Ketamine Treatment Information
Ketamine is a relatively new and innovative psychiatric/psychological treatment
approach, involving ketamine administration in a safe and supportive setting.
The exact nature of the treatment process varies depending on the particular problems
being treated and the specific individual’s needs and goals. Initial sessions will involve
an evaluation of a patient’s: current problems, concerns, and needs; prior history and
review of current or ongoing treatment; overall health/medical condition; and an
assessment of the potential suitability and viability of this type of treatment for that
patient. By the end of the evaluation period, we will offer our clinical impressions and a
recommended approach to treatment. These goals will be reviewed during the course of
the treatment in order to assess and/or modify them according to changing needs,
perspectives, and progress.
Current treatments for depression including medication usually have a 40% success
rate. To make matters worse these medications do not reduce suicidal thoughts. They
must be taken daily, and cause unwanted weight gain and other ongoing side effects.
This is a time consuming and frustrating process for depressed patients. By contrast,
ketamine treatment can reduce or eliminate suicidal thoughts, often immediately. It
treats depression rapidly, with no ongoing side effects.
With ketamine, the effects are more robust than with medications. Ketamine is about
70% effective, it also helps patients with more than just their mood and depression, it
seems to help them start over, and reconnect with who they are.
The neuroscience on ketamine is fascinating. Unlike most antidepressants, it does not
appear to work by serotonin or dopamine. Its mechanism is through a different
neurotransmitter called glutamate.
Glutamate is everywhere in our brain and it handles learning, attention, and novelty
seeking. The novelty seeking part is the most important. Ketamine seems to help our
brain rid itself of old patterns, and try new ones. This appears to be essential to having a
good mood. People with good moods are usually trying new things, whether recipes,
books, parks, hobbies, or making new friends. Depressed people usually lose these
abilities. After ketamine infusions, people often break old patterns and try new ones,
which is amazing to see.
Ketamine, in low doses, reduces the amount of control we have over the direction of our
Think of your mind as a river. Every day we are met by a fresh supply of tastes, sounds,
smells, and interactions with people, and we react to this supply with fresh perceptions,
thoughts, and decisions of our own. Each day, the water in a river is different water,
even though the shape of the river does not change much.
Now, imagine a pond, or a backwater, unreached by any fresh current. The water is
always the same, and it becomes stagnant. Like a swamp. In depression, having a bad
mood is a lot like that. People with depression have a mind that doesn’t change much
from day to day. It becomes stuck on a few stagnant negative thoughts and emotions.
Like an eddy in a river, where the water beings to swirl around, without moving
downstream, depression leaves people stuck in a whirlpool of repetition and negativity.
To heal, they must let go, surrender and release repetitive thoughts, and allow into their
minds a fresh stream of experience. Ketamine works by taking away the degree of
control you have over your thoughts.
Many people report being swept away by water during their ketamine treatment.
Emotions that are stuck, will be released, and you may rediscover within yourself a new
valuable perspective on life.
When we are depressed, we control our mental contents, but we cannot control our
mood. Our mood is like the smell of stagnant water in a pond. We cannot keep it fresh.
Whereas, when we are floating downstream, say, on an inner tube, we cannot grab onto
anything. We cannot control what scenes pass by on the riverbank. But we are detached
enough to control our perspective towards what we see. This is the reason ketamine will
allow you to rediscover a healthy perspective on your life, and in turn, will elevate your
Most people undergoing ketamine infusions do not report hallucinations. However
many people report distortions in the size and shape of their body. For example, some
feel as if their hands, or lips, have increased in size. Some also experience synesthesia,
which is the unique experience of seeing a sound, or hearing a color. Many also report
that time does not seem to pass normally. It will dilate, or contract, such that the entire
hour may seem like ten minutes, and vice versa.
During your ketamine treatment, if you close your eyes, you may experience a variety
of visions, memories, emotions, and thoughts that you can’t control, and these are
usually pleasant. However these visions are not hallucinations. We encourage patients
to ‘go inside’ during their infusion, and to try to keep their eyes closed, since, if the eyes
are opened, the experience may be suddenly interrupted.
