Beyond the Darkness

Exploring ketamine’s potential for treatment-resistant depression.

By: Evan Riley

Illustration by Sam Fozard

Ian Halstead wasn't looking for a psychedelic experience, he was searching for relief. After battling depression for years, he decided to try a high dose of ketamine; a last resort, some might call it. What he discovered wasn't just a chemical change. It was a mind-bending journey into a world previously unknown.

“I breathed in and I recognized that my lungs contained this city, this megalopolis of sorts, this huge, huge city, and as I breathed in, the whole city rose, feathered out, with all the buildings glowing beneath that. I exhaled, it all closed up, and night fell on that city,” Halstead, 25, recalled.

As Halstead inhaled deeply, the familiar surroundings of the ketamine clinic dissolved. He was launched into a state known as the K-hole, a profound dissociation from the body and a realm of vivid hallucinations. Some describe it as a near-death experience or a journey through alternate realities.

“Before I was back in my body, I was breathing again, and I could feel the breaths and when I did I realized I wanted to take a big deep breath. So I did. It was euphoric in a way that I couldn't possibly describe. Not like, oh, it just felt really good, but experientially it was like nothing else that I'd ever lived,” Halstead said wholeheartedly. 

Ketamine is a dissociative anesthetic with recreational or therapeutic use. Recreational users might seek out “Special K” for its hallucinogenic effects, feeling pleasantly detached from reality. Medically, it’s traditionally a go-to anesthetic for humans and animals, offering short-term sedation and pain relief. In recent years, ketamine has emerged as a promising relief for treatment-resistant depression and substance use disorders. 

For Halstead, ketamine offered more than just relief; it offered a profound and unforgettable journey.

He received his rather high clinical dose at the AIMS Institute, a ketamine clinic in Seattle. AIMS believes strong doses of ketamine are the key to unlocking a transformative experience, and offer patients a chance to explore the roots of mental illness. 

These high doses can be revolutionary for patients, according to Dr. Alison Draisin, lead psychotherapist at the clinic and director of ketamine-assisted psychotherapy provider training, She said it can trigger a reset within the brain, allowing for the formation of new neural pathways and a shift in perspective that can offer lasting relie"Every time someone goes into a ketamine journey… it’s like going into what recreational users refer to as a K-hole,” she said.  “It is really what we call ego death, which is necessary in order to find healing. In that you have to take away the things that are blocking you from finding health, wellness, and peace and that happens during the ego death."

Dr. Draisin argues that ketamine offers a more powerful path to healing compared to traditional therapy.

"I don't see a whole lot of people for regular psychotherapy anymore because I feel that utilizing ketamine or psychedelics can begin to get to the heart of the problem,” she said. “And people can find hope, happiness and joy in a way that traditional talk therapy can't get to or that might take decades."

Psychedelics have a strong potential for treating depression compared to traditional medications, agrees Dr. Josh Kaplan, associate professor in the Behavioral Neuroscience program at Western Washington University. 

“Prozac and Lexapro are a class of antidepressants known as SSRIs (selective serotonin reuptake inhibitors),” he said. “The problem with those medications is one, they don't work for everyone, and two, they also take a long time to kick in. The main thing that all of these psychedelics have in common… is that they're changing the strength in the way in which certain neurons communicate in ways that can be helpful.”

Halstead credits the ketamine treatment with increasing his overall desire to live and even mentions a newfound appreciation for life itself.

“Just having that experience expanded my horizons so widely," he said. "Bending reality in such a huge way...gave me some perspective on the value of life that I wouldn't have otherwise had." 

However, Halstead readily acknowledges ketamine’s double-edged sword. 

"Sometimes I have a longing to reach that sort of experience again, but it would be something I would think long and hard about before I wanted to do it, “ he said. “It was the scariest experience of my life, as I was left for a while afterward, months afterward practically shaking. Having such intense sort of intrusive synesthetic sort of invasions, I would feel like I was almost about to hallucinate something and it would trigger a lot of paranoia.”

The aftermath, while temporary for Halstead, highlights the importance of careful monitoring and guidance. He recommends that people get properly diagnosed for any mental health conditions before exploring ketamine as a treatment option, as well as finding a facility that is right for them. 

