworthy.

I’m prone to insomnia and ketamine made it much worse. My sleeping schedule was basically in chaos for most of the time and I slept at all random hours on the 24 hour clock. But then, this happens to me when I take most drugs, even cannabis. If you are prone to insomnia I strongly urge you to approach this regimen with caution, but with that said, this might actually help your sleep for all I know.

Though the evidence remains inconclusive, there is the uncharted risk of Olney’s lesions in the brain. This is admittedly due to higher doses of ketamine and regular abuse. I personally believe that the risk is unfounded but it’s one that prospective users of this regimen should know about. Interestingly, Jamshyd mentioned that using gabapentin in combination with this therapy helped him a great deal. This link states that, "In medical settings, NMDA receptor antagonists are used as anaesthetics, so GABA-A receptor positive allosteric modulators are used to effectively prevent any neurotoxicity caused by them." This could suggest that any potential toxicity of ketamine could be at least partially mitigated by gabapentin, though I did not use it so I cannot comment.

 

[Foreigner]

THE SCIENCE

The empirical evidence behind ketamine being an effective diffuser of depressive and suicidal states has already been explored relatively thoroughly in Jamshyd’s thread. I will however add these summary links for further reading:

http://www.sciencedaily.com/releases/2010/08/100819141913.htm
http://www.sciencedaily.com/releases/2012/10/121004141747.htm

In most of the clinical research they administered single larger doses, which usually resulted in temporary depression relief for up to 7-10 days. The regimen I am using, modelled after Jamshyd’s, is based on the hypothesis that ultra low, frequent dosing could have a more cumulative nootropic effect on the NMDA system and therefore could result in longer lasting relief, as well as actual regeneration of synaptic tissue.

A slow release transdermal patch would work great for ketamine. I came across reports of some hospitals using these for post-operative pain in gynecological procedures, but it was formulated to work locally and not pass the blood brain barrier. Since the pharmaceutical industry is hard at work making non-psychedelic NMDA medications, don’t expect a ketamine patch for depression to happen anytime soon.

 

[Foreigner]

WHY I CHOSE TO DO THIS

A combination of reasons really. One reason is that I anecdotally noticed being in a better mood after a brief stint of recreational ketamine use almost 10 years ago, and that already got me thinking about it. The main reason though is that my unusual metabolism means I process most oral pharmaceuticals irregularly from the established norms. I either suffer rarer side effects or I have no effects at all. SSRIs have proven to be of limited value to me. Ketamine’s rapid action means I would have to endure side effects for less time if the medicine ends up working, and its injectable form means I can bypass the limitations of the digestive route.

Additionally, I’ve long since had the perception that trauma after trauma in my life has caused unfavourable neurological and personality changes, combined with past heavy drug abuse with MDMA, and these are all aspects which talk therapy and conventional pharmaceuticals have never seemed to help me recover from. Eventually there comes a time when you've talked until the cows came home and you still feel unfulfilled; and sometimes, it really is just a neurochemical imbalance and there is nothing outwardly the matter anymore. I would describe myself this way.

For a very long time there has been that missing link - something in my mind that feels blocked, unable to be overcome or bypassed. It's not necessarily about logic, but it has felt like a deficit. Now the science about PTSD is more clear on this, but effective reparative alternatives are either still under development or simply not being offered. If there is any remote chance that low-dose ketamine could act as a regenerative nootropic to years of traumatic down-regulation, it’s a chance I’m willing to take.

Last but not least, I needed a medicine that has a psychoactive component in order to connect psychospiritually to the process, which is the opposite of the emotionally deadening effects that conventional anti-depressants sometimes induce. Without this necessary quality, no therapy can work for me. I’m of the opinion that modern medicine should not be trying so hard to demonize “euphoria” as an unwanted side effect of medication, as bliss can be a useful healing tool in the right context.

 

[Foreigner]

PREPARATION ADVICE

I only acquired 1g of pure ketamine, more than enough to last for one cycle of this regimen. Though I am not prone to addiction, the choice to not purchase more was a precautionary measure to prevent abuse. I advise anyone doing this procedure to do the same. Even if you decide to do a second cycle of treatment, just acquire the additional amount at that time, and not in advance.

I recommend titrating your solution so that you are only administering 0.5cc per dose because I found regular injections of bacteriostatic solution (plus the ketamine itself) to be dehydrating and imbalancing to the electrolytes of my body.