Patients who have the best experience fast after midnight the night before, come in on
an empty stomach, and try to arrive with a sense of peace. Patients who worry a lot
about whether the treatment will work, during the infusion itself, do not get optimal
effects. You should do your best in trusting the clinic, the process, and in the
inevitability of getting some relief.
After arriving, you will sign in, report your symptoms on a questionnaire, sit down on a
recliner, and a nurse will start a small intravenous line in your arm or hand. You will
have a blood pressure cuff on your arm as well as a couple EKG leads stuck on your
body, and an oxygen monitor on you forefinger. The nurse will tell you, if you need her
for anything, you simply remove that thing from your forefinger and she will come in.
The ketamine will be administered and you will be closely monitored by our medical
staff. You cannot drive after an infusion, and must arrange your own ride home.
The side effects that occur are during the ketamine treatment session, as there are no
side effects after the fact. The drug is already being eliminated from your body.
During the ketamine treatment, by far the most common side effect is nausea and
motion-sickness. Even though you will be reclined in a comfortable chair, with your
eyes closed, you nevertheless may feel motion sickness.
Keep in mind that side effects vary per patient, some may experience them and some
will not. However there are a few things that can be done to minimize or eliminate
those side effects. The most important thing to remember is to come into the clinic on an
empty stomach. Just like being on a fishing boat, or rollercoaster, eating food
beforehand is not a good idea. We can give Zofran or other nausea medications if
necessary before the ketamine treatment begins to make you as comfortable as possible.
In some, blood pressure increases, it will be managed, however it usually goes
unnoticed by the patient.
There are reports of bladder issues in the literature, but this is almost always in people
abusing ketamine daily at a high dose, and has not been observed in patients getting
occasional ketamine treatments. Again, if bladder problems were a common issue with
ketamine, it would not be considered the safest and one of the most utilized anesthetics
in the world.
The second most important side effect, is intense anxiety from dissociation, although
very rare. The vast majority do not experience this at all. In the few that do, the feeling
is that ‘something isn’t right’ or that the mind is slipping away from the room or from
the body. When this happens, we eliminate the feeling almost immediately, by giving a
fast-acting anxiety medication and the patient is comfortable again, literally in a matter
Despite the scare, this rare feeling of intense anxiety is subjective, and it isn’t really a
danger to the patient.
Some other less common side effects of ketamine include increased cardiac output,
increased intracranial pressure, tachycardia, tonic-clonic movements, vivid dreams,
double vision, injection site soreness, exacerbation of current liver damage and/or liver
disease, and nystagmus (blurred vision). Patients should consult with their cardiologist
prior to seeking ketamine treatment if there is any history of cardiac issues.
When we swallow a vitamin C tablet, it doesn’t seem to matter much what’s on our
mind while we do. We may even believe that vitamin C is a waste of our time, and yet
our body will see a benefit.
Other things seem to be more dependent on our state of mind. Suppose, while you are
sitting down to eat, you are thinking of a loved one who is very upset with you. The
stress may affect your digestion. You mind may literally spoil the process of ingesting
and digesting your food. Italian culture is therefore wise to have a tradition of setting
big meals apart, and of pairing meals with uplifting conversation, and of transforming
some meals into a kind of slow ritual.
Likewise, in some sports such as baseball or golf, players go through complex rituals
before a pitch or a swing. These are past-times in which a player’s mindset matters at
least as much, if not more than anything else.
Finally, there are some things that hinge almost entirely on one’s state of mind.
Psychedelics are an example of this. Ketamine therapy is so much like this that some
people have reported that every ketamine session is an entirely new experience.
Worry and doubt seem to spoil the infusion experience, and reduce its effectiveness for
depression. For patients who can’t let go, and who attempt to control the experience,
and fight against the effects, there is unnecessary anxiety created, and any effectiveness
is lost. With ketamine therapy, unlike with most other treatments, it is important to
trust, to let go, and to surrender to the experience.
