In memory of Donovan

In a span of 1 week, I had 3 clients ask me about ketamine therapy for their mental health. I vaguely recalled (mostly from the show Dexter) that ketamine was some sort of tranquilizer. And it wasn’t until later when I was doing some research, that I connected that ketamine was the same as “Special K”, a drug I remember people using when I was in college.

Beyond that, I knew nothing about ketamine or why people were using it to help their mental state.

NATHAN

Insert Nathan, whose name’s been changed to protect confidentiality. Nathan’s a client that I’ve worked with for years in couples and individual counseling. He’s a helicopter pilot turned handyman on the outside…and an artistic, wise, big-hearted soul on the inside. Nathan came to see me because he was trapped in a mind-body feedback loop that likely originated from his past.

Nathan was sexually abused as a child. The pain and isolation that resulted were made worse by his deeply religious upbringing. Night after night, Nathan waited fearfully as a young child for the devil himself to take him to hell. Needless to say, he was tormented by this.

After years of struggling through his adolescence and teenage years, Nathan joined the military where he served his country for 13 years. His wife and children embraced the military lifestyle and supported him through 3 combat deployments (2 of which were completed). Nathan spent a combined 2 years in Afghanistan and Iraq.

Nathan’s post-military life has been difficult at best. Since leaving the military, Nathan struggles daily to find his purpose. I remember the time he sat there in disbelief, desperately trying to conceptualize how he can go from having a powerful and respected position in the military to being a cashier at Auto Zone practically making minimum wage.

He knows at a gut level that he’s made for more, but his self-defeating patterns stemming from PTSD made it difficult for him to move on. Though Nathan, and his wife, are some of the most resilient people I’ve ever known, they understandably were wearing thin.

Nathan’s PTSD showed up in many different ways. Somedays he was angry at the world and some days he was filled with shame. On days that were particularly hard, I would ask Nathan if he was having any thoughts of hurting himself. It was a stupid question, and I felt that every time I asked. The truth was, Nathan was never NOT thinking about suicide. Suicidal thoughts were his baseline.

THE TRIGGER

We had recently started back to couples counseling and Nathan and his wife were in a good place. Nathan’s new handyman business was starting to pick up, the family was finally feeling financial relief with Nathan’s new disability payment after being declared 90% disabled from the military.

I was skeptical about how well they were getting along. We all were. Their relationship felt like a house of cards. We could get it working, but then the wind would blow, and everything they worked so hard to build would collapse.

And then came the news. One of Nathan’s closest comrades completed a murder-suicide. This was the 4^thsuicide from Nathan’s peer cohort of 12 in his squad. Nathan was feeling all the feelings. Sadness, anger, fear, and especially betrayal by his government, who had seemingly discarded him and his comrades with a head full of trauma to deal with on their own. Nathan was coming undone.

With daily, if not hourly, thoughts of suicide, Nathan found himself constantly questioning his purpose. Although Nathan had been approved for services at the VA, there were so many hoops to jump through, that he had all but given up. He admitted himself into an inpatient treatment facility. Other things he had tried were RRT hypnotherapy, weekly talk therapy, EMDR, and CBT. While he experienced the most success with EMDR, he was still struggling.

THE KETAMINE TREATMENT PROCESS

All within the same week, several people suggested Nathan look into ketamine therapy. Faced with the dreaded thought of going back to the hospital, Nathan decided to look into it.

Having done psychedelics in his younger years, and even having some scary experiences, Nathan wanted to make sure this was safe and a good fit for him. He learned that when children experience trauma, the development of the brain’s neuropathways are affected and ketamine helps kickstart the brain and regrow synaptic connections. He became fascinated with the results and reached out to the Ketamine Wellness Center.

The process went fairly quickly. Once he contacted the Ketamine Wellness Center, he went through a medical screening and met with a psychiatrist to make sure he was a good fit for ketamine. Both appointments were virtual and approximately 30 minutes in length.

Several days later, he was approved by the medical team. His treatment plan arrived via email and though 4 ketamine sessions are pretty typical, it was recommended that Nathan complete 6 ketamine treatments due to the severity of his trauma. The treatments would be every other day for 2 weeks.

Nathan was sent a welcome packet prior to his first session with a workbook to help him set goals and self-reflect. He was told not to eat for 6 hours or drink for 2 hours before his treatment.

THE DAY OF THE KETAMINE TREATMENT

Nathan got a ride to the clinic so he didn’t have to drive after his ketamine treatment. He was feeling anxious and hopeful about his 1.5-hour long appointment. Being no stranger to psychedelics from his teens, he knew a bad trip was a possibility.

