In this conversation, I really enjoyed learning about somatic bodywork, the difficulty of identifying complex post-traumatic stress disorder, integration between infusions, and the downsides of thought-based approaches in talk therapy. Thanks to this person for their insights
What was your specific ketamine treatment?
I did a series of six infusions. The first two were at 0.5 mg/kg, the second two were 0.6 mg/kg, and for the last two, I decided to go back to 0.55 mg/kg—they let me tweak it. I did these infusions twice a week for three weeks. At 0.5 mg/kg, I struggled a bit with getting overwhelmed at the thoughts and memories that were coming up, but it was manageable. At 0.6 mg/kg, I had some anxiety and felt like I couldn’t control the experience as well. I also felt like it was over too fast, and that I had a hard time remembering the experience after. So I decided to ask for the dosage to be tweaked to 0.55 mg/kg, which was the best dosage for me. My clinic was really good about trying to find the ideal dosage for their patients based on patient feedback.
What was the ketamine intended to treat?
It was intended to treat complex post-traumatic stress disorder (CPTSD) from childhood trauma.
How did you find out about ketamine? What were the factors that were in consideration when deciding whether or not you should do it?
Desperation. It was desperation that drove me to find out about and try ketamine.
In the past, I’ve done a lot more traditional psychotherapy. I’ve had mixed results: some bad experiences and one good experience. I also was seeing a massage therapist for some somatic bodywork and getting great results from working with him. Somatic bodywork is something that’s usually done by a massage therapist, and it’s really about treating the way people with trauma histories hold tension and emotion in their bodies. It focuses a lot on working through implicit memory with supportive, therapeutic touch.
He mentioned that I should look into ketamine, and that someone he knew had tried it for bipolar disorder and had gotten good results. He knew I was struggling with trying to safely process trauma in therapy, and that safety aspect was really where I was stuck: with CPTSD or PTSD, it’s like your fight or flight system is always activated. So you almost need to be in that middle space where you’re not overwhelmed or dissociated, where you’re grounded and safe, to be able to deal with that trauma. I had a lot of bad experiences in therapy with finding safety.
The one therapist that did work for me moved online after the pandemic hit, and teletherapy was ineffective, so I terminated with her. A lot of my resources were gone at that point, and I was sinking quickly. Doing some googling late at night, I stumbled upon ketamine again and requested more information. And I decided to give it a go.
Was it difficult to obtain ketamine treatment? What kind of obstacles did you run into on the way?
It was pretty easy for me. I just needed a summary and a diagnosis from my old therapist. Because of the pandemic, a doctor prescribed ketamine for me over a telehealth visit. It involved minimal records and just a short, twenty minute intake appointment.
What other treatments did you try?
I was on Zoloft for a couple of months 20 years ago. I just felt dull and disconnected from everything all the time. The medication made me not as depressed, but I wasn’t happy either. This sounds awful, but I could feel this tiny version of myself screaming to get out. I was on it for a couple of months and then went cold turkey, which I know you’re not supposed to do, but I just couldn’t do it anymore.
With talk therapy, it’s been a lot of different clinicians, with a lot of different modalities. What worked for me—psychoeducation and a lot of grounding and coregulation—was with the last person I saw; other than that, somatic therapy—learning where you feel emotions in your body—was really helpful for me.
What I found disastrous: thought-based approaches, specifically CBT, REBT, and Schema Therapy. Especially for someone with PTSD, it can feel really patronizing to be told that your thinking is wrong, and that you just need to fix yourself to feel better. If we could all control our fight or flight systems like that, we wouldn’t have these problems.
How would you describe the history of your mental health? How would you describe your current mental state?
I’ve had a history of mood disorders since I was a teenager. I remember always being unhappy as a child, always feeling isolated and empty, but I didn’t have a diagnosis and couldn’t put a name to it.
I’ve been diagnosed with clinical depression. One therapist didn’t know how to categorize CPTSD and told me I had relational trauma. I also received the diagnosis of an unspecified personality disorder from him.
I’ve had a lot of ups and downs. It wasn’t until I was 36 that I realized this history of mood disorders was caused by childhood trauma. Because it wasn’t a one-time incident of trauma, it took me a while to recognize—it can be hard to identify emotional abuse and neglect. As a child, there was a lot of invalidation, lack of support, and lack of unconditional love—all that be very traumatic, but people often don’t realize that you don’t need isolated incidents of this very bad thing happening to cause long-lasting trauma. The six infusions I did three months ago sent my symptoms into remission, and I’m still doing really well. I have another infusion scheduled for this week, since a couple of major life events have happened lately.
What was the actual experience of the ketamine infusions like?
Ketamine was a game changer. I felt immediate relief after the first infusion and had a lot of insights and shifts in perspective. Now, I’m not triggered as easily. It feels like years worth of therapy in a couple of weeks. For that reason, it was exhausting, of course, but more than worth it.
Everyone’s tolerance is different, so finding the ideal dose was a pretty big deal. It was like exploring an inner dreamscape: I had thoughts and memories come up, and I had all these feelings about them, but I still had some distance from them. It felt like I was wrapped in a warm blanket. That’s how I was able to process trauma during infusions.
During the infusions, there were huge shifts in perspective, but I was able to maintain an element of control. If things got upsetting, I could bring in a friend or family member into the dreamscape and change the course that way.
Did you experience any side effects from the treatment?
The headaches after the infusions weren’t my favorite. But I managed them with Advil, so I can’t complain. I didn’t experience nausea, actually, which is uncommon. I did, however, have to urinate right after the infusions, and then more frequently for the rest of the evening. I know that can freak people out, but I was fine the next day.
I did have some uncommon side effects after my first infusion: for 36 hours, I had constipation and no appetite.
How much of the effectiveness of the treatment comes from the “trip”? Did you know about that aspect going in?
I didn’t know about that aspect at all. I wasn’t clear about how it worked until after the first infusion, and was surprised at all the emotions that came up. I just started crying out of nowhere. After the first infusion, the person who ran the clinic told me that the thought and insight aspect was really important. I’m glad I was given that advice, because had I not heard about how to make the best use of my infusions, I don’t know if they would’ve stuck. So I think it would be better if everyone knew what to expect going in.
Do you think ketamine should be a first line treatment?
I absolutely think it should be first line treatment. Well, I think people should try talk therapy first to figure out how deep their problems run—I wouldn’t send someone to ketamine therapy for a bad breakup, for instance. But I do think it should be offered before antidepressants. If someone has a history of mood disorders, or has childhood trauma they need to work through, it should definitely be first line treatment.
Ketamine is a tool for healing, not a maintenance drug like most antidepressants. Ketamine also does not have the side effects that maintenance drugs have.
How much of your own work do you need to do to make sure that the effects of ketamine are long-lasting?
It’s the processing and integration that I did between infusions that made a difference. Before I did these infusions, I had a pretty good life, but I wasn’t able to enjoy it. I had no toxic relationships or toxic behavior patterns—I just needed to feel better about everything.
I do see a lot of people struggle with trying to find the right dosage. Not all clinics are the same: a lot of people are overmedicated and go into k-holes; then, the positive effects of the ketamine wear off in days because the patients can’t remember anything from the infusion.
My infusions were 40 minutes; I definitely needed to continue that work of exploring thoughts and insights outside of infusions, though, because you can’t process all that in 40 minutes.