It's important to note that not everyone undergoes ketamine treatment the same way. While Halstead received a high dose aimed at a transformative experience, others receive much smaller and regular doses for a different therapeutic effect. 

One is Ella, a 19-year-old sophomore at Western, whose journey with treatment-resistant depression began at the young age of 8. Years of battling the darkness culminated in a desperate search for relief. Traditional medications failed to provide a lifeline, leaving her feeling hopeless and suicidal. It was at this moment that ketamine emerged as a treatment option during her junior year of high school. 

Suicidal thoughts are an alarming symptom of depression. Dr. Draisin recounts one of her client’s experiences to emphasize ketamine's remarkable potential. 

“For people who are suicidal, ketamine is the best tool I've ever seen,” Draisin said. “I had a client who I had been seeing for psychotherapy, and she started talking about having suicidal ideations. I got her in immediately, and she hasn’t had a suicidal ideation in three years. She had been in and out of psych hospitals for attempted suicides as a teen. And in three years, she's had no suicidal ideation whatsoever since she's been doing ketamine. It's amazing!”

Unlike Halstead, who described a vivid, psychedelic experience during his ketamine treatment, Ella's journey was subtle. The initial infusions didn't produce immediate results. It was a gradual shift, a slow easing of the oppressive symptoms. Over time, her parents and therapist noticed a change in her mood and a decrease in suicidal ideation.

"I've been suicidally depressed since I was eight," said Ella, now 19. "So me being able to leave home and go to college... it felt like leaps and bounds."

Her journey wasn't without its challenges. Finding a clinic in Bellingham, Washington that offered treatment in the way she was accustomed to proved to be difficult. She now utilizes a nasal spray form of ketamine,  Spravato (esketamine) approved by the Food and Drug Administration, as a safety net during difficult times, but her overall goal is to become completely medication-free. Importantly, Ella emphasizes that it’s crucial to find a treatment approach that works for the individual.

The most significant impact of ketamine on Ella was the cumulative effect. It wasn't a magic bullet she said, but rather a steppingstone on the path to recovery. When combined with therapy sessions, it provided the stability she needed to navigate a particularly challenging time in her life. Ketamine, she said, "helped me keep going."

"It wasn't immediate," she said, "but I did notice when I started to taper off and that would be when I was feeling more depressed and also being more suicidal than normal."

Ella's story highlights the growing body of evidence supporting the use of ketamine for treatment-resistant depression. While the exact explanation remains uncertain, a 2023 study suggests that ketamine works by rapidly restoring communication among brain cells. This enhanced communication may help to "reset" dysfunctional neural circuits associated with depression.

Traditional antidepressants work by gradually increasing serotonin levels in the brain. Ketamine, however, appears to target a different neurotransmitter system, glutamate, leading to a faster and more potent response, according to 2023 research published in the journal Neuropsychopharmacology.  NMDA receptors are a receptors of glutamate, the primary excitatory neurotransmitter in the human brain.

“NMDA receptors are an important type of neurotransmitter receptor, which can drive long-term changes in the strength of chemical signaling between brain cells,” Kaplan said. “Ketamine blocks these receptors most strongly on inhibitory neurons, thereby freeing up the excitatory neurons to make long-term changes in signaling strength that have been associated with clinical recovery.”

The future of mental health treatment might lie beyond traditional medication. Kaplan says that there is potential in ketamine, and that it could bring much-needed relief to those who haven't found success with existing methods.

“One of the challenges we face in medicine largely is how we provide safe and effective treatments to everyone,” he said. “For most (mental health) conditions, only about 80% respond to the medications that are currently available, which leads to 20% that are left with nothing. Thinking outside of the box whether it's cannabinoids, cannabis, ketamine, and other psychedelics is a really exciting future that can help people that otherwise are not getting relief.”

Ella and Halstead's experience is a powerful illustration of how ketamine can offer a lifeline to those struggling with treatment-resistant depression. It's important to remember that ketamine is not a cure-all, but rather a promising tool emerging in mental health. As research continues, ketamine and other psychedelic treatments hold the potential to transform the lives of millions battling treatment-resistant depression.