He arrived at a cozy clinic that he equated to a therapy office. There were big lazy boy recliners, dim lights, blankets, pillows, music, and a tv. Prior to starting the session, the nurse let him arrange the room in a way that was comfortable for him.

He didn’t see anyone else in the clinic…just him and the nurse, whom Nathan described as extremely welcoming and accommodating. Once everything was set up, the nurse hooked Nathan to an IV, an EKG, a pulse oximeter, and a blood pressure machine to monitor his vitals during the ketamine treatment. Nathan said it was a little annoying to be hooked up to all the wires, but he was still able to move around and feel comfortable. Overall, he felt like he was in a safe place, with a safe person to help him if there were any concerns.

Connected to the IV, the ketamine is continuously infused into his body. The treatment lasted 1 hour and it took 3-5 minutes to start feeling the effects of the ketamine.

INSIGHTS! Spoiler Alert…this is the best part!

Nathan described his trips as “very heady. He never hallucinated, more so just felt a really intense out-of-body experience. He said it felt like he returned to his soul before it got all tangled up in the trauma of being human.

Throughout all 6 treatments, Nathan said that he just let his mind open up as he listened to the universe. He had so many big insights about himself, his life, and all his pain that he emptied an entire pen in his journal. He acknowledges that it all sounds so crazy to say out loud.

“Everything in my life has burned down. I lost my home, and my marriage and was separated from my boys. In the middle of this, I was still able to find peace and let go of worry.”

Here are some of my favorite of Nathan’s insights!

• To live in reality, you have to relax and let the thoughts come and realize that maybe they’re true and maybe they’re not. Don’t get too attached to them.
• Everything always came back to love. All my questions were answered with love.
• I found acceptance in myself, my mistakes, and the life I had lived.
• I felt like I had died and let go of everything in my life. It was peaceful and I felt the peace of the universe. I knew in that moment that I needed to live. I needed to live to be a father and to spread love. I felt a deep connection to energy and the force of the universe.
• Fear is not real. It’s just something that your mind creates. It’s a construct of the mind.
• I felt a divine power that’s in all of us. It’s a duality….light and dark. Good and evil. And that power felt loving and dualistic in nature.
• Death is when you have the weakest connection to life and you’re at your strongest spiritually. Enlightenment is being able to let go now and find that peace now.
• Trauma is a trap. It traps you in your pain and suffering. It traps you in the bad moment and makes you relive it over and over. Once you can see it from an outsider looking in, you’re out of its control.
• I found that I have a deep desire to help protect others and guide people and be a positive force in the world. Even my capacity for violence comes from a place of love, responsibility, and protection.
• Art is an expression of the deepest part of our soul manifested through our body and mind. A symbolic union and reflection of life itself…
• I’m enough. My home is here (points to his heart).
• One of my biggest takeaways is the sense of letting go of yourself. Letting go of the habit of being yourself. It felt like I wasn’t learning or coming up with new thoughts. It felt like I was remembering something old.

“My brain just feels alive.”

AFTER THE TREATMENT

Nathan said that his sense of time was distorted. Time can either feel fast or slow. There were moments that seemed to last forever when it had only been a minute. After 1 hour, the nurse begins to unhook you and within 5 minutes, the trip is over.

Nathan wasn’t allowed to drive afterward and agreed that it wouldn’t have been safe. He felt dizzy and a little out of it. But, by the time he arrived home, 20 minutes later, he felt good enough to go to the gym, run errands and do homework.

When asked about any side effects, Nathan said they were minimal. He felt like he had a dehydration headache, a little nausea, and maybe some indigestion.  All side effects quickly subsided.

THE COST OF KETAMINE THERAPY

The cost for the screening was $125.  The normal cost for each treatment is around $449, but the Ketamine Wellness Center offers a generous discount to veterans and so Nathan’s treatments were $275/session. When he returns for maintenances treatments, he’ll continue to pay $275/treatment.

QUESTIONS ANSWERED!

After listening to Nathan’s experience, I had so many questions. Here are some of Nathan’s responses. 

Did every trip feel the same?

All the treatments felt similar, but each one was a little bit different. You bring in what you have inside you so it’s different every time. Each session I brought in a different intention and that set me on a different path.

Were there ever any scary parts?

There was one time I was focused on a weird construction noise outside of the room. I got fearful for a moment but was able to redirect my focus. It never got bad or scary.

Would you recommend this to other people?

Yes. It really opens your eyes and puts you back into getting to know your true self. It helps you get out of the trap of trauma. It allows you to step back and see where your traps are and how they make you powerless.

Are there people you wouldn’t recommend this to?

I can imagine that some people may not be ready for this. If you’re close-minded and can’t let go of control, I’d think doing some EMDR therapy first could be helpful. But close-minded people are probably the ones that could benefit from this the most.

