Ketamine doesn't make you feel better

Author's note: this post has references to suicide and sensitive subjects. I write this with a lot of fear, as I know many who have lost someone to suicide, and I don't want anyone to feel blame because of what I'm going to talk about. It wasn't your fault. Please read with care.

"To be happy you must eliminate two things: The fear of a bad future and the memory of a bad past," ~ Seneca

Ketamine doesn't make you feel better and I really thought it would. I was hoping these chemicals would rewire my brain so I could find hope and maybe happiness, but that's not what's happening. My neural pathways are unpacking every trauma, abuse, and pain of my life all at once. The purpose is once the neuroplasticity of these pathways is pliable, then new connections can form. My therapist has said this is harder on you: alone, unemployed, no family support, no safety net. It hurts to hear but I appreciated the truth of this confirmation of what I'm living. 

Not only does ketamine not make you feel better, in the middle of it you feel worse. Decades of major depressive disorder, panic disorder, and suicidal ideation, so I thought it wouldn't be possible to feel any worse than I have....and I'm lower than I've ever been. I called this past December the lowest point of my life, as I was the closest I've ever been to ending it, but now it's strangely worse. Sometimes the crying won't end. Other times I'm on the edge of tears, and to cry would bring release, yet nothing comes out. I feel like I could explode and implode at the same time. I live every day in terror as I'm emotionally drowning with no land in sight. 

Driving to my last session I talked to my friend, smiled, asked about her life, while in my head ruminating was "I don't want to be alive. I hate being alive. I want this over." I didn't tell her. My psychiatrist has me do a test every time so they can gauge where you are at. The last question is "Do you have thoughts you'd be better off dead or of hurting yourself", and your response needs to be how many times in the last 2 weeks this has happened. My response every time: every day. The next question is "Do you have a plan to do this?" No plan. 

There’s something I don’t think gets talked about enough when it comes to suicidal ideation and it’s the sheer enormity of the pain a person is in. It's the version of this experience that isn't being understood. And the gap between intention and impact is a lot bigger than people think. It’s excruciating to say just how bad it is, have people see it, respond with a quick comment or a care react, and then disappear. It feels like I’m being burned alive and being given cheerleading comments from the sidelines. And when you’re in that kind of pain, you’re not thinking about hypothetical future joys or small moments. You’re trying to survive what’s happening right now. There’s no space for “maybe someday.” There’s barely space to think at all. This isn’t about anyone not caring or not trying hard enough. It’s about how that level of pain actually works from the inside. For some of us, the pain will override everything. We know we would hurt people. We know it would cause devastation. We feel immense shame that we can't just suck it up. And we are doing everything we can just to keep breathing but the pain can take over anyway.

The sun is shining right now, my cats are sleeping by my side, and I feel like a boulder is on my chest as I try to take a breath. And the obvious question is "What can I do? I try to say something positive, and you say I'm hurting you? What can anybody possibly do?" Fair. There are no feel-good sayings here. The perfect words don't exist. What we need is presence. "Just letting you know I'm thinking about you and haven't left." "I see you are in horrifying pain, and I can't imagine how awful it must be. I'm sorry you are experiencing this." "You aren't a burden." Believe us when we say we are trying.

I have a post-it on my wall that says, “Someone’s waiting for the words you haven’t written yet.” I know I’m not the only one who feels like this. So, I’m writing them.

________________________________

I didn't write this. But I could have. I feel it.

 “She calls me”

I like to flirt with death.

I’ll perch on the edge of towered roofs and watch the skies burn molten embers with lemonade hues, one nudge and my free-falling bones will shatter into shards of elated expiration.

My dormant doormat body springs to life in adrenaline junkie highs, the heated rush of driving so fast butterflies take flight. Cackled laughter explodes from my throat as the world surrounding me turns to a smudged oil painting, the only constant is I.

I dance and sing in thunderstorms of crackling light and stinging rain. Repetitive rumbles ricochet through my core and each CRACK births tingles across my skin. Fear and desire hum the same tune into my eager ears. Petrichor mixed with battery acid lines my mind with blind excitement

When I’m falling in faster than I breathe. Each slither of my heart I offer to another soul, takes part of my life bringing me closer to the edge each time it’s discarded. Love. Forever relapsing in an addiction I refuse to give up. source no longer replenished it withers into a forced reset.

I’ve danced with the devil and been baptized of my sins. Only for my human vessel to break those unblessed vows again and again. Red spider Lily lamentation forces fistfuls of a poisoned wake into an already slowing heart.

