One of the most recent studies on the subject, published in early September in the Journal of Clinical Psychiatry, found that people who received intravenous ketamine sessions showed notable improvement in depression and anxiety symptoms. It also significantly reduced suicidal ideation. Treatments like ketamine therapy are still very new and need more research before becoming more widely accepted or available. Still, many people have had tremendously heartening luck, and it’s their stories that will ultimately broaden acceptance of these therapies. Molly Jenks is one of them.
When Nothing Else Worked
While going through a divorce, Molly Jenks began feeling depressed and overwhelmed. Up to thatpoint, she felt like she could muster through difficult events in her life. “It really took this divorce to bring me to my knees and ended up bringing up everything in my life,” she says. She started realizing that her relationship with her husband, who was addicted to pain killers, had similarities to her relationship with her alcoholic mom. As she processed the loss of her marriage and co-dependency issues, she found it difficult to function. “I couldn’t get out of bed. I had alot of anxiety and even started having suicidal thoughts,” Jenks says. Her primary doctor suggested that Jenks see Mike Dow, PsyD, PhD, for psychotherapy. For about four months, Dow led her through hypnotherapy and EMDR (Eye Movement Desensitization and Reprocessing). However, neither seemed to help, and Dow recommended she try psychedelic-assisted therapy, which involves talk therapy and the use of psychedelics. Her story is becoming more and more common.
Considering Ketamine
In the United States, ketamine, a dissociative drug that interacts with brain chemicals to produce visual and auditory distortion and make one feel like they’re detached from reality, is the only psychedelic legal for off-label use. This means that ketamine is FDA approved for another indication—anesthesia. Once a drug is approved, physicians can prescribe it for alternative indications, explains Dr. Todd Gould, MD, professor of psychiatry, pharmacology, and anatomy & neurobiology at the University of Maryland School of Medicine. “That is referred to as off-label prescribing and is not uncommon. Esketamine, a form of ketamineadministered intranasally, is FDA approved for the adjunct treatment of depression,” he says. Ketamine has two differences from other drugs on the market for depression. “It can work quickly, sometimes within hours. Also, it is often effective in patients that have not responded to any other treatment,” adds Gould. Jenks had never experimented with ketamine prior to seeing Dow, “and it was a little scary for me,” she says. Learning about some of the science eased her concerns. “Around 2000, it was discovered that people who got ketamine for anesthesia were reporting remarkable reductions in depression and anxiety,” says Dow.
The Science Behind the Therapy
According to a retrospective analysis published in the Journal of Affective Disorders in March 2022, ketamine intravenous therapy helped with depression. Researchers found that of 537 people with depression who received a series of 4 to 8 ketamine infusions between 2016 and 2020, more than half responded that their depression fell by 50% or more. Additionally, of the 356 participants who had experienced suicidal thoughts, 73% had a reduction in those thoughts after treatment. Plus, there was a 79% chance that recipients would feel relief four weeks later and about a 60% chance at 8 weeks, without having to get additional ketamine treatments. “We think that depression is associated with weakening of connections between neurons, which are the principal cells of the brain. Ketamine appears to work by rapidly repairing and strengthening those connections,” says Gould. In addition to its effectiveness, Jenks was also concerned about the potential for ketamine to be addictive. Dow explains that the main mechanism of ketamine is not an upper or downer, but rather it falls in a category of what he calls “all-arounders.” “Psychedelics inherently don’t tend to be addictive because they’re not flooding the brain with tons of dopamine like speed, crystal meth, or cocaine do and, they’re not flooding your opioid receptors like downers or heroine or prescription pain killers,” he says. However, he noted that ketamine does increase dopamine levels, which can give a feeling ofwanting to escape. When used in a clinical setting, he says this isn’t a concern.
Finding Relief Through Psychedelics
In 2021, Jenks underwent six treatments of ketamine that occurred over a couple of months. The first three sessions were within a week of each other. After the first sessions, she says she felt immediate relief. “I was able to get out of bed and function,” she says. The last three sessions were spaced out a few weeks apart with her last treatment in December 2021. “It felt like it was the most that I had processed and the afterglow of that lasted a lot longer, taking me through April of this year, and I started noticing that I could use a refresher and did another round in April and in July for eight total,” she says.
Taking it one session at a time
For each session she spent about three hours at Field Trip Health, where Dow works. Before receiving ketamine, he talked to her for 25 minutes about what to expect during the session and helped her set an intention for the session, such as whether she wanted the ketamine to help her find relief or help her to process childhood trauma. Then 25 mg of ketamine was inserted into her arm with a small needle. Over the next 45 to 75 minutes, she fell into a dissociative trance that Dow describes as a deep form of meditation. “Sometimes you have the softening of the ego and spiritual experiences and sometimes people are verbal. Over the course of the sessions, we’ll beef up the dose and we’ll have ego death, the feeling of being a single point of consciousness, and when people come back about 75mintues after the injection of the medicine then we really start to process,” he says. Jenks went into the sessions focused on her divorce; however, a surprising experience occurred during her second round of ketamine where she unlocked a childhood memory from when she was 8-years-old in what she said felt like an out-of-body experience. “I was all the sudden in Mexico and I was hearing Mariachi…I had a memory of me being at a Mexican restaurant and [my mom] had been drinking a lot and her now husband who she was dating at the time was ordering her drinks and Mariachi, and I remember being confused as an 8-year old,” saysJenks. She hadn’t thought about that memory until then. After the session, she talked it through with Dow,and began to realize she had unresolved issues with her mom. From a physical standpoint, after her treatment, she immediately felt better and that ketamine had catapulted her out of a depressive state.