An example of the wrong mindset, would be a patient who asks a nurse every five
minutes “Am I doing it right?” or who tells us frequently “I just feel like I’m doing it all
wrong.” This sort of patient is full of worry, doubt, and thinks that in order to heal, they
have to do something. Instead they should approach the experience in a passive state,
like drifting down a river on an inner tube.
We want you to get the most out of your treatment with ketamine. Some people find it
difficult to settle into the proper mindset.
If you are one of those people, this handout will help get you there.
We have found three things to be of prime importance:
We will discuss each of these, one at a time.
1. Have faith: in the medicine, in us, and in yourself
First, it is important to have faith in the medicine.
For most people this can be accomplished simply by talking to Dr. Cook or reading
about ketamine’s effectiveness and safety profile.
There is another, more important element to having faith in this unique medicine.
People often get a mild placebo (i.e. a feel-good) effect from a brand name drug due to
its catchy or slick advertising. This is one form of placing one’s faith in a drug. We can
put concerns of consumerism aside and see that this is indeed a faith which can greatly
enhance a response to a drug. In our culture we have a tremendous fear of addiction,
we are suspicious of loving any drug too much, and our culture has an unfortunate idea
that only brand new medicines are good.
Suspicion of controlled medications may not be helpful at all. It may not even help stop
addictions. Consider that Italians especially love and praise wine, but their rates of
alcoholism are low. A famous journalist G.K. Chesterton once said, “I thank God for
beer and burgundy by not having too much of them.” This is the proper mindset
toward alcohol. Likewise, it is important to be free from any suspicion towards
ketamine. Consider that when we harbor mixed feelings, or fears and doubts about
medicines, we render them incapable of helping us. It sounds like Peter Pan or Disney
more than it sounds like science or medicine, but it is nevertheless very true that for
anything to heal our minds, we must have positive thoughts and feelings towards it. A
proper perspective towards ketamine is to hold it in profound respect. Do not be afraid
of it. Remember that it helped rescue twelve boys from a cave in Thailand, and it may
likewise help to rescue you from a labyrinth in which you are trapped.
Second, have faith in us.
You are safe, and you are in good hands. We think about your safety more than you do,
so that you don’t have to. We know what we are doing, otherwise we wouldn’t be
doing it. We are like ground control at the airport. We take care of your body, so that
your mind can drift, relax, let go, and give itself permission to surrender to its own
If you have doubt about us, or our clinic, express it. Ask us questions. Do not go into an
infusion with concern that has gone unaddressed.
Lastly, have faith in yourself
You possess an inner healing wisdom. Which is to say, you already know the changes
needed for you to heal from depression. You may not be aware of this information, but
this healing capacity is within you already. It is very common for people to have
epiphanies, or shining realizations, right after their ketamine infusions.
Some people expect their healing to have always an upward trajectory, and when it
doesn’t, they lose confidence in themselves. Ketamine has a way of removing layers and
layers of negativity from the personality, and this means that sometimes people get
worse before they get better. They may feel worse after the first ketamine session, and
yet, they leave with an intuition that healing is right around the corner. Again, have
faith in yourself, that whatever comes up during your session is exactly what needs to
come up. As layers and patterns of negativity are lifted from the personality, the mind
returns to childhood so to speak, or its original state. This state of mind is naturally
happy, curious, and spontaneous.
For those that have experienced trauma during early childhood, ketamine may cause a
feeling of vulnerability which is difficult to tolerate. If you choose to work with a
therapist, they will be there to help you maintain hope and confidence during the
process so that your sessions are well tolerated.
Though a therapist may be of great assistance, ultimately you must remember that your
confidence to heal cannot be acquired outside yourself, but can only be re-discovered
within yourself. It was already there within you in the beginning, before it was lost,
forgotten, or unlearned. Other people can remind that you have what it takes, and
encourage you when you are not feeling it, but no other person can provide you with it.