I timed this regimen during a period when I would be off work and free of the usual daily obligations. I let my closest and most supportive friends know what I was about to do, both because I planned to still spend time with them while there was ketamine in my system, and because I wanted them to observe me for positive or negative personality changes. (Hey, sometimes it’s possible to go off the deep end and not realize it!) I also made sure the fridge was stocked so that going outside was optional, and had a good playlist of tunes at the ready in case silence became a burden.

Basically, try to make life as materially easy on yourself as you can. During this period of neuroplasticity, you don’t want to be bogged down with run of the mill minutiae. Treat this as therapy and build your healing container accordingly.

In my case I decided that a healthy balance between social time and alone time were necessary. Exposure to the outside world allowed me to alter my approaches and reactions to many different situations, at will, thanks to the enhanced novelty effect. (More on this later.) Being with friends helped me to expand the pallet of venues and events that I could practice new ways of being in. Then, being alone allowed time for deep reflection, inner processing, and connecting with whatever was surfacing. Even at low doses, I would not recommend isolating oneself as dissociatives can be illusory.

I do believe that ketamine in of itself relieves the symptoms of depression, but perhaps more crucially than that, it offers the opportunity for you to explore the root of it. You can just sit there and do nothing while the biochemistry does some of the work for you, or you can go a bit further and delve into your own psyche. The choice is yours.

 

[Foreigner]

TCM PROPERTIES
(If you have no interest in eastern medicine then just skip over this section.)

Jamshyd touched on this briefly in his write up, but since I’m an eastern medicine practitioner I was able to analyze ketamine from a qi and meridional standpoint to provide further insights. Here is what I would write for ketamine’s energetic profile:

Property: bitter, warm, toxic
Action: lifts yangqi, descends kidney qi
Channels entered: bladder, kidney, liver, gallbladder, lung
- I felt movement in these meridians, as well as the physical organs
Contraindications: do not use if lung or kidney yin deficiency are present, as ketamine produces heat in these two systems while depleting them. Do not use if spleen qi is deficient, as the lifting yangqi places a higher burden on the resources of the spleen’s qingyang (clear, upward moving nutrient qi). Basically, don’t use ketamine if you are in any way chronically malnourished or suffer from heat disorders.
- the prolonged upward yang effect will cause dryness in anything above the lungs: including nose, mouth, throat, eyes, and ears.
- during the regimen, avoid activities that further deplete kidney yin, such as extreme physical exertion, over-depletion of kidney essence (sex), or consuming foods too yang in property; at night time I felt internal heat which made it hard to sleep; malar flush and five palm heat were present.
- do not use if liver qi stagnation is present; by day 3 I had liver qi stagnation with heat reversal (cold hands and feet, hot interior) which meant the liver was starting to struggle.
- do not use if there are any outstanding gallbladder diseases; bitter taste in the mouth, hypochondriac distension, and smelly stools were present by day 4; transient occipital and temporal headaches were present on day 2
- I am not clear on what ketamine is doing to the lungs but it is definitely entering the channel; the tongue coating for lung became absent after day 2, the lung pulse became slippery, and there were transient spasms in Yuji (LU-10) and Lieque (LU-7). I also felt very minor aching in the lower lobes of both lungs. Aside from that, the only outward sign I could see was lung dryness but there may be something else going on. The only theory I can come up with based on these criteria is that ketamine somehow inhibits lung fluid clearance, causing an excess syndrome. Related to this, I had transient heart aches, but nothing that warranted alarm. It was probably due to fluid pressure of some kind.

Important: Taking hydergine as per Jamshyd's report did not pan out well for me (see below). Some of the "side effects" I was attributing to ketamine were in fact from hydergine, and once I removed it, the ketamine side effects were downgraded to being far less severe. However, the above attributes still apply to ketamine and are no less accurate.

Subjective comparison: similar to other psychedelics like LSD and psilocybin, ketamine lifts qi upward toward the head, while taking qi and yin from the lower jiao (root). However, it simultaneously has a grounding effect that somewhat preserves the root, akin to strengthening of kidney qi. This may be a mild tonifying effect or it may simply be the material substance burden placed on the kidneys, making their qi go downward more because they are more filled with excess. Either way, the kidney meridian was the most active of them all during this treatment. Even yongquan (KI-1) was active.

In Jamshyd’s writeup he referred to an inhibitory/excitory effect. In eastern parlance I would call it grounding of the kidney qi while simultaneously lifting yangqi (and consciousness) to higher states. This makes it an effective tool for exploring higher consciousness without being completely removed from bodily reality. Because ketamine acts on the thalamus, it may have some sort of adaptogenic effect on the way the brain filters and prioritizes stimuli.

