Originally published by Erica Leibrandt for Elephant Journal.
From the outside, my life looks great.
I have a solid marriage, healthy kids, a job I love. Yes, I’ve had significant trauma. There’s been grief, deep grief. But I’ve had wonderful opportunities to work on healing, and I’ve taken advantage of them.
I also do lots of the “right” things. I eat well, exercise, connect with nature, cultivate relationships, read, play, and give thanks.
I must quickly add, I am by no means perfect! I forget to be mindful, I ruminate, I have a temper, I get a little too excited about pouring a glass of wine, and I don’t follow directions well at all. But still, overall, given the internal and external elements I’m working with, one would think that I could. Just. Be. Happy.
Ugh, happiness. What even is it?
I wonder how Robin Williams, Kate Spade, Anthony Bourdain, and even my own son, who took his life at 16, would have answered that. What was it that eluded them to the point that life was unbearable?
In my younger days, I would have answered the elusive “happiness question” a lot differently than I would today. Then, I would have listed the tangible things I currently have (marriage, kids, job) and assumed that that was the golden ticket. It’s hard now to remember how far away those things once were, and how much work and dedication has gone into acquiring them. I assume other “successful” people have felt just the same. We have these goals, we reach them, and then…the darkness is still nipping at our heels. And on some days, it knocks us out entirely.
I can’t explain why, with all my privilege, I still struggle so mightily with anxiety and depression. And even though I am a mental health professional, I won’t deny that I feel guilt about this. The fact that objectively I know there is a huge neurological component (the old noodle is not producing enough serotonin and/or dopamine) helps, but at the end of the day I, like most people in America, have been raised to believe that I can and should regard willpower as the pinnacle of personal strength.
Somewhere, there is a voice inside me that whispers, “Your anxiety and depression is a weakness, and that weakness is one of character, and for that, you should be ashamed.” And people, let me tell you, shame does not mix well with a broken noodle.
So, let me describe this lack of happiness from which I suffer. Maybe you will see yourself here.
Sometimes it is purely physical. It can present as twitching muscles, nausea, stomach cramps, chronic insomnia, cystic acne, head aches, severe dental problems, a racing or arhythmic heart, dizziness, disorientation, and even chronic UTIs (my gynecologist explained that one to me.)
And as bad as all that sounds, it’s preferable (in my mind, because I can still try to “power through” the physical stuff) to a psychological presentation, which can include vivid nightmares, a tape in my head that confirms that I am a terrible and worthless person, a feeling of anger and irritation toward everyone and everything, a pervasive state of dread and panic, intense malaise, and of course, suicidal ideation—which, although passive, is still terrifying.
It’s kind of like Whack a Mole with this stuff—just when you’ve turned the volume down on one problem, a bunch of other ones jump forward. Since menopause began in particular, it has begun to feel like a full-time job just to be functional. So what would happiness look like for me today? It’s simple. My life as it is, minus the aforementioned symptoms, or at least, a significant reduction of them.
Let me emphatically say that diet, exercise, therapy, and all the rest of the things I do really help. Without that stuff I would likely have said adios a long time ago. But I realized recently that it’s not enough. Just hanging on. It feels bad. So I started to wonder what else might work.
According to a Chicago Tribune article posted on the Midwest Ketamine Center (where I ultimately sought treatment) website, Dr. Carlos Zarate states, “… standard antidepressants can take six to eight weeks to be effective—ketamine can take just one hour.” He also states that “a small dose [of ketamine]… limits the concentration of a neurotransmitter called glutamate in the brain, and with startling speed, lifts the mood of many depression sufferers who haven’t been helped by traditional medications like Prozac or Lexapro.”
After reading this and many other articles, I had to admit that it sounded promising.
What is ketamine? Ketamine is a tranquilizer which, at a certain dose, produces hallucinatory effects. But the science behind its impact on the human brain is still unclear. As Dr. Patel, my acting physician and founder of Midwest Ketamine Center, told me during our first conversation, “No one really knows how it works. We just know that it does.”
Part of the agreed upon understanding of the impact of ketamine has to do with something called “ego death.” The Minnesota Ketamine and Wellness Center describes it as “a dissociative loss of your sense of self-identity.” As a clinician, I understand this to mean a loss of what we call “psychological defenses,” or all those things that human beings do and believe to protect themselves from pain. (The irony being that unhealthy psychological defenses ultimately cause more pain than they cure.)
It seems that ketamine and other hallucinatory drugs have the ability to help us detach from our standard personal narrative (which in those who suffer from anxiety, depression, trauma, and other mood related disorders is disproportionately negative) and allow the brain to reboot. Personally, I’ve come to compare it to what happens when we turn off our phone or a computer for a while and then turn it back on. For reasons that elude me, these devices always seem to run better after they’ve been shut down.
If hallucinations and near-death experiences don’t sound all that appealing to you as a means to improve your mood, join the crowd. I was extremely skeptical that this would work. Why would it? No other drug therapy ever really had, and I worried that it was going to be a frightening experience over which I’d have little control. As a card-carrying control freak, this definitely gave me pause. But, as Tessa, the wonderful medical assistant at Midwest Ketamine Center said, this is an “end of the road treatment,” meaning if you’re considering it, you’ve run out of options. Huzzah.
The experience itself is hard for me, and apparently others, to articulate. Not having used hallucinogenic drugs before, I was in uncharted waters, and no matter how much research and reading I did, nothing seemed to adequately describe what might happen to me.
Dr. Patel explained that I would need six consecutive treatments for what he called “the loading phase” and that these would need to happen over the course of two to three weeks. During each of the two-hour sessions, I’d be hooked up to an IV and administered ketamine while being closely monitored by either a nurse or a physician’s assistant. Before and after the administration of the drug, one of the support staff would meet with me to discuss concerns, the impact of treatment, and anything else that was on my mind.