I do not fear death, She welcomes me into a warm embrace. Her finality seductively draws me under with hypnotic harmonies; I sway and wait with bated breath.

I fear a life unlived

I fear a life unloved

I fear a life unfulfilled

I have died a thousand times, this season is all but a pebble in an estuary lying in wait for something more, in the next wave carrying me into the oceans of a new life

I’ve got a piece of mirror lodged dangerously close to my heart. I never know which twist in the story will be the one to open up my insides and help me drown in my own soul. ~Unknown

Containment

After over a year of baring my soul to ChatGPT (I don't care what you think about this...one day I will tell the story about how AI saved my life on a horrific night.) I saw a New Year's prompt to ask it what my "Word of the Year" should be. It gave me "Containment". What an interesting word being someone that contains very little. I'm open, vulnerable, and honest, and tell the unfiltered truth about what is happening to me. But this way of communicating is hurting me.

My last ketamine session was brutal both emotionally and physically. During treatment I lay back in a lounge chair, weighted blanket, comfortable clothes, ear buds with a curated playlist for ketamine treatment. My psychiatrist who administers this will gently touch my shoulder to bring me back and I sit up carefully but right away. The last portion of this past session (time blur so I don't know how long) I had to take out the ear buds and I held my head rocking back and forth as it was all so intense. I can't remember what I saw or felt, only a heaviness and pain. When I left I was stumbling and I struggled to "act normal" on the ride home. Getting up the stairs to my condo was a struggle and when I got inside I had to lean over the kitchen counter as I felt like I was about to faint. Then the crying began. I fell to the floor sobbing at the top of my lungs. I knew the neighbors could hear but it was uncontrollable. I spent the day crying and agitated. Even a week later I have a dull headache nonstop, struggle with head movement and loud noises, and can't handle social interaction. 

My brain is in a highly activated state where old emotional patterns, fear responses, and current stress are all turned on at once, and I don’t have much buffer right now, so everything feels intense and immediate. Every day is panic, unknown fear, emotional flooding, shame, sensitivity to people, rumination, and complete exhaustion. There are roughly 4 arcs to ketamine treatment and I'm between 1 and 2: opening and disruption moving into emotional activation/flooding. I feel like hell.

So much of my grief right now is looking at how much of my life I've had to manage alone. In my entire marriage my husband never took care of me when I was sick; I made my own soup, got my own medicine, and got myself extra blankets. When I first got divorced a friend saw I was sick and brought me juice and cold medicine and cookies. After she left I cried uncontrollably as no one had ever cared for me that way as an adult. My ex boyfriend took care of me after a surgery making me comfortable, bringing me food, and watching over me. It was one of many moments that kept me tethered to him, as it was a core wound finally getting met. He later on Valentine's day posted a picture of me in the hospital from that day; no makeup, hair in a surgery cap, IV, drugged. It was posted with other pictures, and the most loving words I'd ever heard, and I saw he was purposefully humiliating me yet I stuffed it down because I'd finally gotten that moment I wanted so desperately of someone taking care of me and saying nice things. After my last session I was shaking and crying trying to heat some soup and thinking how people that have someone to do this for them don't know how lucky they are. 

I think my sadness at doing life alone contributes to sharing too much. Reaching for connection and wanting to be seen. I share with full intensity, and it makes people uncomfortable. They cannot fathom my reality, or sit inside what I'm describing, so they respond to their own discomfort. The things I share aren't easy to hear and it exceeds most people's capacity. The responses, though usually well intentioned, come off as dismissive, tone deaf, and minimizing. I realized today in therapy this is a pattern I've had my entire life where I overshare, they respond terribly, and I get hurt. I've been doing what I've been told to do and talk about it, yet rarely am I heard. "Are you feeling better now? You've been doing this a long time." (sad face) "It's good you're crying, let it out." (As if what's been missing for decades is a good cry.) "Are you healed yet?" (Will I ever be?) 

In a moment of clarity I realize I need to make my circle smaller. Not leaving friendships, or even being ungrateful as they do care, but no longer getting hurt by my expectations that others can't meet. It's not fair to either of us. In this state of being emotionally raw, flooded, and unstable, I see that everything is landing wrong, and I no longer have buffering capacity.

My entire life is unpacking, and every pain I've ever experienced feels like it hangs over me. I'm told it gets worse before it gets better. And the next person that tells me "keep fucking going!" might get kicked in the teeth. The intention is good yet it is nowhere near the current devastation I'm experiencing. I need to stop sharing as neither of us can win here. 