Nootropic levels of ketamine seem to inhibit what has been overly yang (active), and stimulate what has been too yin (passive/inactive), simultaneously. This leads to more profound levels of self-awareness but without the destabilizing overactive factors found in other psychedelics, and amphetamines. It is neither jittery nor lazy. In effect: balanced. What was too jagged becomes softened; what was too subtle or under-expressed becomes more enlivened. LSD by comparison is a direct lifting medicine -- it is mostly sympathomimetic. It takes all yin and converts it to yang, while lifting it upwards; it also strongly moves blood and relieves blood stagnation. The grounding factor is practically non-existent. Mushrooms are more similar to ketamine in energetic profile in that they are both lifting and grounding simultaneously, and interestingly they are also used for depression; however, lack of precise ROA, longer duration of its psychoactive effect, and rapid onset of tolerance makes it impractical as a daily depression medicine.

 

[Foreigner]

THE REGIMEN

The regimen lasted 7 days and was performed with intramscular injection (IM). If you can’t set this up to be IM then it’s going to be difficult to precisely regulate your intake and in my opinion there would be no point in attempting this, but others may disagree and I have spoken with those who have used the snorting ROA with success.

The goal, based on research and anecdotal reports of others who have personally done this regimen, was to maintain the alteration of consciousness similar to having drank one beer. You bring yourself to the threshold of onset with each dose, without actually triggering the psychedelic experience. If you do this, you will benefit from the nootropic effect. If you take the psychedelic dose, you will achieve the opposite and suffer ketamine abuse side effects. Heed this warning: do not succumb to the desire to do higher doses or to dose more often. It will compromise your therapy.

The goal is to maintain threshold ketamine levels in your brain so that the NMDA receptors remain saturated but not over-stimulated. You will know that saturation is being achieved because eventually hourly doses won’t feel like they are doing much. Even the light buzz with each dose is no longer all that present. In my case, day 3 was when this happened. At this point you can begin spacing out the doses to every two hours, followed by every three hours, and then finally every four hours. One individual I connected with said they took 10mg every hour for 3 days intranasally and then stopped. The proposed length of this regimen is still debated, but from my past experience with nootropics, their effect is cumulative and so a longer course at lower doses tends to be more productive than higher doses in a shorter course. So that's the theory I worked with.

Each person's threshold dose must be determined based on their own unique physiology. Some people will need more, some people will need less. From talking to other people, the average threshold dose does not extend beyond 10-12mg. However, because I am sensitive and basically a ketamine virgin, 12mg or even 10mg per hour was too much to start. Believe it or not, on day one when I did 12mg I entered the psychedelic range and had to lie down for a few minutes. I decided to halve the dose and ended up doing 6mg per dose for the entire regimen.

The first couple of days give you some leeway with finding the right dose. It’s okay if you accidentally go over it at first, just don’t do it deliberately in order to get high. Once you find whatever your threshold dose is, keep it there. I did accidentally exceed my threshold halfway through the regimen on one occasion, but as Jamshyd remarked, the prior nootropic effect of the therapy will cause you to return to baseline instead of hangover territory. If you keep doing it deliberately though, you'll shift your therapy from nootropic to recreational, and abuse signs will begin.

Days 1 and 2 had hourly doses. On days 3-5 it was every 2 hours. Halfway through day 5, I switched to every 3 hours. On day 7, every 4 hours was sufficient. I did not dose right before bedtime or during the night, and then I would dose immediately in the morning upon waking.

Yes, you will need a lot of needles, and yes the first couple of days are tedious. My very first day of the regimen was my busiest day. I was only home for a couple of hours, the rest were spent grocery shopping, spending time with a friend, and basically running around. I had to keep a close eye on the clock and find the nearest washroom to take a dose. This made things completely chaotic (not to mention legally risky) and if I had my time back I wouldn’t have done it, but c’est la vie, a.k.a shit happens. As an aside: major respect to people who have addictions that require them to dose in potentially risky locations!

Based on Jamshyd’s writeup, I started taking hydergine at day one. This was a mistake. It potentiated the side effects of the regimen too strongly. It exacerbated the dryness, headaches, insomnia, and nasal stuffiness to such a level that I was really suffering. When I cut out the hydergine the symptoms reduced a lot and were downgraded to minor ketamine side effects. I strongly recommend doing the regimen only with ketamine, and if you decide to repeat the regimen you can consider adding other factors.

