“Think of it this way,” my psychiatrist said. “It would be unethical for me not to refer you to a treatment that I think may work for you.” The treatment was ketamine infusion, which has increasingly been found to be helpful in treating previously untreatable and drug-resistant depression.
I sat across from her with all the telltale signs of depression and anxiety evident in my body language. My legs were double-crossed (leg over leg, then ankle wrapped around its opposite calf), my hands gripping each other, my body moving slightly back and forth in the chair. I was yawning and my eyes felt heavy. I was about to go on an almost-three-week-long trip; I was exhausted before it had even begun, and here was my psychiatrist telling me that she’d like me to try ketamine treatment for my depression. We’d exhausted all other options. This seemed to be it.
Two months later, I was lying down in the offices of Dr. Glen Brooks in New York. In the interest of full disclosure, the treatment I was about to receive six times over the course of two weeks—the initial infusions after which the treatments are fewer and farther between—is not cheap. It is, in fact, ridiculously expensive, and it is only because I am lucky enough to have had a bunch of people die in my life that I was able to afford it. Maybe it’s my natural inclination and maybe it’s my depression, but I find gallows humor in that fact: all four of my grandparents and my father died before I reached the age of 17. It is because of their deaths that I could afford to treat the depression that may have been caused by their deaths, as well as by various other things.
I had my doubts about ketamine treatment, especially as I’d dated and known enough addicts in my time to be wary of anything that I knew to be used recreationally, and Special K, while maybe not as popular as X or MDMA these days, is still abundant. My psychiatrist told me that ketamine is used, for the most part, in intensive care units and emergency rooms. She described how, when she was on rotation as a resident a long time ago, an eight-year-old boy came into the ER with third-degree burns on his arm. He was howling in pain. The procedures to treat burns are—and this is a gross understatement—unpleasant, and she had no idea how the doctors would be able to keep him in place to clean the wounds and sluff off the excess burned skin. What they did was give him an infusion of ketamine and put Spongebob Squarepants on the television. The boy sat there, utterly calm, watching the cartoon. As a child who’s endured several extremely painful procedures (one of which involved all my toenails being crushed and needing to be picked out of my flesh), this struck me deeply.
It was Dr. Brooks who finally convinced me, though I suppose my being there meant I was going to go through with it. He calmed me down beforehand, told me the stuff wasn’t addictive, and showed me two images of rats’ neurological pathways. Rats who’d been made depressed and given peanut butter for a week had broken and shriveled pathways; similar rats whose peanut butter had ketamine in it showed new growths splitting off from the existing, already more robust pathways. It looked, to say the least, promising; this is what ketamine does in humans with depression too—it treats people whose dopamine and serotonin are actually being generated normally (unlike people for whom SSRIs and other antidepressants work), but for whom the pathways for those chemicals to go through are broken or underdeveloped—often because of early trauma of some sort, whether specific and pinpointed (such as physical or emotional abuse) or complex (made up of many smaller events that don’t seem obviously traumatic). I was surprised to learn that my symptoms of depression and anxiety, along with others, all matched the symptoms of PTSD, but Dr. Brooks said that I had them all except for rage (which I also have, if I’m being perfectly honest, though it wasn’t on display that first day).
When he hooked me up to the IV, I was nervous. I am told that I am a type-A, and while I don’t exactly know what that means—I’m not a Myers-Briggs personality type aficionado, or any other personality type test at that—I’ve gathered that it means that I like being in control, that I pay attention to details, and that I’m a perfectionist to the point of self-destructiveness. While the loss of control is appealing to me on an abstract level, the reality of it is rarely something I enjoy.
I put on my headphones—I was instructed to bring music—and sank into a playlist titled “Peaceful Piano.” The next hour passed in a strange state of timelessness, a floating feeling in which I didn’t think anything much mattered, in which I felt a sereneness that was discomfiting to that part of my mind that is unable to detach from any experience.
The scariest part was towards the end, when a Beethoven piece came on. When I was little, the piece was on a tape I used to listen to when falling asleep, a tape called “Beethoven Lives Upstairs” which told the story of the composer’s life and music through the eyes of a fictional boy who was his neighbor. On that tape, this particular piano piece narrated Beethoven’s death.
“How are you feeling, hon?” Dr. Brooks asked me, holding my hand as he came in when the infusion was just about done, when this melody was still playing in my ears.
“It feels like dying,” I told him. He frowned and told me it wasn’t supposed to feel like that. “No, no,” I tried to explain. “It’s good. It’s nice. It’s going to be okay.” He patted my hand again, and with a pained expression told me I wasn’t dying, and repeated that it shouldn’t feel like it.
I made the connection between that remark of mine and the melody later, when I was coming out of the strange stupor-like high that the ketamine had put me in. I explained this to Dr. Brooks, but he still seemed profoundly sad for me. Every time I tell him how badly I feel, he shows a true empathy that I’ve found rare in the medical profession. He feels for his patients, whether they come to him for depression or for terrible neuropathic pain (another thing that K treats).
After the first three infusions, I called him. I had a bounce in my step. I’d been giggling for days. Enjoying sex more. I hadn’t napped in days. “I kind of feel on top of the world,” I told him.
“Oh. Em. Gee,” he said back, and I could hear the smile in his voice.
What I haven’t said yet was that shortly before my first ketamine treatment, I became suicidal for the first time in my life. I had never before wanted to die in the immediate sense, until then. If I hadn’t started ketamine treatments when I did, I don’t know whether I’d be here writing this article now. I had so many pills lying around on my dresser from past attempts at medication that hadn’t worked, that I knew exactly how I would go. Enough of those, my partner out of the house, my phone in another room, and I would die painfully and with lots of vomiting, but I would still likely die.
I didn’t die. I went and got treatment. Treatment that I am lucky to be able to afford, and that I wouldn’t be able to afford if I didn’t have parental support.
Why then, if this treatment is so incredibly helpful and getting so much press (I am far from the only one with a ketamine success story) is it still relatively unknown and not widely available? Why is it so expensive? Why is it that there are so few studies being done, and that the few studies that are being done are testing new drugs that have K in them rather than developing a cheaper method to give ketamine to patients?
The answer is simple, and it was Dr. Brooks who explained it to me: money. Ketamine is a generic, its patent lapsed, and is thus not making any big bucks for pharmaceutical companies. Developing ketamine into something more readily available—especially when it’s a controlled substance and will require a lot more research to make it FDA-approved for the use in depression—means spending a lot of money, very little of which a pharmaceutical company would see back in its coffers. The studies being done on straight K are mostly university and NIH funded. Big Pharma is much more interested in finding a pill that combines K with something else so they can patent it and make money off of the backs of the mentally ill.
So while it does seem like there’s a future for ketamine treatment, it doesn’t seem like it’ll be getting much cheaper than the privately administered stuff that the few and far-between anesthesiologists, like Dr. Brooks, are able to offer.
Ilana Masad is an Israeli-American writer living in New York. Her work has appeared in The New Yorker, McSweeney’s, Marie Claire, Tin House, Printer’s Row, Joyland Magazine, Broadly, Hobart, and more. Find her at her website or tweeting about books, writing, and feminism. She is also the founder of The Other Stories, a podcast featuring new, emerging, and struggling fiction writers.