Patient Interview #4: Early Adopter of Ketamine Infusion Therapy with Treatment-Resistant Depression (man, 30s, Pennsylvania, white)

This early adopter talks about his experience with psychomotor retardation and anhedonia. He also goes into what it was like to work in Big Pharma, and how the trip-like aspect of ketamine wasn’t personally the most important component for him.


What was your specific ketamine treatment and dosage?

I did the standard protocol of six infusions, pretty close together. I started at 0.3 mg/kg, and then I think they ramped it up to 0.6 mg/kg.

What was the ketamine intended to treat?

For me specifically, it was treatment-resistant depression.

How did you find out about ketamine? What were the factors that were in consideration when deciding whether or not you should do it?

It was very much my own volition and research.

I had been given 3rd line type treatment already. It’s slightly complicated because I was diagnosed with bipolar 2. They started giving me 3rd line mood stabilizers, but they were not only unhelpful but also quite harsh on me. So at some point, it was the classic, okay well, it’s either ketamine or medications that have more severe side effects.

What other treatments did you try before then?

I’ve done a lot of therapy—CBT, DBT, IPSRT, and stuff like that. Otherwise, I’ve tried a lot of medication from pharmaceuticals—so many SSRIs, antipsychotics, and mood stabilizers.

At first, I was fitting more into the bipolar 2 modality, but over time, as I got older, the depressive side became more dominant, and it stopped responding to anything.

What was your experience like working in big pharma?

Data science is my background. I meet so many people who talk about big evil Pharma, and on one hand, they’re totally right. There are some serious systemic problems with current psychiatric practice; patients are both overdiagnosed and overmedicated, while the most vulnerable populations are often underdiagnosed and not offered sufficient or appropriate treatment. But Pharma companies are still made out of people, many of them researchers and scientists who have second or even first-hand experience with severe mental illness who want nothing more than to find some novel therapeutic to relieve the considerable social and personal burden these pathologies have had on their own lives.

I was actually in uni when I was working for a Big Pharma company as a grad student. Pharma companies do do really evil stuff, but it’s more nuanced than that.

How would you describe the history of your mental health? How would you describe your current mental state?

A disaster, honestly. But I’ve had a turnaround.

At the time, I lost pretty much everything. I started out really fortunate, actually. When I became really dysfunctional, I still had a full time job. Between the savings I had and health benefits through the job, I could go on disability leave. I was really fortunate in that sense. My boss was nice and didn’t ask many questions, and so the full-time employment benefits package afforded me the kind of financial and logistic latitude to manage my own care.

I’ve also been on the other end of it. Recently, between COVID-19 and some other unfortunate things that have happened, I’ve been financially a lot more stretched than I’ve ever been. It was very painful going down: I lost my place in school, had trouble holding a job, lost relationships, lost autonomy at times. It’s been a herculean effort. I’ve still managed to be financially independent, but it hasn’t been easy.

What was the actual experience of the ketamine infusions like?

I did it very early, back in 2015, at an offshoot clinic in New York. I was an early adopter. At this point, the treatment was still really fresh off the initial clinical trials. So my provider was very rigorous, and very picky about sticking to the trial. There wasn’t a lot of literature on it yet, so I didn’t have much to go off of. I was reading scientific papers, not blog posts by people who’d experienced it. So I sort of went into it not having a strong placebo effect—I didn’t expect much.

The effects were subtle and over time. Ketamine almost feels like the same deal as brushing my teeth every morning: only after a while do you start to see the benefits. It took me until the 5th infusion, actually, to notice a clear difference. But when I did, it was like a light turned on. It wasn’t like I was suddenly happy and everything was great; it was more like I suddenly had energy to do things. My vitality was back. I thought, this is what it’s like to be a person my age. That thought in itself was kind of devastating. What I really want is what everyone else takes for granted.

For me, my symptoms were always physical. Imagine you have a flu and high fever—you know how people become weak and fatigued? That’s what depression was like for me. It was hard for me to move. The most salient feature of my depression was the psychomotor retardation. It just makes it impossible to do anything. I went 2 years without being able to fill out my taxes. That’s something I knew how to do, but I just physically couldn’t get myself to do it. It was a very different feeling from, let’s say, someone being depressed and sitting at the computer all day. I couldn’t even do that.

It reminds me of animal models of depression: the idea of a mouse being uninterested in a sugar pellet. There’s a tendency to inject a lot of psychological parts to depression, but if you think about something as simple as a mouse, it’s not like the mouse has complex childhood trauma. My depression was on that level. I remember moving to a new place, and when I was moving out, I still had boxes and boxes of stuff in my room that I had never unpacked. It was like catatonia.

In addition to the psychomotor retardation was anhedonia: nothing was pleasurable or rewarding, even at a microscopic level. You know how you put on a blanket if you feel cold and it feels good? That pleasure was something I wasn’t able to feel.

Suddenly being able to move and do things felt as if I had been wearing metal boots for a couple months and suddenly found out I could fly. This sounds stupid, but there was a period of time when I was very nomadic; I was couchsurfing and Airbnbing, so I was hanging out at coffee shops a lot to work as a result. Normally, I’m able to just barely do the minimum I need to get the work done, even though it’s always painful. The turning point was sitting at my computer, putting my headphones on, listening to something on Spotify, and enjoying it! That was a totally novel experience.

Depression is described as a deficit, but my theory is that it’s an active process. It’s almost like in that moment, this pain inside me stopped. It was like someone stopped pinching me, and I was finally able to concentrate and enjoy things.

Did you experience any side effects from the treatment?

I tolerated the side effects pretty well. To be honest, I was always confused when people talked about how the dose of ketamine “sent them to space” or was traumatizing. There was a story on Reddit about how someone did the ketamine and became violent toward their spouse. I know everyone responds differently, but it did sound a bit fantastical to me at times. I think I might be more tolerant of it than others. For me personally, I just really needed to pee.

How much of the benefits of ketamine come from the headspace?

In my opinion, ketamine is nothing like psychedelics. The part that is hardest for me to relate to other people is I never feel like I’m not in reality. I don’t necessarily see a direct benefit always from the more “psychedelic” experience in how it helps me with my symptoms.

The psychedelic-like effects of ketamine, for me, are more just benign side effects. It’s not where I derive the benefit of ketamine, even though I can’t deny that it’s there.

I can totally see how if you gave me an infinite amount of ketamine, I could just keep taking it, and it would make my life more tolerable. In that sense, the drug effects are more similar to those of an opioid for me. Not in their physically addictive properties, but in that acutely they can attenuate flavors of emotional pain, and though it would be highly impractical, I could imagine how someone might be drawn to abuse it in lieu of any other effective treatments.

Specifically with anything related to trauma, I do think the “psychedelic” aspect of it is helpful. For me personally, it was the more biological aspect that seemed most robust and long-lasting.

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This is such a different perspective on Ketamine than I’ve seen before, your background in data science and in the pharmaceutical industry is especially interesting. thank you so much for sharing your story