A Traveller’s Guide to Ketamine

Ketamine was discovered in 1956 and was used as an anesthetic during the war in Viet Nam. It’s been used to relieve refractory pain in hospital patients, and more recently, for chronic pain. It’s also been used to treat suicidal thoughts, and in the past few years, has begun to be used to relieve treatment-resistant depression. 

That’s where I come in. I’ve been depressed, on and off, since I was a pre-teen. When I began to read about ketamine in August of 2020, I was encouraged by the idea that it might break my persistent depression, which had become worse over the past few years. I read that it was believed to shake up the brain’s negative patterns and allow you to reform new patterns—to reset. 

But one shouldn’t go into ketamine treatments without a map of the terrain. So I made one up.

You can read more about my ketamine trips here.

The Trip Itself

Choose your music wisely. Familiar, warm, (maybe not isochronic tones?), drums are good, nature sounds. Any words will become a part of the trip. 

Record your trip if possible. (My partner kept a fairly extensive record of the words I said, which sounded pretty random, but connected for me with things that I saw/experienced which otherwise I would not have remembered.) 

Have something to ground you—a person, a stuffed animal, a worry stone. I used a bracelet of stones or a representation of the chakra system. My partner was also there with me for most of the time, which I considered invaluable. He comforted me when the trip was upsetting, which I sometimes was aware of consciously. When I wasn’t as deep in the trip, I remembered about the stones I was holding, and it showed me that I was still in a clinic in a physical body.

At first, I kept my eyes open, but after the second time, I used a mask to cover my eyes. This deepens the trip and keeps you from incorporating office furniture into your experience, but the first time, not covering your eyes might be comforting. I could also see light through the mask, so sometimes I opened my eyes to remind myself where I was. 

Scope out a place to eat after your treatment. You will have gone without food for five to seven hours. I felt like eating something low impact an hour after the ketamine stopped flowing. I didn’t want meat or too much spice. French fries, ketchup and cheese sandwiches were fine. Something familiar and comforting. Soup would probably work. (In COVID time, my partner bought us food and we ate in the park.)

Blood Pressure If your blood pressure is on the high side, or if getting a ketamine infusion makes it high, you can try these options.

  • Ask your provider to extend the time. This spreads the infusion out over a longer time, which can keep your bp from going too high. It also makes your trip a little less intense, but that’s a bonus in my book. 
  • Don’t take a pill right before the infusion. This is something the provider will offer, but in my experience, taking a pill makes me feel ill and does little to lower my bp. They can give you bp meds into your IV that work fast and clear your system quickly. 
  • Take a warm bath before you go to your appointment; it can lower your blood pressure, at least temporarily (though here’s an article about a recent study that indicates it might lower bp overall https://www.healthline.com/health-news/hot-baths-reduce-risk-of-heart-disease-stroke#Free-stress-relief). 
  • Don’t be worried that you will not be able to lower your blood pressure. Starting with very reactive blood pressure that is a bit high and sometimes very high, my bp didn’t settle down until I went without a dose for a week, but it did settle down. I would recommend keeping tabs on your blood pressure every day while you are taking ketamine. 

Bad Trip If you have a bad trip, an experience in which you feel bad or scared, here are some options to improve things the next time.

  • Ask your provider to slow the infusion down. You’ll get a longer, less intense trip. – Find out if your provider gave you an initial push (bolus) of ketamine to help you get ramped up to the dose faster. I felt like I was being rushed around in the experience. I told the nurse it felt like I was being bullied or pushed. (I only learned about it after the second time, so this was not an anticipatory response.) I’m OK with having had this experience, but if it bothers you, tell them to quit it. 

Nausea I only felt nausea one time, after taking a pill before the infusion. Here’s some things I think helped me stay nausea-free. 

  • Don’t take anti-nausea meds or anything by mouth unless you need them. I didn’t get sick, even though I’m prone to it, until I took Tylenol in pill form just before the eighth infusion. 
  • After the infusion, keep your eyes closed and stayed seated until you don’t feel dizzy. 
  • Tylenol (acetaminophen) mixed with ketamine increases its effect on pain and depression according to new studies. If you want to try this, don’t take the medicine before the infusion. I would suggest not taking anything at all by mouth in the two hours before the infusion. I became sick to my stomach only once—when I took Tylenol as a pill before the eighth infusion. 