 

[Foreigner]

EFFECTS OF THIS REGIMEN

Positive:
- heightened novelty and creativity across many situations
- insights into areas where mind or emotions have been at an impasse, along with solutions;
- greater level of interpersonal skills, less inhibition around being direct toward other people and constructively confronting them if necessary
- easier to speak my truth rather than hold it in or worry about what others might think
- easier to observe alternative pathways of action and carry them out without hesitation
- the tendency to avoid challenges and what isn’t working was replaced with a stronger desire to directly confront and implement immediate changes
- higher levels of motivation, ambition and will power (i.e. I spring cleaned my entire home and took honest stock of crap I wanted to get rid of)
- able to go with the flow more easily instead of being impatient and stubborn
- noticed that challenging or negative situations still have emotional impacts in my gut-body, but they do not have a disruptive recoil effect on my mind; the body-mind connection around negative habits and patterns is broken and the mind feels more protected from harsh impacts (i.e. if I am anxious, angry, irritated, it does not disrupt my logic)
- cognitive abilities heightened, or as Jamshyd put better than I could: “While the typical effects of recreational K use seem to be primarily expressed as difficulties in memory and language-recall; the chronic administration of low doses does the exact opposite: memory becomes like this new automatic-search in google, to use an analogy, and this is logically followed by a wonderful "flow" of linguistic concepts. Synonyms, analogies, grammatical constructs, all are far more easily-grasped than when sober and one knows one wasn't just maniacally tripping out is through things like unusually-high marks on language courses or on essays.” For the first time in my life, I am able to understand the lyrics in songs by listening to the music instead of having to lookup the words. Grasping of discrete language components is far easier.
- semantic recall heightened to impressive levels
- effects on dreamtime: several of my dreams during the regimen were uncanny reviews of traumas from early childhood and adolescence, and the novelty of the ketamine allowed me to take new action in those dreams, effectively reframing and healing the memories. Most of my dreams during this period were ones where old situations or relationships were rectified, or were metaphors for “cleaning house”
- a subjective feeling of my mind feeling more “solid/concrete” and less prone to fluctuations or stress
- ego softened so that inner critic had less of a chance to spin stories and stop me from taking positive life-altering action
- euphoria, Divine connection, feelings of God and being cared for by the light
- friends reported that I was more friendly, creative, approachable, and direct; they noted I was less diplomatic in my speech, and instead of beating around the bush I was more to the point. Things that I normally would hold back on I was just stating plainly and effortlessly.
- increase in personalization
- mind is more quiet, and present; far fewer extraneous thoughts and imaginings intrude in my moment to moment focus

I'll add more noteworthy positive changes as I notice them.

Negative:
(Most of the side effects were transient and did not last.)
- insomnia severely aggravated to the point where sleep became spread out throughout a 24 hour period (polyphasic) instead of monophasic; I chalk this up to the dopergenic effect of ketamine because the same thing happens to me when I do any psychedelic, including cannabis.
- less of an ability to empathize with people, so you care a bit less about how others feel (though in my case this was a good thing because sometimes I am overly concerned about what others think/feel)
- nausea on the first day, but no vomiting thankfully
- reduced libido in initial days (but no erectile dysfunction like with conventional anti-depressants)
- reduced appetite, though I forced myself to eat regularly
- more frequent urination, darker urine
- liking the mini hourly buzz a bit too much, but was able to stick to the regimen
- occasional slurred speech, memory lapses (especially episodic recall), transient and mild ataxia in the initial days
- increase in orthostatic hypotention along with increased heart rate, decreased blood pressure
- heart palpitations
- transient feeling of being detached from the world and wanting to stay out of it; transient feelings of escapism
- increased internal heat, worse at night
- electrolyte imbalance from frequent injection, as well as dehydration (could be the benzyl alcohol in the bacteriostatic solution though)
- headaches, especially occipital ones, in the first few days
- some concerns about the dopergenic effects of ketamine, despite the NMDA benefits
- unfortunately started to have acute seasonal hayfever mid-regimen which made things a tad exhausting, but I can’t blame the ketamine for this (thanks mother nature!)
- diarrhea on day 3 that did not return
- sore deltoids and quads from all the IM injections

 

[Foreigner]

CONCLUSION

The regimen has ended and I feel like a different person. The changes were already noticeable during the regimen, but now that the drug is out of my system and I am back to my normal levels of health, my state of consciousness is a lot more clear. A circuit in my brain has been made complete. I feel more in touch with my intuition than ever. My inner voice no longer feels like a harping inner critic, but rather a loving force that is watching over me – one that I can trust and rely upon even more than I did before.