The big thing is, you don’t do this to forget or run from your pain, you do this to accept what’s happened and realize it’s made you who you are today.

Do you feel like you needed all 6 treatments?

I felt a huge benefit after the 1^st treatment. Because I combined that with journaling and EMDR therapy, I think that 4 could have been enough. Most people get 4.

How did ketamine differ from other psychedelics you’ve tried?

Nathan compared ketamine to his experiences with LSD and mushrooms in his younger years. LSD feels harsh and sharp. Mushrooms are more gentle. Ketamine felt intense like LSD but without the harshness. It also wore off extremely fast.

How is this different than using ketamine as a street drug?

Ketamine can be used as a street drug, but you never know what you’re going to get. This feels like a safe, controlled environment. It was helpful to have an intention to get better versus an intention to have fun and party.

Does the nurse interact with you during the treatment?

Nathan had the same nurse each time with only one exception. The nurse was there to interact with him if that’s what he wanted, or else they would just quietly sit and monitor. Nathan said there was one day that he got into a deep conversation with his nurse, otherwise, he more so kept to himself.

Was there anything you wish was different?

The time in my treatments was very unstructured. I could’ve watched tv, listen to music, or really anything I wanted as long as I stayed in the treatment room. It’s nice to be able to design your session how you want, but I also think having some guidance or structure to make the most of your treatment could be helpful. I have a lot of mindfulness training, so I was prepared to make the most of my session. I also brought my journal, so I was able to capture so much of the experience. I do think a guide or a coach would’ve been beneficial…although I’m still on the fence about whether that structure would good or bad.

BEFORE AND AFTER KETAMINE THERAPY

Nathan continues to have zero anxiety and depression. He still feels like himself, and in the middle of a divorce, still feels sadness, but he sees the sadness as different from a life-sucking depression that steals your identity. It feels like a normal sadness. “It’ll change your life, but it doesn’t change the human factor. That’s why acceptance and letting go are so important. Trust that everything should happen as it happens.”

Ketamine helped Nathan realize was years and years of therapy couldn’t…that he is not his thoughts and his feelings. Nathan’s now able to understand that his feelings are not who he is. It’s just something he was attaching to because he was stuck in a habit.

“When you say these things to the lizard brain, it doesn’t understand. You can’t hear something until you’re ready to hear it. These treatments gave these concepts meaning and anchored them into my brain.”

Although Nathan is feeling no decline weeks after the treatment, he sometimes feels the old habit of suicidal thoughts or conditioning coming back to him. He recalled the day that he was feeling the stress of money and divorce. In a habitual way, he thought, “I should just end this.” As quickly as he had that thought, he remembered, “This isn’t me. I love life. This is just the habit of the old me.” Nathan has never said anything like that to himself before.

WHAT NOW?

Nathan was both relieved and sad to be done with the treatments. He’s excited to let the dust settle after all the processing he’s been doing. He reports feeling better than he’s ever felt and has ZERO depression and anxiety for the first time in his life. He’s going through some major life changes and still feels upset. What’s different is that he’s able to stop himself from attaching to his feelings and thoughts.

Nathan will return for maintenance treatments after 2 weeks and then one month out. From there, he will return as needed since the treatment effects differ for everyone. At the time of writing, it’s been 2 weeks since his last treatment and there’s been no decline in his mental status.

He’s excited about the possibility of getting off anti-depressants and would much prefer to maintain ketamine treatments than being on medications that never felt helpful in the first place.

Since the start of his treatments, Nathan said that he has worked out, meditated, and journaled on a daily basis. He’s showering, brushing his teeth, and eating healthy. Inspired by his treatments, Nathan has started painting again and even started playing his guitar again for the first time in 10 years.

“I knew I was capable of greatness, but I couldn’t be great because I was so trapped in my own mind.”

FROM A THERAPIST’S PERSPECTIVE

Working with complex PTSD is a very difficult task. Although therapists are trained to detach from the outcome with our clients, it’s impossible to stop caring and feeling the pain that our clients are in.

Nathan works hard in therapy. And while there has been so much progress, we would also hit so many walls. It was like his brain would shift and then would go right back in between sessions. EMDR was hands down the most helpful to Nathan, but Nathan was often too dysregulated to do the therapy.

Though it’s only been a few weeks, Nathan feels like a different person. He’s able to stay grounded in the wise part of his brain, and detach from his overwhelming emotions.

I’m excited to see what the future holds.

***Please know that the information in this article may not reflect the values of the author. This is one person’s experience. If you think ketamine therapy may be right for you, it’s recommended for safety purposes that you contact a ketamine treatment facility and speak with your doctor.