You don’t need to have the answers. Our only concern here is to just relax. And to
banish from our minds certain ideas, e.g. that you can’t do it right, that you are cursed,
or that you are a hopeless case. Often, depressed people feel as if their sufferings are so
rare, so special, or so unique that healing is impossible. These are the fears we are
addressing here, which block healing, and which stand in opposition to a simple faith in
your own healing wisdom.
This is all happening in the realm of mental and spiritual warfare, which is totally
outside the realm of medicine, science, and progress. Consider that the technologically
advanced countries today have the highest rates of depression. Consider likewise that
the highest suicide rates occur in countries with a very high standard of living, and
outstanding medical care.
2. Let go
In our day and age, it is unusual to hear ‘surrender’ used in a positive way.
Ketamine is most effective for those persons who surrender to the effects, and who let
go during the experience. Ketamine puts people into a mild hypnosis, or trance state, in
which the mind’s control valves are released. Any strong resistance to this process will
Remember that most people are able to let go, and do just fine at this. This is not an
achievement you are going to need to work at. In fact, the more we think of relaxation
as an achievement, the harder it is to get there. Similarly, “Whatever you do, do not think
of a pink elephant.” It is impossible… so long as that is the goal. Again you are not here
to ‘do’ anything during your ketamine treatment, but merely let go, trust, and follow
the experience. Most of the thoughts, memories, and feelings which come up will be
coming from your own inner healing wisdom. By worrying about what you must ‘do’,
or what you must focus on, you will only interfere with the experience.
Releasing control is difficult for some, but not because they aren’t trying hard enough.
Oddly enough, they may be trying too hard. John Lennon said in a Beatles song, “Turn
off your mind, relax, and float downstream.” That is good advice. When people try too
hard to meditate, they are not actually meditating, but are instead merely thinking
about themselves meditating. This gets in the way of meditation.
It is important to remember that we live in a culture of hyper-reflection. It is one of the
reasons we have so much depression. We have a compulsive need to think, and to think
about ourselves thinking, and to think about that, ad nauseam. For example, when we
are confronted by a thing that may lead us out of that hyper-reflective whirlpool, our
first impulse is to reach for a camera. For instance, stepping on a ride at Disneyland
might lead us out of our self-conscious thoughts, but we have an impulse to get out a
camera. Entering an old darkened cathedral might do so as well, but as tourist we reach
for a camera. A photograph allows us to control the experience, and to turn it against
Luckily, dreams cannot be photographed, and it is difficult to analyze a dream. This is
perhaps one of the purposes of dreaming: to relieve prolonged sadness by leading us
out of a mind that we control. Dreamland is a place in which we must relinquish
control, and in dreams it is as if we are observers, even of our own senseless actions. But
it is this helplessness and vulnerability which make sleep so restorative. Again, to fall
asleep is to let go, and ketamine is no different than that, except that you are not asleep.
3. Make your mind a sacred place
Most people would not store diamonds and pearls or other precious jewelry together in
a bin with paperclips, scotch tape, and a can opener. We all feel instinctively the need to
set things of great worth apart, so that they aren’t mixed in with things of lesser worth.
Consider for a moment that your soul, mind, and spirit are things of great worth. Yet,
our minds are assaulted nearly everyday by advertising, social media, and other
worthless stuff. Sooner or later, it fills up our soul, and there is no room for anything
else. We may begin to feel that we ourselves are items of low worth.
There are two first steps to making your mind a sacred place. One is decluttering, and
the other is banishing toxic thoughts.
Decluttering is the first step.
This is nothing more than to value your soul highly enough to refuse to allow anything
into it that is a cheap distraction. The goal isn’t to worry about cleaning your mind
constantly, and to let nothing in. The motivation is not an empty and meaningless duty,
but instead, a simple difference in value. Stuff will inevitably come in. We have five
senses, after all, and our minds are in constant contact with the practical everyday
needs of the world. We cannot all live as Tibetan monks, and sometimes, you do just
need a paperclip, and sometimes you do need to check your email and do your laundry.