I do believe that this is more than an up-regulatory effect. A gap has been filled. My ability to understand discrete language in music has remained. This has been something I have not been able to do for most of my life, and it has also made learning languages difficult. I used to just enjoy the melody of music because the lyrics sounded like long, non-sensical, conjoined words. Now I hear the discreteness and can understand the meaning.

My depression has cleared. The foggy-mindedness has been replaced with a newfound clarity and... well... a desire to get out and do stuff! Annoying situations that are happening in front of me are no longer perceived as happening *to* me, nor do they increase my mental burden. Random happenstance just feels incidental now, and there is no more bracing for impact. Even interpersonal challenges are being met with novel solutions, and conflict has become far more constructive rather than something to be avoided. It also feels as though some of the lingering thoughts of past traumas that used to come up in the back of my mind are now quiet. They are no longer passing through my mind on a daily basis... rather, the ones that I was able to review while on ketamine feel resolved and integrated.

All in all, I would say this therapy has worked for me so far. Time will tell how long it lasts, as depression can be a tenacious thing. But I am hopeful!

 

[Swimmingdancer]

Thanks for sharing this

How long has it been since you last used ketamine?

 

[Solipsis]

Nice, thank you...
would you like me to turn that into a multi-post thing that has Index-like links to each chapter?

(Also, if bacteriostatic water is dehydrating or desalinizing, why did you not use 0.9% physiological saline instead? If it is isotonic, it should be fine...)

 

[Foreigner]

Sure if you'd like to index it, that'd be great, but I don't want to create more work for you. Re: the solution, I thought 0.9% benzyl alcohol prevented bacterial growth if the ampule is used repeatedly? Does 0.9% saline have the same effect?

Swimmingdancer... it's been 5 days so far. Unless you're asking me when I last used it in my life, which would be about 10 years ago in the rave scene. I did it two or three times back then, but moderate psychedelic doses only.

 

[edzeppelin]

In my opinion all the eastern stuff(meridians, chakras, qi, etc.) makes this detailed and helpful report feel less useful. What if you don't believe in all that? Perhaps you should leave it more generic; I think more people could understand and relate that way.

 

[Foreigner]

That's why I put a disclaimer under it saying if you're not interested in eastern medicine then just skip over it.

I believe in it so it's important to me.

 

[Swimmingdancer]

Swimmingdancer... it's been 5 days so far. Unless you're asking me when I last used it in my life, which would be about 10 years ago in the rave scene. I did it two or three times back then, but moderate psychedelic doses only.

I meant since you stopped this ketamine therapy regimen. I was interested in seeing if the positive after-effects were lasting. How are you feeling now that it's been 5 days?

 

[johannes kreisler]

hmm. did you also try "classic" nootropics?

 

[Foreigner]

I meant since you stopped this ketamine therapy regimen. I was interested in seeing if the positive after-effects were lasting. How are you feeling now that it's been 5 days?

It's now day 6 and I'm still feeling great

hmm. did you also try "classic" nootropics?

The nootropics I've tried on other occasions are piracetam, lily bulb extract, selegiline, and vinpocetine. Right now I'm taking piracetam because I've read it pro-longs the effects of the ketamine regimen while repairing any potential damage it might have caused (though at ULD I doubt there's much).

 

[Solipsis]

Sure if you'd like to index it, that'd be great, but I don't want to create more work for you.

No problem, it's done. Happy support something like this, I really respect it. Plus I am something of an indexing freak.

Re: the solution, I thought 0.9% benzyl alcohol prevented bacterial growth if the ampule is used repeatedly? Does 0.9% saline have the same effect?

No, the saline is to make a solution isotonic meaning it has the same concentration of electrolytes/salt as your blood/body. That way it is neither dehydrating nor desalinating. If you don't inject a lot it might not be such a big deal, but I get cheap sterile saline anyway so it is easy.

Indeed benzyl alcohol is a preservative.

That's why I put a disclaimer under it saying if you're not interested in eastern medicine then just skip over it.

I believe in it so it's important to me.

Yes IMO it did not really get in the way of things, hopefully the way it is set up now it seems more like an optional chapter to people.

 

[Foreigner]

^ Thanks so much! It looks a lot cleaner now. I humbly bow to your indexing fetish :D

Re: solutions: Does that mean I could dissolve the ketamine into a saline solution, and then add the benzyl alcohol to the solution to preserve it? Or are the two mixtures incompatible?