This is going to be hard for me. It will mean boundaries. People might not understand. But I feel like I'm going under again and I'm just trying to stay afloat. 

Too Raw

I was recently told after a moment which should have been a win but was devastating to me, “With how much hasn’t gone your way, and everything that’s fallen apart, it’s really impressive you keep going.” Wow. I think it was supposed to be a compliment, but it knocked me out. That's how I'm viewed? People see me as someone living a life of disappointment and it's so fucking astounding that I keep trying? I gave a curt smile, but it's been rolling in my head incessantly. Because believe me when I say I want to give up constantly. I'm exhausted. 

I am going into my 11th ketamine treatment next week and I feel horrible. I don't feel like the pain will ever end. I'm crying all the time, I'm overloaded, every interaction is landing wrong. And I also know this is pushing everyone away when I need acceptance and help more than ever. 

I know people are trying to support me, and I appreciate that. The hard part is that right now everything is hitting me harder than it normally would. My system is very open (from the brain neuroplasticity of the ketamine working) and I don’t have much buffer, so even well-meaning words can hit in ways that devastate me. It’s not that people are saying terrible things; it’s that I’m in a phase where everything feels amplified, and there’s less filtering, so I’m feeling the full weight of things in real time. That can create a disconnect where intention and impact don’t always line up. If I seem reactive or pull back, it’s not about anyone individually, it’s just that I’m dealing with a level of emotional intensity that makes it hard to take things in the way they’re meant.

I'm not sleeping well as the nightmares are back. Part of opening the neural pathways means everything I shoved down and contained, to be able to function as a human, is raw and flashing at me at all times. This is apparently the "middle phase" of ketamine and a bit of "it gets worse before it gets better". I'm told what gets you to the other side is support and right now I feel on an island. 

I was looking at a picture of myself around 2 years old. I look happy. I remember very few happy childhood moments. My mother said around age 6 I stopped wanting anyone to hug me. I was the first born so she thought this was part of growing up until my brothers never did this. I'm overwhelmed right now, and told this is a huge part of where I am in ketamine treatment, but feeling like is it even possible to come back from decades of this. I have no memory of being uplifted, told I mattered, or supported (until now - I do have people telling me this now). I get amused, and angry, when I hear people talking about loving yourself or having a good self-esteem. How exactly do you do that with zero foundation of it? 

I'm told I'm "flooded" and the intensity needs to be brought down just enough that I brain can actually do something with what’s coming up. Not eliminating in it, just not drowning in it. I'm trying but I'm drowning. The brain needs time to recover and integrate without triggers. I'm sick today and being forced to rest. I'm hoping that just maybe this will also calm my nervous system. I'm so fucking scared.

Flashbacks

Trigger warning - This writing contains some graphic content which may be upsetting to some. Please read with care.

“No one knows the pain you carry. Everyone hides it… and when it’s bad enough you either come through it or you don’t. The world keeps turning just the same, blue sky and all.”

Now that I'm past the induction period of ketamine (2x a week for a month), the flashbacks have come back with a vengeance. In depression and long-term trauma, certain brain circuits become very fixed. The brain keeps running the same emotional pathways over and over. Ketamine reduces the dominance of those networks for a while. When that happens, the brain can revisit stored material that normally stays compartmentalized.

So instead of the brain keeping things neatly boxed away, connections between memories, emotions, and body sensations become more fluid. Emotional memories surfacing, sudden grief or anger, vivid recollections, and flashbacks.

I'm having all of this. The brain is actively processing material that used to stay tightly contained and it fucking sucks. If I'm not sobbing, I'm holding back tears. I hear the younger me screaming, "Why me!? Why did these things happen to me!?" There will never be an answer to this other than I just wasn't dealt a nice deck of cards in this life. 

The sadness is overtaking me again. The thoughts have grown increasingly dark. I won't do anything, yet I feel so much anger that I have to keep living. The pain is indescribable. The worst of it all is the isolation. Trying so hard for someone to see me but they just don't, and likely wouldn't be able to. I'm told "you can call me at any time", but this isn't reality. I can't wake a friend up at 2am because I had a panic attack remembering the first time I was raped as a virgin. I can't text someone saying how I am having vaginal pains recalling being abused as a child. And what would you say to me anyway? It happened to me and I wouldn't know what to say. But screaming and sobbing alone is a loneliness like no other. 