Processing Trauma and “Aha!” Moments
Dow says that ketamine leads to a significant increase in the neurotransmitters dopamine, serotonin, and GABA, which all anti-depressant and anti-anxiety medications target. “So if you really just want that lift, it doesn’t last forever. With that being said, there are some spiritual aha moments and those can last forever,” he says. The severity of depression will determine whether a person needs long-term treatment or not. “If it’s hard to get out of bed, that person will need to come back every four months. With that being said, we’ve had people who have these breakthroughs in therapies and it ends in four months. And we do have people who don’t come back—they got what they needed,” he says. For those who need help processing trauma, Dow says if they have successful reprocessing with ketamine and psychotherapy, they may not need to come back. In Jenks case, she plans to receive ketamine every three months for maintenance as she feels it’s needed to keep her depressivesymptoms manageable. While psychotherapy isn’t harmful, Gould points out that it’s common for ketamine to be administered independent of psychotherapy. “Actually, the majority of the clinical trials that have proven the efficacy of ketamine for depression did not provide therapy along with medical treatment,” he says.
How Psychedelics Can Help Women and People Who Menstruate
Jenks’ journey to the path of psychedelics began about 7 years ago when she started seeing a holistic doctor (who is a MD and DO) after dealing with infertility in her mid-30s and was not feeling well overall. When nothing worked, she became exhausted with traditional medicine; however, as a daughter of a lung doctor, it was hard for her to branch out to non-traditional medicine. “[My] doctor started doing bioidentical hormone replacement therapy and functional nutrition and completely totally changed my health,” says Jenks. Dow works with many women seeking help from his clinic who have tried other methods for mentalhealth. Part of this may be the fact that it wasn’t until the 1990s that Congress passed the National Institutes of Health Revitalization Act, which required that women be included in clinical research. Not only are women behind decades in understanding how diseases relate to them, but a 2020 study found that 88% of 86 medications approved by the US Food and Drug Administration were more likely to cause adverse side effects in women than men. When it comes to mental health, Dow points out that generally about 1 in 10 American adults are on a SSRI anti-depressant, but for women between ages 40 to 50, it’s closer to 1 in 4. “In the US, there are a lot of women in their 40s and 50s which tends to be the group that is most likely to be on a SSRI anti-depressant. We want to say [ketamine is] a treatment that…can really help that 40-year-old single woman of two who is experiencing side effects of her Lexapro,” he says. Additionally, women are more likely to have post-traumatic stress disorder (PTSD) than men and one in eight women suffer from peripartum depression (formerly called postpartum depression). A review of studies on the psychedelics MDMA (ecstasy) and psilocybin (magic mushrooms) have shown benefits for helping with PTSD, which have led to the FDA to designate those drugs as breakthrough therapies for PTSD and treatment-resistant depression. This doesn’t mean the FDA approved them for use yet, just that it intends to help develop and review the treatment faster than other therapies for the conditions. “MDMA has an empathogenic response…it really helps people to connect with and put the ego defenses down and open their heart so they can get in contact with whatever is ailing them,” says Dow. In 2023, Oregon will be the first state to allow psilocybin-assisted therapy. Dow predicts that in the next 4 to 5 years, MDMA and psilocybin will be legal for use in most states within the context of psychedelic-assisted therapy. Additionally, he said LSD may make its way into approved treatment for mental health. “There is good research on using micro-dose LSD for reduction of symptoms in dementia. I think we’ll see novel uses in the future,” says Dow. However, he adds that a downside of psilocybin and LSD is they are all-day events, “and when you have licensed professionals sitting in a room for you for 8 hours a day, it becomes costly and requires people to take time off work [to receive the treatment].” Further into the future, he anticipates more formulations of all psychedelic therapies will become available to treat a wider variety of conditions and will be “more integrated in the working professional’s or parent’s lifestyle.”
Who Shouldn’t Use Psychedelics?
Dow says 1 or 2 out of every 10 people who come to his clinic for ketamine treatments aren’t good candidates. Conditions and circumstances that exclude people from being eligible include:
History of psychosis, bipolar 1 disorder, inactive psychosis, or schizophrenia. “Ketamine can increase levels of dopamine, which is usually a very good thing if you have low levels of dopamine and depression, but if there is psychosis, the increase in dopamine can also increase psychosis, so we don’t want to use it in those cases,” he says.Women who are nursing or pregnantDrug-seeking people who want to try the medication for the wrong reasons.Having uncontrolled hypertension. “Ketamine can raise the blood pressure a little bit just about as much as exercise would…but if it is controlled by medication, then we can see those people,” says Dow.
