First Therapeutic Experience with Ketamine - Set and Setting

Okay, my first therapeutic experience with ketamine was not a good one... But let me explain.

When talking about psychedelics, the concept of "set and setting" is probably the key to having a successful experience. "Set" refers to your mindset, your intention for the "trip" and the story that you are telling yourself about what it will be like. You want to be comfortable with the experience you are about to have, if you don't feel safe about taking the medicine, it can impact your experience of it. "Setting" refers to where you are taking the medicine, who is administering it, and the environment that you will be in. If you don't feel like you are in a safe place or you don't feel supported by the people that are administering the medicine, this can also affect your experience.

There are a few different ways to take ketamine therapeutically. One is to take it intravenously: you are hooked up to an IV and the ketamine dose is slowly dripped into your system. From what I understand about ketamine treatments, it is recommended that you go four to six times over two to four weeks. I should also mention that these ketamine treatments are not cheap, and they are not covered by insurance, or they weren't at the time. 

I made three appointments right off the bat. The place I went to for my first ketamine treatments was a joke. It was a group of anesthesiologists who saw a way to make some easy cash, rented an examination room, and set up shop. It was impersonal and borderline inappropriate, like seriously these people should not have been allowed to practice. I just didn't know any better.

I went to my first appointment. The examination room was very sterile and cold, the only ambience was provided by the muzak playing outside in the hall. 

As the doctor was preparing the IV, she advised me that ketamine works in conjunction with anti-depressants, and warned me that if I was not taking a selective serotonin reuptake inhibitor (SSRI) that it was likely that the treatment would not work as well for me. 

As I have mentioned before, I have treatment resistant depression, anti-depressants do not work for me. Because most anti-depressants come with negative side effects, it would not have made sense for me to be taking them. 

It also didn't make sense that a drug that was being touted as a breakthrough for people with treatment resistant depression, would require that the patient be taking a treatment that doesn't work for the medicine to be able to work.

Nevertheless, the IV was already in my arm and it was too late to stop it, so I let her continue. The experience was vaguely reminiscent of my partying days, the dissociation, the feeling of being somewhere else. I remember being annoyingly tuned in to the muzak from the hallway. 

I left there feeling worse than before I started. But, not to be discouraged, I went back the next day for treatment number two. My mood continued to plummet. Because this was over the Christmas/New Year holidays, I assumed that my worsened mood was being brought on by the holidays and I went back a week later for a third treatment. After three appointments ($1500), I was feeling worse than when I started. So I decided not to continue with any more treatments.

When I declined to continue the treatments with them, citing my worsening mood, the woman had the nerve to blame me, claiming "I told you it wouldn't work if you were not on anti-depressants." (Apparently, she had no problem taking my money for a treatment she believed would not work for me.)

But she was WRONG, WRONG, WRONG! This group that I went to was not trustworthy, had no idea about how the medicine worked, and did not care whether the treatment was helpful or not. It just goes to further my point that set and setting are the key to a successful experience. 

Hindsight is 20/20, but at the time, the only conclusion I could come to was that ketamine was another treatment that didn't work for me.