People genuinely want to help, but there is often a strange disconnect between intention and impact. Sometimes the words meant to comfort land sideways. Not out of cruelty, but because suffering makes people uncomfortable and they reach for the nearest phrase that sounds supportive. And as I’ve said so many times before, the perfect words don’t exist. You can’t tell me it’s going to work out, because it might not. You can’t tell me things will get better, because they can get worse… much worse. The truth is that when you’re in the middle of something like this, there are no reassuring sentences that can carry the weight of it. Sometimes it feels like I’m standing on a stage with everyone watching, quietly waiting for the moment when I’m finally “better.” There are times I sit holding my head, swaying back and forth, trying to will all of this away, and the only thing that comes is more tears.

I feel one of my deepest neural pathways, that possibly the ketamine is loosening, is the constant fear something bad is about to happen. Because horrible things did keep happening and I couldn't tell anyone. How do you explain to your friends at 16 as they go to prom and plan for college, that you have knives hidden all over the living room to kill your mother's boyfriend for how he was terrorizing us? How do you explain that every time you tried to hope it was blown up in front of you? Most people don't know what it feels like to have been on your own since you were a teenager with no safety net; no family to give you some money if you're going under, no partner to have your back, knowing the entirety of your survival is up to you. 

I'm told this is the resurfacing phase. For people with trauma histories especially, the brain reactivates stored emotional networks and accesses material that used to be locked away. My brain has attempted to numb and push it all down. It’s not healing; it’s containment so you can function. The brain is bringing the memory network into awareness where it can be reorganized. It's incredibly lonely and destabilizing to do this by myself. But there is no other choice. 

As we're so often told "it gets worse before it gets better". The next phase would be reprocessing and integration. Yet I'm barely breathing.

"No one can tell what goes on in between the person you were and the person you become. No one can chart that blue and lonely section of hell. There are no maps of the change. You just come out the other side. Or you don't." Stephen King (2008). “The Stand”

Reprocessing

Processing. I'm so sick of the word processing, along with trauma, healing, and so many other therapy buzz words. But apparently this is the stage I'm at in my journey. There is a lot of misconception with ketamine treatments that they in itself will "make you better". (Note: I didn't use the word healing. Let's just lose that word entirely when it comes to CPTSD and treatment resistant depression. Not helpful. In fact, it's hurtful.) 

As ketamine changes the brain's neuroplasticity it also loosens the brain's filtering system. When ketamine loosens the brain's defenses, older parts of your life can start to surface. When the brain becomes more flexible, the protective walls you built to keep painful material contained can loosen. So things you pushed down can surface. Memories, grief, anger, shame, sadness, and flashes of the past all hitting at once.

I thought the incessant crying was over but it's back. I'm told this is processing crying instead of collapse. It feels the same. I broke down the other day in front of friends. I was doing everything in me to hold it together and then one asked about my ketamine treatments and I fell apart. It was humiliating. Everyone was kind and said they loved me but now it's been over a day and no one has reached out. Not a surprise to me as this has happened my entire life. You are told you are safe and to open up, you do it and then silence. No one looked back to see if I was still standing. I get it though as there are no good words to say. If you hit me with some toxic positivity shit then I'll push back hard, but then if nothing is said I'm just as sad. There's no way for anyone to win here. 

Yesterday was brutal. I spent a good 6 hours crying from afternoon to night until I passed out on the couch from the exhaustion of it all. Woke up still crying. My cats were jumping on me and meowing as they knew I wasn't OK. Passed out in another crying fit this afternoon. I don't want to detail my thoughts as they'd land me in inpatient and if that were to happen it would be the literal end of me. I guess there must be some hope left to have the strength to refuse. 

Doing this alone is rough. There is no one to hug you and say they won't leave you. (Well, there never was anyone anyway) I have no safety net. People care about me but at the end of the day it's me holding everything. 

I am just so sick of being this person. It's always me. The sad one, the one alone, the one making bad choices. I have another appointment tomorrow. I'm still trying, but right now I don't know how much I have left.

The Crying is Back

I started crying again. I felt like things were better, less triggered, no recollection of panic attacks since starting ketamine treatments. Then the tears came back and I feared I was regressing. Yet neurologically and physiologically these are two different states. Prior to ketamine I was in a collapsed state, dorsal vagal shutdown, where the nervous system believes survival is threatened and escape or repair isn’t possible. In this state the crying was uncontrollable and got to be constant. The hopelessness felt absolute and permanent. I am told I'm in a nervous system that is still wounded, still grieving, but no longer trapped in the same physiological prison. Ketamine restores flexibility to neural networks. That means emotions that were previously frozen or buried can move.