Our minds will be constantly assaulted by trifling things, and the goal is not to avoid
them, but to make sure they pass through our minds briefly, but not for long. The goal is
to prevent any minor concern from taking up residence in our minds. For example,
many of us check our smartphones or email inboxes way too many times per day. A
person with obsessive compulsive disorder allows his precious mind to be oppressed by
concerns about germs. To declutter, you simply must affirm that your mind is of far
greater value than these things. For instance, the person with OCD might decide they’d
rather actually get an infection once in a while, in exchange for setting their precious
mind free from oppressive worry.
Imagine how in a musical, there are sudden transitions between dialogue and song.
There are few things more exciting than the moment a character bursts into a song. It is
a wonderful shift because dialogue represents the everyday. Song represents the sacred.
Perhaps this is why music is so helpful for anxiety, because it declutters our mind
automatically. At any rate, please consider the transition from dialogue to song as a
To prepare for ketamine, and to make your mind a sacred place, we do not recommend
always having a song in your head. Instead, imagine it is your job to keep your mind
ready to fall into a song, at all times of the day! Again, it is to hold your mind, ready to
be captured by a song, at any moment.
Banishing toxic thoughts is the second step.
This step takes a bit more practice, and to many of us, does not come naturally. The
problem lies in the fact that we identify too much with our thoughts. We ‘side’ with our
thoughts, so to speak, even when they may be hurting us.
Consider that many of our thoughts are automatic, and pop into our head
unannounced. Your mind is like a living room, and your thoughts are the furniture.
Make your mind a comfortable place. Who would put a horsehair couch or a bed of
nails in their living room? Likewise, protect your mind from irritating, alienating, or
Toxic thoughts may also be imagined as unwelcome visitors. For example, “I can’t make
friends” is a rude thought, who waltzes into your mind and tosses himself, all sweaty,
on your favorite recliner. Later he invites the thought “it’s no use” to come over, who
eats out of your fridge. Finally the thought “my life is not worthwhile” comes in, and
stamps muddy shoes all over your rug.
In depressed people, there is a tendency to give very high worth to thoughts, and to be
attached to thoughts. Even when they are harming us. Pardon me for saying but the
proper perspective towards our thoughts is to regard most of them as a burp or a fart.
They often make no sense, and like a burp or a fart, they are unwelcome and
To make our mind a sacred place is to set it apart from the profane, from the everyday.
Profane doesn’t mean bad or unholy, even in its religious context. It is not a moral term
at all. It just means ordinary, everyday, common. Toxic thoughts are obviously ‘bad’,
since they devalue our worth, and they must be banished. Yet, much of the work of
making our mind a sacred place is not moral at all. You should not think of this work as
a duty or as something to beat yourself up over. You are merely protecting your mind
from being flooded by everyday concerns.
Because ultimately, you yourself are not an everyday concern. You are of great worth,
but perhaps not in the way you have imagined.
Many people with depression have placed enormous pressure on themselves, and are
heavily disappointed in themselves, and what they most need to heal is to re-imagine
themselves and to rediscover their worth.
Ketamine is very helpful in this process.
But in order to get the most out of its effects, it is necessary to anticipate, cooperate, and
to prepare for its effects. Try to apply the above recommendations and put yourself in a
healing mindset for a full week prior to your first infusion.
For example, imagine being at a carnival, riding a carousel and eating cotton candy, and
then suddenly being whisked off to a funeral. Even if the funeral was for a stranger, and
you knew nobody there, yet it could be stressful to transition your mind so suddenly.
This analogy, as well as the analogy of holding your mind ready at all times for a song,
are helpful to understand what it looks like to prepare yourself properly for ketamine.
Remember finally that we are there for you, and we have great confidence in your
ability to heal.
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