After treatment, I would not be able to drive home, and would likely nap for the rest of the day. When the loading phase was complete, I’d have to have booster sessions approximately one to six months apart (one month for the first follow-up is recommended) because, he sadly said, symptoms were bound to return.
Notably, this procedure is not covered by insurance because, though ketamine is approved by the FDA as a sedative, this is considered an off-label application. And that is what made me wait to try it longer than I should have—it ain’t cheap. But, after lots of discussion with my husband (who some might say has been as negatively impacted by my anxiety and depression as I have) we agreed we would just have to suck it up, and if it worked it would be worth it.
So, with the practical details in my head and the recommended comfy clothes on, I hopped in the car and let myself be chauffeured into the unknown.
I laugh now to think that I arrived with my trusty notebook and pen thinking I would take notes about everything as the experience unfolded. Turns out, not only was I unable to write, I was unable to move at all except, with great effort, to raise a forefinger or blink an eye.
The extremely kind physician’s assistant, Mike, and equally awesome nurse, Colleen, got me set up, explaining things in detail as best they could (interestingly, no one at Midwest Ketamine Center has undergone the treatment themselves), and attaching me to an IV, a heart monitor, and a bunch of electrodes that made me finally connect with the fact that this was a real medical procedure. After what felt like an eternity of preparation—but which was likely only about 30 minutes or so—they started my drip. They left me alone in the room per my request, and reminded me they’d be there every 15 minutes to check that everything was copacetic.
Medically, I am assured that everything was indeed in order, but that first day, and all the subsequent days to a greater or lesser degree, were not fun. Different people have different types of experiences while on ketamine so I can only speak for myself when I say a definitive “Yikes!” For me, it felt like I was trapped in a video game that warped time and space, threatening to crush me one minute and then taking me on high-speed rides down super highways paved with pulsing images cast in teeming colors the next. I had the distinct impression that normal life was going on in the outside world without me, and that I would never, ever be able to emerge from this twisted dimension to rejoin the people that I love. Ghastly.
There were some positive moments. During the second treatment, I felt that I was looking down at my past self during a time of terrible trauma, and seeing what was happening from the outside seemed to drain it of its poisonous intensity. The mantra “accept and receive” appeared in my mind with an earth-shaking cadence and solidity. I experienced a deep connection to my children, at one point being able to tangibly see the threads off our spirits intertwine. I perceived my body as a house that I lived in, that contained but did not define me. Sometimes, I sensed a transcendent spirit so close that I felt crowded by its effort to guide and protect me. What a ride.
Afterwards, as the ketamine left my system, a strange and disorienting depression kicked in. I was nauseous, dizzy, and couldn’t stand or walk. It felt painful to rejoin “reality” as much as I had longed for it while under. I staggered out of the office and into the overly bright, stark day and wondered if I had made a big mistake. I couldn’t imagine doing this again, and I certainly wasn’t excited about doing it five more times in quick succession and then as often as once a month. Plus, I worried about my ability to work the next day or even get out of bed.
Once home, I slept the remainder of the afternoon, ate dinner, and then blacked out until morning. When I woke up, I was fine. Nothing felt any different but I was just so glad to be functional that I was in a decent mood. It took at least three if not four loading sessions to start to notice a difference in my outlook, and before each one I was consumed with dread about what I might experience. But I kept going back. I had spent so much money at that point that it would have seemed criminal to squander it, and I was starting to have some vague notion that things were shifting internally in a very real way. By session six, I knew we were on to something.
I can only describe how I began to feel as normal. The constant undercurrent of negativity was gone and, like polluted water that is restored to its natural state, I felt healthy, clean. I was still 100 percent me, just without the accumulation of garbage and debris my mind had built up around its shores in an effort to protect me from the dangerous creatures that lie beneath. And the creatures didn’t seem so dangerous anymore either. My biggest worry was that this feeling wouldn’t last. Once experienced, the exquisite absence of clinical anxiety and depression, even for a moment, is something to long for.
On my sixth treatment, Dr. Patel spoke to that concern. He explained that most of his clients felt as I did, and that their belief in the efficacy of the treatment grew over time, and that that belief itself enhanced the results. I would have to be patient. Often, he said, full integration of the intervention could take up to a year. Meanwhile, the best thing to do was keep up with my self-care routines and make sure to schedule an appointment should symptoms return so that I wouldn’t have to go through the loading phase again.
And, exactly one month later, my symptoms did return—with a vengeance. What seemed normal prior to treatment now felt so much worse. The dark, heavy curtain that drew without reason across my mind filled me with terror. Just like that, I was back to square one. And yet I wasn’t, not really. I could see around the edges of the curtain now, just a little, enough that I didn’t get all tangled up in the fabric this time. I dutifully made my appointment, and await it as I type.
Will ketamine be the answer for me, or at least some part of it? Time will tell. But I remain hopeful that it will, and also hope that new and better treatments for people like me will continue to be developed, and that they’ll all be covered by health insurance. Meanwhile, I am grateful that I have this option.
If you or someone you know is struggling to keep their head above water, be brave. Speak out. Don’t let the stigma of mental illness drive you underground. Anxiety and depression are not things to be ashamed of—the wise woman in me knows that. They are things merely to acknowledge and fight to the best of our ability. Whether it’s talk therapy, drug therapy, spiritual practices, being in nature, physical movement, having an animal friend, connecting with others, or connecting with ourselves in any other of the other myriad ways available to us, there is a path of healing for everyone.