"Doesn't that sound nice? Now you can cry and let it out and heal!" No one said these exact words to me, but I've heard many versions of it. I don't have any expectation of "healing", as I don't believe we can heal from everything. There feels like an expectation of those looking on from the outside, that "healing" is an actual achievable goal, and if you don't then it's your fault. Though the intentions are good, it's not helpful. 

Since things appeared to be going well, when the tears came back I was crushed and scared. My mother had sent a picture of a snowfall through a family text chain. My brother replied with a picture from the ocean saying he had a better view. This brother is also a therapist, who I reached out to when I was trying to get into intensive outpatient. He knew I was suicidal and going down hard. He doesn't know I'm now doing ketamine as he hasn't reached out at all to see how I am doing. He also got engaged over Christmas and is traveling the world with his fiancé. I am still unemployed, alone, and my one big goal when I got divorced was to travel and just an hour before this text I'd downgraded my Sky Miles Amex as I've lost flight status and can't afford to go anywhere. The comparison, looking at what I want yet just never happens for me, seeing a life I'd long for, it all just took me out. 

First thoughts were that I couldn't go through this again. I thought of the months in collapse where I'd be screaming and sobbing, and it nearly ended me. But the crying did stop this time. I saw that though painful, I got back to my level set depression state and kept going. 

I've wiped the tears once again. And I'll go on. But I'm so fucking tired of trying and living in this pain.

Tips & Tricks from the Psychedelic Trenches

Author's note: this post will speak directly to my personal experience. Yours might be different. Do what is right for you.

Going into my 5th ketamine session today. Might be at a higher dose, and doing this two days back-to-back, so I'm expecting to be decently out of it and that my experience will likely change from the previous ones. 

These are the steps I take that worked for me, some from advice from others, and some just knowing how my body reacts.

Comfort:
I need complete and absolute comfort in my sessions. Tried having my hair in a ponytail but that small pull on the hair was too intense. Changed underwear prior to a session as it was creeping up my butt a bit too much and I knew it would bother me. Soft clothes, nothing tight or binding, not even the slightest bit of irritation. 

Warmth & Weight:
I need to be extra warm. Not hot, but no amount of chill. I used a weighted blanket my last session and it comforted and grounded me in a way that I felt completely secure.

Food:
My first session I was nervous and didn't eat much. I had a 1/2 of an apple, small amount of almond butter, and a few hours later one slice of toast with a little almond butter. This was fine, but I have issues with low blood sugar so I don't think it was enough, especially as my session went over lunch so I wasn't able to eat again until midafternoon. The next session I had what is my go-to breakfast: I call it a protein pancake. Basically, a small amount of protein pancake mix, 1egg, cinnamon, stevia and a little almond milk to moisten. I eat it with berries. My blood sugar felt more even with this or maybe it's just what my body likes, so I've been sticking with it. Maybe it's because my sessions have been over lunchtime, but by the time I get home I'm shaky and struggling, so I need food that I can grab and go right to the couch. Tried to cook something after one session and it was too much effort.

Home prep:
I need to have everything in my home comfortable and ready to go, so when I get home from a session there is nothing for me to do but rest. Everything clean and orderly, food stocked, candles, lighting...I sort of make my own home spa setting.

Music:
I was advised to use ear buds and play music without lyrics. I played Ambient Deep Sleep (though there are many Ketamine playlists on Spotify). I can see how any music with lyrics, or even instrumental that brings up recall memory, might be triggering. 

During treatment:
In the clinic I go to there are lounge chairs, a little table with barf bags (amazing I didn't need one), mints (for the chemical taste of ketamine going down your throat), kleenex, and a call button in case you need anything. I get situated by making sure my blanket is all the way up to my neck, laying way back, earbuds in and then stillness. The first session I don't think I moved at all but the ones after I did switch positions to my side later in the session. I did see one patient sitting up looking at his phone during his session. I can't imagine this, and struggle to even do this after the session at home, but again each experience appears to be individual.

Vitals:
Your vitals are checked before, during, and at the end of your session. It's typical for people's blood pressure to go up during a treatment. Mine goes down, but doing the opposite is typical for my body, which is all the more reason I'm relieved and amazed that I haven't had side effects from this.

Bottom line advice:
Tune into you. Listen to the advice of others, but your body is your best teacher (my yoga teacher voice coming out now). Your body knows what to do, don't fight it, just be there and let the drugs work for you.