Opening August 3rd 2020


Wired: Ketamine Stirs Up Hope—and Controversy—as a Depression Drug

Written by Moises Velasquez-Manoff

Michael was on the 55th floor of a high rise in an Asian capital, in a conference room, when his world cracked open. His heart began to race and the building felt as if it were swaying. “I’m dying,” he remembers thinking. He excused himself from his meeting and returned to his hotel room. His mind on fire, he wondered how to call for help, whether insurance would cover him, and what his wife and two daughters would think if he died here, half a world away from his home in Northern California. He tried lying down but it felt like he was rolling off the bed. He found that if he did jumping jacks while holding his breath, his chaotic mind calmed down.

Michael (who asked that his last name be withheld) didn’t die. His psychiatrist back in California diagnosed him with panic attacks and prescribed Xanax. It helped, but something had changed that day in Asia, and the panic attacks began to strike regularly—while driving his daughter to art class, at the office, at home. “Once I had broken that shell,” he tells me, “it became spontaneous.”

It was 2013. Michael, age 43, had suffered from psychiatric problems since he was a teenager—epic procrastination, binge drinking, and depression. He’d seen psychiatrists for 20 years and tried almost every antidepressant. What had helped him, at least temporarily, was a prescription for stimulants in the wake of a diagnosis of adult attention deficit disorder in his early thirties. The drugs immediately improved his mood, giving him energy and focus. His career had advanced steadily; he was in executive management at an IT firm. But now it seemed like the darkness he’d pushed aside for so long had come roaring back to claim him.

His wife, Lynn (who asked to be identified by her middle name), watched him spiral downward. Irritable and withdrawn, he’d often watch movies from Friday to Monday. He stopped doing chores. Lynn began parenting their two daughters mostly alone and, in some ways, became a caretaker to her husband as well.

Michael’s wake-up call came when his eldest daughter, then 8, landed in therapy. She’d started throwing fiery tantrums and frequently succumbed to emotional meltdowns. Michael suspected that she wasn’t just being a kid, she was imitating his own erratic behavior. He indulged in profanity-laden fits for the most insignificant reasons—if he dropped something, say, or if he forgot to complete an errand. He needed to change for her sake.

Motivated by guilt and desperate for anything that might halt his own downward spiral, he scoured the internet for something new to try. He quickly came across headlines trumpeting a new treatment for depression. He didn’t know it yet, but he’d just found the medicine that would change his life—ketamine.

KETAMINE IS AN old medication; it was first synthesized in 1962 as a safer alternative to then-available anesthetics, which sometimes suppressed patients’ breathing to the point of killing them. It’s considered so safe by anesthesiologists that it’s routinely used on children. But it has also become a popular club drug and can be addictive. Recreational users call it “special K,” and the euphoric, hallucinatory experience it induces the “K-hole.”

Research on ketamine as an antidepressant is in its infancy, but scientists speculate that it increases brain plasticity, the ability of the brain to change. To Michael, it made intuitive sense that augmenting your brain’s malleability might help you break out of what felt like an otherwise inescapable mental rut.

He started hunting for clinics willing to prescribe ketamine despite the unsettled science. Such clinics have been popping up in recent years, overseen by physicians willing to prescribe the drug off-label, meaning to treat conditions for which it is not FDA-approved, which is legal. But the places he found—in Portland, Oregon, and another in Freedom, California—seemed to take a dehumanizing approach, leaving patients alone as they received the drug intravenously, the liquid dripping into the bloodstream from a bag on a pole. He had a visceral aversion to this type of impersonal, hospital-like setting. The drug was infamous for causing a rupture with reality, and it seemed to him that patients receiving it should be tended to more closely.

Then he discovered a psychiatrist in a small town north of San Francisco. His name was Phil Wolfson, and with his partner Julane Andries, a therapist, he’d pioneered what he called ketamine-assisted psychotherapy. The couple didn’t see the drug solely as an antidepressant, but as a vehicle for self-exploration and understanding. They drew inspiration from folk-healing traditions as well as traditional psychiatry. Instead of intravenous delivery, they used ketamine lozenges or a quick injection into a shoulder. Their less medicalized, more humanistic approach appealed to Michael.

So one day in January 2016, Michael drove with his wife to meet Wolfson and Andries at the Pine Street Clinic in San Anselmo, where they rented space. There, water gurgled in a fountain, a bird twittered in a cage, and the smell of Chinese herbs filled the air. Wolfson, a big garrulous man with white, curly hair and a pronounced limp from several back surgeries, asked about Michael’s medical history. As a teen, Michael had had a noncancerous tumor removed from his abdomen. The tumor was acting like an extra adrenal gland, secreting hormones that prevented him from growing and caused him to sweat profusely, often until his clothes were drenched. The surgery was successful, but recovery had been long and difficult, he told Wolfson. He’d been intubated in the intensive care unit for nearly a week.

As Michael recalls, Wolfson told him, “You may be depressed, but I don’t think that’s the root of your problem. You have every glaring symptom of PTSD.” Michael wasn’t a veteran. He’d never been sexually abused. Wolfson’s diagnosis felt off. He also knew that, years ago, Wolfson had lost a son to leukemia; the detail was on his website. In that moment, Michael diagnosed his therapist. “He’s projecting,” he thought.

Still, he felt comfortable enough with Wolfson to proceed. Ketamine can cause blood pressure to rise and the heart to race, so Michael began with a low-dose lozenge to see how he’d react. When nothing untoward happened, Wolfson gave him a shot in the shoulder. At subanesthetic doses, ketamine is considered a dissociative agent: You remain conscious but may lose awareness of your body and, depending on the dose, feel like you’re traveling to other realms.

After the shot, Michael heard a buzzing noise that, as it pushed toward a crescendo, became almost intolerably loud. Then, all at once, the pressure of the noise seemed to release. He lost any sense of his body and felt completely at peace. No thoughts. No discrete sense of self. Just pure awareness. Behind the eyeshades Andries had given him, he saw a huge dome of sky, like a planetarium.

The session lasted maybe two hours. Afterward, the difference in Michael’s mood was immediately apparent to Lynn. He was less irritable, more optimistic. She felt as if they’d been treading water for years in their marriage. But they started moving again—making plans, working on problems. Long estranged from his mother, Michael called her and reestablished the relationship.

“It’s just been transformative,” Lynn told me. She calls Wolfson and Andries “miracle workers.” Michael is not, by his own admission, cured. He still has bad days, and he still needs occasional ketamine “booster” sessions to keep his mood up. But he credits ketamine with bringing him back to life and, ultimately, with saving his relationship with his wife. “It’s probably the only reason I’m still married,” he says.

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