A friend texted me a day ago saying they didn't think they'd make it through the night. They have a long suicidal ideation history like me, and also a dark sense of humor, so initially I thought we were doing our melancholy joking. Then they sent me the letter they'd written their dad explaining and saying goodbye. A few more texts got progressively worse...and I didn't know what to say.
I've said before that there are no perfect words when someone is this far down. I wanted to say, "Please keep going." "I will be devastated if you're gone." "You have so much to live for." Yet those same things have been said to me, and I know how they don't land well and many times feel like a slap in the face. I felt the pain that others have expressed that they feel with me: helplessness, sadness, and fear. Then deep shame for what I've put people through by sharing so much and choking them with the agony I'm drowning in. And I felt like it all hung on me in this moment.
I did the only thing I knew to keep them alive: I stayed and wouldn't let them go. I asked where they were. They were sobbing, earbuds cutting in and out, I couldn't decipher much but I kept them talking. They got home and the pain was pouring out of them. "I have nothing to live for." "I'm a loser in this life." "I can't take anymore." I said I understand and feel every one of those thoughts every day. I asked if I could come over and they said their roommate would be home soon. More ominous talk. I asked if I could take them to the hospital. But then we both talked about what would happen: handcuffed to the bed for suicide watch, drugs, 72 hour commitment, and then nothing really changes. They smoked some keef and said they were passing out. I said my phone ringer was on high and I would have it by me all night. I didn't know if I did the right thing.
Woke up and immediately texted to make sure they'd made it through the night. Though deeply depressed the urgency to die appears to have softened for the moment.
I'm living it too and I still don't know what to say.
How ketamine works chemically in the brain
Ketamine works primarily by affecting the brain’s glutamate system, which is the main system responsible for learning, adaptation, and neural communication.
Most traditional antidepressants work on serotonin or dopamine and take weeks to gradually adjust levels. Ketamine works differently. It acts upstream, at the level of neural connectivity itself.
1. Ketamine temporarily blocks NMDA receptors
NMDA receptors normally regulate glutamate activity. Ketamine blocks these receptors briefly, which creates a controlled disruption in the brain’s usual signaling patterns.
This interruption prevents the brain from running its habitual loops in the same rigid way. (I'm a hard ruminator. Even when having a good time, in conversation, doing anything, the thoughts are incessant.)
2. This causes a surge of glutamate release
Because NMDA receptors are blocked, the brain releases more glutamate through other pathways, particularly AMPA receptors.
Glutamate is not a “mood chemical.” It’s a plasticity chemical.
It tells the brain:
“Pay attention. Something new is happening. Adapt.”
3. This activates repair and growth mechanisms
The glutamate surge triggers downstream processes, including the release of a protein called BDNF (brain-derived neurotrophic factor).
BDNF supports:
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growth of new synaptic connections
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strengthening of healthy neural pathways
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repair of stress-damaged circuits
Chronic depression and trauma tend to weaken and prune neural connections. Ketamine temporarily reverses that pattern. (Temporarily. I just had my gut clench in fear of what happens when this ends. I wonder if you do enough of these sessions that it actually allows for repair.)
4. The brain becomes more flexible
For a period of hours to days after treatment, the brain enters a state of increased neuroplasticity.
This means neural pathways are less rigid and more capable of reorganizing.
Thought patterns that previously felt automatic and inescapable may loosen. Emotional responses may no longer trigger the same intensity of physiological alarm.
This flexibility allows the brain to update itself.
Why effort is not required
This process is chemical and cellular. It does not depend on conscious effort. (This is a hard one for me. I've been told for so long that my mental state is from my lack of effort while I'm always trying.)
You cannot “force” neuroplasticity through concentration or willpower during a session.
The beneficial effects come from the biological cascade:
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NMDA receptor blockade
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glutamate release
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BDNF activation
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synaptic remodeling
These processes occur regardless of whether your mind is quiet, busy, creative, or distracted.
Trying to control your thoughts does not enhance the effect. In fact, excessive effort activates control networks that can interfere with the nervous system’s ability to settle.
The brain repairs itself best when it is not being micromanaged. (I straight up laughed out loud on this one! I absolutely micromanage my brain.)
What you may notice subjectively
Because the brain becomes less locked into old patterns, people often experience:
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more space between thoughts and reactions
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reduced rumination
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emotional distance from previously overwhelming material
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increased ability to choose responses instead of being driven by reflex (Though mostly responsible, I'm a highly impulsive person. I've been judged harshly "Why would you do that?". I don't fucking know!)
These changes often emerge gradually, not all at once.
The key point
Ketamine does not insert happiness into the brain.
It restores the brain’s ability to change.
Once flexibility is restored, the nervous system is no longer trapped in fixed survival patterns. New responses become possible.
And importantly, this process happens whether you try to make it happen or not.