Therapy and Integration

Find a trusted therapist before you have a ketamine treatment if possible. If you have to find one for the infusions, interview them first. The therapist recommended by the clinic may not be the right fit for you.

Don’t expose yourself to any unpleasant reading, events, or shows while you are being treated. Ketamine opens you on an emotional/psychic level, and you don’t want negative stimuli. 

It’s better to have a trusted therapist who understands the nature of a ketamine trip, but you can do this for yourself if you commit the time and effort to it. If you can talk to someone about the trip itself, without any criticism or unpleasantness, do it. Remember that you are the best judge of your own experience.

Consider that your infusion obsession topic might be important, but don’t let it fool you into thinking that there’s not more going on than the manifest content. It’s like dreaming. The trip is a symbol for some aspect of you. It isn’t all—or only—what it seems. 

Write down what you feel psychologically/emotionally before and after the infusion. 

Set an intention after the first two or three infusions. Let the thinking you did inform your intentions, because this isn’t about being a better person. This is about who you are, and what you need. Your intention should be very simple because it’s hard to remember anything once the propofol kicks in. 

If the infusions don’t help at first, don’t give up unless you really hate them. I didn’t begin to feel a difference that mattered to me until the fifth infusion. 

Choose Your Clinic Carefully

When you interview them, they should have you talk to a CRNA, not just a secretary or PR person. 

They should tell you about titrating the dose to your response. (Raising the amount.)

They should have a plan of treatment between six and ten treatments over a period under three months. Probably the faster the better, though I appreciated taking a two-week break in the middle. It helped me integrate the experience and come back with a plan for the final two treatments. 

A followup plan may be one a month, as needed, or some other plan. They should have a plan for you. They may also offer you troches, or lozenges, of ketamine that deliver a dose about half of what you get in the infusion.

They should know a lot about the latest ketamine studies, be able to answer all your questions with lots of difficult to understand detail. Ask to record the interview if you need to listen more than once. 

The clinic should be clean, but also warm, friendly, and quiet. If there are lots of people there, your treatment will be affected by the noise and by not having someone pay close attention to you. 

I would pick a clinic with three or more CRNAs. Professionals need to be talking and learning from each other. 

If you can have someone who cares for you take you to and from the treatments and ideally sit with you while you get the treatment, do that, especially the first couple of times. 

Private rooms for the treatment aren’t necessary, but they are nice. A private space that is quiet is absolutely necessary. (My clinic was near a train track, and that noise didn’t bother me, as it was very much in the background. However, every time someone spoke in the room, their voices and words would become a part of my trip.)

You need to trust the people who are infusing you one hundred percent, especially if you will be alone. Waking up from ketamine is a vulnerable feeling. 

You will likely get several different drugs in your IV in addition to ketamine, including propofol, to relax you, and clonodine, to lower your blood pressure. Find out what drugs you’ll be given and which ones might be given in case of emergency, especially if you have had any negative reactions in the past. They don’t want to make you nervous, telling you chapter and verse, but these are things you might want to know as things go on. 

You will definitely be pressured to take something by mouth for nausea, but in my case, getting anything by mouth gave me nausea. By chance I didn’t get anti-nausea meds the first time, and it turned out I didn’t need them. My take: never take anything you don’t need. If you get sick, that’s time enough to take medicine for it. And NEVER take anything by mouth. Empty stomachs hate pills!

Keep your eyes closed until you feel yourself. Don’t feel you have to get up from your chair, or even move at all, until you are one hundred percent non-dizzy. They will likely support you in that—no one wants to clean up vomit. 

If you have to take an Uber, the clinic should verify your transportation, make sure you get in it, and follow up to make sure you made it home. You are NOT a responsible adult for a few hours after the treatment. My clinic did this with others, and I realized how necessary it was. I would not recommend public transportation.

A Few Sources

I can’t guarantee their veracity, but these are some of the articles I read when making my decision about taking ketamine.

https://www.scientificamerican.com/article/behind-the-buzz-how-ketamine-changes-the-depressed-patients-brain/

https://www.psycom.net/ketamine-depression

https://pubs.asahq.org/anesthesiology/article/113/3/678/10426/Taming-the-Ketamine-Tiger

https://aeon.co/ideas/ketamine-trips-are-uncannily-like-near-death-experiences

I saw this later, one of the few personal stories I’ve read about ketamine that I thought was helpful. Also, who wouldn’t want to check out a site called “Kick Depression’s Ass?”

Another experience I found helpful:

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